Pharmacy has long wrestled with how to get men talking about their health. Could the Viagra Connect POM to P switch help this neglected demographic access much-needed support?

It’s a common complaint among healthcare professionals of all stripes: that men are reluctant to come forward to discuss conditions affecting their health and wellbeing. Some men may perceive asking for help as a sign of weakness, some may have a tendency to downplay symptoms, while others are less likely to walk through a pharmacy’s doors in the first place.

One subject that men may be particularly hesitant to open up about is sexual issues, like erectile dysfunction (ED). For most men who experience ED, it is a temporary condition, but erection difficulties of any kind can knock a man’s confidence. For many men, the ability to get and maintain an erection is closely bound up with their sense of masculinity.

There are hopes that a recent change in medicines policy – the reclassification of Viagra (sildenafil) as an over-the-counter pharmacy (P) medicine – will chip away at some of the barriers that prevent men from seeking help.

Increasing access, raising awareness

Amid a busy year for POM to P switches (reclassifications for antimalarial Maloff, rhinitis drug Nasonex and psoriasis treatment Dovonex were also approved), the Medicines and Healthcare products Regulatory Agency’s (MHRA) announcement of the sildenafil switch in late 2017 was undoubtedly the most high profile, attracting high levels of media attention.

The Royal Pharmaceutical Society welcomed the November announcement, saying that providing in-depth advice on the benefits and risks of particular medicines is an “integral part of the role of a pharmacist,” and that the switch would increase access to a drug that “has been proven to be safe and effective when used appropriately”.

Mick Foy, group manager for MHRA’s vigilance and risk management of medicines division, describes the decision as “good news for men’s health” and says it would raise awareness of the condition. “Erectile dysfunction can be a debilitating condition, so it’s important men feel they have fast access to quality and legitimate care, and do not feel they need to turn to counterfeit online supplies, which could have potentially serious side effects,” he says.

Dr David Edwards, a GP with a special interest in sexual dysfunction and a past president of the British Society of Sexual Medicine, says: “In my clinical experience a man’s ability to attain and maintain an erection is of paramount importance to him.

“When erection difficulties do occur, emotional and physical closeness between a man and his partner can diminish, leaving a man with a sense of isolation and lacking confidence in day-to-day life. A new initiative that enables men to go to a pharmacy to get help for their erectile dysfunction is welcome.”

Navigating the launch

Following the spring launch, men who wish to buy Viagra Connect will be able to do so following a consultation with a pharmacist who has judged the medicine to be appropriate and explained that the patient may experience certain side effects, such as headache, flushing and nasal congestion. If necessary, pharmacists should suggest that the customer sees their GP before progressing to treatment with sildenafil (manufacturer Pfizer also recommends that all patients follow up with their doctor within six months of first receiving the medicine).

The medicine cannot be sold to men with severe cardiovascular disorders or a high risk of developing heart disease, to men with liver failure or to those taking certain medicines that can interact with sildenafi.

All this might make it seem like Viagra sales will be tricky for pharmacy teams to navigate, but Bristol pharmacist Sadik Al-Hassan says the launch builds on skills that community pharmacy has already fi ne tuned: “Pharmacists have always been very good at having confidential conversations with patients on matters of sexual health. In terms of the soft skills that are needed, I think pharmacy teams are already there. They are able to have sexual health-related conversations; to anyone who’s offered chlamydia screening or treatment, having conversations around sildenafi should be easy.”

To support pharmacy teams, Pfi zer is providing face-to-face, print and digital training. Pfizer medical manager Kristie Sourial says that in addition to training for pharmacists, “tailored educational content will also be provided for pharmacy assistants, who may be the first point of contact for men presenting to the pharmacy seeking help for the symptoms of erectile dysfunction.”

All training has been “developed to ensure that pharmacists and pharmacy assistants sensitively broach and respond to the subject of erectile dysfunction with men, and remove any perceived embarrassment for the customer,” Kristie adds.

ED under the spotlight

Occasional difficulty in getting or maintaining an erection is nothing to worry about for most men. It can be caused by everyday stress and anxiety, and for some it can accompany life events such as the birth of a child, or it can be caused by something as simple as having overindulged in alcohol.

But when erection difficulties occur regularly, it’s worth getting a healthcare professional involved. This could indicate emotional issues such as relationship problems, or an underlying physical problem, such as heart disease, which can reduce blood flow. High blood pressure, diabetes, hormonal problems and medication side effects are other potential culprits.

