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We have changed to Nitrofurantoin(brand name Macrobid) as first line treatment for women with lower urinary tract infection (also called cystitis)due to the NICE (National Institute for Clinical Excellence) guidelines for women who do not have a catheter. It aims to optimise antibiotic use and reduce antibiotic resistance.(1)

Previously Trimethoprim was recommended as first line treatment but developing resistance to it’s effectiveness has meant that Nitrofurantoin may be the preferred choice. It depends on your geographical location and your kidney function.

PHE (Public Health England) have found that the number of urinary tract infections (UTIs) caused by drug resistant bacteria is increasing. One in three (34%) of the samples analysed were found to be resistant to Trimethoprim whereas only 3% of the UTI samples showed resistance to Nitrofurantoin.(2)

NICE have recommended that the first choice antibiotic for an uncomplicated urinary tract infection, UTI, be either Nitrofurantoin, if you are not suffering from reduced kidney function, or Trimethoprim  if there is a low risk of resistance to it where you live. (3)

There are AMR (Antimicrobial Resistance Indicators) local indicators that can give your doctor and yourself information on the effectiveness of any antibiotic. (4)

Antibiotic prescribing and antibiotic resistance are inextricably linked, as overuse and incorrect use of antibiotics are major drivers of resistance. The AMR local indicators are publicly available data intended to raise awareness of antibiotic prescribing. They can be used by your doctor to prescribe the most effective antibiotic appropriate for your infection.

We will offer Nitrofurantoin to women with cystitis but if Trimethoprim is deemed to be more appropriate by our doctor, using the AMR local indicators and other factors, then she will change it to Trimethoprim.

Why do we only treat women?

Urinary tract infection is more common in women and easier to treat than in men ; when it occurs in men they have to have the cause investigated and treated.

We only treat women with typical symptoms of cystitis when there is no concern that the infection has extended beyond the bladder. This is defined as acute simple cystitis. When there is concern that the infection has spread (eg when there is flank pain or other features suggestive of inflammation of the kidneys, fever and/or other signs of systemic illness including sepsis) we consider this to be a complicated UTI and needs referral to the GP.

However, Nitrofurantoin should not be used by women who have a reduced kidney function where their eGFR (estimated Glomerular Filtration Rate) is below 45(ml/min/1.73m ).

Most people are aware that their blood pressure and cholesterol numbers are important in knowing their risk for heart and blood vessel disease. Yet few know about their eGFR, one of the numbers that tells them about the health of their kidneys.

What is the glomerular filtration rate (GFR)?

When your kidneys are working well, they filter out wastes and excess fluid that become part of the urine your body makes each day. When kidneys aren’t working well, you do not remove enough wastes and fluids to keep you healthy. You also cannot make important hormones for your blood and bones. Your eGFR number is an estimate of how well your kidneys are working and keeping you healthy. If your eGFR number is low, your kidneys are not working as well as they should.

In adults, the normal eGFR number is more than 90. The eGFR declines with age, even in people without kidney disease.

How is kidney function measured?

A blood test called eGFR (estimated glomerular filtration rate) indicates roughly how well the kidneys are working to filter out waste from your blood. eGFR is reported in millilitres per minute and a normal eGFR is greater than 90 mL/min. eGFR is often shown as a percentage of normal and people find it useful to think of kidney function as a percentage, going from 100% (fully functioning) to 0% (no function). (5)

The table below indicates the various stages of chronic kidney disease (CKD)

Therefore, people with a moderate to severe loss of kidney function should not take Nitrofurantoin.

Our doctor will review your completed medical questionnaire for cystitis and decide which antibiotic is most appropriate for you.

