Alprostadil Injections & Cream

User

Posted 05 Oct 2020 at 16:36

I'm new to this forum, 65 and just coming up three years post prostate removal. I had partial nerve sparing robotic surgery. I have recovered really well from the operation, continence is excellent, PSA unmeasurable, back to full fitness and strength, but......

Erectile function is still a problem. I was prescribed low dose daily cialis by the consultant at my six week check up post surgery. After a month of that the prescription changed to the higher dose (20mg I think) Tadalafil 'weekend' tablet which the consultant delicately put that I should take once a week or when I was planning something! Neither the low dose or the higher dose have given me an erection when I wanted one but the higher dose does seem to cause very fleeting erections in the middle of the night/early morning but these are gone pretty quickly. I stayed on the tablets for about two years fully expecting them to work as I was told that it can take up to eighteen months for the preserved nerves to recover.

I have tried the vacuum pump in conjunction with the ring to create an erection and have intercourse but it felt far from 'normal' and with absolutely no spontaneity. I persuaded my urology nurse to let me try Alprostadil injections. I did wonder how I would react to sticking a needle where I didn't really want to stick a needle, but it was OK and gets easier each time. First I tried Caverject Duo - suggested dose 2.5 micro grammes. What a reaction, proper erection but it lasted about 4 hours and was getting pretty uncomfortable by the end of it. I felt that I probably needed a smaller dose. The problem with the Caverject is that it is limited to 10, 7.5, 5 and 2.5 mg doses.

So, I went on to Viridal Duo 10mg - this doesn't have the set doses like the Caverject so I can squeeze out most of the syringe contents before I inject. I have to get rid of pretty well all the contents before I inject to get an erection that last about an hour and stays comfortable.

The waste of the 'complicated' syringe system just to get a tiny dose seemed mad, so having spoken to the Urology nurse again I recently got my GP to write a private prescription for Vitaros Cream. I have tried this twice to not much effect. First time I didn't have it out of the fridge for very long so wasted a fair bit of it trying to get it into the end of my penis - the consistency was sort of 'waxy' - not what I expected. Second time I had it out of the fridge for about 8 hours at not very hot room temperature. It was marginally more successful in that I got most of it in but it just stayed in a gluey sort of lump just inside the opening. Both times I got a tingling in the head of my penis and the head did firm up somewhat, but no erection.

Have any of you had similar experiences with Alprostadil injections and cream? Any advice? Is there a really low dose injection available anywhere? Is there a way of getting the cream to be more runny?

Thanks in anticipation - Pete

Edited by member 05 Oct 2020 at 18:05 | Reason: missed a word out

User

Posted 06 Oct 2020 at 10:01

Hello Chris,

Thanks for the info on the pellet. I'm pleased to hear that it works for you - the general feeling I get is that the cream and the pellet are not effective for most guys - so hopefully it will do the trick for me.

My wife still ticks all the boxes for me and even after prolonged foreplay, I look down and I'm gobsmacked to that I don't have an erection when everything else fully up to speed.

Now, perhaps if I could Carol Kirkwood on prescription .......

Pete

User

Posted 07 Oct 2020 at 16:44

I’m 64 and have given up now on all that malarkey. Her Loveliness, my Fiancée of forty years is quite relieved!

My only regret is that I didn’t ejaculate more often, which it is said can prevent prostate cancer. Either that’s a myth, or I didn’t ejaculate enough, although I tried my hardest!

All the best.

Cheers, John.

User

Posted 07 Mar 2021 at 07:26

Definitely try a simple jelly cock ring from lovehoneys basics range. You get 3 for £10. They are not really tight like a pump ring but in my case turn an 80% Tadalafil lob into a 100% lob. Cheap fix.

The chambers in your penis are connected.

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User

Posted 05 Oct 2020 at 16:55

Pete

I used the muse form of alprostadil, from memory it comes in 250,500 or 1000 doses. Not as effective as the caverject,but sounds like you might need something less effective. To use it you put a small applicator down the eye of the penis, and press the button on the end.