Age is an important factor, and it’s important for men to realise that some loss of libido and erectile hardness is normal as they get older. The Massachusetts Male Ageing Study found that 52 per cent of men aged 40-70 were affected to some degree, with 10 per cent of cases described as severe.

Treatment for ED can depend on the cause, and some men may benefit from trying out lifestyle changes such as quitting smoking and getting daily exercise before exploring medical solutions.

If hormonal issues are to blame, testosterone replacement may be an effective solution. Licensed medicines such as sildenafi l are another solution, and may attract greater interest with the launch of Viagra Connect.

Benefits for pharmacy

Pharmacist Sadik thinks the launch could be “a great gateway opportunity for pharmacy”, in part due to how it can spark conversations around healthy lifestyle, a key focus for many pharmacies with the growth of the healthy living pharmacy initiative. Sadik says: “Some of the causes of ED can be helped by losing weight, giving up smoking, cutting back on alcohol and stopping the use of recreational drugs.”

Kristie adds that it could make men seek treatment sooner: “Research indicates that 40 per cent of men with erectile dysfunction do not seek help from a healthcare professional; we believe that the availability of Viagra Connect in pharmacies could help facilitate earlier presentation of these men to a pharmacist.”

Tact and sensitivity

Sadik advises pharmacies to think strategically about how they can position themselves as a natural first port of call for ED treatment: “I think it’s going to be a very good idea for pharmacies to think about how they’re going to promote this and make sure people with ED think of pharmacy – especially for those who are reluctant to see a GP.”

For Kristie, it’s about finding opportunities to raise the topic in a tactful way: “As men may initially be hesitant to raise the issue of erectile dysfunction, pharmacists can help by sensitively raising the topic during general health discussions if erectile dysfunction is suspected, especially within private consultation rooms.”

Kristie also has advice on drawing customers’ attention to the pharmacy’s offering: “Strategically placed patient information materials will provide encouragement to men who are considering raising the subject of erectile dysfunction with pharmacy staff. Placing such items near popular men’s health and hygiene products, such as razors, shaving cream, condoms or men’s deodorant, can provide men with a prompt to head to the counter and help start the conversation.

“Additionally, communicating the availability of private consultation rooms can help men to see pharmacies as a suitable place in which to raise the topic of erectile dysfunction.”

Better options

Of course, it’s not just pharmacies that stand to benefit from the Viagra launch. As Sadik points out, giving men access to sildenafil in pharmacies could reduce counterfeit sales, or stop men reaching for alternative products with unproven efficacy. Sadik says these “may not help patients, and may even be harmful to them”. Illegitimate ED remedies are a key focus of MHRA efforts to crack down on the sale of falsified, unlicensed and counterfeit medicines online.

And as Kristie points out, getting more men into pharmacies could open up the playing fi eld to discuss a range of issues: “By being able to sensitively address the subject, pharmacists can empower men to treat the symptoms of their erectile dysfunction and give them the confidence to seek health advice from their pharmacist and other healthcare professionals in the future.

“Giving men the option to buy Viagra Connect from a pharmacy could be a real step forward to encourage more men into the healthcare system.”

Surviving life with a Y chromosome

Men are prone to many of the same health concerns as women – as well as a few male-specific ones, like ED. Here’s a look at some of the more common queries male customers present with, and how pharmacy teams can offer a high quality service.

Sport & fitness

It’s always a positive sign when someone takes up or renews an interest in exercise. However, those who have been out of the game for a while may benefit from some pointers on safe exercise and injury prevention. Failure to warm up and cool down properly, using incorrect technique and overdoing it can all increase the likelihood of an injury that could put budding athletes out of action, so it’s worth covering these points with customers embarking on a new regimen.

If someone does sustain a minor injury such as a sprain or strain, PRICE therapy – protection, rest, ice, compression and elevation – along with overthe- counter remedies is often sufficient to treat the problem. If that doesn’t work, or if you suspect the customer’s condition is more serious, you can recommend they speak to the pharmacist.

Bladder weakness

Like ED, bladder weakness is often an age-related condition that many people feel embarrassed to talk about. Sufferers may take heart from hearing that far from being alone, this is a fact of life for many – and that help is available in pharmacy

Men may have stress incontinence (causes of which include prostate surgery or taking certain medications), urge incontinence or overflow incontinence (both of which can be caused by an obstruction of the bladder, such as an enlarged prostate, or by constipation).

This is another area where tact and sensitivity are paramount. Pharmacy teams should do all they can to maintain the customer’s dignity while guiding them towards an effective solution.

Some of the causes of ED can be helped by losing weight, giving up smoking, cutting back on alcohol and stopping the use of recreational drugs

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