Erectile dysfunction can occur for a number of reasons. Consequently, no one solution is able to treat all instances; which is why there are several different treatments available for ED, and why sometimes, non-medicinal routes such as lifestyle changes and counselling may be more suitable.
Currently, ED medicine can taken in the form of PDE5 inhibitor tablets (Viagra, Levitra, Cialis and Spedra), and alprostadil urethral suppository creams (Vitaros), urethral applicators (MUSE) and injections (Caverject).
However, pharmaceutical companies are continuing to invest in the development of other treatments too. Further research is being carried out in the hope that more treatments will become available which are even more effective than those medications already on the market.
In this post, we’ll explore the different kinds of treatments currently in development, and when they might be likely to be made available.
Topiglan cream contains prostaglandin E1, or ‘alprostadil’. The product has been in testing for some time; an entry in the British Journal of Urology International from 2003 describes a (quite successful) clinical trial undertaken with the treatment.
Alprostadil is also the active ingredient in Vitaros, a cream which is applied via a urethral applicator and is already available in the UK.
Topical prostaglandin E1 cream has been found to effectively increase erectile function while being well tolerated by its users. One study concluded that it can be an effective alternative for men who are unable to tolerate PDE5 inhibitors or do not achieve a satisfactory response from them.
The difference between Vitaros and Topiglan is that while the former is inserted into the urethra with a plunger, Topiglan contains an agent called SEPA (Soft Enhancement of Percutaneous Absorption) which enables the active ingredient to be absorbed through the skin.
CSD500/Blue Diamond condom
British pharmaceutical group Futura Medical specialises in transdermal technology, allowing medicine to be directly absorbed through contact with the skin; and have been using this technology to develop two products for the sexual healthcare market.
The CSD500 (or ‘blue diamond’) condom contains Zanifil gel in the teat. The active ingredient in Zanifil is a small dose of glyceryl trinitrate (GTN), a treatment used in angina.
Applied locally, this helps to relax blood vessels in the penis, and when the condom is worn, the drug is absorbed through the skin.
According to the Futura website, the condom helps to improve erectile firmness, while facilitating a longer lasting sexual experience. The CSD500 condom is currently on sale in Belgium and the Netherlands, but is not yet licensed for sale in the UK.
Another ED treatment still in development is ‘MED2002’, or Eroxon gel. This topical treatment also uses transdermal technology for the application of glyceryl trinitrate, a potent vasodilator.
Vasodilation refers to the widening of blood cells, which increases blood flow to the penis thus producing an erection.
The medication is directly absorbed by the glans penis, allowing for quicker activation which is said to improve sexual experience.
The nature of topical treatments means that some side effects associated with oral PDE5i medications are not as likely (less of the medication is absorbed into the bloodstream or passes through the vital organs), and the risk of interactions with other medicines is lower too.
Some scientists think that gene therapy may become an treatment option for ED in the future.
This involves the insertion of certain genes via injection into the penis. This gene then creates a protein, which helps the smooth muscle cells in the penis to relax (again, facilitating better blood flow and improved erections).
Research into this area of treatment is still young, but initial studies have shown improvements in International Index of Erection Function (IIEF) scores of participants.
One review by a team of US-based urologists concluded that gene therapy could become an effective route for men who do not respond to PDE5i.
Stem cell therapy
Another promising area of research, particularly for men with damaged penile nerves, is stem cell therapy.
One study harvested stem cells from the abdominal fat of male participants. The cells were then transplanted into the damaged cavernous nerves found in the penis.
In the six months following on from the treatment, eight out of 21 study participants reported improved sexual function suitable for penetrative intercourse.
Scientists involved in the research are hopeful that this method of treatment could even restore spontaneous sexual function in some men.
Low-Intensity Extracorporeal Shockwave Therapy (Li-ESWT)
There has been some research into the use of Li-EWST for ED, but much more research is needed before it can become a widely offered treatment.
This type of therapy helps the formation of new blood vessels through a process called neovascularisation, which in turn helps to improve blood flow.
A recent study published in the Journal of Sexual Medicine suggested that LI-ESWT did improve IIEF scores compared to ‘sham’ therapy (placebo).
However, a 2017 review by a team comprised of urologists from Denmark, the Netherlands and Israel opened by saying that results had been contradictory, with some studies showing promise, some providing inconclusive findings and some even discouraging. Another drawback the review noted was that the optimal regimen (timings, energy densities and so on) had not yet been defined. The review did go on to say that the treatment is perceived as a safe one by urologists.