The days of erectile dysfunction being a taboo subject are gone, and men can now get help without prescription from the community pharmacy.
Erectile dysfunction (ED) is simply referred to as a problem in getting or maintaining an erection, but finding the causes of ED can involve a complex investigation. ED may manifest from a physical problem, or it may have a psychological cause. The HSE states: “It’s more likely to be an emotional problem if you only have erection problems some of the time. For example, you still get erections in the mornings, but not during sexual activity.” In these cases, the HSE recommends psychotherapy, however this might be suggested in combination with medication.
The chances of suffering with ED increase with age, so with Ireland’s increasingly ageing population, treating the condition will be a growing challenge for primary care, including pharmacies. However, ED is not confined only to older men.
Research into the problem is increasing. For example in the US, the Massachusetts Male Aging Study (MMAS) reported that male sexual dysfunction usually manifests in the early 40s and increases with age. At age 40, 40 per cent of men taking part in the research acknowledged some degree of impaired sexual function. However, data from the National Health and Social Life Survey indicated that 31 per cent of younger men (aged 18-to-59 years) also reported some kind of sexual dysfunction.
Though the risk of ED increases with age, it is still possible for young men to suffer with ED for a variety of health reasons. A study published in the Journal of Sexual Medicine found that ED affected about 26 per cent of men under the age of 40. Some of the potential reasons for this are outlined below.
RISK FACTORS
A separate study showed that certain risk factors predispose someone to be more at risk. As well as increasing age, men are more at risk of ED if they have diabetes. This condition can cause nerve damage and circulation problems. Obese men are also at greater risk of ED, and studies have shown that almost 80 per cent of men with ED have a body mass index (BMI) greater than 25.
In psychological considerations, there is a strong correlation between ED and men with depression. It has been speculated that this might be a ‘chicken or egg’ situation — some men may have been depressed before their erectile problems, while others may become depressed due to ED itself. Other potential risk factors include cardiovascular disease, low testosterone, high cholesterol, high blood pressure, smoking, or metabolic syndrome.
Overall, ED is the most common type of sexual dysfunction among men. Risk factors for ED, apart from increasing age, include cardiovascular disease, diabetes, hypertension, dyslipidaemia, hypogonadism, smoking, depression, and medication use. Many commonly prescribed medications can have an impact on sexual function.
Some of the more common medical conditions that cause ED include:
- Chronic kidney disease.
- Atherosclerosis.
- Type 2 diabetes.
- Heart and blood vessel disease.
- High blood pressure.
- Multiple sclerosis.
- Peyronie’s disease (a condition in which plaque forms under the skin of the penis).
- Injury from treatments for prostate cancer, including radiation therapy and prostate surgery.
- Injury to the penis, spinal cord, prostate, bladder, or pelvis.
- Surgery for bladder cancer.
DISTRESS
The physiological causes of ED are complex and can be compounded by emotional issues. ED can itself be caused solely by psychological distress. According to the HSE, if a man only has erection problems some of the time — for example if he gets erections in the morning but not during sexual activity — this may be a sign of a psychological cause.
The Urology Care Foundation, a part of the American Urological Association, states that the emotional causes of ED can include:
- Depression.
- Anxiety.
- Relationship problems.
- Stress at home or work.
- Stress from social, cultural or religious conflicts.
- Anxiety over sex performance.
Sometimes, a man may be suffering from a combination of these factors.
Lifestyle changes can have an effect on the severity of ED. These include: Smoking cessation; losing weight (if overweight); an improved diet; daily exercise; and dealing with stress and anxiety. The HSE also recommends to avoid cycling for more than three hours per week, as cycling can damage nerves and compress arteries in the penis if done excessively.
The Executive also recommends limiting alcohol intake to less than 17 standard drinks a week. Customers can be given counselling as to risk factors that can exacerbate their ED, and the pharmacist will discuss this with them during the consultation.
ORAL MEDICATIONS
If the patient has no underlying medical conditions, oral medications are the most common and trusted treatment for ED. They are also the first line of treatment for ED that does not improve with lifestyle modifications.
The most commonly-used ED treatments are referred to as phosphodiesterase type 5 ( PDE5) inhibitors. PDE5 is an enzyme in the walls of blood vessels that affects blood f low, and also inf luences how cells signal within the body.
