Sexual Health Compounding

Key takeaways

• Made to your exact strength: Watkins compounds sexual health medications to the dose, combination, and form your prescriber orders, and custom formulas are welcome.
• Progesterone cream: Prescription progesterone cream in 2%, 10%, or custom strengths, unlike over-the-counter creams whose content varies.
• Trimix and Bimix for ED: Injections combining papaverine, phentolamine, and alprostadil (prostaglandin E1) in three standard strengths, shipped frozen on dry ice.
• Naltrexone vaginal cream: Available alone (10 mg/gram) or combined with estriol, a form of naltrexone not sold commercially.
• Testosterone cream and troches: Precise doses for men and women, in transdermal cream or troches that dissolve between the cheek and gum.
• Scream Cream: A topical arousal cream for women made with sildenafil, theophylline, and L-arginine.
• Pelvic pain relief: Diazepam, baclofen, and ABG suppositories deliver muscle relaxants right where they’re needed.
• Prescription required: Watkins is a PCAB-accredited 503A pharmacy. Prescribers can fax (231) 737-1329, email us, or call the lab at (231) 683-1708.

What is sexual health compounding?

Compounding is when a pharmacist prepares a medication from individual ingredients to fit one specific patient. Instead of choosing from the handful of strengths and forms a manufacturer happens to produce, your prescriber can ask for the exact dose, combination, and delivery method that suits you.

That flexibility matters in sexual health. Some of the most widely used treatments in this field, like Trimix injections or naltrexone vaginal cream, aren’t sold as mass-produced products at all. Others, like low-dose testosterone cream for women, aren’t available commercially in the strengths patients need.

Watkins Compounding Pharmacy is a 503A pharmacy, which means every medication we make is prepared for an individual patient under a valid prescription. We are also PCAB accredited, an independent quality standard for compounding pharmacies.

Progesterone cream and progesterone capsules

Progesterone is a hormone that plays a central role in the menstrual cycle, pregnancy, and the transition through perimenopause and menopause. When levels shift, many women notice changes in sleep, mood, and libido. Prescribers often use progesterone alongside estrogen therapy, and compounding lets them choose both the strength and the way it’s delivered.

Prescription progesterone cream

Watkins compounds progesterone cream in 2%, 10%, or a custom percentage, in 30, 60, 90, or 120 gram sizes. It’s dispensed in a metered click pump (2 clicks equal 1 gram), so measuring your prescribed dose is simple and consistent.

Over-the-counter “natural” progesterone creams are sold as cosmetics or supplements, not as drugs. Their strength isn’t standardized, and the amount of progesterone they contain can vary widely. A compounded prescription cream is made to a specific, measured strength that your prescriber chooses and can adjust over time.

Oral progesterone capsules

For patients whose prescriber prefers an oral form, Watkins compounds progesterone capsules in 50 mg, 100 mg, 150 mg, or 200 mg, or a custom strength. Our capsules are made in a slow-release (E4M) base and are typically taken at bedtime.

Trimix and Bimix injections for erectile dysfunction

Oral erectile dysfunction pills don’t work for everyone. Men with diabetes, nerve damage, cardiovascular conditions, or who are recovering from prostate surgery often need a different approach. For many of them, urologists prescribe penile injection therapy, and the most common versions, Trimix and Bimix, are compounded.

These injections work directly on the blood vessels of the penis to produce an erection, usually within minutes. Because they act locally rather than through the whole body, they can work for men who don’t respond to oral medications.

Watkins compounds three standard formulas, each per 1 mL:

Prescribers can also request custom strengths.

Papaverine

Papaverine is a smooth muscle relaxant that widens blood vessels. It has long been used to treat blood vessel spasms, and in Trimix and Bimix it relaxes the smooth muscle and arteries of the penis so blood can flow in. Papaverine is the base ingredient in all three Watkins formulas.

Phentolamine

Phentolamine is an alpha-blocker, a medication that blocks the signals that tighten blood vessels. In general medicine it’s used to manage sudden blood pressure spikes, to protect tissue when certain IV medications leak under the skin, and to reverse dental numbness. In Trimix and Bimix, phentolamine works alongside papaverine to keep blood vessels open, which strengthens and sustains the effect. Watkins offers it at 0.5 mg or 1 mg per mL.

Alprostadil (prostaglandin E1)

Alprostadil is a synthetic form of prostaglandin E1, a natural compound that relaxes smooth muscle and widens blood vessels. It’s the active ingredient in FDA-approved ED products such as Caverject and Edex, and in Trimix it’s combined with papaverine and phentolamine so each ingredient can be used at a lower dose. Watkins compounds Trimix with 10 mcg or 20 mcg of prostaglandin E1 per mL.

Bimix leaves alprostadil out, which some men prefer if prostaglandin E1 causes aching or discomfort.

How Trimix is supplied

Trimix and Bimix are dispensed in frozen 1 mL vials (100 units per vial) to protect their potency. We can also supply 1 mL insulin syringes (10 per pack) and alcohol swabs (100 per box), so you have everything you need in one order. Because the vials must stay frozen, orders ship on dry ice. 

Important safety information: Your prescriber will teach you how to inject and will set your dose, often starting low and adjusting. Don’t use these medications more than once in 24 hours or more than three times per week. An erection that lasts longer than 4 hours is a medical emergency (called priapism); seek emergency care right away.

Naltrexone vaginal cream

What is naltrexone?

Naltrexone is a medication that blocks opioid receptors in the body. It’s best known in tablet and injectable forms that are FDA-approved to treat alcohol use disorder and opioid use disorder, and some clinicians also prescribe it at low doses (often called low-dose naltrexone, or LDN) for other conditions.

