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April 10, 2000 (Mill Valley, Calif.) — In his early 40s, Ron Hanson was too
young to be having trouble getting and sustaining erections. But like many men,
he was too embarrassed at first to talk about the problem. Hanson (not his real
name) waited seven years to see a urologist. By the time he spoke up, erectile
dysfunction had become a household word, thanks to the popularity of the drug
Viagra. But the widely touted drug, Hanson soon learned, doesn’t work for
everyone.

When Viagra (sildenafil) hit the market in 1998, some men thought it was the
answer to their problems. Many rushed to doctor’s offices to give
it a try. According to the Grey Clinic in , which specializes in
erectile dysfunction, 17% of men between 18 and 55 experience occasional
impotence, while 6% have regular erectile . For men over 55, that
number jumps to about one in three. Some common causes of impotence are
diabetes, heart disease, and psychological problems. It also frequently occurs
after prostate cancer surgery.

Because Viagra works in a way that’s similar to drugs that contain nitrates,
however, it isn’t recommended for men who take nitrates for heart disease or
those with certain other heart conditions. In some men, it causes bad
headaches. In others, it just plain doesn’t work. In some instances, men may
notice they have trouble telling blue and green colors apart when they start
taking the drug.

During an erection, blood flows quickly into the penis, which increases its
length, width, and firmness. If the “in” vessels (arteries) are too
narrow or if blood drains too quickly through the “out” vessels
(veins), men may have trouble achieving or maintaining an erection, says Arnold
Aigen, MD, a urologist with Camino Medical Group in Sunnyvale, Calif. Viagra,
which increases inflow, may not be strong enough to work its magic if the
arteries are too narrow.

Hanson tried Viagra, but he couldn’t tolerate the headaches it caused.
Luckily, when Viagra fails, he discovered, there are several alternatives.

Alprostadil to the Rescue

A drug called Alprostadil, either alone or sometimes in conjunction with
others such as papaverine and/or phentolamine, can be injected directly into
the penis to dilate the arteries, experts say. The drug produces an erection in
about 10 minutes that can last up to an hour. But there are several
disadvantages, says Teresa Beam, MD, a urologist with the Grey Clinic. Some
patients are averse to using a needle, which is why many men abandon the
therapy. Those who give it a try may experience pain at the injection site or
priapism (a painful erection lasting too long).

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
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.