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.