I have good things to say about MUSE (alprostadil), which is a small, waxy pellet that you insert into your urethra. It is not pleasant poking a small plastic tube into the opening of your penis, but once you get used to this you may find this is a pretty interesting product. My insurance company pays for it and it is pretty cheap (although pharmacies don’t have it in stock – they have to order it).

I started with 125 mcg – the smallest dose – and then went up to 250 mcg. A “mcg” is a microgram – one thousandth of a gram – so 250 mcg is .25 grams. Sounds like a small amount but that means it is very potent. You can go up to 1000 mcg (1 gram), if necessary.

Alprostadil is a chemical that is apparently the same as prostaglandin E1. This is a chemical in your body that causes the blood vessels in your penis to expand. This is important because:

  • In the flacid (non-erect) state, the penis is blocked from being erect because chemicals in the penis keep tiny muscles on blood vessels contracted (small), so that the blood vessels do not fill up with blood.
  • When a man is sexually stimulated, his brain triggers his penis to release chemicals the remove this block, so that the tiny mucles relax, the blood vessels expand, and blood fills the blood vessels; this causes an erection. After sex, the blocking chemicals come back and the blood vessels constrict (contract) again, and the erection ceases.
  • While there are many other factors involved (and some are not even fully understood), two well known systems involved in the blood-vessel relaxation are the nitric oxide system and the prostaglandin system.
  • Nitric oxide, a gas, is released during arousal, which causes cGMP to make blood vessels relax and fill with blood. Viagra, Cialis, and Levitra work by blocking an enzyme, PDE5, that reduces cGMP levels. Viagra was originally studied for patients with heart disease, because they have problems with their blood vessels. But many patients reported that the drug increased erections, so Viagra was discovered somewhat by accident.
  • The other system the increases blood vessel relaxation uses prostaglandin E1. By inserting MUSE into your urethra, you are causes the blood vessels to relax and blood to fill the penis using this second system.

The interesting thing about MUSE is that it is the only product I have found that actually CAUSES an erection, unlike Viagra, which only SUPPORT an erection following sexual stimulation. Another good thing about MUSE is that it can be used WITH Viagra, because they use different mechanisms. In the future, some sort of combination product will no doubt be available, using multiple systems.
The only question I have about MUSE is if there is a long-term benefit from using it. There is some research that suggests that taking Viagra every night will help your penis. This is because you should have several erections at night (nocturnal tumescence), which increase blood flow to the penis at night and presumably are healthy. So, taking Viagra at night will support this process and help your penis health. Is the same thing true for MUSE? Will taking MUSE every night result in more blood flow to the penis, and support improved penis health (or at least prevent penis health decline?) Or will it somehow use up chemicals in the penis, actually causes a decline in sexual function? As far as I know, there is no research on this question.