Erectile Dysfunction – Don’t Let It Get You Down

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Erectile dysfunction (ED) is a condition in which a man can no longer get, or maintain, an erection firm enough for sexual intercourse. This may be a persistent or recurrent problem. This problem is much more common than may be realised, affecting one in ten men in the UK. (1) The number of men suffering from this condition increases with age. It is recognised that this condition may have an effect on the quality of life and self-esteem of the patient, and it is a condition that is taken seriously.

Online DoctorAs this is a very personal problem, in many cases the sufferer does not seek advice because of the embarrassment of talking to anyone about the matter, in many cases, especially their GP. However, this attitude is unnecessary as the doctor will have encountered other people with very similar conditions countless times before. A moment of bravery to talk about the issue with the doctor should lead to a diagnosis and treatment, and in the end, will lead to much greater confidence in the bedroom, and no further embarrassment about being ‘unable to perform’. This will also give you a chance to look at what could be causing the problem, which may not necessarily be medical. It is important to remember that the doctor is a professional who is there to help you.

There are some lifestyle changes that can be carried out which may contribute to improving matters, such as: quitting smoking; ensuring alcohol intake is limited to three or four units per day; reducing weight if overweight; and trying measures to reduce stress and anxiety, something which can be easier said than done! These will all contribute to an overall healthier lifestyle, all of which can be discussed in detail with your GP or pharmacist.

In younger men, the single biggest cause of ED is anxiety, which could be about concerns over being inexperienced, or about the possible consequences of the sexual intercourse such as pregnancy. This problem could turn into a vicious circle, with the initial anxiety causing ED, which leads to further anxiety and so on.

In middle-aged men, stress can be a factor in the development of ED, whether about work or family life; in regards to their sex life; or it could be the result of another medical condition, such as diabetes or heart disease. In this case, the underlying condition will have to be controlled first, before treatment begins for ED.

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Healthy HeartIn older men over 70, the main cause is more likely to be medical, because of a deterioration of the blood vessels which supply blood to the penis. It may also be linked to heart problems. In this case, it is best to see your GP for an overall health check-up.

It is important to recognise that erectile dysfunction can be a warning sign of heart problems. Risk factors increasing the chance of getting both heart disease and ED include: having diabetes; high cholesterol; smoking; high blood pressure; a relative having heart disease; being overweight, or being depressed. It should also be noted that the younger the age at which the ED develops, the higher the risk of an underlying heart problem. Therefore if you have some of these risk factors, it is important to get your heart health checked out, as well as seeking help for the ED. (3)

It’s a common assumption that the only treatment for ED is that little blue pill, but in reality, there is a wide range available. Developments in the treatments for ED over the last ten years have been huge, and the majority of men will be able to return to a satisfying sex life after advice and/or treatment. The treatments are now varied and effective as compared to 30 years ago. (4) The goal of treatment is to allow the man or the couple to enjoy a satisfactory sexual experience. (5) Its now even easier to get these treatments, you can buy ED medication online from legitimate online pharmacies or buy ED medication over the counter.

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Sexual therapy

If the erectile dysfunction has an underlying cause that is psychological, for example, stress, the couple can undertake therapy together to discuss any sexual or relationship issues that may be a cause of the ED. By talking together about any concerns or anxieties, any stress can be reduced and the ED may be able to be overcome. The therapist will also be able to provide practical advice on, for example, foreplay techniques and the use of other treatments for ED. This type of counselling may take some time to have an effect. It is a good idea, however, to consider non-drug treatments, such as this, firstly, especially if the ED could have an underlying psychological cause.

Prescription treatments

Oral agents are available; these are known as phosphodiesterase inhibitors and are the most widely used and very effective medications. These work by temporarily increasing blood flow to the penis but do not cause an erection on their own, or increase sex drive. Sexual stimulation (foreplay) is required for the onset of an erection. This occurs because blood vessels in the penis relax, allowing increased blood flow to the penis.

There are three medications of this class available in the UK: sildenafil, better known as Viagra; vardenafil, with the brand name Levitra; and tadalafil, brand name Cialis. Sildenafil (the name of the drug) and Viagra (the brand name) are both available. These pills both contain exactly the same drug and work in exactly the same way. Sildenafil is cheaper because the patent on Viagra has expired and so more companies are allowed to manufacture the medication, rather than just the one which developed it. Both are equally effective.