References

1. https://bnf.nice.org.uk/drug/nitrofurantoin.html
2. https://assets.publishing.service.gov.uk/government/uploads/system/ uploads/attachment_data/file/656611/ESPAUR_report_2017.pdf
3. https://cks.nice.org.uk/urinary-tract-infection-lower-women#!scenario
4. https://fingertips.phe.org.uk/profile/amr-local-indicators
5. https://www.kidneyresearchuk.org/health-information/stages-of-kidney-disease

Author
Superintendent pharmacist Margaret Hudson BSc(Hons) MRPharmS
 12th September 2019

Epididymitis is a painful condition which affects men and has several causes, with a major cause being sexually transmitted infections (STIs), particularly in men under the age of 35. Most cases can be resolved with a course of antibiotics. (1)

What is epididymitis?

Epididymitis is the medical term for inflammation of the epididymis, which is a tube which runs along the back of the testicle. Both testicles have an epididymis and it is possible for one or both to become inflamed. When the condition also affects the testicles themselves, it can be known as epididymo-orchitis (orchitis means inflammation of the testicle(s)). (1)

What are the symptoms of epididymitis?

Epididymitis symptoms can include:

• Pain in one or both testicles (the onset of epididymitis pain can be sudden or gradual)
• A painful, swollen, tender scrotum which can feel hot to the touch
• Fluid collecting around the testicle(s), giving a swollen or lumpy appearance and feel
• Trouble passing urine
• Discharge from the tip of the penis - this can be white, yellow or green, which signals an infection (1)

What are the causes of epididymitis?

There are a number of epididymitis causes, but the most common is an untreated STI - the main culprits being chlamydia and gonorrhoea - especially in men under 35 years of age. A less common cause is a urinary tract infection (UTI), which is rare in men. However, men are at higher risk of a UTI if they have an enlarged prostate gland, a urinary catheter, or are recovering from groin, prostate or bladder surgery. Even less commonly, epididymitis can be caused by mumps, tuberculosis, injury to the groin area, Behçet's disease (an autoimmune condition affecting the blood vessels), and can be a side effect of the heart medication amiodarone. (1)

How is epididymitis treated?

Epididymitis treatment in most cases is a course of antibiotics. The aim of treatment is to clear up both the primary infection (e.g. the STI or UTI) as well as the associated epididymitis. It is important that the course is completed, even if symptoms ease off - otherwise the infection will most likely persist and symptoms will return. It can take as long as two weeks to feel completely better.

Over-the-counter painkillers can be used alongside antibiotics. Ibuprofen is the best choice because of its anti-inflammatory action. A cold pack can also be applied to the area to help soothe burning and inflammation.

Antibiotics for epididymitis can be prescribed by your GP, but are also available from sexual health clinics and, if the epididymitis is linked to chlamydia or gonorrhoea, they can be purchased from Webmed Pharmacy.

Wearing supportive underwear can also help to ease epididymitis pain. (1)

What is chronic epididymitis?

Chronic epididymitis is inflammation of the epididymis that has persisted for a long time, and it may come and go. The pain tends to be milder, but can be more widespread, affecting the rest of the groin area and even the thighs and lower back. A cause is rarely found. Chronic epididymitis treatment is most commonly a course of anti-inflammatory drugs, usually ibuprofen taken for at least two weeks. Occasionally, chronic epididymitis is caused by a long-standing infection and can be treated with antibiotics. (2)

References

1. The British Association of Urological Surgeons. Chronic Epididymitis [cited 22 July 2019]. Available at: https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Chronic%20epididymitis.pdf

Author
Gabby Gallagher MPharm

Medically reviewed by
Superintendent pharmacist Margaret Hudson BSc(Hons) MRPharmS
30th July 2019

Our returning guest blogger Hanna, 35, today talks about her experience getting STI tested.

Well I never thought my last boyfriend and I were destined to be together forever, but we’d fallen into a comfy routine of watching box sets whilst eating take away. Plus, we’d both reached our mid-thirties and were cohabitating in relative contentment; or so I thought…

When I found out that his ‘work’ nights out were a string of one-night Tinder hook ups I suddenly had that dread that he’d left me with more than just the outstanding rent; so I started looking online for ways I could get tested, sharpish, and without anyone finding out.

