My Penis Stuff

MUSE stands for “medicated urethral system for erections.” The medicine is a small pellet that is inserted inside the opening at the end of the penis (urethra). The applicator has a thin tube that contains the pellet of medicine. The tube is inserted into the urethra. By pressing a button on the applicator, you release the pellet. The medicine is absorbed through the membrane that lines the inside of the urethra. An erection develops in about 10 minutes and lasts at least 30 minutes, but usually less than 60 minutes.

Your doctor may have you try this medicine while you are in the office. This allows the doctor to see how well the medicine works, see whether you can properly use the medicine, and check for adverse reactions, such as a painfully long-lasting erection (priapism) or an allergic reaction.

What To Think About

When considering MUSE, it is important to include your partner in your decision.

This medicine is less likely to be effective in men whose blood flow into or out of the penis is severely impaired.

Partners of men who have vision problems or who may have difficulty inserting the pellet can be taught how to use these products.

This medicine can be used by men who are taking medicine to prevent blood clots (anticoagulants), such as warfarin [Coumadin, for example]).

The medicine may cause irritation to the vagina of the man’s partner when he ejaculates.

When you use this medicine, your partner should avoid performing oral sex.

Examples

Flexeril, Valium, Skelaxin

How It Works

These medications relax muscles throughout the body. They are believed to work because they calm both the central nervous system and the muscles. These medications may make you sleepy.

Side Effects

The side effects of these medications include:

• Drowsiness.
• Dry mouth.
• Urinary retention.

Examples

Zoladex, Lupron, Trelstar Depot

How It Works

Luteinizing hormone-releasing hormone (LH-RH) agonists and gonadotropin-releasing hormone (GnRH) agonists are hormone therapy drugs that lower the production of testosterone in a man’s body. This drop in testosterone usually slows or stops the growth of prostate cancer for a period of time.

These drugs work by causing the pituitary gland to release the hormones that cause the testicles and adrenal glands to make testosterone. The pituitary gland then runs out of its hormones, and testosterone production drops.

These drugs are usually given by injection. They may be given once a month, once every 3 to 4 months, or once a year.

Side Effects

Side effects from LH-RH agonists and GnRH agonists may include:

• Erection problems.
• Decreased sex drive.
• Hot flashes.
• Thin or brittle bones (osteoporosis.)
• Spontaneous bone fractures.
• Breast enlargement (gynecomastia).
• Anemia.
• Fatigue.
• Weight gain.
• Loss of muscle mass.

Because these drugs work on the pituitary gland to release its hormones, the testicles may temporarily produce extra testosterone, causing a temporary growth in the tumor. This is called a tumor flare. Tumor flare may be accompanied by bone pain, urinary blockage, or other symptoms of rapid cancer growth. This may indicate that the drug is working, and although the tumor may grow initially, it will shrink over time. Tumor flare can be prevented by taking a different hormone drug called an antiandrogen before or during treatment with the LH-RH agonist.

One study found that treating prostate cancer with drugs to block androgen may increase the risk for gum disease.

Examples

Caverject (alprostadil), Pavabid (papaverine hydrochloride), Regitine (phentolamine mesylate)

Some doctors have these three medications mixed together by a pharmacist. This preparation is often called Trimix.

You inject this medication into the side of the penis with a tiny needle. The shots usually are not very painful, but you may find the thought of injecting yourself uncomfortable. Less commonly, these medications also may be available in an auto-injector in which the needle is hidden, making them easier to use. You can adjust the dose of medication to create an erection that lasts the desired length of time.

Your doctor may give you a trial use of this medication while you are in the office. This allows the doctor to see how well the medication works for you, see whether you can use it properly, and check for adverse reactions, such as a painfully long-lasting erection (priapism) or an allergic reaction.

What To Think About

When investigating injections for erection problems, it is important to include your partner in your decision.

These medications are less likely to be effective for men in whom blood flow into or out of the penis is severely impaired.

They may cause problems for men with severe mental illness or for those who would have difficulty giving the injection. If you have vision problems, your partner can learn to give you the injections. Make sure your partner is comfortable with helping you and with using injections.

These medications can be used by men who are taking medication to prevent blood clots (anticoagulants, such as warfarin [for example, Coumadin]).

Medications that are injected into the penis can be given no more than every other day. Excessive use may cause scarring.

Some men may find the idea of self-injections unpleasant, or they may find self-injections difficult to do. The use of an auto-injector, in which the needle is hidden, may make the shots easier for some men to use.

Couples trying to have children may prefer injections over a vacuum device, because the vacuum device blocks ejaculation.

Up to 60% of men stop using the medications. Reasons include:

• Partner relationship issues (being able to have erections doesn’t solve relationship problems).
• The mechanical nature of the process, which interferes with spontaneity.
• Fear and discomfort about giving an injection into the penis.
• Concern about effects of long-term use.
• Development of tolerance to the medication (which rarely happens).
• Development of scar tissue.

How It Works

hCG

Treatment for undescended testicles with human chorionic gonadotropin (hCG) stimulates the testicles to release testosterone. As a result, a boy’s undescended testicle may complete its descent, at least temporarily.

Treatment with hCG also stimulates enlargement of the testicles and growth of blood vessels to the testicles.

HCG usually is injected into a muscle, such as in the buttocks, and may be given daily or weekly.

GnRH

GnRH stimulates the pituitary gland to produce luteinizing hormone (LH). In men, LH stimulates the production of testosterone. GnRH is sometimes also called luteinizing hormone-releasing hormone (LHRH).

