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Intracavernosal administration of alprostadil (Caverject) has reported success rates of 67 to 85 percent and has been used in the treatment of erectile dysfunction for several years.11 When injected directly into the corpus cavernosum, alprostadil (prostaglandin E1) acts on the arteriolar smooth muscle cells, causing them to relax and produce an erection, usually within several minutes. Its mechanism of action is to stimulate an increase in the levels of intracellular cyclic nucleotides that cause relaxation. The usual dose is between 5 and 40 �g per injection. The current average wholesale price ranges from about $86 for six of the 5-mg doses to approximately $163 for six of the 40-�g doses.12 Patients usually start at 2.5 �g and titrate up in 5-�g increments for effect, with a maximum dose of 60 �g. No more than three injections per week are recommended, with a minimum period of 24 hours between injections.13 Initial dosing and required adjustments should be carried out in the physician's office.
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"Actually, it is psychological distress associated with not measuring up rather than physiological problems that causes most sexual dissatisfaction," Shaw says. "For many, many men -- maybe most -- problems with sex are due to ignorance, anxiety, and inability to communicate with their partners. I think sexual dysfunction is the inevitable result of the effort to attain perfection."
Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid (see figure 3). Tubes connect the cylinders to a fluid reservoir and a pump, which are also surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis somewhat. They also leave the penis in a more natural state when not inflated.
The inflatable penile prosthesis consists of two cylinders -- a reservoir and a pump -- which are placed surgically in the body. The two cylinders are inserted in the penis and connected by tubing to a separate reservoir of fluid. The reservoir is implanted under the groin muscles. A pump is also connected to the system and sits under the loose skin of the scrotal sac, between the testicles.
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