This article explores the treatment options for erectile dysfunction and the pivotal role that pharmacists play in its management
Erectile dysfunction (ED), also known as impotence, is characterized by the consistent or recurrent inability to achieve and/or maintain an erection sufficient for sexual intercourse. It becomes increasingly common with age, affecting approximately 50 – 55 per cent of men aged between 40 and 70 years.
ED is estimated to affect up to three-quarters of men globally, and by 2025, 322 million men are expected to experience it.
Research indicates that erectile dysfunction is highly prevalent in the UK, affecting over a quarter of younger men. Among Brits with ED, cardiometabolic and psychological conditions were frequently observed.
Despite the high prevalence of erectile dysfunction among men, it remains poorly understood, underdiagnosed, and undertreated.
Causes
Impotence can arise from various factors, such as physical or psychological issues, and can manifest either gradually or suddenly.
Erectile dysfunction is often associated with obesity, high blood pressure, high cholesterol and diabetes, all of which pose significant health risks. Therefore, seeking medical advice is crucial.
As per the British Association of Urological Surgeons Limited (BAUS), 90 per cent of men experiencing erectile dysfunction have at least one underlying physical cause for their problem. The primary abnormalities identified are – cardiovascular disease in 40 per cent and diabetes in 33 per cent.
Other associated physical factors include hormone imbalance (high prolactin or low testosterone levels), side effects of certain medications (antihypertensives, antipsychotics, antidepressants, antihistamines, heroin, cocaine, methadone), neurological disorders (multiple sclerosis or Parkinson’s disease), pelvic surgery or trauma, and anatomical abnormalities (tight foreskin, short penile frenulum, Peyronie’s disease which causes scar tissue and curvature in the penis).
Psychological causes may encompass anxiety, stress, depression, and relationship issues. According to BAUS, a psychological component, commonly referred to as “performance anxiety”, is prevalent in men with impotence.
Treatment
If the cause is psychological, the patient and his partner may benefit from counselling. Typically, physical causes are treated by directly addressing the underlying condition. In some cases, lifestyle changes—such as adopting a healthy diet, reducing alcohol consumption, quitting smoking, losing weight, and increasing physical activity—can significantly improve erectile dysfunction.
If no treatable cause is identified, first-line treatment often involves the use of phosphodiesterase inhibitors such as sildenafil (Viagra, Eropid), tadalafil (Cialis), vardenafil (Levitra) or avanafil (Spedra). These medications are recommended to temporarily enhance blood flow to the penis. However, the type and dosage of the medication will depend on the patient’s situation.
Sildenafil and tadalafil are available both over the counter (OTC) and through prescription in the UK.
If the medication proves ineffective, causes significant side effects, or cannot be used, other treatment options may be indicated. These include penile injections, the medicated urethral system for erection (MUSE), vacuum erection devices (VEDs), vascular surgery or angioplasty, and penile prostheses.
However, a multidisciplinary approach that combines medical treatment with psychological therapy is preferred over a single-mode treatment. Increasing evidence suggests that psychological interventions for ED can enhance the effectiveness of medical treatments, and improve patient’s adherence to treatment and the quality of the sexual relationship.
The dangers of buying ED medications online
Patients can obtain branded versions of sildenafil, such as Viagra and Eropid, through a private prescription from their doctor, at a pharmacy via a discussion with the pharmacist, or purchase online.
Even though ED medications are accessible for purchase without a prescription from pharmacies, men are still opting for cheap versions found online, risking their health.
According to the Medicines and Healthcare products Regulatory Agency (MHRA), erectile dysfunction medicines are a popular target for criminals selling unlicensed and counterfeit medicines.
The MHRA and UK Border Force seize millions of pounds worth of unlicensed and counterfeit ED medicines every year.
When dispensing sildenafil, pharmacists are encouraged to inquire about patients’ overall health to ensure the pill is safe for them to take, and to educate them about potential side effects. If there are any safety concerns, the NHS advises pharmacists to recommend that the patient consult a doctor.
The NHS cautions people to be careful when purchasing sildenafil online, as “many websites sell fake medicines.”
“Online medicines are not always regulated and the ingredients in them can vary from one pack to another. They can cause unpleasant side effects or may not be suitable for you,” the NHS website reads.
If you choose to buy sildenafil online, the health service advises ensuring that the online pharmacy is registered with the General Pharmaceutical Council (GPhC), the online doctor service is registered with the Care Quality Commission (CQC), and all doctors are registered with the General Medical Council (GMC).
Consult a pharmacist for OTC treatment: PAGB
Michelle Riddalls, CEO of PAGB, noted that the availability of over-the-counter erectile dysfunction medications has transformed the ability of men to take control of their sexual health and manage self-treatable conditions. However, he also acknowledged that ED medicines have become a popular target for criminals selling unlicensed and counterfeit medicines.
“Erectile dysfunction can be a debilitating condition and ensuring men feel they have choice and fast access to safe treatment is important.
“Unfortunately, erectile dysfunction medicines have been a popular target for criminals selling unlicensed and counterfeit medicines,” she told Pharmacy Business.
When asked if the PAGB has taken any actions to prevent the sale of fraudulent OTC medicines, Riddalls said: “Our members have not raised any concerns about reports of an increase in the sale of unlicensed or counterfeit erectile dysfunction medicines.”
Meanwhile, they urge individuals seeking OTC treatment for erectile dysfunction to speak to a pharmacist who can provide advice and support about products.
People are also advised to ensure that any online purchase is made from a reputable source, such as a licensed brand or pharmacy company’s website.
How pharmacists help in ED management
Alwyn Fortune, RPS Policy and Engagement Lead for Wales and a community pharmacist, stated that pharmacists are well positioned to provide advice on the treatment of erectile dysfunction.
He highlighted that pharmacists can offer confidential, private consultations and assist in addressing any concerns patients may have.
“Using standardised checklists, pharmacists identify suitable treatments and can detect signs of underlying health conditions. If there are concerns or if medicines may not be suitable, pharmacists can refer patients to other practitioners.
“Pharmacists also support broader public health messaging, like conducting blood pressure checks and providing smoking cessation advice, which can address some underlying issues contributing to erectile dysfunction,” he told Pharmacy Business.
With many effective options now available without the need for a prescription, pharmacists play a crucial role in helping patients ensure they receive appropriate treatment, he added.
