Oral medication is usually the first-line treatment for ED when lifestyle changes are ineffective. Sildenafil tablets (e.g., Viagra Connect) are now available over-the-counter (OTC) in pharmacies and have proved to be very effective. However, they are not suitable for everyone, and there are many restrictions on who can purchase sildenafil OTC. The main concerns about safety relate to use in those with recent cardiovascular disease events, such as myocardial infarction or stroke, and the concurrent use of nitrate drugs for angina. 

If deemed suitable, no more than one 50mg dose of sildenafil should be taken per day. It should usually be taken around one hour before sexual activity. 

Most side effects are mild or moderate and of short duration. The most common are headache, which may affect more than one in 10 men, and indigestion. Nausea, stuffy nose, dizziness, facial flushing, hot flush, colour tinge to vision, blurred vision, and visual disturbance are also seen. Advise customers to seek medical attention if a sudden decrease or loss of vision occurs.

Enquiries for sildenafil provide a good opportunity to offer information on the lifestyle changes as outlined above, since these can all help in the management of ED. Customers should be advised to see their GP within six months of purchasing sildenafil OTC for a follow-up. 

Men should be advised not to take unlicensed herbal remedies for ED, as the MHRA has warned these can contain drug substances that may be contraindicated or interact with prescribed medication. Some have been found to contain sildenafil. 

Treatments such as injections, pellets, topical creams, vacuum devices, testosterone replacement therapies and surgically implanted devices are also available, depending on the cause of the ED, and other tablets are available on prescription. These options can all be discussed with a GP. 

If ED is caused by anxiety and depression, individuals may find counselling and cognitive behavioural therapy (CBT) useful. 

Sex therapy is considered effective in addressing the main causes and contributing factors of sexual difficulties and can be used in combination with other forms of treatment. It’s a talking therapy where an individual or couple work with a therapist to assess and treat their sexual and/or relationship problems. There’s usually a long wait for these services on the NHS, but they are also available privately.