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Nitroglycerin Gel for ED: Pros, Cons, & Practical Information

About Nitroglycerin Gel for Erectile Dysfunction

Medically reviewed by Matt Coward, MD, FACS — Written by Sara Lindberg on December 16, 2020

This article is a repost which originally appeared on Healthline

Edited for content

Erectile dysfunction (ED) may affect as many as 30 million men in the United States. People with ED experience an inability to get or keep an erection firm enough for sex.

You may be familiar with some of the more common treatments for ED, including lifestyle modifications, oral medications that include phosphodiesterase type 5 inhibitors (PED5 inhibitors), and penis pumps.

But a study published in the Journal of Sexual Medicine also looked at the use of nitroglycerin gel or cream as a topical treatment for ED. Although results look promising, it’s important to note that nitroglycerin gel or cream isn’t approved by the Food and Drug Administration (FDA) to treat ED.

Here’s what you need to know about nitroglycerin as a topical treatment for erectile dysfunction.

What is nitroglycerin?

Nitroglycerin is part of a class called vasodilators, which widen the blood vessels and improve blood flow to allow oxygen-rich blood to reach the heart.

It comes in a variety of forms, including sublingual (under-the-tongue), topical cream or gel, and as a transdermal patch. Nitroglycerin is most often used to prevent angina or attacks of chest pains.

Nitroglycerin for ED

“The idea of treating ED with topical nitroglycerin is not new and was first described in the 1980s,” says Dr. Joseph Brito, a urologist at Yale New Haven Health, Lawrence + Memorial Hospital. Brito is also a member of Healthline’s clinical review network.

In general, Brito says nitroglycerin works by dilating the blood vessels, which is why it’s traditionally used for patients with angina or chest pain due to poor cardiac vessel blood flow.

The concept is the same for ED, although Brito says it may have a dual mechanism of action:

  • It widens blood vessels helps blood flow.
  • It relaxes penile smooth muscle, which in turn compresses penile veins and impedes blood flow out of the penis, which causes rigidity.

How does nitroglycerin gel work?

According to Brito, nitroglycerin gel or cream differs from other ED treatments such as oral medications:

“[Topical nitroglycerin] acts as a nitrogen donor to increase local levels of nitric oxide, which works through molecular signaling (cGMP pathway) to cause this response,” he says.

On the other hand, Brito says PDE5 inhibitors (like tadalafil and sildenafil) work at a later step in the chain by inhibiting the breakdown of cGMP.

Nitroglycerin for ED doesn’t have enough research

That said, Brito points out that nitroglycerin gel or cream is currently not approved by the FDA to treat ED.

Moreover, Brito points out that the American Urological Association guideline on erectile dysfunction published in 2018 didn’t include topical nitroglycerin as a suggested treatment for men with ED.

“Though this therapy was not specifically mentioned, the authors did state ‘the use of these treatments may preclude the use of other treatments known to be effective,’ and felt more research was needed,” he explains.

And there’s another factor to consider: Nitroglycerin cream on the outside of the penis might be transferred to your partner.

Why are people interested nitroglycerin gel for ED?

“Nitroglycerin may have some benefits over standard oral ED medications,” Brito says.

The onset of topical nitroglycerin is between 10 and 20 minutes, which Brito says is better than the quickest acting oral agents, with sildenafil taking at least 30 minutes.

In fact, the 2018 study published in the Journal of Sexual Medicine found that 44 percent of patients saw erection beginning within 5 minutes of application. Seventy percent of the men noticed an erection within 10 minutes.

The randomized, double-blind, placebo-controlled study included 232 men with ED who participated in two 4-week trials. One trial used a 0.2 percent glyceryl trinitrate topical gel before sex, and the other used a placebo gel.

“This may help with spontaneity, which can be an issue for couples using oral agents,” Brito explains.

Another benefit, Brito says, is that unlike other ED treatments like oral agents, nitroglycerin doesn’t need to pass through the gastrointestinal (GI) tract.