Sildenafil and Vardenafil act on the body for about 4 hours, and are designed to act ‘on demand’, in reaction to sexual stimulation. Tadalafil is the better choice if treatment is required for a longer period of time as its effects last approximately 17 to 18 hours. For all of these, it takes about 30 to 60 minutes for the drug to get into the system and begin working, and for the maximum effect, they should be taken about an hour before the man plans to have sex. These tablets should be taken on an empty stomach as if they are taken with food they will take slightly longer to begin working. Only one tablet can be used in any one 24 hour period. Side effects of viagra and other ED medications occur because of the relaxing of blood vessels in other parts of the body and include headaches, nausea, flushing and indigestion. (7,8) You will not be able to use these medications if you are already on a medication that is a nitrate, for example, glyceryl trinitrate for a condition called angina. There are still many questions you may have for example there’s so many different ED medications, whats the difference? Is Viagra Safe? Is it better to buy viagra online or over the counter? Can you trust an Online Pharmacy?

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Product Description

How does Viagra and Sildenafil work?

Viagra (Sildenafil) helps men to get and maintain an erection when sexually stimulated and/or excited. The medicine relaxes the blood vessels in the penis which results in more blood flowing to the penis when you are sexually excited.

How do I take it?

You should take Viagra (Sildenafil) approximately 1 hour before planning to have intercourse. Within a window of between 30 minutes and 4 hours after you take the medicine, it will be easier to keep and maintain an erection when you are sexually excited. If you take this medicine after a meal with a high fat content it may take a little longer to start working. This medicine will only work when you are sexually excited. You won’t get an erection just by taking Viagra (Sildenafil).

Dosage

The standard recommended dose for Viagra (Sildenafil) is 50mg and this will be suitable for most people.  If this dose is not effective, you can try 100mg and if 50mg gives you side effects you can also reduce the dose to 25mg tablets.

You must not take more than 100mg daily of Sildenafil/ Viagra. Clinical trials have been conducted in patients taking up to 200mg sildenafil and it was found that ‘doses of 200mg did not result in increased efficacy but did increase the incidence of adverse reactions (headache, flushing, dizziness, dyspepsia, nasal congestion, and altered vision).’

In addition, in patients taking more than 100mg daily, there have been reports of rhabdomyolysis (a breakdown in skeletal muscle tissue the byproducts of which can lead to kidney failure), visual perception changes, vertebral artery dissection (a tear in the artery supplying blood to the brain), heart attacks and aggressive behaviour.

If the 100mg strength doesn’t work for you, there may be alternatives you can try and we recommend that you call us for a free consultation with our pharmacist or doctor to discuss any underlying conditions you may have. We recommend that all men taking medicine for erectile dysfunction have regular tests for blood pressure, cholesterol, diabetes and hormone imbalances. For instance, it may be that by fixing a hormone imbalance such as testosterone, your Viagra medication will be even more effective.

In addition, drug manufacturers do not advise patients to split tablets in half to get the correct dosage as they cannot guarantee that the active ingredient will be distributed evenly throughout the tablet.  For instance, if you cut a 100mg tablet in two, you may find that you get 80mg in one half of the tablet and 20mg in the other half leading to either an overdose (increased risk of side effects) or a suboptimal dose (the medication may not work).

It is important that you choose the correct dose for you. If you wish to talk to our pharmacist or doctor about this, please contact us in the pharmacy on 01625 460621 or email [email protected]

Side Effects

Viagra (Sildenafil) is normally well tolerated, however, side effects can include:

  • Headache
  • Dizziness
  • Nausea

Side effects normally subside after a few hours, however, if you experience a prolonged or painful erection (longer than 4 hours), then you must contact your doctor immediately.

Drug interactions

There are a number of medicines which interact with Sildenafil/ Viagra. For an exhaustive list please see the patient information leaflet (see section below) or call us in the pharmacy to discuss your specific situation. The main drug interactions are listed here:

Recreational drugs such as ‘poppers’ or amyl nitrate
Alpha blockers used for urinary retention or blood pressure problems (eg Flomax or Cardura)
Anti- arrhythmic drugs such as disopyramide
Antibiotics such as erythromycin
Antifungals such as itraconazole
Antivirals such as drugs used to treat HIV
Bosentan
Cobicistat
Calcium channel blockers to treat blood pressure and angina such as amlodipine
Dapoxetine (Priligy – used to treat premature ejaculation)
Grapefruit juice**
Nicorandil
Nitrates
Riociguat
Cimetidine (to treat stomach ulcers)

Please do not take Sildenafil/Viagra if you have taken any of the above drugs within the last 60 days without first consulting with either us in the Pharmacy ([email protected] / 01625 460621) or via email with our doctor [email protected]

**We advise not to take Sildenafil/Viagra with grapefruit juice as the blood concentration of Sildenafil will possibly be increased resulting in side effects.

