Erectile dysfunction

This service is suitable for you if you are:

• 18 years of age or older.
• Male.
• Experiencing erectile dysfunction (difficulty getting or maintaining an erection satisfactory for sexual intercourse).

This service is not suitable for you if you:

• Are younger than 18 years of age.
• Are female.
• Have experienced erectile dysfunction since the onset of sexual activity.
• Have been advised to avoid sexual activity by your doctor.
• Have had a heart attack, stroke or other serious cardiovascular event in the past 6 months.
• Have any of the following heart problems:
  • Unstable angina or chest pain/ angina during exercise or sexual activity.
  • Uncontrolled high blood pressure.
  • Very low blood pressure or a tendency to faint.
  • Serious or uncontrolled irregular heart rhythm
  • Heart failure, heart valve problems, cardiomyopathy
  • Significant breathlessness, dizziness or fainting during exercise or sexual activity.
  • A heart condition for which they have been advised to avoid sexual activity.
• Have significant liver or kidney disease.
• Have significant eye or retinal conditions including:
  • Previous sudden or unexplained loss of vision
  • NAION (non-arteritic anterior ischaemic optic neuropathy).
  • Retinitis pigmentosa or another inherited retinal disorder.
  • Macular degeneration.
  • Diabetic eye disease/diabetic retinopathy.
  • Glaucoma.
• Have a blood condition associated with an increased risk of prolonged or painful erections (priapism), including:
  • Sickle cell disease/anaemia.
  • Leukaemia
  • Multiple myeloma
• Have a bleeding or coagulation disorder e.g. Haemophilia.
• Have a significant penile condition, including:
  • Peyronie’s disease.
  • Significant penile curvature or deformity.
  • A previous prolonged or painful erection (priapism).
• Have an active or recent significant stomach/peptic ulcer.
• Have previously had a serious allergic reaction to PDE-5 inhibitors.
• Are taking certain medications
  • There are several potentially serious drug reactions with ED medications. There is more information on this below. Please check this carefully.

It is important that you understand this information and how it relates to you. If you have any questions, you can contact us via our Contact Us Form and we can help.

Erectile dysfunction (ED) is when it is difficult for a man to get or keep an erection firm enough for penetrative sex. It is a common problem and happens to most men from time to time, especially if they are feeling tired, stressed or have consumed too much alcohol.

For some men, it can become a recurring or persistent problem. This can happen at any age but is more common with increasing age due to many different physical causes. It can lead to stress and have a negative effect on your self-confidence and relationships. This in turn can worsen ED symptoms.

Approximately half of all men between 40 and 70 years have experienced ED.

ED is not the same as premature ejaculation (when ejaculation occurs less than 2 minutes after penetration). If this is more in keeping with your symptoms, please use our Premature Ejaculation service.

Erectile dysfunction (ED) can occur at any age, but is more common as you get older. There are physical and psychological causes of ED. The cause can be related to a combination of these factors listed below.

The main physical cause of ED is the narrowing of the blood vessels supplying the penis. This prevents adequate blood flow to this area to get or maintain an erection. Diabetes, high blood pressure and high cholesterol are all causes of ED as they cause narrowing of the blood vessels. These are by far the most common causes of ED in men over 40 years of age.

ED can be an early warning sign of these conditions, and others such as heart disease, which is why men are advised to have a physical check-up with some routine blood tests.

Other physical causes of ED include:

• Obesity.
• Hormonal abnormalities.
• Smoking, alcohol and drug use (especially with long-term or heavy use).
• Some Medications (e.g. steroids, including anabolic steroids).
• Nerve damage (Such as can occur in Multiple Sclerosis).

In most cases that are due to a physical cause, the symptoms develop gradually and you may have intermittent symptoms for a while before they become more persistent. Your libido (sex drive) is likely to be normal if the cause is not related to hormones or psychological reasons

Psychological causes include:

• Stress.
• Anxiety (including performance anxiety).
• Depression.
• Relationship problems can also play a role.

If the cause is due to psychological factors, the symptoms will often develop suddenly. They may improve spontaneously as your psychological state improves.

Medications can help you to achieve and maintain an erection. However, ED medications will not treat any underlying medical conditions that are causing or contributing to this problem. We strongly advise that you consult with a doctor for advice on assessment and management of any underlying cause. This is a good opportunity to review your general health, including cardiovascular risk factors.

There are some drugs that should not be taken together because of potential adverse interactions, making the risks outweigh the potential benefits.

It is VERY important that you let us know exactly what medications you are taking so that we can safely prescribe a treatment for you.

We can provide a range of erectile dysfunction medications, both branded and generic, subject to clinical suitability. This includes oral tablets and an oral suspension, a newer option for patients who prefer a liquid alternative to tablets.

A prescription will be issued based on the treatment approved by the doctor. For tablet-based medications, this is typically a 6-month prescription for up to 16 tablets per month. For the oral suspension, a 6-month prescription (6 bottles) will be issued — one 30 ml bottle provides approximately 15 doses. These medications should be used as per the instructions on the prescription. Do not take more than the recommended dose.

