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Erectile Dysfunction: When Viagra Doesn't Work

Experts discuss alternative treatments for erectile dysfuntion.

Alprostadil to the Rescue continued...

As an alternative, Alprostadil is available as a pellet-like suppository that is inserted into the tip of the penis and absorbed through the lining of the urethra. This can help produce erections lasting for 30 to 60 minutes, according to the Impotence World Association (IWA). Unfortunately, the suppositories are less effective than injections and may cause pain and irritation, according to both Aigen and Beam.

Last November, a topical gel formulation of alprostadil was approved by the U.S. Food and Drug Administration. It is too soon to know if this form of alprostadil therapy will become widely used.

Mechanical Help

With a vacuum constriction device, the penis is placed in a cylinder with an attached pump, creating a vacuum to draw blood into the penis. Firmness is sustained by a constriction band placed around the base of the penis. The IWA estimates the technique can produce erections for up to 30 minutes. Beam calls the alternative "a good way to go" because it has minimal side effects, but admits it is cumbersome and takes some practice.

Some men opt for penile implants, which involve the placement of tubes in the penis and a pump in the scrotal sac. The pump (usually the size and shape of a testicle) enables men to obtain an erection whenever and for as long as they desire by pumping a saline solution from a reservoir into the penis. Implants are a last resort, however, says Beam. "Once a prosthesis is implanted, a patient cannot respond to anything else because it alters the natural anatomy."

Fortunately, Ron Hansen didn't have to go that far. He has become used to injecting himself with Alprostadil, which produces a firmer erection than he experienced with Viagra, and one that lasts at least 30 minutes. It also doesn't cause the headaches associated with Viagra. Hanson occasionally uses the suppositories, though they take longer to work.

For Hanson, admitting that he had a problem in the first place was the hardest part. "But when you don't function as you should," he says, "the therapy makes a big difference."

Mari Edlin is a freelance journalist and marketing communications consultant specializing in health care. She contributes regularly to Healthplan magazine, Modern Physician, and Managed Healthcare magazine, and works with many health care organizations in the San Francisco Bay Area.

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