Travel Sickness

Erectile dysfunction (ED) is when a man either can’t get an erection or can’t maintain it long
enough to have penetrative sex with a partner and it is a persistent problem. It’s common,
affecting around half of men between the ages of 40-70[1] and can be distressing.
Fortunately, a number of effective treatments exist to help and are available to purchase
here, following a free assessment by our doctors to see if these medicines are suitable for

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Information about Travel Sickness

ED has a variety of causes. For example, it can be a sign of more serious problems with your heart or blood vessels, diabetes or hormone levels, particularly if you are over 40 years old. Choosing the right treatment depends on the cause. If you haven’t previously seen a doctor about your ED, or it is a new problem, we recommend you book an appointment with your GP as a physical examination and tests may be required. The earlier any issues are detected, the more opportunity there is to improve your health for the future. During sexual arousal, nerves carry messages from the brain to the penis which causes blood vessels in the penis to relax (widen). This in turn causes more blood to flow into the penis and creates an erection. Causes of ED include: Problems with the blood vessels – factors which increase the risk of heart disease (obesity, smoking, high cholesterol, age, diabetes) also contribute to ED, however the blood vessels of the penis are smaller than those in the heart, so ED may be an early warning sign of heart disease. Problems with the nerves – diseases that affect the transmission of nerve signals from the brain to the penis can cause erectile dysfunction. For example: multiple sclerosis, spinal cord injury, damage due to diabetes. Cycling for more than 3 hours per week has been associated with ED due to pressure on the nerves. This is usually reversible (the nerves recover) over a few weeks after stopping cycling. Problems with the penis itself – deformities of the penis such as a very tight foreskin, or a condition called Peyronie’s disease can cause ED Psychological problems and relationship issues – anxiety, depression and stress can all cause ED. Relationship issues – performance anxiety with an unfamiliar partner, no longer being attracted to your partner, tiredness can all affect sexual desire, performance and the ability to get an erection. If a man is getting early morning erections as normal and is able to get an erection for masturbation, psychological or relationship issues are a more likely cause of the ED. For more advice on psychological or relationship issues leading to problems with sex, see here (link to sexual advice association). Sometimes, even when performance anxiety or stress is the root cause of the ED, it may be appropriate to use medication to achieve an erection as this can allow men to regain their confidence and feel better about themselves. Hormonal problems – low levels of the male hormone testosterone along with other hormone imbalances can cause ED, often along with other symptoms such as a reduced sex-drive. Drugs – Some medications affect sex drive and the ability to get an erection. For a list, see here. If you are experiencing ED while taking any of these medications, we recommend speaking to your doctor. The consumption of alcohol can cause difficulty getting an erection v. This may be a one-off related to a bout of heavy drinking. However, regular consumption of high levels of alcohol has a range of affects on the body that includes altering hormone levels. This can cause persistent ED
Lifestyle measures: Losing weight, stopping smoking and increasing exercise can be enough to improve ED alone with the added benefits of improving general health and reducing your risk of heart disease, cancer and diabetes. If cycling has contributed to your ED, switching to an alternative form of exercise may be worthwhile. Psychological treatment: If psychological causes are at the root of your ED, it makes sense to address these in order to improve your sex life as well as your overall well-being. Identifying the problem, whether its stress at work, personal or relationship issues, is the first step to tackling them. Self-help books and various forms of counselling are available to help you work through these issues either alone or with a partner. Medication: Millions of men worldwide have used medication to help them achieve an erection. The medication works by helping to relax the blood vessels of the penis to increase blood flow. The medicines differ in the time it takes for them to work, how long their effects last and their side effects. Our doctors can help advise which one may be right for you and see our table comparing the main features of each medicine (here). These medicines will not cause an erection on their own, they work together with the body’s normal processes. When you become sexually aroused these medicines temporarily boost the normal increase in blood flow to the penis so that a more satisfactory erection is achieved and maintained. These medicines are unlikely to work without sexual arousal. Medicines for injection: Medicines are available that need to be injected into the penis to cause erection. These are not available to purchase from this website. Devices: Specially designed vacuum pumps can be placed over the penis to generate an erection, which is then maintained by a constriction ring around the base. They cannot be used in men with bleeding disorders or on anticoagulant medication Surgery: If deformities of the penis such as a tight foreskin or Peyronie’s disease are contributing to ED, these may be corrected by surgery.
There is a potentially FATAL reaction between a group of medicines called ‘nitrates’ and ED medication. Anyone taking nitrates should speak to a doctor before considering ED medication. Nitrates are usually prescribed to treat heart conditions such as angina (heart related chest pain). The recreational drug amyl nitrate, otherwise known as ‘poppers’, is also a classed as a nitrate. The following list includes some nitrates prescribed in the UK. If you are unsure you must check with a doctor first • Glyceryl trinitrate or GTN. This can be in the form of a spray, gel, patch or cream to treat angina. It is also used to treat piles (Rectogesic). • Isosorbide mononitrate (ISMN) • Isosorbide dinitrate • Nicorandil • Amyl nitrate (poppers) Other reasons NOT to use ED of medicines include: People for whom sexual activity is inadvisable Having a previous history of an eye condition called non-arteritic anterior ischaemic optic neuropathy (NAION). If you experience sudden loss of vision in one eye while taking ED medication you should stop immediately and consult a doctor straight away. If you have recently had a stroke, heart attack or unstable angina (chest pain at rest) If you have low blood pressure (systolic blood pressure below 90 mmHg)
Published research suggests that these medicines will work for most men, however up to one quarter will not get the desired effect. It can be a simple case of needing to adjust the dose. Advice is to try 8 times at the maximum dose for you with sexual stimulation before you give up. Sometimes switching to a different medication offered here can resolve things. If you find this is affecting you, one of our doctors, or your own GP, will be more than happy to discuss this with you to find a way forward.
Common side effects include • Headache • Flushing • Dyspepsia (heartburn) • Rhinitis (nasal congestion) • Dizziness • Back pain • Disturbance of vision. STOP using the drug if a sudden deterioration in vision occurs. Rare but serious side effects that have been reported include: • Major allergic reactions • Priapism (painful condition where an erection is prolonged for more than 4 hours and requires medical treatment) • Serious problems with the heart • Fainting • Problems with hearing and vision. Please see the patient information leaflet for the full list of side-effects. If you are concerned about side-effects, please discuss with a doctor.
Generic Sildenafil is available on the NHS. Branded Viagra and other medications for erectile dysfunction are only available on private prescription.

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