Patient Information Leaflets

Please click here for the patient information leaflet for Viagra.

For Actavis Sildenafil please see the following leaflets: 100mg, 50mg, 25mg.

Storing Medicines Safely

Please keep your medicine out of the reach of children and store at room temperature.  Unwanted medicine can be disposed of by returning it to any local pharmacy or indeed to us here for us to dispose of it for you.

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Vacuum erection devices

Vacuum Erection DeviceWhile these devices may sound scary, they are highly effective in inducing an erection. Satisfaction rates of between 35% to 84% have been gathered in studies on erectile dysfunction. (5) A device will consist of a clear plastic tube connected to a hand or battery activated pump. The penis is placed in the tube and all the air is pumped out. This creates a vacuum which causes blood to flow into the penis causing it to become erect. The man then places a band of rubber around the base of the penis which allows the penis to remain hard for around 30 minutes. While it may take a few attempts to learn how to use the pump correctly, it has been reported that 9 out of 10 men using a vacuum pump gain an erection allowing them to have sex. Side effects reported include local bruising and pain and on occasion, failure to ejaculate, occurring in less than a third of men using the pumps. This technique does require both a motivated patient and a partner that is willing to co-operate. (4)

Alprostadil

This is a second line treatment if you have tried an oral treatment or vacuum pump and they have not worked effectively, or if you are unable to use one of these. (4) This treatment is a man-made hormone-mimicking the natural substance prostaglandin E1. It acts on the body to widen blood vessels and increase blood flow to the penis. This is available as an injection, brand name Viridal, administered directly into the penis or as a small pellet placed inside the urethra, brand name MUSE. For these methods, you will be taught how to use devices by a doctor. It takes about 5 to 15 minutes for an erection to result and this will last for approximately one hour. Side effects may include a burning sensation or pain in the penis.

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Summary

Erectile dysfunction is a condition which is likely to have a negative effect on a man’s quality of life. There is a link between ED and heart disease. Many lifestyle factors can contribute towards both of these conditions, and making positive changes here will help reduce the risk of, and help in the resolution of both. There is a wide range of treatments to suit both the underlying cause of the ED and personal preference. Most commonly used are the oral medications which will cause an erection in response to arousal. Sexual therapy is also important to consider, especially if the cause of the ED is psychological. To conclude, although this can be a scary condition initially, it is important to remember that most men will find a treatment that will work for them, and will regain a happy and healthy sex life.

 

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References

1 Sexual Advice Association http://www.sda.uk.net/ Accessed 16.10.14

2 British Pregnancy Advisory Society http://www.bpas.org/bpasman/erectile-dysfunction Accessed 18.10.14

3 Mayo Foundation for Medical Education and Research http://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/in-depth/erectile-dysfunction/art-20045141?pg=2 Accessed 18.10.14

4 McMahon, C.G., 2014. Clinical perspectives: Erectile Dysfunction. Internal Medicine Journal 44. Accessed on http://onlinelibrary.wiley.com/doi/10.1111/imj.12325/pdf 18.10.14

5 British Society for Sexual Medicine http://www.bssm.org.uk/downloads/BSSM_ED_Management_Guidelines_2009.pdf Accessed 18.10.14

6 NHS Choices http://www.nhs.uk/Conditions/Erectile-dysfunction/Pages/Treatment.aspx Accessed 16.10.14

7 Markou, S. et al, 2004. Vardenafil (Levitra) for erectile dysfunction: a systematic review and meta-analysis of clinical trial reports. International Journal of Impotence Research, 16, 470-478.

8 Bupa http://www.bupa.co.uk/individuals/health-information/directory/e/hi-erectile-dysfunction Accessed 17.10.14

 

Assured Pharmacy is not liable for the currency or accuracy of the information contained in this blog post. For specific information about your personal medical condition, please contact our doctors or pharmacists for advice on [email protected].