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An embarrassed silence

The Viagra POM to P switch provides a perfect opportunity to start a conversation around the difficult subject of erectile dysfunction. Victoria Goldman reports.

Sildenafil 50mg tablets (in the form of Viagra Connect from Pfizer) will shortly be available over the counter for erectile dysfunction in men over the age of 18. The MHRA hopes that this POM to P switch will discourage men from buying their Viagra supplies from unregulated websites.

Over the past five years, investigators from MHRA have seized more than £50 million of unlicensed and counterfeit erectile dysfunction medicines.

Some pharmacists have already been supplying Viagra through private PGD-led services. However, many men with erectile dysfunction are still not accessing medical help, support and advice. The condition may be a sign of undiagnosed diabetes, hypertension or heart disease, so it is essential that men obtain a proper diagnosis. It is hoped that the switch will encourage more men to seek advice from their local pharmacy, not just about erectile dysfunction but wider health issues as well.

Symptom management

Most men experience difficulties getting or keeping an erection from time to time, often due to stress, anxiety or too much alcohol. However, if the symptoms occur regularly, it is likely that there is an underlying physical or emotional problem. Erectile dysfunction is particularly common in men over 40. Phosphodiesterase-5 (PDE- 5) inhibitors, such as sildenafil (Viagra), are the medicines most commonly prescribed by GPs to manage the condition, as well as treating any underlying issues, such as hypertension.

According to Kristie Sourial, medical manager at Pfizer Consumer Healthcare, research indicates that currently over 40% of men with erectile dysfunction may not seek help from a healthcare professional.

“Giving men the option to buy Viagra Connect from a pharmacy could be a real step forward to encourage more men into the healthcare system,” she says. “As all men will be advised to see their GP within six months of starting Viagra Connect, there is also the potential for underlying conditions to be investigated and picked up sooner. Where Viagra Connect has not been supplied due to a contraindication, men should be referred to see their GP as soon as they can within six months.”

Reducing stigma

The psychological impact of erectile dysfunction can be considerable, leading to anxiety, depression and a lack of self- confidence, but it is often overlooked. Some men with the condition may not seek help from a healthcare professional because they are too embarrassed to do so. Hopefully, bringing the condition to the pharmacy counter will change this.

Terry Maguire, of Maguire pharmacy in Belfast, says any media coverage surrounding Viagra’s new OTC status should help to drive more men to the pharmacy for advice.

“The Viagra switch will enhance the role of community pharmacies in treating a condition where there is a lot of unmet need, as well as enabling men to access healthcare professional advice in what they may perceive to be a ‘non-threatening’ environment,” he says. “A customer’s first question is likely to be around the product itself, but pharmacists can use this to discuss wider issues. Significant numbers of men with erectile dysfunction do nothing about it or, if they do, it can take two years before they go to their GP for treatment. The Viagra switch will enable pharmacists to engage with men who don’t usually look after their health, by advising on simple lifestyle changes, such as stopping smoking, losing weight, increasing exercise and reducing stress.”

Stuart Gale, owner and manager of the Frosts Pharmacy Group, says the switch provides an opportunity to start the conversation and to get men thinking about possible causes that they may never have considered. “This is often one of the most challenging conversations to have with men, as they are not naturally inclined to seek help for their health needs,” he says. “Because erectile dysfunction is also often a first sign of other conditions, such as high cholesterol or diabetes, it provides an opportunity for the right questions to be asked and health issues to be identified.”

Pharmacy support

Pharmacists will have training materials to help them assess patients and screen out any customers who may not be suitable for Viagra Connect. Pfizer has launched an extensive pharmacy education programme, including face-to-face sessions, regional meetings and e-learning modules, as well as print-and-keep resources.

Pharmacy staff need to be well briefed, especially those at the counter who will need to be sensitive to men trying to access Viagra Connect. “Prominent messaging in store, on shelves within men’s sections of the pharmacy and at the counter are all good ways of raising awareness, as well as clear signposting on the associated websites,” says Stuart Gale.

Kristie Sourial agrees that strategically placed patient information materials should encourage men to raise the subject with pharmacy staff. “Placing such items near popular men’s health and hygiene products, such as razors and shaving cream, condoms or men’s deodorant, can provide men with a prompt to head to the counter and start the conversation,” she says. “Additionally, communicating the availability of private consultation rooms can help men to see pharmacies as a safe place in which to
raise the topic. The management of erectile dysfunction can potentially be linked in with existing pharmacy services, such as blood pressure and cholesterol testing, smoking cessation programmes and lifestyle advice.” 

Wider health issues

The POM to P switch of Viagra will hopefully help to raise awareness of other key areas of men’s health within the pharmacy. According to Donna Wilson, TENA training and brand manager, research from TENA Men in 2016/17 revealed that while 53% of men claim that they don’t worry about their health as much as women do, a quarter of men said the fear of treatment holds them back from discussing common concerns like urine leakage and prostate problems. “With 29% of UK men admitting they should try harder to look after their health, pharmacy staff are in an ideal position to encourage this conversation with practical guidance and product recommendations,” she says.

Urine leakage affects one in four men over the age of 40. It is often associated with a prostate problem, but may also be a sign of urinary tract infections, obesity, medication or diabetes. Benign prostate enlargement (BPE), an enlarged prostate, is common in men over 50. It isn’t a sign of prostate cancer, and doesn’t increase the risk of prostate cancer, but many men are reluctant to seek help. BPE seems to be caused by hormonal changes as men get older and can often be managed with lifestyle changes and medication. Prostate cancer often doesn’t cause any symptoms, but any symptoms that do occur are mainly linked to urination. According to Prostate Cancer UK, the number of men dying from prostate cancer has recently overtaken female deaths from breast cancer for the first time in the UK.

“When pharmacists are having a consultation with a man to establish whether Viagra Connect can be provided, this may provide an opportunity to broaden the conversation,” says Kristie Sourial. “Pharmacists can discuss related conditions that may be of a sensitive nature, such as bladder weakness and prostate problems, and provide according treatment or onward referral.”

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