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Erectile dysfunction (ED) is incredibly common, with an estimated 40 to 50 per cent of men in the UK experiencing it at some point in their lives. Despite this, a 2024 survey by LloydsPharmacy Online Doctor found that only a third of UK men seek medical help for their condition.
With treatments widely available over the counter and on prescription, and lifestyle changes known to help, community pharmacy teams have an important role to play here. With the right knowledge, they can help men to access treatment and support not only for their ED but also for their overall health and wellbeing.
Stigma and misunderstandings
ED, sometimes referred to as erection problems, is the inability to get or maintain an erection for long enough to have sex.
Although extremely common, misunderstandings, stigma and even shame still surround ED, making it difficult for men to address the problem. “Because of the perceived stigma, many men and women also underestimate how common it is,” says Leon Almashan, lead clinician and men’s health specialist at MansMatters, London.
“Although prevalence increases with age, ED can affect younger men as well, particularly where lifestyle factors such as stress, metabolic disease or hormonal issues are present.”
Stigma might include questioning masculinity, not understanding the causes of ED, and sexual health concerns being seen as ‘taboo topics’ – all of which can negatively impact men’s lives in significant ways and make it difficult for them to access treatment. “One of the biggest misconceptions is that ED is simply a consequence of getting older or that it is purely in the mind,” says Leon.
“In reality, the causes of ED are far broader and symptomatic of what else is going on in a person’s body. An erection depends on healthy blood vessels, nerves, hormones and psychological wellbeing all working together. Problems affecting any of these systems can contribute to ED.”
Causes
Helping sufferers to understand the causes of ED is a great way to tackle stigma and misconceptions. This has to start with addressing what is causing the problem, and this could be a combination of physical and psychological factors.
Physical causes
ED is more common as men get older because of an increased likelihood of underlying disease. Leon points out some of the most common physical causes:
- Cardiovascular disease
- Diabetes
- High blood pressure
- High cholesterol
- Obesity and metabolic syndrome
- Hormonal disorders, including testosterone deficiency
- Certain medications
- Neurological conditions.
Psychological causes
Psychological causes may include:
- Performance anxiety
- Stress
- Anxiety disorders
- Depression
- Relationship difficulties
- Low self-confidence.
A combination of causes
Recognising that psychological and physical causes are intertwined is key for sufferers to understand their ED.
“In many men, physical and psychological factors interact,” says Leon. “For example, a mild physical problem may lead to one unsuccessful sexual experience, creating anxiety that perpetuates the cycle. A thorough assessment is therefore essential to identify and address all contributing factors.”
“An erection depends on healthy blood vessels, nerves, hormones and psychological wellbeing all working together”
Myth busters!
In a world of misinformation, pharmacy teams have a key role to play in helping to bust health myths and stop stigma from spreading.
Leon Almashan, lead clinician and men’s health specialist at MansMatters, London, aims to champion facts when it comes to erectile dysfunction (ED)…
Myth: ED only affects older men.
False. Although erectile dysfunction becomes more common with age, younger men can also be affected. Lifestyle factors, anxiety, obesity, diabetes, hormonal disorders and cardiovascular risk factors can all contribute.
Myth: ED is only a sexual health problem.
False. Erectile dysfunction may be an early warning sign of wider health issues, including cardiovascular disease, diabetes and metabolic syndrome.
ED can provide an opportunity to identify previously unrecognised health problems and address cardiovascular risk factors.
Myth: Masturbation leads to ED.
False. There is no good scientific evidence that masturbation causes erectile dysfunction. There is, however, ongoing research into whether problematic pornography use may be associated with sexual difficulties in some people.
Myth: ED is linked to infertility.
Not necessarily. Erectile dysfunction and male infertility are separate conditions. A man may have healthy sperm production but difficulty achieving or maintaining an erection.
Equally, a man with infertility may have completely normal erectile function. While some medical conditions may contribute to both, one does not automatically cause the other.
Myth: ED is a normal part of ageing.
False. While the likelihood of erectile dysfunction increases with age because medical conditions become more common, ED should never simply be accepted as ‘normal’.
Many underlying causes are treatable, and men experiencing persistent symptoms should seek medical assessment rather than assuming nothing can be done.
Over-the-counter support is available from community pharmacies.
Treatment options
Once the possible causes have been assessed, men can consider the range of treatment options available.
OTC medicines
Medicines called PDE-5 inhibitors aim to increase blood flow to the penis in response to sexual stimulation to help men achieve an erection. They include sildenafil and tadalafil, some brands of which can be purchased in the pharmacy by men over the age of 18 following a pharmacist consultation and assessment of suitability. Other PDE-5 inhibitors require a prescription.
“Anyone with a heart condition or taking medication for a cardiovascular problem should speak to their doctor before using ED treatments to ensure they are safe and appropriate for them,” says Ruth Goss, senior cardiac nurse at the British Heart Foundation.
“Some heart medications, including certain beta-blockers and diuretics, can also contribute to or worsen erectile dysfunction. Other medicines can also interact with medicines that treat ED and can cause problems like very low blood pressure.”
Prescription medicines
PDE-5 inhibitors are available on prescription. Customers may also ask about testosterone replacement therapy, which is also available on prescription. However, it is used to treat confirmed testosterone deficiency and is not a routine treatment for ED in men with normal testosterone levels.
Other treatments
Vacuum pumps are another option. According to the NHS, they work for most men and can be used if medication is not suitable or does not work.
Lifestyle changes
Lifestyle changes can help in many cases. Stopping smoking, reducing alcohol consumption, getting more exercise and eating a healthy diet can all help.
For men who are overweight, weight loss can improve cardiovascular health and may improve erectile function too.
From a psychological standpoint, managing stress, anxiety and other mental health concerns also plays an important role.
Further treatment
Some private clinics offer non-surgical approaches, including focused shockwave therapy, electromagnetic transduction therapy (EMTT), functional magnetic stimulation, NanoVi Exo and E-Shot/photoactivation.
Evidence for these approaches varies, and they are not all established treatments within NHS clinical pathways.
“There can then be a gap when first-line treatments are no longer effective, leaving some men considering whether to pursue further treatment or accept their symptoms,” says Leon.
“For men with severe erectile dysfunction who do not respond to, or cannot use, other treatments, penile implant surgery is one specialist option.” For more information, visit mansmatters.co.uk
Red flags and referral
“ED can sometimes be an early warning sign of underlying heart and circulatory disease,” says Ruth.
“The same process that leads to heart attacks and strokes, known as atherosclerosis, causes arteries to become narrowed and hardened by fatty deposits. This can reduce blood flow throughout the body, including to the penis, making it more difficult to achieve or maintain an erection.”
Men with persistent ED should be referred to their GP or sexual health clinic for medical assessment.
New chest pain requires urgent medical attention, while changes in urinary symptoms should prompt appropriate medical assessment.
Pharmacy teams can use ED discussions with customers as an opportunity to open up wider health conversations.
You can also signpost customers to further support:
- British Heart Foundation: bhf.org.uk
- Men’s Health Forum: menshealthforum.org.uk
- British Association of Counselling and Psychotherapy (BACP): bacp.co.uk
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