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Alprostadil Cream: Is It Effective for ED?

Mike Bohl, MD, MPH, ALM

Reviewed by Mike Bohl, MD

Written by Shannon Ullman

Published 03/23/2021

Updated 01/18/2024

Erectile dysfunction (ED) is a serious buzzkill that can affect guys everywhere. An estimated 30 million men struggle with the issue in the U.S. — and the longer you live, the higher your chances of dealing with this common form of sexual dysfunction.

The good news is that ED is treatable, with options ranging from prescription medications such as sildenafil (the active ingredient in Viagra®) to vacuum erection devices and injection therapy.

One medication that’s gained attention as a form of treatment for ED is alprostadil. It comes in several formulations, including an injectable solution, a urethral suppository and a topical erectile dysfunction cream or gel. 

If you have erectile dysfunction and prefer not to take oral ED medication, alprostadil cream is one of several treatments for erectile dysfunction worth considering. 

Below, we’ll talk about what alprostadil cream is and how it works as a treatment for erectile dysfunction.

We’ll also discuss the potential side effects of alprostadil cream, as well as alternatives to consider if you’re one of the tens of millions of men affected by ED.

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Alprostadil is a medication used to treat and manage ED. It belongs to a class of medications known as vasodilators, which work by relaxing blood vessels and improving blood flow throughout the body.

Healthy, rigid erections are all about healthy, consistent blood flow. When you feel aroused, your blood vessels dilate, allowing blood to flow more easily into the corpora cavernosa — two cylindrical areas of erectile tissue inside your penis.

As blood pressure inside your penis increases, you’ll develop an erection firm enough for penetrative sex.

So, how does topical alprostadil cream work? As a vasodilator, alprostadil cream relaxes the muscles of the blood vessels supplying the penis, making it easier for blood to flow and stay in the penis long enough to get an erection.

One popular brand of alprostadil cream is Vitaros®, though it’s not FDA-approved and is currently only available in Europe. Vitaros cream is applied intraurethrally — meaning into the opening  of the penis — shortly before sexual activity. This stimulates local blood flow and makes it easier to get and stay hard.

Currently, alprostadil cream for erectile dysfunction isn’t a first-line treatment, meaning your healthcare provider typically won’t prescribe it as the first thing to try if you have ED.

Instead, most men with ED are treated with phosphodiesterase type 5 inhibitors (PDE5 inhibitors), which are also taken before sex.

Our guide to erectile dysfunction creams goes into more detail about how these products work for the treatment of erectile dysfunction, as well as their unique advantages and disadvantages.

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If alprostadil cream isn’t a first-line ED treatment, how effective is it?

We’ll start off by saying that cream for ED doesn’t cure erectile dysfunction or increase sexual desire. With that out of the way, there are definitely benefits to this ED treatment. 

According to several studies, some of which were double-blind and placebo-controlled, alprostadil topical cream works well and is well tolerated in ED patients with mild-to-severe symptoms.

One of the main reasons it’s not a first-line treatment for ED is that the cream doesn’t have FDA approval. Alprostadil does also come as an injectable, though, which is sold under the brand name Caverject®. This form of alprostadil is FDA approved to treat ED.

Based on its effectiveness, some in the scientific community think alprostadil topical creams have the potential to be first-choice alternatives for ED patients who don’t respond well to or can’t tolerate PDE5 inhibitors.

A 2016 review of Vitaros topical cream for erectile dysfunction found that it was 83 percent effective with a 300-microgram (mcg or μg) dose in patients with severe ED — significantly better than the placebo group. What’s more, systemic adverse effects were only reported in three percent of the treated population — not bad.

Another 2016 review found that clinical trials of topical alprostadil cream showed it to be effective, increasing the erectile function score on the International Index of Erectile Function (IIEF) by 13 points from baseline.

Like all medications, side effects are always on the table.

Here are a few alprostadil erectile cream side effects:

  • Burning sensation at the site of application

  • Penile pain

  • Prolonged erection (priapism)

  • Painful erection (Peyronie’s disease)

  • Vaginal burning or itching (for female partners)

A 2009 study looked at 1,161 male patients with ED. For the first four weeks, they used eight doses of 200-mcg topical alprostadil cream before sex, up to two times per week. Based on their response to the cream, they could stay the same, decrease to 100-mcg doses or increase to 300-mcg doses for up to nine months, at two doses per week. The results were as follows:

  • Twelve percent of patients stopped using the cream because they were either too sensitive to it or not sensitive enough. 