In Europe, GnRH has been approved for and used in the treatment of undescended testicles for many years. Although GnRH has been approved for use in the United States for other conditions, it has not been specifically approved (labeled) for the treatment of undescended testicles. But because it is an approved medicine, a doctor can choose the unlabeled use of GnRH to treat undescended testicles.

What To Think About

Hormone treatment may need to be continued for weeks or months, depending on factors such as the age of the child and where the undescended testicle or testicles are in the body, as well as the timing and size of the dose given. When both testicles are undescended, a relatively high dose of hCG is given for a short period of time. When only one testicle is undescended, a smaller dose is given over a longer period of time.

In some boys, an undescended testicle will descend during puberty without needing hCG.

A doctor may try hCG shots to help decide whether surgery is needed. If the testicle does not descend—even temporarily—with hCG shots, it is not likely to do so on its own; and surgery may be needed.

A testicle may descend only part of the way when the boy is treated with hormones. But this may still be helpful, because the testicle may descend to a position that is easier to treat with surgery. HCG also stimulates enlargement of the testicles and growth of blood vessels to the testicles, and surgery may be easier when the testicle is larger and has an improved blood supply.

Examples

Depo-Testosterone/Virilon IM (testosterone cypionate), Andryl/Arderone (testosterone enanthate), Androderm/AndroGel/Testoderm transdermal (testosterone), Parlodel (bromocriptine mesylate), Dostinex (cabergoline).

These medications can be used to treat men who have high prolactin levels, which can reduce the amount of testosterone produced by the body and may lead to problems such as infertility or erection problems. Bromocriptine and cabergoline are taken by mouth.

What To Think About

When considering hormonal therapy for erection problems, it is important to include your partner in your decision.

During the first year of testosterone therapy, you should receive a prostate examination, a PSA blood test, a complete blood count, and a liver function test every 3 to 6 months.

Although replacement of testosterone through injections or patches can improve a man’s libido, it does not always improve a man’s ability to have an erection.

Cabergoline given weekly is as effective as daily doses of bromocriptine and may be associated with fewer side effects. Prolactin levels should be monitored monthly.

How It Works

Finasteride interferes with the effect of male hormones (androgens) on the prostate gland, which cause the prostate to become larger. This stops the growth of the prostate and can even cause it to become smaller. Stopping the growth of the prostate or reducing its size may help relieve pain or urination problems caused by prostatitis.

What To Think About

This medication should not be used by men who may father a child, because it may cause birth defects in male babies. Women who are pregnant or might become pregnant should not handle crushed finasteride tablets. There is a small chance that the medication could get into the woman’s system and cause a birth defect.

Finasteride reduces prostate-specific antigen (PSA) levels. Because PSA levels are used to detect early-stage prostate cancer, men interested in taking finasteride might consider the following:

• Some experts suggest that men be checked for the presence of prostate cancer (using the PSA test and a digital rectal exam) before starting to take finasteride.
• Follow-up PSA tests that have not decreased by approximately 50% after 6 months of taking finasteride may indicate a need for further testing for prostate cancer.
• PSA levels above 2 ng/mL during finasteride treatment may indicate a need for further testing for prostate cancer.

Bleomycin is an intravenous (IV) chemotherapy medication used to treat several types of cancers including testicular cancer and lymphoma, as well as cancers of the head and neck.

What To Think About

Bleomycin should be administered only under the supervision of a medical oncologist.

For both men and women, bleomycin can affect your ability to have children. You may not be able to get pregnant or father a child after taking this medication. Discuss fertility with your doctor before starting treatment.

Bleomycin can cause birth defects. Do not use this medication if you are pregnant or wish to become pregnant or father a child while you are taking it.

Because bleomycin can damage the lungs, you may have tests to measure the function of your lungs before your doctor prescribes bleomycin. These tests may be repeated over the course of your treatment. Tell your doctor if you have any shortness of breath or other problems breathing after you begin taking bleomycin.

Talk to your doctor before taking bleomycin if you:

• Have any of the following medical problems:
  • Chickenpox or have recently been exposed to chickenpox
  • Gout
  • Heart disease
  • Congestive heart failure
  • Shingles
  • Kidney stones
  • Liver disease
  • Other forms of cancer
• Are a woman using birth control hormones (pill, patch, ring, or implant).

Examples

Klonopin (clonazepam), Valium (diazepam), Ativan (lorazepam)

How It Works

Anxiolytic medications may reduce pain in the same way they reduce anxiety.

What To Think About

These medications may be used in combination with alpha-blockers, which relax the muscles in the prostate.

These medications do not cure problems with anxiety that may have contributed to prostatitis. Curing an underlying problem with anxiety may require counseling with a psychiatrist or psychologist.

This class of medications can be habit-forming. Long-term use of these medications to treat a chronic health problem is not usually recommended.

Examples

Enablex (darifenacin hydrobromide), Ditropan/Ditropan XL/Oxytrol (oxybutynin chloride), Vesicare (solifenacin succinate), Detrol/Unidet (tolterodine tartrate), Sanctura (trospium chloride)

How It Works

These medicines calm the nerves that control bladder muscles. They may prevent uncontrollable bladder contractions that force urine out of the bladder.

What To Think About

Some of these medicines may cause you to sweat less. In hot weather, this could lead to heat exhaustion. Ask your health professional whether you should be careful about being physically active in hot conditions.