Intraurethral Suppositories (MUSE)

What is MUSE? 

Intraurethral suppositories (MUSE) are very small pellets of the medication prostaglandin E1 (alprostadil), the same medication used for penile injections. A man inserts the MUSE tablet into his urethra (urinary tube) using a disposable plastic applicator. The suppository melts and the medicine seeps into the erectile tissue. The MUSE system comes in 4 doses: 125, 250, 500, or 1000 micrograms. Most men need the highest dose to get and keep firm erections. 

How Does It Work? 

MUSE is designed to deliver alprostadil to the erectile tissue without using an injection. The small pellet is about the size of a grain of rice and is put into a special plastic applicator. First, a man urinates to moisturize the inside of his urethra. Then, he slips the applicator about one inch into the urinary opening and gently pushes a button on top of the applicator, releasing the pellet inside his urethra. In order to help the medication melt, he needs to sit, stand, or walk while massaging his penis for at least 10 minutes. 

Although the medication alone causes some swelling of the penis, erections are typically firmer with sexual stimulation. MUSE does not change sensation on the skin of the penis or a man's ability to reach orgasm. Ejaculation of semen and urination are not affected. 

Like the medication used for injection therapy, the alprostadil in MUSE should relax the soft tissue inside of the penis and allow blood to flow in and create an erection. Unfortunately, MUSE is not nearly as effective as penile injections for men who have medically-caused ED. Even when men use the highest dose, many never get a firm erection. It is reported to sometimes work on about half of tries.

MUSE can also be combined with a vacuum pump or a constriction band on the base of the penis. Some urologists suggest combining MUSE with a PDE5 inhibitor. However, using the two medications together could lead to priapism (prolonged erection), or to a sudden drop in blood pressure.  Always consult your doctor before combining therapies. When Can MUSE Help? 

MUSE may make enough of a difference in erection firmness to be helpful to men who get erections on their own that are almost firm enough, or to give a boost in self-confidence to men with anxiety-based erection problems.

Recently MUSE has been used for penile rehabilitation after cancer treatment, since it can increase blood flow in the penis, although usually not to the point of a full erection. In one recent study, daily dosing with either a PDE5 inhibitor or MUSE both appeared to help men recover erections in the first year after radical prostatectomy. 

Ask your oncologist or urologist if MUSE might work for you.

What are Common Side Effects? 

The most common side effects of MUSE, like injection therapy, is a "pins and needles" aching or burning sensation in the penis. However, each man's reaction to the medication is quite individual, and it is hard to predict whether pain will be a problem without trying MUSE. 

The medication can also leak into the vagina during intercourse and about 5% of women complain of some vaginal burning when a man uses MUSE. A pregnant woman should not have intercourse with a partner using MUSE unless he uses a condom to prevent the medication from affecting the fetus. 

Are There Health Risks? 

Like injection therapy, MUSE can cause scarring in the penis or priapism. Some men have fainted the first time they try MUSE, so it is recommended that the first trial happen in a doctor's office for safety.