Dated April 2018

This page contains a brief summary of the devices and therapies discussed by Sarah Roth and available to alleviate Erectile Dysfunction (ED), also known as impotence, ie the inability to get and sustain an erection. Ideally there should be pictures to explain and show how devices are used or treatments applied. Hopefully more information is available elsewhere on the Internet.

Oral Treatments - Viagra, Cialis, and Levitra

These are the traditional oral drugs available for the treatment of ED. They were not discussed in any detail in this presentation.

Vacuum Therapy Device (VTD)

The tubular device is placed over the penis. When the pump mechanism is activated (manually) blood is drawn into the penis causing an erection. When the penis is fully engorged, a tension ring is placed at the base of the penis, maintaining the erection for something like 15 minutes. There are a number of such devices on the market, one of which is selected for NHS use. However, it is not universally available, and you need to ask your GP whether he/she can prescribe it.
It was suggested that use of a pump was a good therapy in itself for encouraging blood flow to the penis.

Medications for ED

There are several treatments which involve the use of alprostadil which is similar to the natural substance in your body called prostaglandin. It widens blood vessels, increasing blood flow to the penis making it easier for you to have an erection.

Vitaros (Alprostadil)

This is a fast acting prescription medication for the treatment of ED. It is a liquid designed for topical use, in the form of disposable applicators. Studies show that Vitaros once applied can take effect within 5 minutes and may last from 1 to 2 hours. It is hoped this treatment will become available at UHCW in the not too distant future.

Intracavernosal Injections (CAVERJECT)

Caverject is a vasodilator used to treat ED or impotence by relaxing penile muscles and widening blood vessels, allowing sufficient blood flow to maintain a firm erection.
A trained nurse will show you how to inject the penis with Caverject. The nurse will then help you to inject yourself. The injection does not always work well in clinic, but with use at home you should be able to get an erection sufficient for penetrative sex.
You can use the injections 2-3 times per week, but need to leave 24 hours between each injection.

Sarah reassured us about such injections; they're not as bad as they sound (apparently no worse than have a blood sample taken from your arm).  

Intracavernosal Injections (INVICORP)

Invicorp is an alternative intracavernosal injection. It is not currently stocked at UHCW. Hopefully it will soon be available for situations where other treatments are not effective.

Urethral Stick (MUSE)

MUSE is a sterile, single-use transurethral system for the delivery of alprostadil (in the form of a pellet) to the male urethra. Alprostadil is suspended in macrogol, and is formed into a urethral stick (1.4 mm in diameter by 6mm in length) which is contained in the tip of a polypropylene applicator. The medication should work within 5 to 10 minutes to produce an erection that lasts for between 30 and 60 minutes. You are not recommended to use more than 2 doses per 24 hours.

MUSE is available in varying strengths, and dosage is based on your medical condition; however, there currently appears to be a supply problem with the higher strength version.

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Men affected by prostate cancer can be referred to the ED clinic (at UHCW, Walsgrave) by one the consultants or associated nurse specialists.

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Other sources of help and guidance:

PC-UK

Lorraine Glover at the London Clinic