It’s a mine field. The local G.U.M. (Genito-Urinary Medicine; and yes, I had to look it up) clinics open no longer than three hours at a time and the slots that are by appointment only are notoriously difficult to call through and get booked on to. I looked at the NHS home test kit, but due to a staff back log it would take 14 days to send me a kit out and then I wouldn’t get the results for 3-4 weeks. Well, the thought of what I could potentially be harbouring in my nether regions meant that I wanted results in days, not weeks, and certainly not over a month – so I tootled off to my local walk-in clinic.

Well it wasn’t the best start to the day as I had to take last minute half-day holiday as I couldn’t get in before 08:30 (my actual office start time) and I had no idea how long I’d be waiting there. I should be spending my half day holidays in a beer garden, not needing a beer by 10:30. To give the clinic its dues, the place was clean and the staff were very polite. I was the oldest in there by a fair age gap and was by far the most conspicuously fidgety but realised that college students don’t have to explain to their sixty-year-old male boss that they need between 1-3 hours for a personal issue.

Two and a half hours later I was on my way with the promise of the results being texted to me sometime in the next couple of weeks. I’ve never been so anxious about every text I received in that time.

A month later in the pub, after a few wines for courage, I admitted all this to my best friend. She then told me I could get a test kit delivered straight to my home, next day delivery and the results within a week – all for less than we spent in the pub that night. No stress, no time-off, no-one would know. No contest, right? Well I’m actually hoping for no knob-head boyfriends in future…

Want discreet home testing with quick results? Get your home test kit here; delivered within 24 hours* in discreet packaging. Safe, secure, sorted.

*to mainland UK

What are genital warts?

Genital warts is one of the most common sexually transmitted infections – in fact, in England, the only STI that is more common is chlamydia. Genital warts are caused by certain strains of the human papilloma virus (HPV), a large group of viruses which mainly affect the skin. Other strains of HPV are responsible for warts and verrucae found on the hands and feet, plane warts which are usually found on the face, and changes in cells which may lead to development of cancer – most commonly of the cervix. (1, 2, 3)

Genital warts can be unsightly, embarrassing and can cause irritating symptoms, including itchiness, inflammation and disruption of flow of urine, depending on the area affected. Fortunately, they are harmless, they don’t lead to any serious conditions such as cancer, and they are not known to affect fertility. There is no cure – once you have caught the virus, you will have it for life. However, it is possible for your body to eventually clear the warts in time, and there are also treatments available to help with this. (1, 4)

How do you catch genital warts?

You don’t need to have penetrative sex to contract genital warts – the skin of your groin area coming into contact with the skin of the groin area of an infected person can be all it takes to pass the virus on. Sharing sex toys can also lead to infection. Using condoms during sexual activity is highly recommended to reduce the chance of transmission, but since genital warts can affect the surrounding areas and upper thighs, infection can still occur. However, don’t forget that condoms are a highly effective barrier against other STIs, so unless you know for sure that you and your partner are clear, you should be using them regardless! (4)

I think I might have genital warts, what can I do?

If you think you might have genital warts, you can visit your GP or a sexual health clinic for a diagnosis. They appear as painless lumps on the vulva, penis, anus or surrounding areas, and can even be found on the upper thighs. The warts can sometimes become itchy and inflamed, and if warts are present inside the urethra (in men or women), the vagina or the anus, this can lead to bleeding from these areas. Warts inside the urethra can also cause urine to flow at an angle. On the other hand, you can carry the virus without ever having shown any symptoms, or symptoms may develop years after exposure. Despite this, you can still pass the virus on to others through sexual contact. If you have a sexual partner who has genital warts, you should visit a sexual health clinic, even if you don’t have any symptoms yourself. (4)

How are genital warts treated?

