Treatment options

Treatment for ED can depend on the cause, and some men may benefit from trying out lifestyle changes before exploring medical solutions.

Lifestyle measures 

Lifestyle changes that may help men suffering from ED include: 

• Losing weight if overweight 
• Stopping smoking 
• Eating a healthy diet
• Taking moderate daily exercise 
• Trying to reduce stress and anxiety 
• Avoiding cycling for a while if cycling for more than three hours a week 
• Not drinking more than 14 units of alcohol a week. 

OTC medicines 

Oral medication is usually the first-line treatment for ED when lifestyle changes are ineffective. Sildenafil (e.g. Viagra Connect Melts, Viagra Connect Tablets) and tadalafil (e.g. Avarante, Cialis Together) are available OTC in pharmacies and have proved to be very effective.

However, they are not suitable for everyone, and there are restrictions on who can purchase them OTC. 

The main concerns about safety relate to people who have had recent cardiovascular events, such as a heart attack or stroke, and use of nitrate drugs for angina.

If deemed suitable, no more than one tablet should be taken per day, around one hour to 30 minutes before sexual activity. 

Most side effects are mild or moderate and of short duration. The most common are headache (experienced by around 10 per cent of sildenafil users) and indigestion.

Nausea, stuffy nose, dizziness, facial flushing, hot flush, colour tinge to vision, blurred vision and visual disturbance are also sometimes experienced. Customers should seek medical attention if a sudden decrease or loss of vision occurs. 

Enquiries for OTC medication provide a good opportunity to offer information on the lifestyle changes outlined above, since these can help in the management of ED.

Customers should be advised to see their GP within six months of purchasing an OTC product for a follow-up. 

Herbal remedies 

Customers should be advised not to take unlicensed herbal remedies for ED. The UK medicines regulator, the MHRA, has warned that these may contain substances that may be contraindicated or interact with prescribed medication. Some have also been found to contain sildenafil or tadalafil. 

Other options

Treatments such as injections, pellets, topical gels (e.g. Eroxon), vacuum devices, testosterone replacement therapy, surgically implanted devices and prescribed tablet medications are also available. These options can be discussed with a pharmacist or GP. 

Therapy 

If ED is caused by anxiety and depression, customers may find counselling and cognitive behavioural therapy (CBT) useful. Sex therapy is considered effective in addressing causes of ED and can be used in combination with other forms of treatment.

This is a talking therapy where an individual or couple work with a therapist to assess and treat their sexual and/or relationship problems. There is usually a long wait for these services on the NHS, but they are also available privately.