Skip to main content

Sexual Medicine & Andrology Pharmacotherapy

Pharmacotherapy for erectile dysfunction (ED), Peyronie's disease (PD), priapism, male hypogonadism, and female hypoactive sexual desire disorder (HSDD). The toolkit spans oral PDE5 inhibitors, intracavernosal injections, and intraurethral alprostadil[1], intralesional plaque-modifying agents (clostridial collagenase, interferon, verapamil), the testosterone-replacement framework informed by TRAVERSE's 2023 finding that transdermal testosterone gel was noninferior to placebo for the composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke over mean 33-month follow-up in 5,246 symptomatic men aged 45–80 with low testosterone and preexisting or high cardiovascular risk[3], and the female-HSDD agents (flibanserin, bremelanotide, and off-label transdermal testosterone, for which no FDA-approved product for women exists[4]).

For operative treatment of erectile dysfunction, Peyronie's disease, and refractory ischemic priapism, see the Male Sexual Dysfunction Treatment Atlas. For the clinical article on Peyronie's disease see the linked page; male hypogonadism is covered under Testosterone Replacement.

  • PDE5 InhibitorsSildenafil and related PDE5 inhibitors treat erectile dysfunction; tadalafil also treats BPH symptoms.[1][5] The page covers dosing, safety, and off-label uses.
  • Intracavernosal Injection AgentsAlprostadil and compounded mixtures injected into the penis for erectile dysfunction, with priapism precautions.
  • Intraurethral Alprostadil (MUSE)MUSE urethral suppositories for erectile dysfunction (discontinued in the US): technique, how well they work and how they compare with injections.[11]
  • Testosterone ReplacementTestosterone therapy in men: formulations, cardiovascular and prostate safety, and fertility-sparing alternatives.
  • Androgen AdjunctshCG, clomiphene, and related options can raise endogenous testosterone in selected men seeking fertility; the page covers patient selection and semen monitoring.[9]
  • Peyronie's Disease AgentsCollagenase injection and other drug treatments for Peyronie's disease, including which ones guidelines advise against.[12]
  • Priapism ManagementThe page covers intracavernosal phenylephrine and corporal aspiration for acute ischemic priapism, phenylephrine for prolonged post-injection erections, and prevention options for recurrent ischemic episodes.[6][7]
  • Flibanserin (Addyi)A daily pill for acquired, generalized HSDD in women younger than 65: approved use, alcohol warning and modest benefit.[2]
  • Bremelanotide (Vyleesi)As-needed injection for premenopausal women with acquired, generalized HSDD causing marked distress or interpersonal difficulty; dosing, adverse effects and trials.[8]
  • Female Testosterone for HSDDThe page covers off-label transdermal testosterone for postmenopausal HSDD diagnosed after formal biopsychosocial assessment, with physiologic dosing and monitoring.[10]

References​

1. Burnett AL, Nehra A, Breau RH, et al. "Erectile Dysfunction: AUA Guideline." J Urol. 2018;200(3):633-641. doi:10.1016/j.juro.2018.05.004

2. Sprout Pharmaceuticals. "ADDYI (flibanserin) prescribing information." Revised December 2025. DailyMed.

3. Lincoff AM, et al. "Cardiovascular Safety of Testosterone-Replacement Therapy." N Engl J Med. 2023;389(2):107–117. doi:10.1056/NEJMoa2215025

4. US Food and Drug Administration. "Testosterone Information." FDA. Accessed October 6, 2026.

5. Eli Lilly and Company. "CIALIS (tadalafil) tablets: prescribing information." DailyMed. Revised March 2026. Label.

6. Bivalacqua TJ, Allen BK, Brock G, et al. "Acute Ischemic Priapism: An AUA/SMSNA Guideline." J Urol. 2021;206(5):1114-1121. doi:10.1097/JU.0000000000002236

7. Bivalacqua TJ, Allen BK, Brock GB, et al. "The Diagnosis and Management of Recurrent Ischemic Priapism, Priapism in Sickle Cell Patients, and Non-Ischemic Priapism: An AUA/SMSNA Guideline." J Urol. 2022;208(1):43-52. doi:10.1097/JU.0000000000002767

8. Cosette Pharmaceuticals, Inc. "VYLEESI (bremelanotide) prescribing information." DailyMed. Revised March 2024. Label.

9. Lockie AWC, Grice P, Mathur R, Pearce I, Modgil V. "Diagnosis and treatment of hypogonadism in men seeking to preserve fertility - what are the options?" Int J Impot Res. 2025;37(2):109-113. doi:10.1038/s41443-024-00897-4

10. Davis SR, Baber R, Panay N, et al. "Global Consensus Position Statement on the Use of Testosterone Therapy for Women." J Sex Med. 2019;16(9):1331-1337. doi:10.1016/j.jsxm.2019.07.012

11. American Society of Health-System Pharmacists and University of Utah Drug Information Service. "Alprostadil Urethral Suppositories." Drug Shortages. Updated August 29, 2024. Bulletin.

12. Nehra A, Alterowitz R, Culkin DJ, et al. "Peyronie's Disease: AUA Guideline." J Urol. 2015;194(3):745–753. doi:10.1016/j.juro.2015.05.098