Treatment for genital warts is prescription only. Don’t use treatments for warts and verrucae, such as salicylic acid gel, found in pharmacies and some shops to treat your genital warts – they are not designed for this purpose and will irritate and damage the sensitive skin of your genital area. (1)

Topical treatments (liquids and creams) which can be prescribed to treat genital warts include podophyllotoxin, a liquid that is applied to the warts with an applicator stick or as a cream. As the name suggests, it is toxic to the warts and works by killing the cells. It is applied in ‘cycles’ of three days followed by four treatment-free days. In most cases, warts will disappear after four or five cycles. At Webmed Pharmacy we supply it under the brand name Warticon. It can be used for soft genital warts. (5)

Imiquimod (Aldara) is a cream which is applied to larger warts three times a week and left for six to ten hours before being washed off. It encourages your immune system to fight off the virus that causes the warts. Warts should begin to clear up within a few weeks. Aldara can be used for both hard and soft warts not only on the genitals but also those visible in the anal area.  (5)

Trichloroacetic acid (TCA) is applied to small, hard genital warts once weekly by a healthcare professional at a genitourinary medicine (GUM) clinic. It breaks down proteins in the cells of the warts to kill them. Unlike the other topical treatments, it is safe to use in pregnancy. (5)

Genital warts can also be removed using physical ablation:

• Cryotherapy is a procedure during which warts are frozen using liquid nitrogen, which can cause a sensation of burning. Once the procedure is finished, the skin can take up to three weeks to heal.

• Excision is surgical removal of warts, often used for harder warts. Once the warts are removed, the area is stitched together and should heal within three weeks.

• Electrosurgery involves applying a metal loop to a wart, then using an electric current through the loop to burn the wart. Because this procedure can be so painful, general aesthetic is occasionally used.

• Laser surgery can be used for hard-to-access warts, such as those in the urethra or anus. A laser is used to burn the warts, and as with electrosurgery, this may be performed under general anaesthetic. The area may be painful for up to four weeks after the procedure. (5)

It is important to avoid sexual activity until the area has fully healed. (5)

Can I buy treatment for genital warts from Webmed Pharmacy?

Treatment for genital warts is now available to buy from Webmed Pharmacy. You’ll just need to answer a few questions about your symptoms, health and any other conditions so that the doctor can determine whether the treatment is right for you. If so, as with all of our other tests and treatments, your medication will be posted securely to an address of your choice the following day within a one hour time slot!

References

1. NHS inform. Genital warts: About genital warts [cited 23 June 2019]. Available at: https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/genital-warts

2. Mayo Clinic. HPV infection: Overview [cited 23 June 2019]. Available at: https://www.mayoclinic.org/diseases-conditions/hpv-infection/symptoms-causes/syc-20351596

3. NHS. Warts and verrucas [cited 23 June 2019]. Available at: https://www.nhs.uk/conditions/warts-and-verrucas/

4. NHS. Genital warts [cited 23 June 2019]. Available at: https://www.nhs.uk/conditions/genital-warts/

5. NHS inform. Genital warts: Treating genital warts [cited 23 June 2019]. Available at: https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/genital-warts#treating-genital-warts

Author
Gabby Gallaher MPharm

Medically reviewed by
Superintendent pharmacist Margaret Hudson BSc(Hons) MRPharmS
2nd July 2019

Today’s blog is written by Hanna, a 35 year old single female living in the city; but less Carrie Bradshaw and more Bridget Jones. Hanna will be writing for us from time to time on issues that arise in the modern world of dating, love and life in her 30s; and whilst many of us can relate to what Hanna has experienced, all views are her own.

Well festival season is upon us and those who attended Glastonbury this weekend got very lucky with the weather. Of course with scorching sunshine comes the inevitable festival issues; the stench of the toilets and ending up with your face in your dancing-neighbours sweaty armpit; all rounded off by being boiled alive in a tent at 6am with a killer hangover. Yet still we flock, in the thousands, to watch our favourite artists, create amazing memories and meet a range of new people. Mix this in with some alcohol and the laissez-faire environment created at a festival; it’s inevitable we’re going to want to hook up with that hot one we met at Silver Hayes.

This brings me to a topic I’ve discussed many times with my girlfriends and I can honestly say that the group is 50/50 divided; festival sex, yes or no? Stats show that, on average, 34% of Glastonbury attendees will have some sort of sexual encounter; it’s the most promiscuous music festival in the UK. These liaisons mainly happen in the tents but some brave souls get it on in crowds and I read that some even attempt it in the port-a-potties – I had to read that twice.

