Abstract
Despite the proven efficacy of oral therapy for erectile dysfunction (ED), some patients are unable to take these medications because of drug interactions (ie, sildenafil and nitroglycerin) or a lack of response. Topical agents represent another minimally invasive option for the treatment of ED. This review discusses the impediments to effective topical therapy and examines the developmental status of several candidate drugs. Although still in the investigative stage, topical medications can be another tool in the urologist’s armamentarium against ED.
Similar content being viewed by others
References and Recommended Reading
Morales A: Developmental status of topical therapies for erectile and ejaculatory dysfunction. Int J Impot Res 2000, 12(Suppl 4):S80–85. This article is another timely review of topical ED therapies.
Becher E, Borghi M, Momesso A, et al.: Penile hemodynamic findings with a new topical formulation of alprostadil. J Urol 1998, 159(Suppl):239.
McVary KT, Polepalle S, Riggi S, Pelham RW: Topical PGE-1/SEPA gel for the treatment of erectile dysfunction. J Urol 1999, 162:726–730. This article shows that PGE1 with a penetration enhancer can cause a significant clinical response.
Borges FD: A new approach to the pharmacologic treatment of impotence. Int J Impot Res 1994, 6:137–143.
Kim ED, McVary KT: Topical prostaglandin-E1 for the treatment of erectile dysfunction. J Urol 1995, 153:1828–1830.
Samour CM, Donaruma LG, Daskalakis et al.: SEPAs, a new class of percutaneous absorption enhancers. Proc Intern Symp Control Rel Bioact Mater 1989, 16:183–184.
Pelham R, Samour C: SEPA-009: safety and efficacy. Studies of a broad spectrum transdermal enhancer. Proc Intern Symp Control Rel Bioact Mater 1995, 22:694–695.
Morganti F, Bramanti E, Solaro R, et al.: Thermal and spectroscopic characterization of interactions between 2-nonyl-1, 3, dioxolane and stratum corneum components. J Bioactive Compatible Polymers 1999, 14:162–177.
Jain P, Rademaker AW, McVary KT: Testosterone supplementation for erectile dysfunction: results of a meta-analysis. J Urol 2000, 164:371–375. This meta-analysis showed that testosterone supplementation is a good treatment for hypogondadal ED.
Schultheiss D, Hiltl DM, Meschi MR, et al.: Pilot study of transdermal application of testosterone gel to the penile skin for the treatment of hypogonadotropic men with erectile dysfunction. World J Urol 2000, 18:431–435. This article attempts to refine transdermal testosterone replacement.
Porst H: The rationale for prostaglandin E1 in erectile failure: a survey of worldwide experience. J Urol 1996, 155:802–815.
Palmer LS, Valcic M, Melman A, et al.: Characterization of cyclic AMP accumulation in cultured human corpus cavernosum smooth muscle cells. J Urol 1994, 152:1308–1314.
Lee SW, Wang HZ, Zhao W, et al.: Prostaglandin E1 activates the large-conductance KCa channel in human corporal smooth muscle cells. Int J Impot Res 1999, 11:189–199.
Padma-Nathan H, Hellstrom W, Kaiser F, et al.: Treatment of men with erectile dysfunction with transurethral alprostadil. Medicated Urethral System for Erection (MUSE) Study Group. N Engl J Med 1997, 336:1–7.
Donatucci CF, Lue TF: The combined intracavernous injection and stimulation test: diagnostic accuracy. J Urol 1992, 148:61–62.
Goldstein I, Lue TF, Padma-Nathan H, et al.: Oral sildenafil in the treatment of erectile dysfunction. N Engl J Med 1998, 338:1397–1404.
Goldstein I, Payton TR, Schechter PJ: A double-blind, placebocontrolled, efficacy and safety study of topical gel formulation of 1% alprostadil (Topiglan) for the in-office treatment of erectile dysfunction. Urology 2001, 57:301–305. This is another successful study of PGE1/SEPA. It reaffirms the possibility for meaningful topical ED therapy.
Padma-Nathan H, Steidle C, Tayse N, et al.: A randomized, double-blind, placebo-controlled trial of the efficacy and safety of Aprox-TD cream for erectile dysfunction. Int J Impot Res 2001, 13(Suppl 5):S62.
