10051 Alprostadil

Overview

Alprostadil is a medicine used to treat erection problems (also called erectile dysfunction, or ED). It is a man-made copy of a substance your body makes naturally, called prostaglandin E1. It works by relaxing the muscle and widening the blood vessels in the penis, so more blood can flow in and an erection can happen. It comes in two forms: a very fine injection given into the side of the penis, or a tiny pellet that is placed into the opening at the tip of the penis. In hospitals, a form of this medicine is also used to help newborn babies with certain heart problems, but that use is managed entirely by specialist doctors.

Erection problems are very common. Around half of men over 40 report some difficulty getting or keeping an erection, and it becomes more common with age. Alprostadil is a well-established treatment that has helped many men regain confidence.

Alprostadil is mostly prescribed to adult men whose erection problems have not been solved by other options, or who cannot take other medicines. It can affect men of any age, though it is most common in men over 40. It is also used in newborn babies in hospital for a specific heart condition, always under specialist care.

Symptoms

Common symptoms

• Trouble getting an erection firm enough for sex
• Trouble keeping an erection long enough
• Needing more physical contact or stimulation than before to get an erection
• Erections that are less firm than they used to be
• Worry or loss of confidence about sex, which can make the problem worse

Symptoms in children

• Erection problems are not a childhood condition. The medicine is used in newborns only in hospital, for a heart problem that keeps blood flowing through a vessel called the ductus arteriosus.
• Signs of that heart problem in a baby include bluish lips or skin, fast or hard breathing, poor feeding, and being very sleepy.
• All of these need emergency medical help straight away.

Symptoms in older adults

• Erection problems are more common with age and are often linked to other health conditions such as diabetes, high blood pressure or heart disease.
• Some medicines for blood pressure, mood or prostate problems can also affect erections. Ask your clinician or pharmacist to review your medicines.
• Older men may need a careful check of heart health before starting treatment.

Causes

Main causes

• Narrowed or damaged blood vessels, often linked to diabetes, high cholesterol or high blood pressure
• Nerve damage, for example from diabetes or prostate surgery
• Low levels of the male hormone testosterone
• Side effects of some medicines, such as certain blood pressure or mood medicines
• Stress, anxiety, relationship worries or low mood
• Smoking, heavy drinking or drug use

Risk factors

• Being over 40
• Diabetes, heart disease, high blood pressure or high cholesterol
• Being overweight or not being physically active
• Smoking or vaping
• Drinking more alcohol than is recommended
• Depression or ongoing anxiety
• Prostate surgery or injury to the pelvis

When to see a doctor

See a doctor urgently if:

• An erection lasting more than 4 hours
• Severe pain, swelling or a hard lump in the penis
• Signs of infection such as fever with redness or warmth
• Any sign of an allergic reaction

Book a routine appointment if:

• Erection problems that are affecting your confidence or relationships
• No improvement after using your treatment as instructed
• Side effects that bother you
• A new health problem or new medicine that might be affecting your erections
• A change in the shape of the penis, or pain during sex

Diagnosis

Your clinician will start by asking about your erections, your general health, your medicines and your relationships. They will check your blood pressure and may arrange blood tests. The aim is to find any underlying cause, such as diabetes or a heart problem, and to make sure a treatment like alprostadil is safe for you. If needed, you may be referred to a specialist clinic.

Tests that may be done

• Blood pressure check
• Blood tests for blood sugar, cholesterol and hormone levels
• A physical examination
• A review of all your current medicines
• Sometimes an ultrasound scan of the blood flow to the penis
• Sometimes a heart health check, because erection problems can be an early sign of heart disease

What to expect at your appointment

The appointment is private and confidential. You will be asked some personal questions, but you can answer at whatever pace feels comfortable. If alprostadil is an option for you, your clinician will usually show you how to use it and give a small first dose in the clinic so you can be checked afterwards.