  • Sixteen percent withdrew from the study for various reasons.

  • Fewer than five percent stopped the treatment because of adverse effects.

  • Seventy-three percent of patients used 300-mcg.

  • Seventy-four percent of patients experienced an overall improvement in erectile function using the cream.

In terms of side effects, the study found that:

  • Roughly 12 percent of patients experienced burning at the application site. 

  • Four percent experienced penis pain.

  • About one percent experienced a prolonged or painful erection.

  • Less than one percent reported a prolonged erection of four or more hours. 

  • Around two percent of the patients’ sex partners reported vaginal burning or itching.

Choose your chew

There are plenty of alternative alprostadil cream treatments for ED. The first place to start is typically with oral medication, often in conjunction with lifestyle changes and potentially therapy.

Medication

As noted, PDE5 inhibitors are typically first-line treatments for ED. The most common PDE5 treatment options include:

Viagra was the first PDE5 inhibitor. Introduced in 1998, it treated more than 20 million men during its first six years on the market. Levitra was approved in 2003, followed a few months later by Cialis. And in 2012, Stendra was introduced.

This class of drugs improves ED by relaxing arterial smooth muscles and increasing blood flow to the penis.

Common side effects of PDE5 inhibitors include:

  • Headache

  • Flushing

  • Nasal congestion or runny nose

  • Indigestion

  • Visual abnormalities (less common)

If you don’t like swallowing pills, you could try chewable ED meds like our hard mints. Alternatively, certain foods and supplements may help increase blood flow to your penis.

Another medication option is the injectable form of alprostadil, although the route of administration may make men less likely to want to try this approach.

Other treatments

There are several other medical interventions that can assist with ED. Eroxon is a non-prescription, non-medicated topical gel that was recently FDA authorized for ED. There are also vacuum erection devices that can be used (with a constriction ring) as well as surgical implants as an option.

Counseling and Therapy

Anxiety and depression can play a role in developing ED. The brain and the body work together to get aroused, sending blood flow to the penis so you can get and maintain an erection. If you’re feeling low or nervous, as with sexual performance anxiety, you might experience ED.

Psychological ED (meaning the cause of ED is mental instead of physical) can be manageable. Therapy or sexual counseling are tools that can help you work through mental hurdles contributing to your ED.

There are more than eight types of therapy, so explore your options to see which might be best for you.

Lifestyle Changes

Some of the latest ED treatments work in tandem with lifestyle changes. Lifestyle factors that could affect ED include:

  • Excess body weight

  • Lack of physical activity

  • Poor diet

  • Smoking

  • Heavy alcohol use

  • Substance use

  • Chronic stress

According to a 2020 review of studies, lifestyle modifications play a significant role in improving sexual health.

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If PDE5 inhibitors aren’t working for you, or you just don’t want to take them, alprostadil cream might be an effective alternative. Studies show this topical ED medication is effective in more than 80 percent of ED patients.

When looking for erectile dysfunction solutions, keep in mind:

  • ED is common. It affects around 30 million men in the U.S. alone. 

  • The first line of treatment is PDE5 inhibitors. These medications include Viagra® and Cialis®, among others.

  • Alprostadil cream is a next option. If you don’t want to take PDE5 inhibitors or don’t tolerate them well, erectile dysfunction cream can serve as a secondary option.

  • Alprostadil cream might have side effects. Potential side effects include application site burning, penis pain, prolonged erections, painful erections or burning in your partner’s genital area.

  • Lifestyle factors can help improve ED. Maintaining a healthy weight, eating a nutritious diet, exercising, keeping low stress levels and avoiding drugs and excessive alcohol can help improve ED and sexual intercourse.

  • Talk to a healthcare provider. Always consult a medical professional before starting any new medication for ED. They can discuss the side effects, potential drug interactions and contraindications.

If you have ED and think a psychological issue might be at play, consider speaking with a mental health provider. 

You can ask a healthcare provider for a referral or connect from home via our online mental health services. You can also access evidence-based medication for ED with our range of erectile dysfunction medications.

