What To Know About Creams For Erectile Dysfunction

Erectile dysfunction (ED), also known as impotence, is a health condition in which men have persistent difficulty getting or maintaining erections, leading to unsatisfactory sex lives for themselves and their partners. 

ED is a very common problem, especially among older men. It can have various causes, both physical and psychological. 

Fortunately, there are a variety of medications available for treating ED. Most of these are in the form of orally-administered pills such as Viagra or Cialis. However, in certain countries, ED medications are available as creams—most notably Vitaros in the UK and Canada. 

What are erectile dysfunction creams?

Erectile dysfunction creams help men with erectile dysfunction get and maintain erections to have more satisfying sex for themselves and their partners. 

Important cautions

The manufacturer of Vitaros warns that it should not be used more than 2–3 times per week and only once every 24 hours. One of the concerns with drugs that can cause or prolong erections is that they can lead to priapism if overused. 

Priapism is a prolonged erection of the penis (e.g., more than 4 hours), which is usually painful and can potentially cause permanent damage to tissues inside the penis. It can even worsen ED. 

Overdosing with Vitaros may also lead to a drop in blood pressure, dizziness, and fainting, although overdoses requiring treatment have not been reported so far. 

Vitaros may also interact with certain other drugs if you take them simultaneously, which you should discuss with your doctor or pharmacist. 

Types of erectile dysfunction creams

There are several kinds of ED creams currently available. However, Vitaros is the only one available on prescription for treating ED—and only in certain countries such as the UK and Canada. It is not currently available in the US due to a lack of FDA approval. 

Vitaros relies on an active ingredient called alprostadil, previously used in other formulations for treating ED. It became available in a cream formulation in Europe in 2013. 

In addition to alprostadil, Vitaros cream contains a proprietary ingredient called Nexact®, designed to enhance the absorption of alprostadil into the penis. 

Other creams are available over the counter that is advertised as being able to help with ED; whether they do or not remains unproven. Examples include creams containing L-arginine, a naturally occurring amino acid that your body can convert into nitric oxide. 

The best cream for erectile dysfunction

Creams for erectile dysfunction are relatively new on the market, and it is currently unknown what the best cream for ED is. 

Vitaros has been through phase II and phases III clinical trials, where it was shown to be generally safe and effective. 

The FDA has twice declined to approve Vitaros, most recently in 2018, citing safety concerns surrounding Nexact® and “deficiencies in chemistry, manufacturing, and control,” according to a document from the Securities and Exchange Commission.¹ 

While you may find other creams that claim to be able to treat ED for sale online or as over-the-counter medicines in pharmacies or supplement shops, in most cases, there isn’t much solid evidence to support their use. 

One example is creams that contain L-arginine. These are sometimes marketed as “male enhancement” creams that can help with ED. Theoretically, such creams could work by promoting nitric oxide (NO) production. This is because the body uses L-arginine to make NO, and NO is a vasodilator that could increase blood flow into the penis.

However, over-the-counter medications and supplements generally are poorly regulated products that may or may not do what they claim. They may even be harmful. For example, the FDA has issued warnings about sexual enhancement products tainted with unlabeled active ingredients.

Other creams are undergoing clinical trials, including a cream containing sildenafil, the same active compound in Viagra. 

How does cream work for erectile dysfunction?

ED creams work by relaxing blood vessels in the penis, increasing blood flow, and producing erections. They can do this because they contain a drug called alprostadil.² 

Alprostadil is another name for a naturally-occurring compound called prostaglandin E1. Prostaglandins are a class of lipid-based compounds that serve as signaling molecules that let cells in your body communicate with each other. 

Prostaglandin E1 normally enhances blood flow to sites inside the body where it is released by acting on smooth muscle cells in the walls of blood vessels, causing them to relax. When administered as a drug, alprostadil can have this same effect. 

Alprostadil can also be administered into the penis by injection or by urethral suppositories, which are pills that have to be inserted into the urethral opening at the tip of the penis. 

Understandably, these routes of administration are not very popular with patients suffering from ED due to the discomfort involved and the complications that can occur, such as scarring. This led pharmaceutical companies to develop creams containing alprostadil that can be topically applied—such as Vitaros. 

How to use creams for erectile dysfunction

While creams are usually applied by rubbing into the skin, Vitaros is applied by dripping the cream into the penis via the urethral opening with the help of a disposable plastic syringe provided by the manufacturer. 

The manufacturer recommends urinating before administering the cream and warns not to insert the syringe into the penis. Hold the penis upright, squeezing at the tip to widen the urethral opening, and hold the end of the syringe as close to the urethral opening as possible while pushing the cream out by pressing down on the plunger.

