Intracavernosal alprostadil injection therapy in diabetics was evaluated in a large, multicenter trial by Heaton, et al . Over 300 men entered the trial, 83% completing the titration period and proceeding to home use. Of those patients using the medication at home, 79% required 30 micrograms/dose or less, and 72% remained satisfied with the initial dose during the followup period (6 months). There were only 2 instances of priapism (sustained erection of greater than 6 hours unaccompanied by sexual stimuli) neither of which required intervention, 1 patient developed a penile nodule, and 24% of patients reported penile pain; the pain led to patient drop-out in 5% of the treatment group. A smaller, more recent study with longer followup (10 years) found that diabetic patients tended to shift towards decreased frequency of use but preferred stronger agents (mixtures of alprostadil with other vasodilators such as papavarine and phentolamine), with type 1 diabetics stabilizing their doses within 5 years and type 2 diabetics stabilizing within 9-10 years.

In patients for whom injections do not work, often a result of veno-occlusive dysfunction, vacuum erection devices (VED) may be useful. There is a paucity of data specifically evaluating the use of VED in diabetics but the drop-out rate for patients is generally quite high, even for patients who are able to achieve a rigid erection with the device. One subset analysis found that despite a good response (i.e. rigid erection) using VED, only 50% of those couples found the treatment to be satisfactory . This may be due to the “unnaturalness” of the devices, as well as the fact that they may have several local side effects, including glans petechia, a feeling of having a cold penis, and abnormal sensation of ejacuation.