Urethral suppositories for ED: using MUSE after prostate cancer treatment

Older woman behind the wheel of a car smiling at the male passenger

Urethral suppositories are small, medicated pellets that you put into your penis to get an erection and can be used for erectile dysfunction resulting from prostate cancer treatment. They contain the medication alprostadil and are commonly referred to by the brand name MUSE®. (Alprostadil is also available as a penile injection.)

How do MUSE suppositories give you an erection?

The medication (alprostadil) in MUSE suppositories widens blood vessels and helps you have an erection by increasing blood flow into the penis. MUSE suppositories are about the size of a grain of rice, so they’re pretty tiny. And they need to be this small because they’re inserted into the opening at the tip of the penis (the urethra) using a special applicator. Alprostadil can also be made into a gel that is inserted into the urethra.

Used at the correct dose, MUSE can produce a firm erection in 5 out of 10 men when used with sexual stimulation and foreplay. Getting an erection using these urethral suppositories does not depend on nerve sparing during surgery.

Side effects of MUSE suppositories

Although inserting the suppository is not painful, for a short time afterwards you may experience:

  • Penile pain.

  • Urethral pain.

  • Burning sensation in the urethra.

  • Urethral bleeding.

  • Testicular pain.

However, there are some medical conditions which could make urethral suppositories risky for you so be sure to tell your doctor if you have any of the following:

  • Sickle cell anemia

  • Leukemia

  • Lymphoma

  • Myeloma

  • Urethral stricture

Getting an erection using MUSE suppositories does depend on taking the correct dose. So, be sure to ask your doctor about the recommended dose for you. Your doctor can also teach you how to correctly insert the suppository.

Using urethral suppositories for ED: tips for success

You should prepare to use MUSE suppositories (or pellets, as they're also referred to) about 30 minutes before you plan to have sex.

The suppositories are inserted using an applicator into the opening at the tip of your penis where urine comes out. This is called the urethra. The applicator has a narrow section that is inserted into the urethra at the tip of the penis to the depth of about 2.5 centimetres (1 inch). The pellet is then released into the urethra.

No skin is punctured during this process and the suppository is not painful to insert but following the tips can smooth the process. Your doctor can also take you through how to correctly insert the MUSE pellets into the urethral opening in your penis.

  1. Urinate prior to using. The small amount of urine left in the urethra will help dissolve the suppository after it’s inserted.

  2. While sitting or standing, gently stretch your penis outwards and upwards.

  3. Insert the narrow section of the applicator into your urethra up to the collar on the applicator.

  4. Press the button on top of the applicator as far as it will go to release the pellet.

  5. Holding the applicator in your penis, gently rock your penis and the applicator as one from side to side and back and forth. This helps to make sure the suppository has been successfully released from the applicator.

  6. Remove the applicator while your penis is upright and look at it to check the suppository has been released.

  7. Point your penis toward the sky and roll it between your hands for 15 seconds. This helps to dissolve the suppository. This rolling motion can also help stop any stinging sensation you feel at this moment.

  8. It should take about 10 to 15 minutes to produce an erection. Sitting, standing, or walking during this time helps increase blood flow to the penis which aids in getting an erection.

Foreplay is a must to help MUSE work to produce a firm erection. You should attempt sexual activity within 10 to 30 minutes after using the suppositories.

It is essential you have inserted the correct dose of the urethral suppository, so follow your doctor’s instructions carefully. The dose will vary between people.