MUSE for ED: How It Works, Side Effects, & More

Not to be confused with the British rock band, MUSE® (alprostadil) is an intraurethral erectile dysfunction (ED) treatment that’s been helping men have better erections since 1997. If you’re curious about MUSE for ED, you’ve come to the right place.

Just where do you put it? The suppository is placed directly into the urethra. And although it’s an FDA-approved medication, the MUSE can cause unsavory side effects if it’s not used properly. 

Before you write off MUSE for ED as some sort of medieval-style torture method, we’ll break down how this medication works, side effects you should know about, and other ways to treat erectile dysfunction if you think “urethral” and “suppository” should never be in the same sentence.

MUSE is a urethral suppository medication you insert directly into your urethra (the tube urine and semen come out of) with an applicator stem to treat erectile dysfunction. The medication’s active ingredient is alprostadil, which is chemically identical to the naturally occurring prostaglandin E1 (PGE1).

A prostaglandin is a hormone-like substance that widens blood vessels, which is essential for getting and sustaining an erection.

A typical starting dosage of alprostadil is 125 or 250 micrograms (mcg), though the medication can be dosed up to 1,000 micrograms.

When a MUSE suppository is inserted into the urethra, it is absorbed and then starts to increase the diameter of the blood vessels within your penis. This helps the spongy tissue (called the corpora cavernosa) fill with blood and become more rigid. 

This results in an erection. 

MUSE should be used directly after urinating and before sexual intercourse.

Here’s what to do:

• Shake out excess urine after peeing.

• Remove the applicator from its foil pouch.

• While sitting or standing, slowly insert the tip containing the medicated pellet into your urethra.

• Press down on the applicator button to release the pellet and remove the empty applicator.

The first few times might be uncomfortable or even painful for some. In clinical trials, 36 percent of users reported pain in the penis, and some didn’t continue taking the drug due to discomfort.

Also, you shouldn’t use MUSE more than twice in a 24-hour period.

According to the information on its drug label, MUSE works within five to 10 minutes after insertion. The effects of MUSE treatment usually last about 30 to 60 minutes, but this may vary from person to person.

The medication doesn’t stick around in your system for too long, either. Roughly 80 percent of a dose is absorbed within just 10 minutes.

As mentioned earlier, penile pain was the most reported side effect in clinical trials. Nearly a third of patients reported pain in the penis, just over 10 percent had pain in the urethra, and a smaller number reported testicular pain while using MUSE. 

However, most of these patients noted that the pain was mild and not long-lasting.

Other unwanted effects of a MUSE suppository may include:

• Painful erection

• Minor bleeding in the urethra

• Urethral burning 

• Dizziness

• Flu symptoms

• Headache

• Bodily Pain

• Priapism (painful, prolonged erection)

Priapism is a rare side effect, but it’s been reported.

MUSE may also increase your risk of hypotension (low blood pressure). Blood pressure and heart rate changes have been reported for some patients.

Also, the medication’s warnings about drug interactions include low blood pressure and fainting. If you experience either, seek medical attention.

For these reasons, it is often recommended that you don’t drive or operate heavy machinery after using MUSE.

Side effects can occur for your female partner too. If the medication is transferred to them during sexual activity, they might experience vaginal burning or itching.

This may go without saying, but MUSE doesn’t isn’t a contraceptive and doesn’t protect against sexually transmitted diseases (STIs). So you’re wise to use condoms and/or other forms of contraception when using MUSE for ED.

MUSE medication is approved by the FDA (U.S. Food and Drug Administration). This means it’s been through rigorous trials and testing and determined to be safe when prescribed by a licensed healthcare provider and taken as directed.

However, unlike swallowing a pill, inserting MUSE into your penis could be considered a hazardous task if not done properly. There have been rare instances of urethral bleeding and abrasions. Men with bleeding disorders and those taking blood thinners may have a higher risk of this type of bleeding.

For some men, the physical discomfort of inserting MUSE and the risk of side effects aren’t worth it, especially if the drug has a modest success rate.

In one 2002 study of 100 patients, only 35 percent were successfully treated, and less than half of those continued to use the medication after six months. What’s more, men who stopped using MUSE for erectile dysfunction did so either because it stopped being effective or because the side effects weren’t worth the benefits. 