These medications work by relaxing the blood vessels in the penis, allowing increased blood flow to help you to get and maintain an erection when you are aroused (You will need to have sexual stimulation to help with this medication).

The oral suspension is delivered using a metered pump. Each actuation of the pump provides 12.5 mg of sildenafil in 0.5 ml. The recommended dose is 2 ml (4 pump actuations) = 50 mg, taken approximately one hour before sexual activity, at most once per day. The dose may be adjusted to 25 mg (2 pumps) or 100 mg (8 pumps) depending on your individual response and the doctor's recommendation.

They all belong to the same group of medications but have a different active ingredient. There is a slight variation on how each tablet works, and they each have individual time frames for the onset of action and duration of action.

If your prescription is for an oral suspension, please follow these device instructions carefully:

• Before each use: Shake the bottle for 20 seconds and prime the pump 3 times, discarding the primed liquid.
• To take your dose: Apply the suspension onto your tongue and swallow immediately — do not spray into the nose or apply to the skin.
• After each use: Wash and dry the pump and replace the cap.
• Stop and discard: Once the liquid level falls below the red line on the bottle, stop using it and discard — do not use below this level. The bottle expires 10 months after first opening.

You may need to vary the timing and the dose, or type of medication to get the best individual result.

Your medication may not work the first time you try it, and you may need to take it on 4 to 6 separate occasions to assess the full effect. If it has not helped after this, you can contact us for advice.

These medications are usually tolerated very well.

You are less likely to experience side effects with lower doses of medications, and we recommend that you try the standard dose first – this can be adjusted depending on your response to the treatment and side effects if they should occur.

If side effects occur, they can include:

• Headaches.
• Dizziness or feeling light-headed.
• Flushing or feeling hot.
• Stuffy or blocked nose.
• Stomach upset, indigestion, heartburn or nausea.
• Back pain, muscle aches or pain in the arms or legs.
• Visual disturbance such as blurred vision, changes in colour vision, increased sensitivity to light and a blue/halo appearance around bright light.
• Eye redness, irritation or discomfort.
• Palpitations or a fast heartbeat.
• Temporary changes in blood pressure.
• Tiredness or sleepiness.
• Ringing in the ears (tinnitus).
• Nosebleeds.
• A prolonged or painful erection.

For full details of the potential side effects of these medications, please ensure that you read the patient information leaflet that comes with your medication before you start to use it for full details on potential side effects.

If you are concerned that you are developing side effects, we advise that you stop your medication and seek medical advice.

Rare but potentially serious side effects that require urgent medical attention include:

• An erection lasting 4 hours or longer (priapism)
• Sudden loss or significant reduction of vision in one or both eyes
• Sudden reduction or loss of hearing, particularly with dizziness or ringing in the ears
• Chest pain during or after sexual activity. *Do not use GTN/nitrates* after taking an erectile dysfunction medicine.
• Fainting, severe dizziness or symptoms of very low blood pressure.
• Severe or persistent irregular/rapid heartbeat.
• Seizure.
• Serious allergic reaction, including swelling of the face, lips, tongue or throat, or difficulty breathing.
• Symptoms suggestive of a heart attack or stroke.

Yes!

There are lots of lifestyle changes you can make to help improve your symptoms and your overall sexual and cardiovascular health:

• Drinking alcohol within the recommended limits (< 17 standard drinks per week for men, spread across the week with alcohol-free days).
• Stop smoking (smoking damages and narrows blood vessels contributing to erectile dysfunction.
• Maintain a healthy weight: ED is more common if you are overweight or obese and losing excess weight has been shown to help.
• Exercise regularly, aiming for a combination of aerobic exercise and strength training.
• Eat a healthy, balanced diet, particularly one rich in vegetables, fruit, whole grains, legumes, nuts and fish.
• Manage stress and anxiety, which can contribute to or worsen erectile dysfunction.
• Get adequate and regular sleep.
• Avoid recreational drugs, particularly cocaine, amphetamines and recreational nitrates or “poppers”.
• Manage underlying health conditions such as high blood pressure, high cholesterol and diabetes.
• Have regular health checks, including blood pressure, blood glucose/HbA1c and cholesterol where appropriate.
• Consider relationship or psychosexual counselling if anxiety, relationship difficulties or psychological factors may be contributing.
• Review your regular medications with your doctor if you think they may be contributing to erectile dysfunction. *Do not stop prescribed medication without medical advice.*
• Seek medical assessment if erectile dysfunction is new, persistent or worsening, as it can sometimes be an early sign of cardiovascular disease or another underlying health condition.

When completing the questionnaire, please ensure you let us know exactly what medications you are taking (prescribed and over-the-counter), herbal remedies or recreational drugs as erectile dysfunction medications can have significant interactions with some drugs. This will enable us to advise you on appropriate treatments and prescribe them safely for you.

Do not take more than the maximum recommended dose in 24 hours and do not combine with other erectile dysfunction medications. For tablet-based medications, this means no more than one tablet per day. For the oral suspension, the maximum dose is 100 mg (8 pump actuations) once per day.