Are we ready to explore administration of botulinum toxin in the management of male sexual dysfunctions?

Male sexual dysfunctions (SDs) are highly prevalent conditions with a significant impact on men’s health worldwide. In industrialized countries, erectile dysfunction (ED) affects ~3%-76.5% of men, premature ejaculation (PE) 20%-30%, and Peyronie’s disease (PD) 0.5%-13%. These conditions are typically managed through pharmacological and surgical interventions, yet many existing therapies are associated with side effects or suboptimal outcomes, particularly in more severe or treatment-resistant cases. Indeed, even the most adopted drugs to treat ED such as phosphodiesterase 5 inhibitors (PDE5-is) could lead to flushing, back pain, and headaches which can lead to drug withdrawn. Similarly, Dapoxetine, the only pharmaceutical agent approved in Europe to treat PE, could lead to headache, dizziness, and gastrointestinal issues. Moreover, the most severe manifestations of ED and PD, or when both conditions co-occur, are suitable for surgical implant of penile prothesis. Although this device is effective in restoring the ability of a man to have penetrative intercourse, this comes with risk of long-term complications such as infection and mechanical failure, erosion of distal corpora, urethra, and glans ischemia, and necrosis.1