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Treatment Cannot be used by patients on MAOIs* Orgasm Psychotherapy and behavior modifications in selected patients are considered next if indicated, followed by oral or locally injected drugs, vacuum devices, and surgically implanted devices. In rare cases, surgery involving veins or arteries may be considered. Transurethral alprostadil provides the same significant improvement in erectile function as injectable alprostadil with a better tolerated method of delivery. In one large study,15 65 percent of patients reported successful and satisfactory intercourse. This form of alprostadil is thought to diffuse into the corpus spongiosum and then into the corpus cavernosum. Once the drug enters the cavernosum, the arteriolar smooth muscle relaxes, resulting in erection. In a large double-blind, placebo-controlled study, the most common reported side effect was penile pain (10.8 percent), which was not judged by patients to prevent its use.15 looking for viagra ? viagra no prescription