Home' Australian Pharmacist : Australian Pharmacist November 2016 Contents Australian Pharmacist November 2016 I ©Pharmaceutical Society of Australia Ltd.
Men are shopping online for erectile dysfunction treatments - bypassing
the health checks and balances provided by healthcare professionals.
Men’s health physician Dr Michael Lowy suggests pharmacy could play a
A healthy sex life can contribute
significantly to a man’s quality of life
but when things go wrong, it’s not
only the male ego, sexual intimacy and
relationships that suffer.
Erectile dysfunction is also a harbinger
of underlying health conditions such
as cardiovascular disease.
So there is
a missed opportunity in men’s health
when the one in five men over 40 years2
with erectile dysfunction choose
the internet rather than a healthcare
professional for advice.
Broadening access to effective products
with established safety profiles
for erectile dysfunction within the
healthcare system may provide an
important opportunity to help reduce
the potential risks from men obtaining
unregistered and unsafe products via
online and black-market shopping.
Recent industry submissions to
reschedule phosphodiesterase type
5 (PDE-5) inhibitors from S4 to S3
are recognising the potential for
pharmacists to step up their activity in
the men’s health domain.
Creating the opportunity for another
contact point between men with
erectile dysfunction and a healthcare
professional is, in my view, now an
important and timely consideration.
Australia’s ageing population is the main
driver of increasing demand for erectile
dysfunction medications. According to
the 45 and Up Study, erectile dysfunction
increases by about 11% each year
from age 45.
From 75 years, almost
all Australian men report erectile
But lifestyle is taking an increasing
toll too. Smoking, heavy alcohol
consumption, physical inactivity,
overweight/obesity and diabetes all
increase the risk of erectile dysfunction.3
With about two thirds of Australian
adults already overweight or obese,
it is understandable that erectile
dysfunction is also a growing problem.
About 80% of men with erectile
dysfunction have an underlying
physical cause with investigations
revealing modifiable risk factors such as
hypertension or high cholesterol.
However psychosocial issues including
depression, anxiety, stress and
relationship problems can also impact
on sexual performance.2 How those
conditions interact with ageing and
chronic disease to impact on erectile
dysfunction in older men is not yet clear
but treatments such as antidepressants
can also have an adverse effect.
Dr Michael Lowy is a former GP and now works
as a men’s health physician at The Male Clinic in
Woolloomooloo. He is a fellow of the Australasian
Chapter of Sexual Health Medicine and the European
Committee in Sexual Medicine. Opinions expressed
in this column are not necessarily those of the
Pharmaceutical Society of Australia, its Board or staff.
Safe and effective treatment
PDE-5 inhibitors including vardenafil,
sildenafil and tadalafil have a long
history of efficacy and have displayed a
good safety profile in the management
of erectile dysfunction.
PDE-5 helps regulate levels of cyclic
guanosine monophosphate (cGMP),
which is produced naturally with sexual
stimulation to relax the smooth muscles
of the corpora cavernosa, increase blood
flow and achieve penile erection.
PDE-5 inhibition therefore intensifies the
natural response to sexual stimulation.5
A systematic review of treatments for
erectile dysfunction confirmed that
PDE-5 inhibitors as a class consistently
improve sexual performance in up to
88% of patients.6
Common adverse events such as
headache, flushing, nasal congestion,
dyspepsia, dizziness and reflux are
generally mild and transient. Serious
adverse effects are rare.5
However the vasodilatory effect of PDE-
5 inhibitors presents an unintentional
risk of hypotension, especially with
severe cardiovascular disease or when
taken with nitrates.5
They are contraindicated in patients
with unstable cardiovascular disease
Pharmacy – the new men’s
BY DR MICHAEL LOWY
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