Erectile dysfunction – is viagra the only option?

Following a recent announcement from the Medicines and Healthcare products Regulatory Agency (MHRA), men will no longer require a prescription to obtain the impotence drug Viagra and will instead be able to buy it over the counter at pharmacies.   This is likely to appeal to many men with erectile dysfunction (ED) as it is often considered a taboo subject, with men finding it difficult to broach the subject during a consultation with their GP.

ED (sometimes known as impotence) is when a man cannot achieve and/or maintain a full erection. Sometimes the penis may become semi-erect but may not be hard enough to have sex. In some cases, there is no change to the penis at all.

How common is ED?

Most men at some point in their lives may be affected by ED on at least one occasion. Common causes for this can be stress, fatigue, and excess alcohol to name a few.  However, some men consistently struggle to get an erection.  ED becomes more common with age. Approximately half of the men are affected aged 40-70, rising to two-thirds of men over 70.

What causes ED?

 

There are several different causes that can be grouped into physical or psychological causes. The majority of cases (8/10) are physical.  With most physical causes of ED, men notice a gradual onset of the problem, for example, they may notice intermittent or partial ED which may become worse after a while.

The main physical cause of ED is due to the reduced blood supply to the penis and this can occur due to a build-up of cholesterol deposits that narrow the arteries (atherosclerosis). Diabetes and high blood pressure are also common causes. Conditions such as Parkinson’s disease and multiple sclerosis can also cause ED by affecting the nerve supply to the penis. Other causes can include medication, smoking and alcohol excess.

A number of mental health conditions can cause ED including stress, anxiety, depression and relationship difficulties. In general, psychological causes often result in sudden onset of ED that may resolve when mental health improves. If men can achieve a full erection at other times (for example masturbating or morning erections) then it is likely that there is a psychological cause for their ED.

What tests are needed?

There are a number of simple tests that can be performed in order to help understand the cause of ED. These include a physical examination,  blood tests and procedures such as blood pressure checks, heart tracings (ECG) and urine checks. The main reason for performing these tests is to check for risk factors that can increase the risk of narrowing of the blood vessels in the body.

What treatments are available?

Lifestyle modification is an important factor to address.  ED can often be improved by addressing risk factors, for example, cholesterol and diet, smoking and alcohol.

There are a number of medications available, the most widely known being Viagra (the brand name for sildenafil).  They work by affecting a chemical responsible for widening the blood vessels during sexual arousal. This medication is not suitable for everyone as it can interact with other medications, for example, angina and blood pressure medications.  Other types of medication can be applied directly to or into the penis as a topical cream, injections or pellets.  Testosterone replacement is occasionally used if the man has ED symptoms and has had blood tests that show he is deficient in this hormone.

There are other treatment options if medication is not appropriate, for example, vacuum devices and also surgical options such as a penile prosthesis or a penile implant.

Should Viagra be available to men without a prescription? Do you know anyone who may benefit from reading this article? If so, then please share. If you, or anyone you know, wish to ask a question or discuss any issues in the article with one of our doctors, then please get in touch.