The most clinically proven cream for erectile dysfunction is alprostadil cream, sold under the brand name Vitaros. It’s a prescription topical that has demonstrated efficacy rates up to 83% in men with severe ED during clinical trials. However, availability depends on where you live, and a newer over-the-counter gel called Eroxon has entered the market as a non-prescription alternative. Which one is “best” depends on the severity of your ED, your access to a prescription, and how you respond to oral medications.
Alprostadil Cream (Vitaros)
Alprostadil is the only prescription cream specifically developed and approved for erectile dysfunction. Chemically identical to a naturally occurring compound called prostaglandin E1, it works by relaxing the smooth muscle tissue inside the penis. This widens the blood vessels that supply the erectile tissue, increasing blood flow and producing an erection. You apply the cream directly to the tip of the penis before intercourse using a single-dose applicator containing 300 micrograms of the active ingredient.
Vitaros received European marketing authorization in August 2013 and launched in the UK in June 2014. It is not currently available in the United States. European urology guidelines position it as a second-line treatment, meaning it’s typically recommended for men who can’t tolerate oral ED pills (like sildenafil or tadalafil), have medical reasons not to take them, or found them ineffective.
Clinical trials in men with moderate to severe ED showed significant improvements in erectile function and the ability to complete intercourse after 12 weeks of treatment compared to placebo. Phase III results confirmed these findings across multiple measures of sexual function. The most commonly reported side effects involve local reactions: mild burning, redness, or irritation at the application site. Partners may also experience some vaginal irritation from residual cream during intercourse.
Eroxon Gel: The Over-the-Counter Option
Eroxon (also known by its development name MED3000) is a non-prescription topical gel classified by the FDA as a Class II medical device. It contains no active pharmaceutical ingredients, which is what allows it to be sold without a prescription. The FDA authorized it for marketing in 2022, and it’s now available at retail in the United States.
Eroxon works through an entirely different mechanism than alprostadil. Instead of delivering a drug that relaxes blood vessels, it uses a volatile solvent mixture that physically stimulates nerve sensors in the head of the penis. When applied, the solvents evaporate and create a cooling sensation followed by a warming effect. Researchers believe this temperature shift triggers the nerve pathways involved in initiating an erection, leading to smooth muscle relaxation and increased blood flow without any medication entering the body.
Because it’s drug-free, Eroxon carries fewer contraindications and side effect risks than alprostadil. It’s positioned for men with mild to moderate ED who want to try a topical solution before pursuing prescription treatments. That said, men with severe ED or ED caused by significant vascular disease are less likely to see adequate results from a non-pharmaceutical approach.
How These Two Options Compare
- Severity: Alprostadil has clinical data supporting its use in moderate to severe ED. Eroxon is better suited for mild to moderate cases.
- Access: Eroxon is available over the counter in the US and UK. Vitaros requires a prescription and is only available in Europe.
- Speed: Both are applied shortly before intercourse and work locally rather than systemically, which generally means fewer whole-body side effects than oral pills.
- Mechanism: Alprostadil is a vasodilator that directly increases blood flow through a pharmaceutical pathway. Eroxon stimulates nerve endings through physical temperature changes.
- Side effects: Alprostadil commonly causes localized burning or irritation, and partners may experience irritation as well. Eroxon’s non-medicated formula carries a lower side effect profile.
What About L-Arginine and Herbal Creams?
A quick search for ED creams will surface dozens of over-the-counter products containing ingredients like L-arginine, herbal extracts, or menthol. L-arginine is an amino acid that acts as a vasodilator, and there is some evidence that oral L-arginine supplements may improve erectile function when the cause is physical (such as reduced blood flow). The Mayo Clinic notes it “might be effective” for ED due to a physical cause.
However, there’s an important distinction: most of the evidence for L-arginine involves oral supplements, not topical creams. The skin of the penis absorbs substances differently than the digestive system processes them, and topical L-arginine products have not gone through the same rigorous clinical trials as alprostadil or Eroxon. Many herbal ED creams are marketed as supplements, which means they aren’t required to prove efficacy before being sold. Some may produce a mild warming or tingling sensation that feels like “something is happening,” but that’s not the same as a proven mechanism for producing erections.
If you see a cream advertised with dramatic claims and no prescription requirement (and it’s not Eroxon), approach it with skepticism. The supplement market for ED is large and loosely regulated.
Choosing the Right Option for You
For most men, oral ED medications remain the first-line treatment because they’re well-studied, effective across a broad range of severity, and easy to use. Topical creams and gels fill a specific niche: they’re ideal for men who experience side effects from oral pills (headaches, flushing, nasal congestion, digestive upset), who take medications that interact with oral ED drugs (particularly nitrates for heart conditions), or who simply prefer a localized treatment.
If you’re in the US and want to try something without a prescription, Eroxon is the only topical with FDA authorization. It’s worth trying for mild ED, particularly if you want to avoid systemic medications. For more significant erectile difficulties, alprostadil cream has stronger clinical evidence, but you’ll need a prescription and, depending on your country, it may not be locally available. Your prescriber can help determine whether a topical approach makes sense based on the underlying cause of your ED, since conditions like nerve damage, hormonal imbalances, or psychological factors may respond better to other treatments entirely.