Becher E, Momesso A, Borghi M, et al.: Topical prostaglandin E1 for erectile dysfunction. J Urol 1996, 166(uppl)296A.
Becher EF, Bechara A, Casabe A: Topical alprostadil produces significant clitoral hemodynamic changes. J Urol 2000, 163(Suppl):652A.
Islam A, Mitchel J, Rosen R, et al.: Topical alprostadil in the treatment of female sexual arousal disorder: a pilot study. J Sex Marital Ther 2001, 27:531–540. This small study is one of the few efforts to treat female sexual dysfunction with topical therapies.
Vasko MR: Prostaglandin-induced neuropeptide release from spinal cord. Prog Brain Res 1995, 104:367–380.
Meyhoff HH, Rosenkilde P, Bodker A: Non-invasive management of impotence with transcutaneous nitroglycerin. Br J Urol 1992, 69:88–90.
Sonksen J, Biering-Sorensen F: Transcutaneous nitroglycerin in the treatment of erectile dysfunction in spinal cord injured. Paraplegia 1992, 30:554–557.
Claes H, Baert L: Transcutaneous nitroglycerin therapy in the treatment of impotence. Urol Int 1989, 44:309–312.
Gramkow J, Lendorf A, Zhu J, Meyhoff HH: Transcutaneous nitroglycerine in the treatment of erectile dysfunction: a placebo controlled clinical trial. Int J Impot Res 1999, 11:35–39.
Heaton JP, Morales A, Owen J, et al.: Topical glycerylnitrate causes measurable penile arterial dilation in impotent men. J Urol 1990, 143:729–731.
Owen JA, Saunders F, Harris C, et al.: Topical nitroglycerin: a potential treatment for impotence. J Urol 1989, 141:546–548.
Nunez BD, Anderson DC Jr: Nitroglycerin ointment in the treatment of impotence. J Urol 1993, 150:1241–1243.
McCall JM, Aiken JW, Chidester CG, et al.: Pyrimidine and triazine 3-oxide sulfates: a new family of vasodilators. J Med Chem 1983, 26:1791–1793.
Cavallini G: Minoxidil versus nitroglycerin: a prospective double-blind controlled trial in transcutaneous erection facilitation for organic impotence. J Urol 1991, 146:50–53.
Cavallini G: Minoxidil versus nitroglycerine: a prospective, double-blind, controlled trial in transcutaneous therapy for organic impotence. Int J Impot Res 1994, 6:205–212.
Beretta G, Saltarelli O, Marzotto M, et al.: Transcutaneous minoxidil in the treatment of erectile dysfunction in spinal cord injured men. Acta Eur Fertil 1993, 24:27–30.
Clark RV, Murray FT, Hirshkowitz M, et al.: Treatment of erectile dysfunction in men with diabetes mellitus using a penetration-enhanced topical minoxidil solution. J Androl 1994, 15(Suppl):55.
Radomski SB, Herschorn S, Rangaswamy S: Topical minoxidil in the treatment of male erectile dysfunction. J Urol 1994, 151:1225–1226.
Chancellor MB, Rivas DA, Panzer DE, et al.: Prospective comparison of topical minoxidil to vacuum constriction device and intracorporeal papaverine injection in treatment of erectile dysfunction due to spinal injury. Urology 1994, 43:365–369.
Virag R: Intracavernous injection of papaverine for erectile failure. Lancet 1982, 2:938.
Lakin MM, Montague DK, VanderBrug Medendorp SV, et al.: Intracavernous injection therapy: analysis of results and complications. J Urol 1990, 143:1138–1141.
Kim ED, el-Rashidy R, McVary KT: Papaverine topical gel for treatment of erectile dysfunction. J Urol 1995, 153:361–365.
Chiang HS, Kao YH, Sheu MT: Papaverine and prostaglandin E1 gel applications for impotence. Ann Acad Med Singapore 1995, 24:767–769.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Yap, R.L., McVary, K.T. Topical agents and erectile dysfunction: Is there a place?. Curr Urol Rep 3, 471–476 (2002). https://doi.org/10.1007/s11934-002-0100-x
Issue Date:
DOI: https://doi.org/10.1007/s11934-002-0100-x