Urethral Lozenge To Treat E.D.: What You Need to Know

Andrew Siegel MD   5/5/18

In Greek and Roman mythology, the muses were the goddess daughters of Zeus and Mnemosyne who presided over the arts and sciences. The term is now used to refer to a source of inspiration for a creative artist.  Today’s entry discusses a different kind of muse, technically M.U.S.E., an acronym for “medical urethra system/suppository for erection.” For men suffering with E.D., M.U.S.E. can be a source of inspiration for better quality erections.

In a practical approach to ED, vasodilating drugs (those that expand blood vessels and increase blood flow) can be considered to be third-line treatments for ED. MUSE is formulated as a urethral lozenge (suppository) that when absorbed functions to increase penile blood flow and induce an erection.

MUSE (Medical urethral system for erection) consists of alprostadil (prostaglandin E1) vasodilator pellets—available in 125, 250, 500, and 1000 microgram dosages—that are placed into the urinary channel after urinating.  Absorption occurs through the urethra into the adjacent erectile chambers, inducing increased penile blood flow and potentially an erection.


Image above is the MUSE applicator with the MUSE pellet contained within

One of the problems with MUSE is that it is placed in the urethra, which has little to no role in erectile function, although it is surrounded by one of the erectile chambers (corpus spongiosum) that gets plump, although not rigid at the time of an erection. The neighboring paired erectile chambers (corpora cavernosa) are the two bodies that become rigid at the time of an erection. MUSE relies on the medication being locally absorbed from the urethra, into the corpus spongiosum and then into the corpora cavernosa.

Why did Willie Sutton rob banks?  Because that’s where the money is.  When it comes to erections, the money is in the corpora cavernosa.  Using MUSE is like robbing the building next to the bank.  Because it relies on absorption to an adjacent structure, the dosage required is significantly higher than when the medication is injected directly into the corpus cavernosum (penile injection therapy).  You may need to use a 1000 microgram pellet in the urethra, whereas if injected you might only need 10 micrograms. MUSE is effective in about 30-40% of men, working in about 15 minutes or so and resulting in an erection lasting for about an hour.

How to use MUSE:

Note: An applicator delivers the medicated pellet into the tip of the penis. It should be inserted after urinating, which functions to lubricate the urethra and make the administration easier.  The pellet is formulated to dissolve in the small amount of urine remaining in the urethra after urination.

  1. After the applicator is removed from the foil pouch, remove the protective cover from the applicator stem. The medicated pellet is visible because the applicator is transparent.
  2. Put the penis on full stretch and gently compress the head of the penis to straighten and open the urethra.
  3. Gently insert the applicator in the urethra to the level of the collar of the applicator.
  4. Push down on the button on the top of the applicator and hold for a few seconds to deploy the pellet.
  5. Gently rock the applicator from side to side to separate the pellet from the applicator tip and then remove the applicator and inspect to ensure release of the pellet.
  6. Holding the penis upright and stretched, kneed the penis between your hands for at least 10 seconds; if you feel a burning sensation, continue to kneed the penis until it subsides.
  7. Replace the cover on the applicator, place it in the opened foil pouch and discard.
  8. Stand up or walk around for 10 minutes or so while the erection is developing. Voila!

Side effects include urethral burning, aching in the penis, testicles, perineum and legs, redness of the penis and minor urethral bleeding or spotting.

Bottom Line: MUSE is another tool in the urologist’s erectile dysfunction toolbox.  Although it is not highly effective and its means of administration (via a urethral lozenge) may be distasteful to many, nonetheless it can be a means of improving ED for men who do not respond to lifestyle measures and the oral ED medications. 

Wishing you the best of health,

2014-04-23 20:16:29

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food


These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx


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