MUSE was developed by Vivus, a Californian company, in 1997. It consists of a small specially designed plastic plunger that inserts a small pellet, the size of a grain of rice, into the urethra (the canal inside the penis where urine and semen are passed).

The active ingredient in MUSE is alprostadil, which is absorbed by the erectile tissue in the penis.

Alprostadil is a form of synthetic prostaglandin, a naturally occurring hormone found in the penis, which dilates the blood vessels and creates an erection. Alprostadil is one of the active ingredients used in impotence injections.

MUSE is an effective treatment for men with vascular disease, diabetes or heart disease who are unable to take one of the oral medications such as Viagra®, or where other impotence treatments have failed.

Impotence (or erectile dysfunction) is defined as the inability to achieve or maintain an erection sufficient for sexual intercourse, and includes the inability to get an erection as a result of sexual stimulation or to lose your erection prior to ejaculation.

Impotence does not generally include other symptoms such as lack of libido, inability to ejaculate or the inability to achieve orgasm.

Deciding on the best form of treatment for impotence depends on a number of factors, including your health and physical tolerance, and your personal choice, so it's best to speak with your doctor first.

To compare MUSE with other impotence treatments, and to help you make an informed decision about the best form of treatment for you, we've included a comprehensive comparison table.

Instructions for using MUSE

• Before the pellet of alprostadil is inserted, the manufacturer recommends urination and then a gentle shake of the penis to remove excess urine. Insertion of the MUSE pellet is easier, and absorption of the alprostadil is faster if the urethra is moist.

• An elasticized band is sometimes placed around the base of the penis before the pellet is inserted to ensure the alprostadil remains in the penis. After insertion, it's recommended that the penis is massaged gently to disperse the medication and speed up the process of absorption.

• MUSE usually starts to take effect within 5 to 15 minutes and lasts for up to 60 minutes.

• Medical specialists often recommend that the first trial of MUSE take place in their surgery. By doing this, the physician can ensure that the correct procedure is followed and the correct dosage is prescribed.

Precautions for MUSE

• MUSE is reported to be effective in only 30% to 60% of men.

• MUSE should not be used in the following circumstances:
  1. where there is a health risk if you engage in sexual activity
  2. hypersensitivity or allergic reaction to alprostadil
  3. any deformity of the penis (Peyronie's Disease, cavernosal fibrosis or angulation)
  4. sickle cell anemia
  5. leukemia (cancer of the blood cells)
  6. multiple myeloma (cancer of the bone marrow)

• MUSE should not be used for sexual intercourse with a pregnant woman unless a condom is used.

• It is recommended that patients not drive for at least an hour following application of MUSE.

Side Effects of MUSE

All drug therapies have some side effects, although there have been very few reported with MUSE. The side effects reported include:

• Some minor discomfort, including slight throbbing and burning sensation during and immediately following insertion. This is usually reported by men when MUSE is first used. (Urinating prior to insertion helps overcome this).

• There have been very rare reports of men fainting following the first dose.

• Dizziness and rapid pulse have been reported.

• Female partners have reported mild vaginal itching.

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