12 Sources

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  2. Anaissie J, Hellstrom WJ. Clinical use of alprostadil topical cream in patients with erectile dysfunction: a review. Res Rep Urol. 2016 Aug 3;8:123-31. doi: 10.2147/RRU.S68560. PMID: 27536559; PMCID: PMC4977016. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4977016/
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  11. Symptoms & Causes of Erectile Dysfunction. (2017). National Institute of Diabetes and Digestive Kidney Diseases. Retrieved from: https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/symptoms-causes
  12. Yafi FA, Jenkins L, Albersen M, Corona G, Isidori AM, Goldfarb S, Maggi M, Nelson CJ, Parish S, Salonia A, Tan R, Mulhall JP, Hellstrom WJ. Erectile dysfunction. Nat Rev Dis Primers. 2016 Feb 4;2:16003. doi: 10.1038/nrdp.2016.3. PMID: 27188339; PMCID: PMC5027992. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027992/
Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Mike Bohl, MD

Dr. Mike Bohl is a licensed physician, a Medical Advisor at Hims & Hers, and the Director of Scientific & Medical Content at a stealth biotech startup, where he is involved in pharmaceutical drug development. Prior to joining Hims & Hers, Dr. Bohl spent several years working in digital health, focusing on patient education. He has also worked in medical journalism for The Dr. Oz Show (receiving recognition for contributions from the National Academy of Television Arts and Sciences when the show won Outstanding Informative Talk Show at the 2016–2017 Daytime Emmy® Awards) and at Sharecare. He is a Medical Expert Board Member at Eat This, Not That! and a Board Member at International Veterinary Outreach.

Dr. Bohl obtained his Bachelor of Arts and Doctor of Medicine from Brown University, his Master of Public Health from Columbia University, and his Master of Liberal Arts in Extension Studies—Journalism from Harvard University. He is currently pursuing a Master of Business Administration and Master of Science in Healthcare Leadership at Cornell University. Dr. Bohl trained in internal medicine with a focus on community health at NYU Langone Health.

Dr. Bohl is Certified in Public Health by the National Board of Public Health Examiners, Medical Writer Certified by the American Medical Writers Association, a certified Editor in the Life Sciences by the Board of Editors in the Life Sciences, a Certified Personal Trainer and Certified Nutrition Coach by the National Academy of Sports Medicine, and a Board Certified Medical Affairs Specialist by the Accreditation Council for Medical Affairs. He has graduate certificates in Digital Storytelling and Marketing Management & Digital Strategy from Harvard Extension School and certificates in Business Law and Corporate Governance from Cornell Law School.

In addition to his written work, Dr. Bohl has experience creating medical segments for radio and producing patient education videos. He has also spent time conducting orthopedic and biomaterial research at Case Western Reserve University and University Hospitals of Cleveland and practicing clinically as a general practitioner on international medical aid projects with Medical Ministry International.

Dr. Bohl lives in Manhattan and enjoys biking, resistance training, sailing, scuba diving, skiing, tennis, and traveling. You can find Dr. Bohl on LinkedIn for more information.

Publications

  • Younesi, M., Knapik, D. M., Cumsky, J., Donmez, B. O., He, P., Islam, A., Learn, G., McClellan, P., Bohl, M., Gillespie, R. J., & Akkus, O. (2017). Effects of PDGF-BB delivery from heparinized collagen sutures on the healing of lacerated chicken flexor tendon in vivo. Acta biomaterialia, 63, 200–209. https://www.sciencedirect.com/science/article/abs/pii/S1742706117305652?via%3Dihub

  • Gebhart, J. J., Weinberg, D. S., Bohl, M. S., & Liu, R. W. (2016). Relationship between pelvic incidence and osteoarthritis of the hip. Bone & joint research, 5(2), 66–72. https://boneandjoint.org.uk/Article/10.1302/2046-3758.52.2000552

  • Gebhart, J. J., Bohl, M. S., Weinberg, D. S., Cooperman, D. R., & Liu, R. W. (2015). Pelvic Incidence and Acetabular Version in Slipped Capital Femoral Epiphysis. Journal of pediatric orthopedics, 35(6), 565–570. https://journals.lww.com/pedorthopaedics/abstract/2015/09000/pelvic_incidence_and_acetabular_version_in_slipped.5.aspx

  • Islam, A., Bohl, M. S., Tsai, A. G., Younesi, M., Gillespie, R., & Akkus, O. (2015). Biomechanical evaluation of a novel suturing scheme for grafting load-bearing collagen scaffolds for rotator cuff repair. Clinical biomechanics (Bristol, Avon), 30(7), 669–675. https://www.clinbiomech.com/article/S0268-0033(15)00143-6/fulltext

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