Naltrexone as a vaginal cream

Some clinicians prescribe naltrexone in a different form altogether: a low-strength cream applied vaginally for vulvovaginal discomfort. This form isn’t sold commercially, so it’s only available through a compounding pharmacy. 

Watkins compounds two versions:

• Naltrexone 10 mg/gram vaginal cream
• Estriol 0.5 mg/gram / naltrexone 5 mg/gram vaginal cream: pairs naltrexone with estriol, a gentle form of estrogen, in a single cream

Treatment with the combination cream typically starts nightly, then tapers to a few times a week, following your prescriber’s directions.

Testosterone cream and testosterone troches

Low testosterone can affect desire, arousal, and sexual function in both men and women. Commercial testosterone products are designed and dosed for men, which leaves few options for women who need much smaller amounts. Compounding solves that by allowing precise doses in the form that works best for each patient.

Testosterone cream

Watkins compounds two kinds of testosterone cream:

• Testosterone transdermal cream: 0.5 mg/gram, 1 mg/gram, 2 mg/gram, or a custom strength, in 30, 60, or 90 gram sizes. These low, precise strengths are commonly used for women.
• Testosterone cream (percentage strength): a custom percentage set by your prescriber, in 30, 60, or 90 gram sizes

Both are dispensed in metered click pumps (2 clicks equal 1 gram) and applied to the skin, where testosterone is absorbed into the bloodstream.

Safety note: Testosterone can transfer to others through skin contact. Wash your hands after applying, cover the area once it dries, and keep children and partners from touching the treated skin.

Testosterone troches

A testosterone troche is a small lozenge that dissolves between the cheek and gum. The testosterone is absorbed through the lining of the mouth directly into the bloodstream rather than through the digestive system. Watkins compounds testosterone troches in the custom strength your prescriber specifies, typically used once daily.

Testosterone is a Schedule III controlled substance, so the prescription must include the prescriber’s DEA number.

Scream Cream for women’s arousal

Scream Cream is a compounded topical cream for women made with sildenafil, theophylline, and L-arginine. Clinicians prescribe it for women who want help with arousal and sensation. Because it’s applied locally rather than taken by mouth, it works where it’s needed.

Watkins compounds Scream Cream in a 30 gram size, to be applied as directed by your physician. Like all compounded medications, it requires a prescription.

Diazepam and baclofen suppositories for pelvic floor tension

When the pelvic floor muscles stay tight or go into spasm, sex can become painful or impossible. Conditions like vaginismus, pelvic floor dysfunction, and chronic pelvic pain are often treated with physical therapy alongside muscle-relaxing medication. Delivering that medication as a suppository lets it work where the tension is, which is one reason pelvic health specialists favor this route over oral tablets.

All Watkins pelvic suppositories can be inserted vaginally or rectally, as your prescriber directs.

Diazepam suppositories

Diazepam is a benzodiazepine taken by mouth for anxiety, muscle spasms, and seizures. As a suppository, it’s used to relax tight pelvic floor muscles. Watkins compounds diazepam suppositories in 2.5 mg, 5 mg, or 10 mg. Diazepam is a Schedule IV controlled substance, so the prescription must include the prescriber’s DEA number.

Baclofen suppositories

Baclofen is a muscle relaxant most often taken by mouth for muscle spasticity from conditions like multiple sclerosis or spinal cord injury. As a suppository, it targets pelvic muscle spasm. Watkins compounds baclofen suppositories in 5 mg, 10 mg, or 20 mg.

Combination suppositories

• Diazepam 5 mg / baclofen 5 mg: two muscle relaxants in a single suppository
• ABG suppositories: amitriptyline 20 mg, baclofen 20 mg, and gabapentin 20 mg, a three-ingredient formula clinicians use for pelvic pain with a nerve-related component

Boric acid vaginal capsules

Recurring yeast infections and bacterial vaginosis can make intimacy uncomfortable and frustrating. Boric acid is a long-standing option clinicians turn to when standard treatments haven’t worked or infections keep coming back.

Watkins compounds 600 mg boric acid vaginal capsules, which are moistened and inserted vaginally at bedtime for the length of time your prescriber sets.

Safety note: Boric acid capsules are for vaginal use only. Never take them by mouth, and store them out of reach of children and pets. Talk to your prescriber before using boric acid if you are pregnant or could be.

Vaginal estrogen creams

Lower estrogen around perimenopause and menopause can cause vaginal dryness, thinning tissue, and painful sex. Watkins compounds:

• Estriol (E3) vaginal cream: 0.5 mg/gram, 0.2%, or 0.3%, in a 30 gram size
• Estradiol (E2) vaginal cream: 0.5 mg/gram or 1 mg/gram, in a 30 gram size

Both are typically used nightly at first, then reduced to a few times per week, as directed. Estriol isn’t available as a commercial product in the U.S., so compounding is the only way to get it.

How to get your compounded sexual health medication

1. Talk to your provider. Every compounded medication requires a prescription written for you individually. If you’re not sure where to start, bring this page to your appointment.
2. Your provider sends the prescription. They can fax it to (231) 737-1329 or email it to watkinspharmacy@watkinspharmacy.com.
3. We verify and compound. Our team verifies every prescription with the prescriber’s office, then prepares your medication in our lab.
4. Pick up or have it shipped. Pick up at our Muskegon pharmacy, or we’ll ship it to you.

Questions about a medication or your order? Call our lab directly at (231) 683-1708 or the pharmacy at (231) 739-7158.

Frequently Asked Questions