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module menu icon Understanding the issue

Understanding the issue

There are both physical and psychological causes of ED and most men will experience a combination of these causes, with one type affecting the other and vice versa. 

When to refer

  • Anyone under 18 years of age
  • Anyone taking any other medication
  • If they have had a stroke or heart attack in the last six months 
  • If they have any other medical conditions – e.g., sickle cell anaemia stomach ulcers
  • Those taking other medication for erectile dysfunction 
  • Any concerns about heart health, physical fitness or breathlessness
  • If they are uncertain of their diagnosis or describing symptoms of premature ejaculation
  • If the customer answers 'yes' to any questions on the Viagra Connect Pharmacy Checklist. 

Remember

  • Many people find it embarrassing to talk about sexual health so try and put them at ease by offering privacy and having a non-judgemental approach
  • Think about what you say and how you say it. Tone of voice and gestures are as important as the words you use
  • Explain why you require information to avoid them feeling defensive or intruded upon, for example by saying: “I need to ask you some questions to make sure this is going to be the right thing for you”
  • Remember to protect confidentiality
  • Highlight the risks of buying drugs over the internet and encourage customers to always visit a pharmacy to purchase them safely. 

Causes

Men whose ED is due to a physical cause often experience a gradual onset of erectile problems. These physical causes can include:

  • Cardiovascular disease (CVD) 
  • Diabetes
  • Raised blood pressure (hypertension)
  • Hormone problems
  • Drinking alcohol
  • Smoking
  • Lack of exercise
  • Using illicit drugs
  • Some prescription medicines – e.g., some diuretics, antidepressants and hormone modifying drugs. 

ED can be an early warning sign of future cardiovascular problems, appearing up to five years before a cardiovascular event, such as a stroke or heart attack. Future heart problems may be prevented if treatment for ED is undertaken soon after symptoms start, particularly if lifestyle changes are undertaken. 

A psychological cause is more likely if a man has erection problems some of the time. This can include: 

  • Performance anxiety and the fear that ED will keep occurring
  • Depression – ED may be a symptom of depression. The emotional stress commonly associated with loss of sexual function may also lead to, or aggravate, depression
  • Lack of arousal and/or inhibition, e.g., premature ejaculation
  • Major life stress such as money worries or a bereavement.

Typically, ED develops quite suddenly if it has a psychological cause. It may resolve when the person’s mental state improves – for example, if their anxiety or depression eases. For some men, ED can exacerbate such conditions, leading to a vicious circle of a worsening mental health issue and persisting ED. 

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