Intraurethral Agents 

Intraurethral agents, sometimes called transurethral agents, are medications used to treat male sexual function problems (erectile dysfunction), by increasing blood flow to the penis to achieve and maintain erection. They are inserted directly into the urethra (urine channel) in the form of a suppository. 

Inserting a Urethral Suppository 

Using an applicator, a very small pellet (suppository) about the size of a rice grain is inserted in the opening on the head of the penis. The insertion takes place while the man is standing and directly after urination to help lubricate the suppository and aid its insertion and administration into the urethra. Tissue inside the penis absorbs the suppository after insertion. Patients should massage gently while holding the penis upright to help the absorption and avoid leaking. They should also sit, stand or walk for up to 10 minutes while the absorption it taking place and the penis is erect. 

How Urethral Suppositories Work 

MUSE® (medicated urethral suppository for erection) is the only urethral suppository approved by the U.S. Food and Drug Administration (FDA). Alprostadil, the medicine used in MUSE®, is part of the vasodilators family of medicines that increase blood flow by making blood vessels expand. Once the medicine is inserted, it is absorbed into the tissue around the urethra (corpus spongiosum). The medicine is also transferred to the erectile chambers (corpora cavernosa) through small veins after absorption, which softens the tissue and increases blood flow. The increase in flow causes an erection. 

MUSE® is usually recommended to be used only once per day and comes in four dose strengths (125 mcg, 250 mcg, 500 mcg, and 1,000 mcg). Lower doses are usually not as effective for ED patients, so consult your doctor if you’re not seeing results. Erections should come within five to 10 minutes of using MUSE®, and sexual intercourse should occur within 10 to 30 minutes after the medicine takes effect. Erections that last after ejaculation are not uncommon, but should be gone within an hour. Consult your physician if your erection lasts longer. If your sex partner is pregnant, always use a condom after taking alprostadil in its suppository form (MUSE®). The condom will protect the fetus for exposure to any of this medicine, although the chances of actually harming the fetus are rather low. 

Success Rates 

MUSE® works for roughly 35 percent of men who use it, giving them an erection hard enough to have sex. Unfortunately, the process for administering the suppository is complicated and should be fully explained by a physician before a man uses MUSE®. 

Self-injected medicines are another option for many ED patients who have trouble using MUSE®. 

Side Effects 

Dizziness and pain or discomfort in the penis and perineum (the space between the rectum and scrotum) are the most common side effects of intraurethral agents, but are actually reported in less than five percent of ED patients. Usually the pain goes away as the body begins to adjust to the new medicine that has entered the penis. If an erection becomes painful or lasts for more than four hours (a condition known as priapism), notify your doctor immediately. These side effects are rare, but could be extremely damaging. 

The Cost of Urethral Suppositories 

MUSE® may cost between $125 and $175 for six urethral suppositories, depending on the dose. Contact your health insurance provider to see if MUSE® is covered by your health plan.


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