Back in the day, when A&E waiting lists were not too long - OK, this was 15 years ago - I saw a man who refused to tell the triage nurse what his problem was. He insisted he had to see a doctor, he needed urgent help so I saw him immediately.

He then told me he'd spent the night with his new girlfriend and had failed to get an erection. When she fell asleep, he'd snuck out and come to A&E, thinking we could help him.

As you might imagine, he was discharged with a quick lecture on wasting NHS resources and certainly no treatment.

I hadn't given this much thought until last week when I spoke to a friend, Dr David Weinstein, an NHS GP specialising in men's health: erectile dysfunction, low libido and low testosterone.

'Did you not ask him about his overall health?' he chastised me.

David went on to explain that erectile dysfunction is the 'canary in the coal mine' for cardiovascular disease, because it is so often the first sign of other illness, including heart attack and stroke.

Although I am not suggesting anyone who can't get an erection should come to A&E, there is no doubt that our views on men's sexual health are changing. Poor circulation (whether as a result of diabetes, poor diet, smoking, high blood pressure or being overweight) is one of the main causes of erectile dysfunction as well as the cause of heart attack and stroke - hence the link.

Erectile dysfunction might also be linked to irritable bowel syndrome, according to a recent study in the journal Sexual Medicine.

It showed a strong link between the two conditions - whether this is a direct link or 비아그라100mg a common underlying cause, such as anxiety, has yet to be proven.




What's the solution to erectile dysfunction? There's been a lot of talk about men needing testosterone therapy as levels naturally decline with age

So yes, erectile dysfunction is a bigger deal than we used to think. It can reflect your general health and shouldn't be kept hidden.

But what's the solution? There's been a lot of talk about men needing testosterone therapy as levels naturally decline with age.

But another study, published in the journal Proceedings of the Royal Society B: Biological Sciences a few weeks ago, confirms it's not that simple.

For the study, 41 men recorded their feelings of sexual arousal and desire, and their testosterone levels were measured from sputum samples. What was surprising to me is that if the man's testosterone level was above a certain threshold, 비아그라 효과 it didn't matter whether his level was high or 비아그라100mg low compared with other men in terms of his libido. Not being an expert in this area, I relied on David Weinstein to explain.

'This evidence proves what we knew,' he told me.

'When a man comes to see me and complains of feeling tired all the time, unable to get erections or with low libido, one of the key

things to do is check their testosterone levels. But in many cases the levels are OK, so boosting the levels will not work for erectile dysfunction, for 정품 비아그라 example. We need to look at other factors.

'This includes their cholesterol, HbA1C [i.e. blood sugar levels], blood pressure - and also assessing their lifestyle.

'Lack of erections often causes the low libido - it is not always the other way round,' he explains.

'Crucially we need to look at overall wellbeing and mental health - and take a holistic approach to treatment, managing their lifestyle risk factors such as diet, as well as anxiety.'



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It's only then that a doctor should consider medication for erectile dysfunction, he adds. That, of course, includes drugs such as Viagra that work by opening up blood vessels in the penis.

Topical gels are also being used. Eroxon is a penile gel (available over the counter at pharmacies) which creates a cooling and warming sensation that stimulates blood flow - research suggests it can work in up to 60 per cent of patients.

If not, another new, and novel treatment is low-intensity shockwave therapy - essentially sound waves are blasted at tissue.

This has been shown to help other conditions such as inflamed tendons in tennis elbow.

With erectile dysfunction it seems the sound waves can remodel damaged blood vessels, improve blood flow to the penis and rejuvenate erectile tissue.

A study published in the journal Andrologia in 2022 showed that after weekly treatment for a month, patients had significantly stronger erections than men given a placebo treatment. This effect lasted at least six months.

There are other more cutting-edge therapies which may be useful in future.

One example is injections of platelet-rich plasma (PRP), which is packed with natural growth factors and are often used by sportsmen after injury. These are being trialled for erectile dysfunction and results from a study by the University of Manitoba in Canada, involving 660 patients, are expected at the end of the year.

Stem cell therapy - where cells from the bone marrow are implanted into damaged tissue - also has potential. In a few years' time, it may have moved from the lab to the treatment room.




Eroxon is a penile gel (available over the counter at pharmacies) which creates a cooling and warming sensation that stimulates blood flow

Some supplements such as L-arginine and L-citrulline may help, because they increase blood flow in the same way Viagra does - boosting levels of a natural compound, nitric oxide, that widens the blood vessels.

Research published in the journal Urology in 2011 showed that L-citrulline supplements improved the symptoms of erectile dysfunction of 24 men significantly more than a placebo.

But anything else you might have read about on the internet, such as vitamin this or that, salt injections or bicarbonate of soda, I would avoid.

That there is a huge market for such products online is no doubt largely due to shyness about raising this issue. And we need to get men to talk about their sexual wellbeing with proper experts.

That's where people such as David Weinstein can help - having the time and expertise to go through the issues and make a real difference to people's lives.

While I haven't seen another erectile dysfunction 'emergency' in A&E again, with my male patients - and where appropriate - I've now started asking them about their sexual health. Because it could be a signpost to their general health, and crucially they need to know how important it is to get a medical review.

So if this is you or 정품 비아그라 your partner, do seek help - not only will it help with your sex life but could be a life saver.

@drrobgalloway


NHS