Yohimbine is the by-product of the bark of an African tree. It is felt by some authorities to stimulate sexual abilities when taken orally. The medication is taken twice per day. Studies in the medical literature do not demonstrate any short or long term benefits of this drug, and for that reason, we do not recommend its use. Yet it is the only oral drug available in common use to boost sexual abilities, and it is frequently mentioned in the popular media, or in mailers targeted to older men. These promotions will also mention other "herbal" remedies, none of which possess any demonstrable therapeutic benefit.

Yohimbine can produce headaches due to alterations in blood flow, or even occasional uncomfortable feelings of a "flushing." Although a few of our patients do feel the medication has been somewhat helpful, in general, we cannot recommend the use of Yohimbine as a truly effective drug.

Advantage: Simple oral medication
Disadvantage: Probably ineffective, some annoying side effects

Vacuum Constriction Device

The Vacuum Constriction Device (VCD) comes in a kit. The kit contains a large plastic cylinder, a vacuum pump, lubricant, and rubber rings. The cylinder is placed completely over the penis and lubricant is used to create a vacuum seal against the body wall. The vacuum pump at the other end of the cylinder is used to evacuate air from the cylinder, and the penis expands as blood is pulled into it by the vacuum effect. Once the penis is fully erect the rubber ring is placed on to the base of the penis so as to trap in the blood.

The ring may be left on for no more than twenty minutes, as there is no blood flow through the penis while the ring is on. Because there is little blood flow, the penis may become somewhat cold and blue. In addition, because the part of the penis inside your body is not erect, the erection may be somewhat "floppy" at the base.

In general, the VCD is somewhat awkward and non-spontaneous. Most patients who use the VCD eventually lose interest and stop using it, although some men continue to use it regularly. The VCD costs about $400; it may or may not be covered by insurance, you would have to check with your plan.

It is fair to say that the VCD is the most "labor-intensive" method of each time achieving an erection. The VCD cannot safely be used for men taking blood thinning medications.

Advantages: No medications or surgery
Disadvantages: Non-spontaneous, somewhat awkward

Muse (Intraurethral Suppository)

The Muse system consists of a pill placed down the urethra tube to produce an erection.

The Muse kit contains a special device that holds the pill. The device is placed into the penis (down the urethra) and the pill is released. The Muse medication is absorbed from the urethra into the body of the penis. This medication causes the blood vessels within the penis to expand, fill with blood, and an erection is produced.

Muse does not work for everyone. The medication and the system are relatively new, but from early reports it would appear that about one out of three patients have a good response and develop an erection. Side effects are rare and the medication overall appears very safe. Once placed into the urethra Muse takes about 10-20 minutes to produce an erection.

The correct individual dosage of Muse must carefully determined. Using too much can produce a dangerous prolonged erection that can cause permanent penile damage. There are four different dosages of Muse available. It is best to start out trying the smallest dosage, and then move to higher amounts if the response is poor. The goal is to use the least amount of medication that produces a useful erection. Should the highest dosage of Muse fail to produce a reliable erection, then other options should be considered.

Although Muse is only effective less than half the time, it is easy and painless to administer, and therefore a reasonable "starting point" for the treatment of impotence. A new Muse kit must be used for each erection, and each kit costs $20-25.

Advantages: Easy to administer
Disadvantages: Doesn’t always work, expensive, 10-20 minutes to develop an erection

Caverject Injection

Caverject is a medication, much like Muse, which may cause the blood vessels of the penis to enlarge, filling the penis with