Getting the alprostadil products may be a problem at the moment.

Thanks Chris

User

Posted 05 Oct 2020 at 18:13

Hello Chris,

I've got an appointment with the Urology nurse in early December to try the pellet which could be the way forward if I can't get the cream to be successful. It seems NHS primary care stopped prescribing the cream and pellet a little while ago but are about to about to offer the pellet again - which sounds better that having to get a private prescription and pay £12.50 for each syringe of cream.

Can you break the pellets into smaller pieces or does it come as a sealed device? I'm a bit spooked by having several five hour erections and want to avoid 'overdosing' again if I can help it.

Cheers

Pete

User

Posted 05 Oct 2020 at 19:38

If you have had several prolonged erections (priapism) I am surprised that the doctors have continued prescribing it for you - usually, the first trip to A&E is enough to have your medical records marked up as 'no injections'.

To be honest, to have that kind of response to the 2.5mg suggests that you probably don't need that level of intervention anyway. Muse and Vitaros are renowned for their lack of success in most men. Have you tried Levitra, which (for some men) can be more successful than Cialis or Viagra?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 05 Oct 2020 at 20:30

Pete

The pellet is very small only 2 or3 mm long, in theory you may be able to push a bit out and cut it off. I have heard of guys loosing the pellet. It looked more like hard cream to me, rather than a pellet.

I also had the thought that if you need so little of the substances do you just need more natural stimulation.

Thanks Chris

User

Posted 06 Oct 2020 at 05:51

I was prescribed (on the NHS) a box of four doses of alprostadil cream, which you have to somehow massage down your urethra (unlike Muse where the pellet goes straight down the pipe), and after about twenty minutes I did get an erection in what the surgeon left of my penis, but it was accompanied by a throbbing pain.

The other three doses went out of the fridge straight into the bin. I gave up!

Cheers, John.

Edited by member 06 Oct 2020 at 05:52 | Reason: Not specified

User

Posted 06 Oct 2020 at 09:54

Hello Lyn,

Thanks for your response. I didn't venture to A&E after my prolonged erections. They were obviously subsiding after about three hours and gone after about five. My urology nurse didn't seem too concerned - by the fourth shot I'd got the dose about right - it's just the waste of the whole syringe thing that bothered me and I thought that cream or pellet might be a better option for me.

I have got an appointment at the ED clinic in early December to try out the pellet but in the meantime the nurse contacted my GP and he wrote up a private prescription for Vitaros so I could try that. I've only tried this twice so far over a period of just less than a week - it hasn't worked but I'm not convinced I've managed to get the full dose fully where it needs to be. I've currently got my next applicator in the airing cupboard at 20C (I'm going to leave it in there for about 24 hrs to get fully up to room temperature) and see if that makes the consistency more runny and easier to apply.

I will certainly ask about the Levitra when I'm at the ED clinic in December.

Thanks

Pete

User

Posted 06 Oct 2020 at 10:01

Hello Chris,

My wife still ticks all the boxes for me and even after prolonged foreplay, I look down and I'm gobsmacked to that I don't have an erection when everything else fully up to speed.

Now, perhaps if I could Carol Kirkwood on prescription .......

Pete

User

Posted 06 Oct 2020 at 10:11

Hello John,

Thanks for your reply. Sorry to hear that you didn't respond well to the cream but somehow encouraged by the fact that you did achieve an erection having used it. Can you remember what the consistency of the cream was like when you squeezed it out of the applicator? Was it runny or thick and sticky? Did you do anything specific with the applicator before you used it?

Also interesting to hear that you got your doses on the NHS. My urology nurse says that it used to be available through primary care but it was taken off the list. Was it recently that you were prescribed yours? I hope I have better luck with it than you - I've bought eight doses which has cost me a hundred quid so I don't want most of it to end up in the bin !!

Pete

User

Posted 07 Oct 2020 at 04:02

I guess I’m lucky I have a compliant GP who knows I know more about prostate cancer than he does, and I just told him I wanted to try the Alprostadil cream. Sadly, the NHS is more a Local Health Service, and very much a postcode lottery!