“Since absorption of oral agents like sildenafil is strongly affected by food intake, the medications are much more effective when taken on an empty stomach,” he says. This requires more planning and doesn’t always allow for spontaneity.

Where to buy nitroglycerin for ED

Nitroglycerin gel or cream is currently not approved by the FDA to treat ED.

If you have questions about this topical treatment, you need to talk with a doctor who knows your medical history. A prescription is needed for nitroglycerin.

How to take nitroglycerin gel for ED

Nitroglycerin use is managed by your doctor. Don’t use or apply this topical treatment without guidance.

According to the Journal of Sexual Medicine, the concentration studied was 0.2 percent, which Brito says likely explains why the effect was best for men with mild ED.

He also points out that other studies used concentrations of 0.2 to 0.8 percent for patients with more severe ED, who likely needing higher concentrations.

In general, Brito says people prescribed nitroglycerin by their doctor should apply a small amount (pea-sized) to the head of the penis.

Side effects and contraindications

Nitroglycerin is certainly not for everyone. According to a 2018 review, taking nitroglycerin-based medications with certain PDE5 inhibitors like Viagra is contraindicated. Using them together can result in a sudden and serious decrease in blood pressure and potentially death.

According to Brito, some drawbacks of topical nitroglycerin include possible transmission to the partner, which can lead to the partner sharing in side effects, especially low blood pressure. This can lead to headache and nasal congestion.

Other treatments for ED

There are several treatments available for ED, including:

  • oral medications that include PDE5 inhibitors such as sildenafil (Viagra) and tadalafil (Cialis). Other oral medications include vardenafil HCL (Levitra), and avanafil (Stendra)
  • erectile dysfunction pump (penis or vacuum pump)
  • penile injections
  • inflatable penile prosthesis
  • psychotherapy (talk therapy) for emotional or psychological issues related to ED
  • suppositories (Alprostadil)
  • counseling
  • diet modifications
  • exercise
  • stress reduction

The takeaway

Although some research points to the effectiveness of nitroglycerin gel or cream for improving the symptoms of ED, it’s currently not approved by the FDA as a treatment for erectile dysfunction.

If you have ED or think you may have ED, it’s important that you talk with a doctor about any treatment options. They can talk with you about the range of options, including lifestyle modifications, counseling, oral agents, penis pumps, surgery, and implants.

Why is My Penis Small, or is it?

Why is My Penis Small, or is it?

Medically reviewed by James Keith Fisher, MD on February 26, 2019 — Written by Eleesha Lockett, MS

This article is a repost which originally appeared on HealthLine

Edited for content

When Penises Are Small

How do we decide what’s small?

What’s too small? What’s too big? Research suggests that many men desire a bigger penis regardless of whether they think that their penis size is average or not. And, some men believe they have a small penis when it’s actually within the average range.

This article will look at the science behind the average penis size, how to measure your penis, and the conditions that can cause a penis to be or seem smaller than usual.

What’s average?

The average length of a penis is roughly 3.6 inches flaccid and 5.2 inches erect. But how did this become the number?

Research on penis size

There have been several studies over the years that have attempted to give a definite number for the average penis size.

One smaller 2014 study in the Journal of Sexual Medicine looked at the average penis size in 1,661 men. The researchers found that the average erect penis length and circumference of participants was 5.6 inches (14.15 centimeters) and 4.8 in. (12.23 cm), respectively.

Another larger study from 2014 compiled data from over 15,000 men to determine average size. In this study, length and circumference measurements were taken both flaccid and erect. The results determined the average penis length to be 3.6 in. (9.16 cm) while flaccid and 5.2 in. (13.12 cm) while erect. In addition, the average penis circumference was measured as 3.7 in. (9.31 cm) while flaccid and 4.6 in. (11.66 cm) while erect.

It’s important to note that the first study used self-reported measurements, while the second study used measurements taken by a health professional. Both studies have their limitations, but the numbers reported are consistent with similar studies on average penis size.

