Intraurethral Alprostadil (MUSE)
MUSE - Medicated Urethral System for Erection (alprostadil suppository)
Evidence grade 3 of 5, Mixed. Read how the Atlas grades evidence.
The written rationale for this grade is still being prepared.
- FDA
- FDA Approved (1996); discontinued in the US June 2024
Reference only. Not medical advice.
What can go wrong
The dominant issues were efficacy and tolerability. Real-world response was often 30-40%, well below injection therapy; a urology-practice series found no more than ~30% of men achieved intercourse-sufficient erections at in-office testing, and only ~18.6% continued home use at follow-up. Adverse effects included penile/urethral pain and burning (most common), dizziness, and orthostatic hypotension (reported in ~41% during in-office testing), plus rare hypotensive/syncopal events.
This is something to take to a clinician. The Atlas can tell you what is known about intraurethral alprostadil (muse) in general. It cannot tell you what is happening in your body, and the difference matters most for exactly the symptoms that bring people to this page.
MUSE (Medicated Urethral System for Erection) was an alprostadil pellet inserted into the urethra with a small applicator, offering a needle-free route to the same drug used in penile injections. Approved by the FDA in 1996, it delivered prostaglandin E1 across the urethral mucosa to the corpora. Despite avoiding injection, its real-world efficacy was modest and it was largely eclipsed by oral PDE5 inhibitors and injections; MUSE was discontinued in the US in June 2024.
The needle-free alternative that couldn't match the injection.
What people take it for
These are the reasons people give for taking it. They are not effects it has been shown to have.
How it is supposed to work
An alprostadil pellet placed in the distal urethra dissolves and is absorbed through the urethral mucosa, reaching the corpora via vascular channels to relax cavernosal smooth muscle and increase inflow, the same prostaglandin mechanism as injected alprostadil, but with lower and less predictable delivery.
What people get wrong
Often saidA urethral pellet works as well as an injection because it's the same drug
ActuallySame molecule, but transurethral absorption is far less efficient than direct intracavernosal injection, so MUSE's response rates were substantially lower.
Who profits, and who pushes back
Nobody is named here yet, because we have not done that work on this entry. Read that as unfinished. Somebody almost certainly sells this, and somebody almost certainly disputes it. Assume both until we have checked.
Set against the alternatives
MUSE offered a needle-free option using the well-established alprostadil molecule, but delivered lower and less reliable efficacy than intracavernosal injection while still causing pain and hypotension. That efficacy gap, combined with the rise of oral PDE5 inhibitors after 1998, drove its decline and eventual US discontinuation.
Legal status
No longer available in the US as of June 2024; included here for completeness as a discontinued second-line option.
Status current as of July 2026. Regulatory positions change, sometimes quickly.
The market for this
What follows describes how this is bought and sold. It is not a buying guide and it is not an endorsement of any seller.
Historically costly per dose; one Medicare cost model estimated annual out-of-pocket intraurethral alprostadil around $4,022, the highest among modeled ED therapies, contributing to poor uptake. Now discontinued in the US.
At a glance
- Route
- Intraurethral pellet
- Drug
- Alprostadil (PGE1)
- FDA approval
- 1996
- Status
- Discontinued in US, June 2024
- Efficacy
- ~30-40%; higher-dose in-office ~50%
What this entry does not yet cover
What follows is unfinished work on our side, not a finding about Intraurethral Alprostadil (MUSE). A short entry is not a safe entry.
- Timeline. We have not built the dated record of research and regulatory events.
- Supply chain. We have not mapped where it is made.
- Who uses it. We have not documented the user groups.
- What could change. No forward-looking summary yet.
- Children and teenagers. We have not checked what is known about younger people.
- Where we land. We have not taken a position on this yet.
Sources
The studies below are named and described, but not linked. You cannot open them from here and check our reading against them, which means this page is our summary of the literature rather than a document you can verify. Weigh it accordingly until the links exist.
The studies that matter
Fulgham et al., disappointing transurethral alprostadil results1998
No more than ~30% achieved intercourse-sufficient erection in office; only ~18.6% continued home use, discontinuing for pain, poor efficacy, and cost