I can’t remember whether I got it to room temperature before I used it, but it has a thick consistency, not runny. I am averse to having anything stuck down my urethra, having suffered it once during my biopsy, but obviously something like a Muse pellet would be more efficacious than trying to massage cream down the eye of the trouser snake.

And as for Caverject injections....😫

I can still have a kind of dry orgasm with my flaccid penis, which is pleasurable, but only 25% of what it was before.

Best of luck, as ever.

Cheers, John.

Edited by member 07 Oct 2020 at 04:04 | Reason: Not specified

User

Posted 07 Oct 2020 at 10:09

Hello John,

Once you've 'muscled' up for the first time, injecting isn't too bad. First one was at the ED clinic with the urology nurse in attendance to ensure all was well. After I injected, she told me to go for a walk round the hospital as the exercise would help stimulate a response. I had an erection before I got to the door - it was like being a teenager again back at school trying to hide the lump in your trousers at the end of a school lesson having spent most of the time eyeing up the legs of the girl in the next desk. Didn't you just love the mini skirt era !

First time injecting left handed (you have to do opposite side to the last injection} was probably the most difficult.

Pete

User

Posted 07 Oct 2020 at 10:30

Now I remember why I never learnt anything at school!

My favourite was the maths teacher, Mrs Harding I think her name was - more like Mrs Hardon! She used to sit on the front desk letting all who wanted see exactly what she had! Must have known what she was doing, probably her way of keeping us quiet!

User

Posted 07 Oct 2020 at 16:44

I’m 64 and have given up now on all that malarkey. Her Loveliness, my Fiancée of forty years is quite relieved!

My only regret is that I didn’t ejaculate more often, which it is said can prevent prostate cancer. Either that’s a myth, or I didn’t ejaculate enough, although I tried my hardest!

All the best.

Cheers, John.

User

Posted 06 Mar 2021 at 23:40

Picking up on this thread and adding my limited experience with injections..

Ok, here goes. I'm well over a year post RALP and ED wise, recovery has been painfully slow. My prescription is 2x20mg tadalafil per week, I halve them and take 10mg alternate days.

Getting somewhere with penetration now, but nowhere near pre op standards.

My penis injection experience started at the ED clinic where I was given Viridal duo. (Unfortunately due to covid, my OH wasn't allowed in the consulting room).
This consisted of a cartridge containing 10 micrograms of alprostadil powder and a liquid solution which is mixed together when the plunger is first pressed.
The ED nurse injected only a quarter of the solution into my penis (3/4 was wasted).
I have to say it was a weird experience, but not as bad as the post op dalteparin injections.
The Viridal duo was in a twin pack so I was given the second cartridge to take home along with a prescription for alprostadil.
I had to wait a few minutes checking for any adverse reactions, and after around 15 minutes I had a pretty good lob on so went straight home.
To quote others on here, "the injection is a game changer". That 2.5 micrograms gave me a rock hard erection for around an hour and 15 minutes. It felt a bit painful (a real throbber) but totally worth the pain as it puts all positions back in play.

A week later and I used the second cartridge of the viridal duo, injecting the opposite side of my penis this time as you have to alternate. As before, a quarter of the solution gave me an erection lasting around an hour and a quarter.
What I find interesting, is that a single injection in one side of the penis gives a symmetrical erection.

I handed my prescription in and they gave me four Caverject which is the same stuff, alprostadil.
I found this a bit more complicated to use as the powder and solution are in separate containers. You have to inject the solution into a vial containing the powder, gently mix it before drawing it back into the syringe and swapping needles before injecting. As far as foreplay goes it's a bit of a stretch to incorporate this into doctors and nurses.
As with the viridal, I injected a quarter and had the same result.. well over an hour's rock hard erection and some pain which I found bearable.

I have only used two of each so far, and the effects are the same for me. On balance, I find viridal easier to use.

Maybe at some stage, I'll have the opportunity to try out the invicorp one.

User

Posted 07 Mar 2021 at 07:26

The chambers in your penis are connected.

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