One important thing to note about creams containing alprostadil and alprostadil injections or urethral suppositories is that they directly cause erections, usually within 5-30 minutes. 

This means they should be applied 10–30 minutes before having sex. This is in contrast to orally administered PDE-5 inhibitors like Viagra and Cialis, which do not directly trigger erections but make it easier to get erections and maintain them for longer. 

The erections produced by alprostadil typically last around 1-2 hours and can continue even after ejaculation. 

How effective are creams for erectile dysfunction?

A literature review published in 2016 recommended that, while oral PDE-5 inhibitors³ like Viagra and Cialis should be the first line of treatment for patients with ED, patients who, for some reason, cannot use such drugs should avoid them.

Risks of using creams for erectile dysfunction

Vitaros was found to be safe and relatively well tolerated during clinical trials by most men suffering from ED. 

However, as with most drugs, certain groups of people are at an increased risk of adverse effects and should not use them. In the case of Vitaros, these include people with certain pre-existing health conditions relating to their cardiovascular systems, allergies to alprostadil, and inflamed or infected penises. 

The manufacturers include the complete list of conditions on the information sheet that comes in the box with the drug. As with all medications, patients considering using any medications for ED should discuss it first with their doctors beforehand. 

What are the side effects of creams for erectile dysfunction?

The most commonly reported side effects of ED creams such as Vitaros include itching or burning sensations in the penis, redness, swelling, and rashes. 

Some female partners of men using ED creams have also reported vaginal burning sensations. These symptoms usually resolve within 1–2 hours.

Alternative treatment options for erectile dysfunction

There are several different treatment options available for ED, apart from creams. These include oral prescription drugs, penis pumps, prosthetic implants, and lifestyle/dietary changes. 

Oral prescription drugs

The most commonly used treatment options for ED are oral prescription medications such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). 

While these are often effective at relieving ED, they can also produce unpleasant side effects such as headaches and dizziness that have led some patients to stop using them. 

Another issue with such drugs is that they are not often suitable for patients who are also taking other drugs, such as nitrates for angina, as this combination can lead to dangerous drops in blood pressure. Creams may be a better alternative for such patients, provided they are available in your country.

Penis pumps

Other alternative treatments include penis pumps, also known as vacuum erection pumps.⁴ 

Penis pumps are hollow plastic tubes with a hand-powered or battery-powered pump at one end and a tension ring that fits around the base of the penis at the other end. 

Users slide their penises into the tubes and start pumping until the vacuum draws enough blood into their penises to make them fully erect. Then they apply the tension ring around the base of their penis to trap the blood inside to maintain the erection. 

Penis pumps are often an effective way of getting erections for men with ED, providing they are used correctly. This requires forming a tight seal around the base of the penis, which may require prior trimming of pubic hair or using a lubricant. They can be used with drugs such as PDE-5 inhibitors or as an alternative treatment.

Common complaints from users are that pumps can be cumbersome, take several minutes to produce erections, cause bending at the base of the penis, and erections can feel cold or numb due to vacuum constriction. 

It is important to note that penis pumps will not permanently enlarge your penis and should not be used for that purpose. 

Prosthetic implants

Another option is to try prosthetic implants. These are usually rods of some kind that are surgically inserted into the penis to increase its rigidity. In some cases, the rods are inflatable and controlled by the patient using a pump. In other cases, the rods are semi-rigid all the time. 

Prosthetic implants are usually reserved for patients who have tried other ED treatment options without success. 

Although they are generally effective, surgery and implanted devices are always associated with risk and cost. 

Diet and lifestyle changes

Often, the best treatment option to try first is to change your lifestyle and/or diet. This is because ED is often associated with cardiovascular diseases like atherosclerosis or endocrine disorders like type 2 diabetes, often associated with poor diets high in sugar, fat, and salt and a lack of sufficient exercise. 

Thus, eating a healthier diet and getting more regular exercise may help. Quitting smoking and reducing alcohol consumption have also been found to help treat ED. 

ED is a known possible side effect of many medications, so it is a good idea to check with your doctor if it could be attributed to any drugs you are currently taking. 

The lowdown

Creams for treating ED seems like a good idea and might produce fewer systemic side effects than other ED treatments. However, not many creams are available at the moment. 

Vitaros is a cream formulation of the drug alprostadil, which can produce erections when topically applied to the penis. It is available on prescription in the UK and Canada but not in the US due to a lack of FDA approval.