The physiological causes of ed are complex and can be compounded by emotional issues
PDE5 inhibitors work by blocking the PDE5 enzyme to prevent it from having an effect, which in turn relaxes the blood vessels and increases blood f low. This has also made PDE5 inhibitors useful in treating pulmonary hypertension, as they control blood f low to the arteries in the lungs, and improve blood f low to the lungs. Some research has also suggested that PDE5 inhibitors may be useful tools in treating heart disease, diabetes, and some cancers.
Thankfully, men with this problem can now get help at the community pharmacy without the need for a prescription. These customers will need to have a brief consultation with the pharmacist on duty and will be required to fill out a short form to confirm their suitability for the treatment.
This will involve the pharmacist talking with the customer to establish their medical history, what medications they may currently be on, and their general health at the time. If the pharmacist has any concerns, they may decide to refer the customer to their GP for further medical investigation.
Sidena Sildenafil tablets are the first generic Sildenafil tablet in Ireland to be available to buy over the counter without a prescription. Sidena tablets contain the active ingredient sildenafil and are proven to be effective in treating erectile dysfunction in adult men (aged over 18). Each Sidena Tablet contains sildenafil 50mg, and this product comes in packs of four or eight and helps to achieve and maintain an erection. One tablet should be taken one hour before sexual activity.
Another effective treatment for ED is Cialis for Men 10mg film-coated tablets. These contain the active ingredient tadalafil, which increases blood flow to the penis, helping men achieve and maintain an erection when sexually aroused. Its effect lasts for up to 36 hours. This medication works by increasing the blood flow to the erectile tissue in the penis, helping men to achieve a firmer and longer-lasting erection when sexually aroused.
Also available in the pharmacy without prescription is Viagra Connect Sildenafil. Viagra Connect contains the active ingredient sildenafil 50mg, which is the exact same ingredient that is in the original prescription version of Viagra. It works by relaxing the blood vessels in the penis, allowing greater blood f low into the penis when sexually aroused. Viagra Connect will only help to achieve an erection if sexually stimulated.
HOW THEY WORK
In terms of physiology and how these medications work: An erection starts with nerve stimulation, which releases nitric oxide. This then stimulates guanylate cyclase, which converts guanosine triphosphate into cyclic guanosine monophosphate (cGMP). cGMP then induces smooth muscle relaxation, which allows for f low of blood into the penis and a firm erection. The molecule PDE5 breaks down cGMP and allows the penis to return to the f laccid state.
These medications inhibit PDE5, which keeps the level of cGMP high and promotes erections. This is the mechanism of action of the most common oral medications used to treat ED. However, the pharmacist will explain to patients that in combination with the tablets, sexual stimulation is required to achieve an erection.
These medications inhibit PDE5, which keeps the level of cGMP high and promotes erections.
STIGMA
Work still needs to be done to reduce the perceived stigma associated with ED. Research conducted in 2024 showed that three-in-10 men say they have suffered with ED, with the biggest cohort being those aged 55 and older. However, almost 25 per cent of those aged 18-to-34 said they also experienced ED at some point.
This stigma can lead men to buy illegal ED drugs in order to avoid having a consultation with a pharmacist or GP. The Health Products Regulatory Authority (HPRA) reported a sharp increase in the volume of illegal medicines detained in the first half of 2024 compared to the same period the previous year. Of the 706,881 dosage units of falsified and illegal medicines detained between January and June 2024, 72,555 units were illegal or falsified ED medicines.
Gráinne Power, Director of Compliance at the HPRA, stated: “When consumers acquire any medicinal substances outside the regulated supply chain, they forego any assurance of safety, quality, or effectiveness. Some of these substances might not be authorised by any global health authority, while others may be counterfeit or falsified, despite appearing legitimate. It’s crucial not to compromise your health by taking such risks. We strongly advise anyone who has bought prescription medications from unauthorised sources to cease using them immediately and to consult their healthcare provider with any concerns about their wellbeing.”
At the same time, research into ED and men’s health shows that Irish men are becoming increasingly willing to talk about their ED issues. With better awareness of ED and greater access to therapies, Irish men now have the opportunity to address the problem and be supported in their community pharmacy.
