Erectile Dysfunction
Early in September, the FDA approved an over-the-counter erectile dysfunction gel marketed under the brand name Eroxon. This gel is applied to the head of the penis approximately 10 minutes before sexual intercourse and was shown in some studies to allow patients to achieve an erection that lasts the duration of intercourse. This gives patients a fast-acting option versus pills that can take up to 30 minutes to function. While this may seem like an ideal scenario, it’s essential to understand this gel’s mechanism and what it can and can’t do.
First, we must understand the mechanism of action, which uses a volatile solvent that, after being applied to the head of the penis, evaporates rapidly. It creates a cool, followed by a warming feeling in the penis that allows for an erection. It is claimed to stimulate nitric oxide production, dilating blood vessels. The degree to which this is true is difficult to prove.
This mechanism of function may work well for patients with mild ED or patients that have psychogenic erectile dysfunction, meaning that performance anxiety, as it is often called, is causing them not to be able to achieve or maintain an erection. With that said, erectile dysfunction is usually caused by atherosclerosis or the narrowing of penile arteries due to plaque buildup on the walls. If this is the cause, topical gel will likely not make much difference. Therefore, it’s essential to understand who was likely to achieve an erection in the patient selection for the study. Were these patients generally younger? Did they otherwise have success with ED medication? Many questions must be answered before understanding its effectiveness.
While this gel represents an option for some patients with mild or psychologically induced erectile dysfunction, the tried-and-true Viagra/Sildenafil or Cialis/Tadalafil options are generally going to be much more reliable for qualifying patients. Further, if patients wish to have a spontaneous erection, they can consider low-dose daily tadalafil. However, even full doses of tadalafil are long-acting, with a function of up to three days. There is a point where medication and gels cease to function sufficiently. At this point, the patient may consider injections known as Trimix and Quadmix. Intractable erectile dysfunction that does not respond to these compounds injected directly into the penis is often solved with a penile implant. This prosthesis replaces the corpora cavernosa of the penis with inflatable tubes, and a pump placed in the scrotum draws sterile liquid from a reservoir in the pelvis to create and maintain an erection.
As with any erectile dysfunction option of care, patients should visit a qualified men’s health specialist and urologist to ensure that they are getting the very best care. We encourage you to visit Dr. Natale for consultation no matter what stage of ED you may find yourself as we have tried-and-true options for any patient. We see too many men who are embarrassed or ashamed to visit their doctor about this all-too-common disorder and live a less-than-full life as a result. We look forward to helping you, too.