Erectile dysfunction treatment: a doctor's assessment online

When an online assessment makes sense

Erectile dysfunction means difficulty getting or keeping an erection firm enough for sex. An occasional bad night is normal and usually reflects tiredness, stress, anxiety or alcohol, and the HSE describes the problem as very common, particularly in men over 40. When it keeps happening, a written assessment suits men whose general health is known and settled: no recent heart problems, blood pressure that is measured and controlled, and a clear list of current medicines.

Read the symptom as a signal too. Erection problems share their causes with high blood pressure, raised cholesterol, diabetes and heart disease, and they can be the first sign of one of them. If the problem is new, or your blood pressure, blood sugar and cholesterol have not been checked for a while, ask your GP for that check as well.

How the request works

You start with the questionnaire: what is happening and for how long, your medical history, every medicine you take and a short set of safety questions about this topic. The assessment is written from start to finish, with no video consultation, no phone appointment and no live chat, so answer as fully as you would in a surgery.

A doctor reads your answers. He may write back with a question, ask for something specific such as a recent blood pressure reading or a letter from your GP, or decline when a prescription would not be safe on the information he has. If treatment is appropriate, the prescription is produced as a PDF and sent to the email address you gave, and you take it to a pharmacy with photo identification.

What the questionnaire asks

Most of the questions concern your heart and circulation, because that is where these medicines can cause harm. You will be asked whether you use nitrates, such as a GTN spray or tablets or isosorbide mononitrate, or riociguat, a medicine for high blood pressure in the lungs; whether you have had a heart attack or a stroke in the last six months; and whether you have unstable angina or severe heart failure.

Further questions cover blood pressure that is very low (below 90/50 mmHg) or high and untreated, alpha-blockers such as tamsulosin or doxazosin, any sudden loss of sight in one eye, and retinitis pigmentosa, an inherited condition of the retina. The last one asks whether you have taken a medicine for erectile dysfunction before and tolerated it. A yes to one of the serious questions brings up a short note explaining why a prescription is unlikely.

Sildenafil, tadalafil and vardenafil

All three are PDE-5 inhibitors. They improve blood flow into the penis in response to sexual stimulation, so nothing happens without arousal and none of them changes desire. Sildenafil is usually taken about an hour before sex, and vardenafil works on a similar timescale. Tadalafil acts for longer, up to 36 hours after a dose, and is also used as a low dose taken every day. The doctor chooses the substance and the strength from your answers.

Most side effects come from the widening of blood vessels. With sildenafil the commonest are headache, flushing, indigestion, a blocked nose, dizziness and changes in vision such as blurring or altered colour perception. Back pain and aching muscles are more typical of tadalafil, and headache is the effect seen most often with vardenafil.

The interactions matter more than the side effects. Nitrates in any form, including the recreational drugs known as poppers, and riociguat must never be combined with these medicines, because together they can cause a dangerous fall in blood pressure. If you take an alpha-blocker, you should be on a steady dose of it before treatment starts. Alcohol makes erections harder to achieve and adds to dizziness.

Is a prescription always needed?

Not always. A few 50 mg sildenafil products are authorised in Ireland as medicines that do not require a prescription; Sildenvia 50 mg, for example, received that status from the HPRA in January 2024. They are supplied through pharmacies only, the pharmacist decides whether one suits you, and stock varies from one pharmacy to the next. Most other products, including other strengths, still need a prescription, and the HPRA register shows the status of each.

If that pharmacy route works for you, it is a sensible place to start. An online assessment makes more sense when you need a strength or substance that a pharmacist cannot supply without a prescription, or when you are continuing a treatment that a doctor has already started.

When to see a doctor in person

Chest pain, breathlessness or palpitations during sex or other exertion need a medical assessment before any treatment, and chest pain that does not settle needs emergency care. A heart attack or stroke in the past six months, unstable angina, severe heart failure, or blood pressure that is very low or not under control belong with your GP or cardiologist.

Two effects of these medicines need urgent help rather than an appointment. An erection lasting more than four hours is an emergency, because a prolonged erection can permanently damage the penis: go to an emergency department or call 112 or 999. Sudden loss or dimming of vision in one or both eyes means stopping the medicine and getting medical help without delay. Erection problems that come with pain, a new curve in the penis or difficulty passing urine also deserve an examination.

The prescription and the pharmacy

The PDF follows the Annex to Commission Implementing Directive 2012/52/EU: it names the active substance rather than a brand, gives the strength, form, quantity and dosage, and carries the prescriber's details and signature. It is issued by lek. Damian Wojno, a doctor registered with the Polish Medical Chamber under licence no. 3211301, who is not on the Irish Medical Council register.

Print it and bring photo identification in the same name, as many pharmacists prefer a paper copy; there is no PIN code and no Irish patient number involved. The Pharmaceutical Society of Ireland publishes guidance for pharmacists on prescriptions from other EEA countries, but it obliges nobody: the pharmacist keeps professional judgement and may decline. The medicine itself is priced and paid for at the pharmacy, separately from the doctor's assessment.