Photo by Joseph Rafferty
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Web Exclusive…
3 Alternatives to Sex Drugs
November-December 2003
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Viagra may be a wonder drug, but for some men, getting an erection isn't
as easy as swallowing a pill. Nerve damage from injury, blood vessel disease,
surgery, and even advanced diabetes can make you an inappropriate candidate for
oral medications. But don't despair: Several alternatives can work for you.
Among the most popular:
Intracavernous injection (ICI)
An ultrafine needle is used to deliver an erection-producing drug into your
penis (and guess what, Romeo: you do the injection yourself). Only alprostadil
(Caverject, Edex) is currently FDA-approved for penile injection. It works as a
vasodilator, expanding blood vessels and enhancing smooth muscle relaxation so
blood can rush to your penis. Urologists may also ask compounding pharmacists
(pharmacists who mix customized, specialized medications) to prepare an
off-label injectable generically known as Trimix. It combines alprostadil with
other vasodilators, such as phentolamine and papaverine. Studies show that
injections work in up to 88 percent of cases, and because the drug is
localized, there are no major side effects. Yet despite its success, most
patients don't stick with the therapy, typically because of pain from the
injections and an aversion to any treatment involving the words
"penis" and "needle." But ICI has its fervent supporters.
"For the right guy," says Larry Lipshultz, M.D., professor of urology
at Baylor College of Medicine in Houston, "it's easy to learn, easy to
do, and produces good results." The cost is about $20 per injection.
Vacuum pumps
High-tech gadgets that operate on low-tech principles, vacuum pumps typically
consist of hollow tubes that are placed over the penis, then activated to form
a vacuum that sucks blood into the necessary vessels. Once Mr. Happy is
engorged, a constriction ring is fitted at the base of the penis to keep that
blood where it belongs. Pumps may score low on the discretion scale, but about
75 percent of their users report success. "They're cost-effective,
reliable, and easy to use once you learn how," says Troy Burns, M.D.,
medical director of ProPartnersMD, a medical practice for men in Overland Park,
Kansas. Many pumps are approved by the FDA for sale over the counter; prices
range from $100 to $450.
Surgical implants
With this technique, surgeons implant a prosthesis in the penis—either a
one-piece "malleable" unit that stays rigid (you bend it up to
achieve an erection) or an inflatable device (two elongated chambers are placed
inside the penis; you press an attached bulb hidden in the scrotum to get
erect). The procedure is pricey—$10,000 and up, though it's often covered
by insurance—and it's clearly one of the most invasive forms of treatment.
But when all else fails, it's worth considering. "For a subset of men,
prosthesis actually has the highest rate of satisfaction—higher than injections
and oral drugs," says Francois Eid, M.D., clinical associate professor of
urology at Weill Medical College of Cornell University. A recent study in The
Journal of Urology found that 30 out of 32 patients who received implants were
satisfied with the results 20 months later.
To find an ED expert, contact the American Urological Association online or
toll free at 866-746-4282.
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