Those that are in the yes camp (pun intended) are my more free spirited friends that jump into the festival vibe with gusto from the moment we arrive. I, on the other hand, am firmly in the no camp and whilst that may make me seem uptight; you have not seen me at 7am when I’m sweaty, have no make up on and have scarecrow hair. I wish I could be free-loving and not care about intimate hygiene but as I shower at least once a day at home- you’re at Glasto for four days with only wet wipes. I know you’re thinking, “But surely it’s not that bad as you’d use a condom” and the great thing about Glastonbury is the availability of free condoms, the only single-use plastic that they did allow this year. So each to their own but I’ll abstain for four days, it’s not like I’m not used to it #singlelife

Just returned from Glastonbury and worried you may have contracted an STI? Get your home test kit here - delivered within 24 hours* in discrete packaging. Safe, secure, sorted.

*to mainland UK

The World Health Organization, WHO, has estimated that one million new sexually transmitted infections (STIs) occur every single day. (1)

Overall, in the UK the cases of sexually transmitted infections are increasing.

In England alone, in 2018, there were 447,694 new diagnoses of STIs, a 5% increase on the 422,147 in 2017. (2)

Gonorrhoea increased the most, by 26% to 56,259 cases, the largest number since 1978.

Where can I buy home treatment? Click here

The number of gonorrhoea cases has been increasing for years among both men and women, despite repeated warnings from public health doctors about the risks of unprotected sex.

Gonorrhoea, sometimes referred to as "The Clap", is a bacterial infection passed between people through unprotected sex.

About 50% of women and 10% of men are unaware that they’re infected as they don’t experience any obvious symptoms and this means that the infection can go untreated until the disease has progressed. This can lead to serious long-term health problems and infertility.

If symptoms are experienced, they usually occur about 10 days after being infected. Men and women are affected differently: (3)

Men may experience

• Burning sensation/pain when urinating

• Inflammation of the foreskin

• An unusual discharge from the tip of the penis that may be green, yellow or white.

• Tenderness or pain in the testicles

While women may experience

• Burning sensation/pain when urinating

• Bleeding between periods and/or heavier periods

• A change in vaginal discharge which may be thick and green or yellow in colour.

• Lower abdominal discomfort

• Bleeding after sex

Testing

If you have put yourself at risk and are concerned, then you should wait 14 days before taking a test as it may take this amount of time before the infection can be detected.

If you visit your GP you will probably be signposted to a genitourinary medicine, GUM, clinic which may also be called a Sexual Health Clinic.  If you find it difficult to either get an appointment at a clinic or are simply short of time or indeed too embarrassed to go to a clinic, you can choose to order a test from us at Webmed Pharmacy.

For test kits click here.

Our test kits are sent to The Doctors Laboratory (TDL) in London. They are the largest independent providers of clinical laboratory diagnostic services in the UK. Once the lab has received your sample, your results will be available 2-3 days later.

The kits are posted in discreet plain unmarked packaging with no indication of their contents or who it‘s from.

Treatment

If your test is positive for gonorrhoea we can refer you to a GUM clinic for treatment. The first line treatment, as recommended by the British Association for Health and HIV, BASHH, is an injection of a single antibiotic.

If you can’t get to a GUM clinic, unable to get an appointment or have a needle phobia then our doctor can prescribe second line treatment that comprises of two different antibiotics that you take orally. As our treatment is second line, and therefore not considered to be as effective as the first line treatment, we provide a free “test of cure” that you can send to the lab 14 days after treatment to make sure you are clear of infection.

We will ask that you complete a simple medical questionnaire that our Doctor can assess for your suitability and, if approved, be prescribed the oral antibiotics to treat the infection.

Your treatment will be delivered in discreet, unmarked packaging with no mention of the contents or who it’s from. You can have your parcel delivered to your home or work address and, if in an area where we use DPD, you can have it diverted to a local pickup shop where you can collect it at your convenience.