Perspective

Keep in mind that sizes of “small” and “large” are comparative and that averaging penis size is based on what’s known. Known measurements, even a substantial study where more than 15,000 men were measured, are based on groups. The United Nations reported the world’s male population to be at about 3.8 billion in 2017. That means 15,000 men is only about 0.0004 percent of the world’s male population.

Collectively, average measurements from similar studies set a good average and are important to have, but there’s always more to know.

How to measure your penis

If you’re curious about how to measure the size of your penis, here’s a correct way to get an accurate measurement:

  1. You will need to have either a tape measure or ruler on hand.
  2. To measure the length, start your measurement at the base of the penis, where the penis meets the pubic bone.
  3. Run the ruler or tape measure along the full length of the penis from the base to the tip (glans). Do not measure excess foreskin length.
  4. To measure the girth, wrap a flexible tape measure around the shaft of the penis at the base or around the midpoint between the base and head.
  5. If you are measuring your penis flaccid, be careful not to pull on or stretch it as this can potentially cause injury.

When do penises grow?

Research suggests that there are different periods of penis growth throughout the life cycle. In one study, researchers tracked penis size in more than 3,000 males from birth to 16 years old.

They found that on average, the penis grew rapidly from birth until about 1 year of age. From the ages of 1 to 11, penis growth slowed down to some extent. At about age 11 and entering puberty, the researchers observed another period of rapid growth.

When penises seem small

Most males fall into the range of average penis size. However, some boys and men may have what is known as a micropenis. Also, not all small penises are micropenises.

Micropenis

Micropenis is a condition, most often diagnosed in infants, characterized by a penis that falls below the average size range. The criteria for micropenis in infants is generally a penis size of smaller than .75 in. (1.9 cm), based on the stretched penis length.

According to University of Rochester Medical Center, one of the most common complications of micropenis is lowered fertility due to a decreased sperm count.

A sex hormone imbalance called hypogonadism is a leading cause of micropenis.

Although there are different treatment approaches for micropenis, hormone treatment can be key in treating babies. Early administration of testosterone may even help to increase penis size by 100 percent during the initial course of treatment for an infant.

In cases where hormone treatment doesn’t work, surgery may be an option, while speaking with mental health professional can provide more long-term benefits.

Inconspicuous penis

Inconspicuous penis is an umbrella term for any number of conditions that cause the penis to appear smaller than normal.

The following conditions are all linked to having a smaller than usual penis size.

  • Buried penis. Buried penis is primarily caused by an excess accumulation of skin around the penis. The penis may be buried, or hidden, beneath the abdomen, scrotum, or even thigh. In most cases, the penis is a normal length and functions normally. However, this condition may cause difficulty with sexual arousal and function as well as urination.
  • Webbed penis. Webbed penis occurs when the skin of the scrotum is attached too high on the penis. This can affect the angle at which the penis rests, causing it to appear “webbed” and shorter than normal. Cosmetic surgery is a common treatment approach for this condition.
  • Trapped penis. Trapped penis can occur as the result of a circumcision not healing correctly. With a trapped penis, the scar tissue from the circumcision causes the penis to become trapped beneath the healed skin. This condition can cause serious issues with urinary dysfunction, so steroid therapy or surgery are necessary.

Many of these conditions are uncommon, affecting a small portion of the population. In all cases, however, it’s important to remember that penis size does not necessarily determine sexual attractiveness.

Penis size is only one small element in a list of items sexual partners find attractive — with emotional attractiveness being near the top. Besides, one 2006 study found that almost 85 percent of women are content with the size of their partner’s penis.

The takeaway

Although many men are concerned that their penis is too small, research has shown that most men have an average-sized penis. It’s also important to remember that penises, just like vaginas, come in all different shapes and sizes. There is no one perfect penis, and penis size does not determine your sexual attractiveness or self-worth.

For those who fall outside of typical penis size range for any reason, there are interventions that can help promote a positive and fulfilling sex life. If you are still concerned with your penis size or feel that it’s affecting your sex life, reaching out to a sex therapist can help.  [Editor’s Note: There are plenty of techniques for increasing the size of your penis using manual exercises on PEGym.]

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