ED is the inability to attain and/or maintain an erection sufficient for sexual performance2

Projected 8 million 

men in the UK experienced ED in 20213

What causes ED?

The incidence and severity of ED both increase with age and the presence of comorbidities.4 In fact, 90% of people with ED have at least one underlying physical cause.5 However, ED can also be caused by psychological problems, substance abuse, or even some medications.5,6

Physical
causes

• Cardiovascular disease (CVD)5
• Diabetes5,6
• Hormone problems5,6
• Hypertension2

Psychological causes

• Stress6
• Depression6
• Anxiety5,6

Medical and recreational drugs

• Some medicines (e.g. antihypertensives, antipsychotics, antidepressants)5
• Substance abuse (e.g. heroin, cocaine, methadone)5
• Excessive alcohol consumption6

Erections aren’t the only things affected by ED1

192% increase in risk of depression

in people with ED vs those without8

>8 in 10 partners

of people with ED felt sexually dissatisfied9

>2-fold increase in work absenteeism

in people with ED vs those without (7% vs 3%, respectively; P<0.001)10

Up to 25% of men

are affected by performance anxiety,11 which can trigger or maintain ED2

Some helpful lifestyle changes

ED can be an early warning sign of a serious health condition, such as CVD, hypertension or diabetes.2,12

The presentation of ED is an opportunity to address modifiable risk factors, which can not only reduce the risk of these associated conditions, but also improve erectile function.2,12

So, alongside ED treatment, you may want to recommend some lifestyle changes to your patients,2 which could include:

Cognitive behavioural therapy and mindfulness

have been recommended for reducing sexual performance anxiety that may be triggering or maintaining ED11

Reducing alcohol consumption

Excessive alcohol consumption can cause ED, and limiting consumption to less than 14 units per week can help with ED6

Smoking cessation

improved erectile function by up to 57% in people with ED13

Prospective observational study evaluating the effects of smoking on the sexual functions of men.13

Weekly exercise

of 160 minutes for 6 months contributed to decreased erectile problems14

Systematic review of intervention studies investigating physical activity as a possible treatment of ED.14

Weight loss

contributed to restored erectile function in one third of obese men15

Randomised controlled trial investigating the effect of weight loss and physical activity on erectile and endothelial functions.15

Addressing substance abuse

Substance abuse doubled the incidence of ED vs people with no history of substance abuse16

Observational study investigating how substance abuse effects erectile response in men with a history of previous addictive substance abuse.16

All men seeking ED treatment in your pharmacy should be advised to see their GP within 6 months for a clinical review of potential underlying conditions and risk factors associated with ED.

The British Society for Sexual Medicine recommend examining testosterone levels, HbA1c, lipid profile and blood pressure, which their GP should be able to perform.2

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    Abbreviations:
    CVD, cardiovascular disease; ED, erectile dysfunction; GP, general practitioner; HbA1c, glycated haemoglobin.

    References:

    1. Elterman DS et al. Res Rep Urol 2021; 13: 79–86.
    2. Hackett G et al. J Sex Med 2018; 15(4): 430–457.
    3. Estimated from the Office for National Statistics (ONS) 2021 UK population data and Irrational quantitative survey 2021, where 3,445 (i.e. 34%) of 10,197 adult men qualified or identified as suffering from Erectile Dysfunction.
    4. Li HJ et al. Asian J Androl 2016; 18(5): 773–779.
    5. The British Association of Urological Surgeons. Patients: I think I might have… Erectile Dysfunction (impotence). Available at https://www.baus.org.uk/patients/conditions/3/erectile_dysfunction_impotence. Accessed: May 2023.
    6. NHS. Erectile dysfunction (impotence). July 2023. Available at https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/. Accessed: May 2023.
    7. Gil N. Erectile dysfunction: two women on what it did to their sex lives. 2019. Available at www.refinery29.com/en-gb/2019/04/227131/partner-has-erectile-dysfunction. Accessed: May 2023.
    8. Liu Q et al. J Sex Med 2018; 15(8): 1073–1082.
    9. Wagner G et al. Int J Impot Res 2000; 12(Suppl 4): S144–146.
    10. Goldstein I et al. Int J Clin Med 2021; 73(11): e13384.
    11. Pyke R. Sex Med Rev 2020; 8(2): 183–190.
    12. Yannas D et al. J Clin Med 2021; 10(10): 2221.
    13. Sahin MO et al. Int Braz J Urol 2020; 46(4): 642–648.
    14. Gerbild H et al. Sex Med 2018; 6(2): 75–89.
    15. Esposito K et al. JAMA 2004; 291(24): 2978–2982.
    16. Del Río F, Cabello F and Fernández I. Int J Health Psychol 2015; 15(1): 37–43.

    Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme website www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.