The symptoms for all STIs are very similar and it’s better to get tested to find out which STI you may have rather than trying to guess from your symptoms. Then you can receive the most appropriate treatment and be sure of treating the infection successfully.

This is especially important for gonorrhoea as there is evidence of a resistant strain of gonorrhoea emerging in the UK and unnecessary prescribing of antibiotics can contribute to this.

For Gonorrhoea and Chlamydia treatments, click here. 

References

1. https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis)

2. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/806118/hpr1919_stis-ncsp_ann18.pdf

3. https://www.nhs.uk/conditions/gonorrhoea/symptoms/

Medically reviewed by
Superintendent pharmacist Margaret Hudson BSc(Hons) MRPharmS
11th June 2019

For men who suffer from erectile dysfunction there is a product available called Cialis which is known as the “weekend pill”. (1) It performs the same function as Viagra in that it helps to maintain an erection, but Cialis lasts in the body for 36 hours so you can take the pill on Friday night and it will still be active on Sunday morning. This doesn’t mean that you will have an erection for that length of time but you will be ready for satisfactory sexual activity when you have been sexually aroused.

The active ingredient in Cialis is Tadalafil, and you can now buy generic Cialis under the name of Tadalafil which produces exactly the same effect. The big advantage is that it is much cheaper. You can buy Tadalafil 10mg and Tadalafil 20mg, the latter being the high dose. Tadalafil 10mg is the recommended staring dose, but this can be increased to 20mg if necessary if you find that it’s not as effective as you would like and you haven’t suffered from any side-effects.

You can also buy Tadalafil Daily online.  Tadalafil Daily is available in strengths of 2.5mg and 5mg. The lower dose takes 4 – 5 days to take effect, but once it has you will be able to respond to any sexual stimulation anywhere, at any time.

Tadalafil Daily tablets should be taken once a day and it’s best to take it at the same time of day. So it’s a good idea to stick to a regular time of day, like when you’re having your breakfast, so that you don’t forget. You are advised not to drink grapefruit juice when taking Tadalafil as this can affect the effectiveness of the pill. You should also not drink more than one or two units of alcohol before taking the medication because that can also affect your ability to get an erection. (2)

References

1. Summary of Product Characteristics. Cialis 2.5mg, 5mg, 10mg & 20mg film-coated tablets. Eli Lilly and Company. Date of revision of the text: 03 September 2008. Accessed via http://emc.medicines.org.uk on 7/6/19 

2. British National Formulary, 76th edition. Accessed via www.bnf.org on 7/6/19.

Medically reviewed by
Superintendent pharmacist Margaret Hudson BSc(Hons) MRPharmS
9th June 2019

Sildenafil is a generic treatment for erectile dysfunction and today you can buy Sildenafil online which many men may find less embarrassing and more convenient than having to make a journey to their local pharmacy for it.

Sildenafil (the generic form of Viagra) and Viagra are medically identical, and so are found to be equally effective.

Both products contain the identical amount of active ingredient. (1)

Until 2013 nobody else could produce Sildenafil because Pfizer had a patent. However, that patent expired in 2013 and today other companies can manufacture Sildenafil. As you might expect, generic Sildenafil tablets are less expensive than Viagra even though they contain exactly the same ingredient and produce the same effect. This has enabled many more men to be able to enjoy a more fulfilling sex life.

The only difference between generic Sildenafil tablets and Viagra are the fillers. These are used to bulk up the tablets, since the amount of Sildenafil required in each is only tiny. Different manufacturers use different fillers and that is why the brands differ in shape, colour and size. (2) A commonly used filler is lactose. Those who are lactose intolerant should carefully check the Patient Information Leaflet supplied with their Sildenafil tablets before taking them. There is one brand which does not contain lactose and that is called Mylan.   Fortunately, Webmed Pharmacy only supplies the Mylan brand of Sildenafil.

Viagra contains lactose.

