Erectile dysfunction, Viagra and your heart

What is erectile dysfunction and what causes it?

Erectile dysfunction (ED), or impotence, is when a man has difficulty getting or maintaining an erection for sexual intercourse or other sexual activity.

It can be caused by stress, anxiety or excessive alcohol consumption, but it can also be a symptom of an underlying health condition and a sign you are at increased risk of a heart attack.

How is erectile dysfunction connected to heart disease?

Erectile dysfunction can be warning sign of atherosclerosis, the build-up of fatty material (atheroma) inside your arteries. This causes them to harden and narrow, making it difficult for blood to flow through them.

During an erection, the arteries to the penis dilate to allow more blood to flow in, causing it to swell. But if arteries in the body are affected by atherosclerosis, this causes a reduction in the blood flow, including to the penis.

Atherosclerosis increases your risk of heart attack and stroke. It can be caused by factors including high cholesterol, high blood pressure and diabetes, while smoking, age, drinking excessively, being overweight and having an unhealthy diet, along with a family history, increase your chances of developing it.

Because the arteries in the penis are so narrow, erectile problems can be one of the first warning signs.

So if you’re experiencing problems with erectile dysfunction, book an appointment with your doctor, who will assess you to try to establish the cause and may refer you for tests.

Can erectile dysfunction be a side effect of medicines for my heart?

While high blood pressure can contribute to erectile dysfunction, beta-blockers and diuretics - the medicines used to treat it - as well as heart conditions such as heart failure can also worsen the problem. This is because they can decrease blood flow to the penis.

However, there is limited evidence about the impact of statins - taken to manage high cholesterol – on erectile function.

Some studies suggest these medicines can reduce testosterone, potentially worsening erectile dysfunction, but by helping to reduce blocked arteries, statins may also help men to maintain erections.

What is the treatment for erectile dysfunction?

Medicines known as PDE5 inhibitors can help two-thirds of men with erectile dysfunction. These include Viagra (sildenafil), Cialis (tadalafil) and Levitra (vardenafil).

You may need to take several doses over time before they work properly and you may need to adjust the dose. If you have an existing cardiovascular disease or are on any medicines, speak to your doctor before taking any of these.

Side effects of PDE5 inhibitors such as Viagra may include indigestion and headache, and sometimes muscle aches, flushing, lower-back pain and rhinitis (a runny nose).

Another erectile dysfunction treatment is a hormone called alprostadil, which is applied as an injection or a pellet placed inside the man’s urethra (the tube that travels through the penis).

A non-drug treatment is a vacuum pump – this may take some practice but is usually effective.

Can I take Viagra if I am taking heart medications?

Do not take any medicine for erectile dysfunction without first discussing it with your doctor. You can be prescribed PDE5 inhibitors like Viagra from 6 months after a heart attack, providing your condition is stable.

While PDE5 inhibitors can be taken with most medicines for your heart, they cannot be used with nitrates (GTN) or nicorandil, which are used to treat angina.

This is because the combination of the 2 can make your blood pressure drop to a dangerously low level.

You should leave at least 12 hours between taking a PDE5 inhibitor and using your GTN spray, or if you take nitrate tablets, allow at least 24 hours (48 hours for Cialis).

PDE5 inhibitors such as Viagra are not recommended for people with low blood pressure either, as they dilate the arteries, making the blood pressure even lower.

Do you need a prescription to get Viagra?

Branded Viagra can be bought over the counter in pharmacies, but please check with your GP first if you have a medical condition.

It's important to use a reputable pharmacy, as there is a large market in counterfeit drugs for erectile dysfunction, especially over the internet. These contain varying amounts of the active ingredient and are sometimes completely different drugs.

Bear in mind that if you are over 60, you are entitled to free prescriptions on the NHS in England. You are also entitled to free prescriptions if you are younger but have diabetes that is managed using medication, providing you apply for a Medical Exemption Certificate through your GP.

Prescriptions are free for everyone in Wales, Scotland and Northern Ireland.

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