Erectile dysfunction: Nonoral treatments
Oral medications aren't the only way to treat erectile dysfunction. Know the full range of treatment options and how they work.
By Mayo Clinic Staff
If you have erectile dysfunction and can't take certain oral medications or if oral treatments aren't effective, you have other treatment options.
Understand why you might choose a nonoral treatment for erectile dysfunction and how these different treatments work.
When oral medications might not be safe
Not all men can safely take erectile dysfunction oral medications, such as sildenafil (Viagra), vardenafil (Levitra, Staxyn), tadalafil (Cialis) and avanafil (Stendra). Medications for erectile dysfunction might not work or might be dangerous if you:
- Take nitrate drugs — commonly prescribed for chest pain (angina) — such as nitroglycerin (Minitran, Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket) or isosorbide dinitrate (Dilatrate-SR, Isordil)
- Have very low blood pressure (hypotension) or uncontrolled high blood pressure (hypertension)
- Have severe liver disease
- Have kidney disease that requires dialysis
Some men might also choose another treatment option to avoid the side effects caused by certain oral medications.
Other types of medications
Nonoral medications for erectile dysfunction include:
May 26, 2016
Self-injections. Several medications are commonly injected directly into the penis to achieve an erection. The most often used medications include alprostadil, papaverine, and phentolamine. With this method, you use a fine needle to inject the medications into the base or side of your penis.
The goal of injection therapies is to produce an erection that lasts about 20 to 40 minutes. If an erection lasts longer than one hour, you will need to have the medication or dose adjusted to avoid potentially long-term complications. Because the needle used is very fine, pain from the injection site is usually minor.
Side effects can include bleeding from the injection, prolonged erection (priapism) and formation of fibrous tissue within the penis or at the injection site.
Alprostadil urethral suppository. Alprostadil intraurethral (Muse) therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra. You use a special applicator to insert the suppository into your penile urethra.
The erection usually starts within 10 minutes and lasts between 30 and 60 minutes. Side effects can include pain, minor bleeding in the urethra and formation of fibrous tissue inside your penis.
Testosterone replacement. Some men have erectile dysfunction that might be complicated by low levels of the hormone testosterone. In this case, testosterone replacement therapy might be recommended as the first step.
Testosterone replacement therapy can be delivered via injection, patch, gel, gum and cheek (buccal cavity), intranasal, subcutaneous pellet, or oral medication. Talk to your doctor about your personal preference and the possible side effects.
See more In-depth
- Wein AJ, et al., eds. Evaluation and management of erectile dysfunction. In: Campbell-Walsh Urology. 11th ed. Philadelphia, Pa.: Elsevier; 2016. http://www.clinicalkey.com. Accessed April 5, 2016.
- Ferri FF. Erectile dysfunction. In: Ferri's Clinical Advisor 2016. Philadelphia, Pa.: Mosby Elsevier; 2016. https://www.clinicalkey.com. Accessed April 5, 2016.
- Cunningham GR, et al. Overview of male sexual dysfunction. http://www.uptodate.com/home. Accessed April 4, 2016.
- Martin KA. Treatment of male sexual dysfunction. http://www.uptodate.com/home. Accessed April 5, 2016.
- Schwartz BG, et al. Drug interactions with phosphodiesterase-5 inhibitors used for the treatment of erectile dysfunction or pulmonary hypertension. Circulation. 2010;122:88.
- Erectile dysfunction. National Institute of Diabetes and Digestive and Kidney Diseases. http://kidney.niddk.nih.gov/kudiseases/pubs/ED/. Accessed April 5, 2016.
- Lazarou S. Surgical treatment of erectile dysfunction. http://www.uptodate.com/home. Accessed April 4, 2016.