Sildenafil is usually sold in white or blue tablets, the blue being a form of identification with Viagra which is sold in blue diamond shaped pills. Pfizer has trademarked the shape of its pills which cannot be copied, but they cannot trademark the colour.

Both Sildenafil and Viagra are available in 25mg, 50mg, and 100mg tablets.

References

1) https://sciencebasedmedicine.org/are-generic-drugs-equivalent-to-brand-name-drugs/ (accessed on 7/6/19)

2) https://sciencebasedmedicine.org/whats-all-that-other-stuff-in-my-medicine/ (accessed on 7/6/19)

Medically reviewed by
Superintendent pharmacist Margaret Hudson BSc(Hons) MRPharmS
9th June 2019

Erectile dysfunction (ED) is a problem generally viewed in society as being associated with middle aged and elderly men. However, contrary to popular belief, ED can affect men of all ages, and does affect plenty of younger men. But why?

There are numerous physical and emotional factors which can cause or contribute to ED. Anxiety is a major contributor for younger men. You may worry that your partner is negatively judging your sexual performance, or that they won’t reach orgasm. You might fear that a partner will become pregnant. These anxious feelings may result in a stress response, directing blood away from the penis to other parts of the body, and therefore causing loss of erection. (1, 2)

ED in younger men may also be caused by anxiety or stress that is not directly related to sexual activity. Just a few examples of factors which can contribute to anxiety and stress are problems in the workplace, financial struggles, ill health (yourself or a relative or friend) or a rocky relationship. All of this can have an impact on ED. What’s more, ED can cause further anxiety, worsening the problem in a cruel spiral. (2)

If you smoke and suffer with ED, you may want to consider stopping as smoking is a major cause of the condition in many men, younger and older. The components of cigarette smoke can have a damaging effect on blood vessels, including those in the penis. One such effect is the formation of plaque on the walls of the blood vessels, known as atherosclerosis. This makes the area through which blood can flow narrower, impairing the surge in blood flow to the penis that is essential for an erection. Visit your GP for help getting started on your path to being smoke free. Alternatively, many pharmacies offer a smoking cessation service, with regular meetings with a member of staff to guide you through the quitting process. (2)

Alcohol can also be a culprit. In the short term, after a session of heavy drinking, the physiological response to sexual arousal can be sluggish or non-existent, causing an episode of poor erectile function. However, this should right itself once you sober up. In the long term, persistent binge drinking can damage the blood vessels of the penis, leading to ED. Stick to no more than 14 units of alcohol per week, and no more than 8 units in one drinking session. (2, 3, 4)

Being overweight or obese, particularly if you carry a lot of excess weight around the abdomen, puts you at higher risk of ED. Having a greater body mass means that your heart has to work harder to pump blood around your body and to your extremities, such as the tip of the penis. A diet high in fat and cholesterol can also lead to atherosclerosis, as with smoking. Aim for at least 30 minutes of moderate to intense exercise at least five times a week, and reduce or cut out high fat foods such as cheese, red meat, chocolate, cakes and biscuits, and fried foods. (5)

If you’re an avid cyclist or commute to work by bike, this can work wonders for your cardiovascular health and help to keep excess weight off. But did you know that cycling for over three hours per week can be a cause of ED? Prolonged or regular pressure on the pudendal nerve, which runs through the perineum (the area separating the genitals from the anus), can damage this nerve which plays a part in erectile function. You could consider supplementing cycling with other forms of exercise, or investing in a specialised saddle which is designed to ease pressure on the perineum. (3, 6)

Taking all of this into account, it really isn’t a surprise that younger men can experience ED. There are so many lifestyle factors and health conditions which affect men of all ages and can also contribute to ED. Don’t be embarrassed to seek a diagnosis and treatment – remember there are plenty of other men in your position and your doctor is there to help. If you don’t want to see your doctor initially, Viagra Connect (sildenafil) is available over the counter in pharmacies, subject to filling out a safety questionnaire. However, you’ll be strongly advised to see your doctor within six months of starting Viagra Connect, as it is important that your doctor knows which medicines you are taking on a regular basis, as well as to rule out any serious problems which may be contributing to your ED.