Treatment

Treatment for erection problems depends on the cause. The first steps are usually looking after your general health, reviewing your medicines, and talking about stress or relationship worries. If those steps are not enough, your clinician may suggest one of several options. Alprostadil is one of them, and it is often used when other options have not worked or are not suitable.

Self-care at home

• Follow exactly the instructions your clinician gives you for using, storing and disposing of your treatment.
• Wash your hands and use a clean technique, and change the spot where you give the injection each time if you use the injection form.
• Never use the medicine more often than your clinician advises.
• Keep a note of how well it works and any side effects, and bring your notes to appointments.
• Try to reduce stress and make space for relaxed, unhurried time with your partner.
• Tell any doctor, nurse or pharmacist you see that you use this medicine, especially before surgery or new medicines.

Medical treatments

Alprostadil is given in two ways. One is a very fine needle injected into the side of the penis, which brings an erection within a few minutes that lasts around half an hour to an hour. The other is a tiny pellet placed into the opening at the tip of the penis, which works a little more slowly. Either way, a doctor or nurse teaches you first and checks how you get on. Other general approaches include lifestyle changes, tablets, talking therapy for anxiety or relationship issues, and devices that use gentle suction. Your clinician will help you choose based on your health, preferences and what has worked before.

When is surgery considered?

Surgery is only considered when other treatments have not worked. Options include surgery to improve blood flow, or an implant placed inside the penis that lets a man control erections. These are specialist procedures and are not suitable for everyone, so they are discussed carefully with a specialist team.

Living with this condition

Many men use alprostadil as part of a normal sex life once they are used to it. It takes a little practice, and the first few times can feel awkward. Give yourself time, keep the instructions handy, and go back to your clinician if anything is unclear or uncomfortable.

Lifestyle tips

• Stop smoking — it is one of the biggest things you can do for your circulation and erections.
• Keep alcohol within recommended limits.
• Stay active and aim for a healthy weight.
• Take any medicines for diabetes, blood pressure or cholesterol as prescribed.
• Get enough sleep and find ways to manage stress.
• Talk openly with your partner about what feels good and what you both want.

Diet and exercise

A heart-healthy diet — plenty of vegetables, fruit, whole grains, beans, fish and healthy oils, and less processed food and salt — supports the blood flow that erections depend on. Regular movement, such as brisk walking, cycling or swimming for around 30 minutes on most days, helps too. Even small changes can make a difference over a few months.

Mental health and emotional wellbeing

Erection problems can affect confidence, mood and relationships, and worry itself can make erections harder. This is very common and nothing to be ashamed of. Talking to your partner, a counsellor or your clinician often helps a great deal. If you ever feel hopeless, overwhelmed, or have thoughts of harming yourself, please reach out to a local crisis line or emergency service straight away — support is available and you deserve it.

Prevention

Erection problems cannot always be prevented, but you can lower your chances by looking after your heart and blood vessels: not smoking, staying active, keeping to a healthy weight, limiting alcohol, and getting conditions like diabetes and high blood pressure treated. Problems related to using alprostadil, such as pain or prolonged erections, are best avoided by following your clinician's instructions carefully and reporting side effects early.

Screening programmes

There is no routine screening programme for erection problems, but if you have diabetes, heart disease or high blood pressure, your clinician should ask about sexual health at your regular reviews. Speak up if you are not asked — it is a normal part of your overall health.

Complications

If left untreated

• Ongoing difficulty with sex, which can affect confidence, mood and relationships
• Missing an early warning sign of heart disease or diabetes, since erection problems can appear before other symptoms
• An erection lasting more than 4 hours, if it happens, can cause lasting damage unless treated quickly
• Pain, bruising or small lumps at the injection site if the technique is not right or the same spot is used repeatedly

Long-term outlook

The outlook is good. Most men who seek help find a treatment that works for them, whether that is alprostadil or another option. Many also find that looking after their general health improves things over time. If the first option does not suit you, go back and talk it through — there is usually something else to try.

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