As far as engineering erections is concerned, alprostadil has become a competitor of Viagra. There is no doubt that alprostadil works. Actually, this has been known for some time.

However, previous formulations were awkward to apply, as they were for injections or intraurethral pellets. Most men do not want to inject medications into their penises, and definitely not on a day-to-day basis.

The alprostadil that now has become available can be applied as an ointment to the male genitals. It will reliably cause an erection within minutes.

This is a substantial advantage over Viagra, which usually needs 60 to 90 minutes to take effect (and on a full stomach, even longer). This means that with Viagra, it is difficult to bridge the waiting period with foreplay.

Of course, the opportunity for great sex often occurs rather spontaneously. For men who need erectile support, the use of Viagra is sometimes difficult to plan. Either they take it on the onset of a date. But that could mean that they either take it in vain (because the opportunity for intercourse does not materialize), or they take it too early (because the opportunity comes only after a rather long evening), or they take it too close to the event ("oops, all of a sudden, she wants; but I'm not yet on Viagra!).

Alprostadil cream, which becomes effective within minutes, offers the advantage that when the opportunity actually arises, one just needs a short trip to the toilet where the cream can be applied to the penis.

Information on sources from which alprostadil cream can be bought in the US and in Europe is provided for members of the sexual function package.

Enhancing alprostadil

Alprostadil is a prostaglandin, a hormone-like substance that directly effects the tissue it comes in contact with. More specifically, alprostadil is prostaglandin E1. Prostaglandin E1 is a potent vasodilator.

Erectile dysfunction in the narrow sense is mainly a problem of vasodilation, the widening, or lack of, of blood vessels in the genital region, which is necessary for the two corpora cavernosa to fill with blood and to become stiff.

As a vasodilating agent alprostadil has also long been used to treat neonates with congenital heart defects, leading to severe blood (and oxygen) supply problems. To treat the condition, alprostadil has to be injected into the heart region of neonates.

It's the same alprostadil that is used to engineer erections, and it also only is of use locally. The alprostadil applied on the penis as cream will only effect penile tissue, nothing else.

But good sex, of course, is not just a matter of penile plumbing. While with no erection (deficient plumbing) no sex will be pleasurable, penile plumbing alone is not yet a guarantee for good sex.

The brain has to be involved, too. Which is what we call libido.

But alprostadil (like Viagra) has no effect at all on libido, the erections that can be engineered with alprostadil are rather "cold".

A man's libido is mediated by two body fluids: the hormone testosterone and the neurotransmitter dopamine. However, levels of dopamine, too, are regulated by testosterone (via prolactin), so that originally, it is the testosterone that makes us desire sexual contact, and lets us enjoy it.

And not only in men is testosterone responsible for libido. It has the same effect on women, though female libido requires much lower levels of testosterone.

However, as we age, much of the testosterone in our body is bound to a protein, sex hormone binding globulin (SHBG), and thus rendered ineffective. Increased SHBG is what robs aging men of their libido.

This unfortunate development can be counteracted upon with a medication such as tongkat ali that binds to SHBG, thus preventing that the SHBG captures circulating free testosterone.