Viagra Connect is available to buy from Webmed, and the prescription only ED medicines Cialis (tadalafil), Spedra (avanafil), Levitra (vardenafil) and higher strength Viagra (sildenafil) are available to purchase here, as well as the generic sildenafil and tadalafil, after a quick medical questionnaire which is reviewed by a doctor.

References

1. British Pregnancy Advisory Service. Erectile dysfunction (male impotence) [cited 24 May 2019. Available at: https://www.bpas.org/more-services-information/erectile-dysfunction/

2. International Society for Sexual Medicine. Is erectile dysfunction (ED) common in men under age 40? [cited 24 May 2019]. Available at: https://www.issm.info/sexual-health-qa/is-erectile-dysfunction-ed-common-in-men-under-age-40/

3. NHS. Erectile dysfunction (impotence) [cited 24 May 2019]. Available at: https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/

4. NHS. Binge drinking [cited 24 May 2019]. Available at: https://www.nhs.uk/live-well/alcohol-support/binge-drinking-effects/

5. The Telegraph (2018). ‘Does anxiety cause erectile dysfunction?’ [cited 24 May 2019]. Available at: https://www.telegraph.co.uk/health-fitness/living-with-erectile-dysfunction/does-anxiety-cause-erectile-dysfunction/

6. Men’s Health. Is Your Bike Killing Your Boner? [cited 24 May 2019]. Available at: https://www.menshealth.com/health/a19539158/can-bicycles-cause-erectile-dysfunction/

Author
Gabby Gallaher MPharm

Medically reviewed by
Superintendent pharmacist Margaret Hudson BSc(Hons) MRPharmS
24th May 2019

Gonorrhoea is a sexually transmitted infection and can be caught by having unprotected sex with an infected person. It can affect both men and women. Symptoms do not appear until about 10 – 12 days after infection and some 50% of women and 10% of men are unaware that they have it, because there may be no obvious symptoms. This can lead to long term health problems and infertility. (1)

Symptoms in men are a burning sensation when urinating, pain in the testicles, a discharge from the penis that may be white, yellow, or green, and inflammation of the foreskin if present. In women there will also be a burning sensation when urinating, vaginal discharge which may be green or yellow, lower abdominal discomfort, bleeding after sex, and bleeding between periods. (1)

If you are concerned that you may have been at risk, you need to wait 14 days before taking a test because it may not be detected earlier.

At Webmed Pharmacy we can supply test kits  and treatment for both men and women.  Click here for test kits.

In all mainland UK except the Scottish Highlands and islands, the kits will be delivered the next working day by DPD in unmarked packaging. All other areas will receive their discreet parcels by Royal Mail special delivery the next working day. (2)

You then take your sample using the test kit and send it in a pre-paid envelope to The Doctors Laboratory in London. Results will be available 2 – 3 days later, and we will contact you by email or SMS to tell you that there is a message waiting for you in your secure inbox at Webmed Pharmacy.

If your test proves positive for gonorrhoea or chlamydia we will then ask you to complete a simple medical questionnaire online so that our doctor can assess you for your suitability and, if approved, can prescribe the oral antibiotics that you need to cure the infection. (3)

For Chlamydia and Gonorrhoea treatments, click here

If you have already tested positive using a home test kit from another site or a clinic, you can still complete the online questionnaire and if approved our doctor can prescribe the oral antibiotics. You should then take another test in order to ensure that you are free of infection 14 days after gonorrhoea treatment online, and we supply a FREE test kit to you for this purpose.  

References

1. https://www.nhs.uk/conditions/gonorrhoea/symptoms/

2. https://www.nhs.uk/conditions/gonorrhoea/diagnosis/

3. https://webmedpharmacy.co.uk/buy/gonorrhoea-treatment-kit

Medically reviewed by

Superintendent pharmacist Margaret Hudson BSc(Hons) MRPharmS

 14 May 2019