Options for treating impotence (besides Viagra!)

Injection therapy

Some medical treatments, like injection therapy, which existed when Viagra was released, are still being used.

"Once men get used to injections at the base of the penis, they love it," says Steven Lamm, MD, assistant professor of medicine at New York University and author of The Virility Solution. "It's felt as a tiny bee sting because the shot is put into a relatively insensitive part of the organ with a very fine needle."

The medication injected into the penis is alprostadil, which increases penile blood flow. It's known by the trade names Caverject and Edex. These injections are not intended for men who use blood thinners.

On the medical horizon in the United States is Invicorp, another intracavernous injection that treats moderate to severe ED.

Inhaled medication

Another drug, amorphine hydrochloride, currently in clinical trials, is squirted into the nose in an inhaler and works like Viagra.

Inserted medication

MUSE is a pre-filled, single-use, plastic applicator containing a suppository of the drug alprostadil. You insert the medication into the urethra opening at the end of the penis and let it dissolve. A topical cream containing the same medication is in development.

MUSE is effective in men with diabetes, but because it opens blood vessels, it does not work well in those with severely compromised circulation to the penis. Men with significant nerve damage also do not respond well to MUSE

Oral medication

When giving smokers the drug Wellbutrin (bupropion hydrochloride) to help them quit, researchers found that the smokers experienced enhanced libido. So some men take that drug to bolster their desire.

This type of therapy, however, is treating the problem of reduced sexual desire, rather than of ED, which is an inability to obtain an erection sufficient for consistent penetration.

Hormone therapy is another method of treating ED with oral medication, particularly in older men.

Penile implants

For more serious cases of ED, three surgical implants are available to help men rise to the occasion by literally "pumping it up." But men should be warned that once they have the devices implanted, they might never again be able to independently have an erection because the implants can damage the erectile tissue.

Vacuum devices

There is also a vacuum pump that draws blood into the penis and engorges it. A band is placed at the base of the penis to prevent blood from flowing out again.

Surgery

For men with damaged blood vessels, surgery can be performed to bypass blocked arteries to the penis, or tie off leaky veins that allow blood to escape from the penis during an erection.

Drugs on the horizon

A topical form of alprostadil, called Topiglan, has performed well in clinical trials and may well be available by the end of 2001. Another drug called vardenafil has been shown in clinical trials to help men with ED have erections. It is not yet available in the U.S.

Lifestyle changes

A few lifestyle changes may also help men with erectile dysfunction.

Dean Ornish, MD, a physician famous for treating heart disease with a program of comprehensive lifestyle changes, says he has noticed good cure rates for men with ED when he puts them on his program for treating heart disease. That regimen includes a very low-fat, vegetarian diet, no smoking, a sensible exercise plan, and stress management.

"Many guys can reduce or discontinue anti-hypertensive and cardiac drugs that can cause impotence," Dr. Ornish says. "Plus, blocked arteries usually happen in all of a man's arteries. Sometimes, erection problems appear before heart disease is diagnosed."