Some of the common side effects do sound pretty painful. But given that the 2002 study only called the medication “moderately effective” in treating ED, patients may have simply wanted a higher return for their discomfort.

This might be why MUSE isn’t usually considered a first-line treatment for ED. It’s generally viewed as an alternative for those who haven’t responded well to other options — or for men who can’t use other treatments due to preexisting conditions or potential drug interactions.

Muse has a number of contraindications (a list of things preventing people from being able to use a medication).

It shouldn’t be used by those with:

• Peyronie’s disease (when scar tissue forms under the skin of the penis)

• Sickle cell anemia, myeloma, or leukemia, which increase the risk of priapism

• Urethritis (urethral inflammation)

Let your healthcare provider know if you have any of these conditions before accepting a prescription for MUSE.

So, you’re feeling a little put off by MUSE’s potential side effects and want to know what other options are out there. That’s totally okay.

Several other well-known and thoroughly researched medications are available for ED treatment. Many of them are phosphodiesterase type 5 inhibitors (or PDE5 inhibitors).

How Do PDE5 Inhibitors Compare to MUSE?

Unlike MUSE, PDE5 inhibitors are oral medications that increase blood flow to the penis. Since they aren’t inserted directly into the penis, they can take a little longer to work while they make their way through your system.

However, some of the newer ED medications work in as little as 15 minutes.

These erectile dysfunction medications were originally designed for use in the cardiovascular disease world. PDE5 inhibitors are vasodilators, so they stop the aforementioned enzyme (PDE5) from constricting blood vessels, ensuring continued blood flow.

When it comes to your penis, that means firmer, longer lasting, and more reliable erections. 

PDE5 inhibitor medications include:

• Sildenafil. What many know as Viagra® or the original “little blue pill,” sildenafil is a popular, effective ED drug prescribed for as-needed use. You should take it at dinnertime if you plan on having sex that night.

• Tadalafil. Generic tadalafil (and brand-name Cialis®) can also be prescribed as needed or as a daily medication. Taking it daily means you can be ready to go without popping a pill shortly before anticipated sex.

• Avanafil. Avanafil (generic for Stendra®) is a fast-acting ED medication for those spontaneous occasions. It works in as little as 15 minutes.

• Vardenafil. Vardenafil is the active ingredient in Levitra®. It can work slightly faster than sildenafil and tadalafil but maybe not as fast as avanafil. It’s also prescribed as needed.

A healthcare professional will typically start patients on sildenafil or tadalafil, though other ED meds may be prescribed based on your individual needs and side effects. Learn more in our guide to PDE5 inhibitors.

Most of these medications are well-received and considered first-line treatments over medication like MUSE. PDE5 inhibitors have about a 70 percent success rate in men with ED.

Of course, the effectiveness of these medications depends on many variables, like your overall health, weight, and lifestyle habits, as well as what’s causing your erectile dysfunction.

Medications seem to be most effective for people who don’t have an obvious or specific cause of ED, though your healthcare provider can answer more questions about this. Always seek medical help if you’re unsure. 

MUSE is one of quite a few FDA-approved medications for ED. But it probably shouldn’t be your first choice unless your provider says otherwise.

Here’s what to keep in mind about MUSE for ED: 

• While safe enough, MUSE erectile dysfunction medication comes with some potentially brutal side effects, including urethral bleeding and abrasions. 

• Your healthcare provider will likely only recommend MUSE for ED if other treatments aren’t effective or because of contraindications with other medications or medical conditions.

• PDE5 inhibitors (best known by their brand names Viagra, Cialis, Stendra, and Levitra) are more thoroughly researched and easier to use, though they may not work as quickly as MUSE.

Before starting your search for treatment of erectile dysfunction, your first step should be talking with a healthcare professional specializing in urology. 

Getting medical advice may help you address these problems with a drug-free approach, like healthy eating, weight loss, regular exercise, or therapy for psychological ED. Talking to a healthcare professional will also help you identify other, more serious conditions that might be causing your ED.

Explore ED treatments on our sexual health platform today.