Men's HealthNeeds a prescriber's assessment

Erectile Dysfunction

Also called: ED, impotence, erectile difficulties

Persistent difficulty getting or keeping an erection. Common, treatable, and often an early signal of vascular or hormonal problems worth assessing.

Quick answer

What it is: Ongoing difficulty getting or maintaining an erection sufficient for sex. Occasional difficulty is normal; a consistent pattern over weeks or months is what is meant by erectile dysfunction.
Common symptoms: Difficulty getting an erection, difficulty keeping one, or reduced sexual desire alongside either.
How it's treated: Treating the underlying cause, plus medication where appropriate — most commonly PDE5 inhibitors such as sildenafil or tadalafil.
Who can help: A physician or nurse practitioner assessment is the right starting point, because ED is frequently a symptom of something else. Prescription medication requires one.
Warning signs: An erection lasting more than four hours is a medical emergency. Chest pain during sex needs 911.

This one starts with an assessment Pill4Me pharmacists in Chilliwack can help.

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What is erectile dysfunction?

An erection depends on blood flow, and blood flow depends on healthy blood vessels, nerves and hormones — plus the psychological component that is genuinely part of the mechanism rather than an afterthought. Erectile dysfunction happens when any part of that chain is disrupted, which is why the causes range from cardiovascular disease and diabetes to medication side effects, low testosterone, anxiety and relationship stress.

The most important thing to understand about ED is that it is often an early warning rather than an isolated problem. The arteries supplying the penis are small, and they narrow before the larger coronary arteries do — meaning erectile dysfunction can appear years before cardiovascular disease becomes apparent elsewhere. That is the main reason a proper assessment is worth having rather than going straight to a treatment: blood pressure, cholesterol, blood sugar and medication review are part of the picture, not a detour from it.

It is also very common, becomes more common with age, and is treatable in most cases. Reluctance to raise it is the largest single obstacle to treating it.

Common symptoms

Erectile dysfunction is described by a consistent pattern rather than a single occasion. It can involve:

Difficulty getting an erection
Difficulty maintaining an erection long enough for sex
Reduced interest in sex alongside either of the above
A gradual change over months, which more often points to a physical cause
A sudden change tied to a life event or a new medication, which more often points to a psychological or drug-related cause

Having these symptoms does not confirm a diagnosis — they overlap with other conditions. Assessment by a pharmacist, physician or nurse practitioner is what establishes the cause.

Causes and risk factors

What causes it

Reduced blood flow from narrowed arteries — the most common physical cause, and the reason ED is linked to cardiovascular health
Diabetes, through effects on both blood vessels and nerves
Medication side effects, including some antidepressants, blood pressure medications and antipsychotics
Low testosterone or other hormonal problems
Nerve damage from surgery, prostate treatment, spinal injury or neurological conditions
Anxiety, depression, stress and relationship difficulties, which can be the primary cause or can develop alongside a physical one
Alcohol, smoking and recreational drug use

What raises the risk of developing it

Age
Cardiovascular disease, or its risk factors — high blood pressure, high cholesterol, smoking
Type 2 diabetes
Obesity and low physical activity
Prostate surgery or radiation
Depression, anxiety, and chronic stress
Heavy alcohol use

Risk factors make a condition more likely across a population — they are not causes, and having several does not mean you will develop it.

When should I seek medical care?

Seek urgent or emergency care

An erection lasting more than four hours — this is priapism and it is a medical emergency; go to the emergency department
Chest pain during or after sex — call 911
Sudden loss of vision or hearing after taking a PDE5 inhibitor

If you are unsure how urgent something is, call 8-1-1 to speak with a HealthLink BC nurse at any hour, or 911 in an emergency.

Worth asking a pharmacist

Whether one of your current medications could be contributing — this is more common than people expect and is often fixable
Interactions with an existing prescription, particularly nitrates, alpha blockers and some HIV or antifungal medications
How a prescribed treatment should be taken, and what to expect from it
Concerns about buying treatments online, which are frequently counterfeit

See a physician or nurse practitioner

ED that has persisted for more than a few weeks — an assessment establishes the cause rather than only treating the symptom
Symptoms alongside chest pain on exertion, breathlessness, or leg pain when walking
Reduced libido, fatigue or loss of morning erections, which may point to hormonal causes
ED starting after a new medication was introduced
Low mood, anxiety or relationship difficulties as part of the picture

How is erectile dysfunction treated?

Lifestyle measures

Stopping smoking, which directly affects the blood vessels involved
Regular physical activity, which improves vascular function measurably
Reducing alcohol
Managing blood pressure, cholesterol and blood sugar — treating these often improves ED as well
Addressing sleep, stress and mental health, which are part of the mechanism rather than separate from it

Medication

PDE5 inhibitors — sildenafil, tadalafil and others — are the usual first-line treatment and work by improving the blood flow response to arousal. They do not create an erection on their own and require sexual stimulation. They are prescription-only in Canada. Where a specific cause is found, treating it may resolve the problem: adjusting a medication that is contributing, or treating low testosterone under specialist guidance. Other options including vacuum devices and injections exist for people in whom tablets are unsuitable or ineffective.

Monitoring

Because ED often accompanies cardiovascular risk, assessment usually includes blood pressure, cholesterol and blood sugar. If a treatment is not working, that is worth reporting rather than abandoning — dose, timing and whether it is being taken with food all affect the result, and the cause may need revisiting.

This is a general overview, not a treatment plan. What is right for you depends on your history, your other conditions and everything else you take — that is a conversation with your prescriber or pharmacist.

Medications used for erectile dysfunction

These are commonly used in Canada for this condition. Being listed here does not mean a medication is appropriate for you — that depends on your assessment.

Viagra

sildenafil citrate

A prescription tablet for erectile dysfunction, taken as needed roughly an hour before activity.

Browse every guide in the Drug Information A–Z.

Can a BC pharmacist assess erectile dysfunction?

Not for diagnosis

Erectile dysfunction is not among the minor ailments BC pharmacists can diagnose and prescribe for, and the medications used are prescription-only in Canada — so a physician or nurse practitioner assessment is the starting point. Pharmacists can review your current medications for ones that may be contributing, check for interactions that genuinely matter here, and explain how a prescribed treatment works. Pill4Me's virtual clinic can connect you with a BC physician if you would rather not discuss it in person.

Coverage in British Columbia

Medications for erectile dysfunction are frequently not covered by BC PharmaCare, and coverage under private insurance varies considerably. Coverage depends on the medication, your indication and your plan. Ask Pill4Me Pharmacy to check what you would pay before filling — call 604-705-3644, and generic options are usually substantially less expensive than brand.

Coverage depends on the medication, indication, PharmaCare plan and, for some medications, Special Authority requirements — see BC PharmaCare.

Frequently asked questions

Is erectile dysfunction a sign of heart problems?

It can be, and this is the main reason an assessment is worth having. The arteries supplying the penis are narrower than the coronary arteries, so the effects of vascular disease can show up there first — sometimes years before heart symptoms appear. That does not mean ED equals heart disease, but it does mean it is a reasonable prompt to have blood pressure, cholesterol and blood sugar checked.

Can a pharmacist prescribe Viagra in BC?

No. Erectile dysfunction is not one of the conditions BC pharmacists can assess and prescribe for under the Minor Ailments and Contraception Service, and sildenafil is prescription-only in Canada. You need a physician or nurse practitioner. Pill4Me's virtual clinic can connect you with a BC-licensed physician, and if a prescription is issued we can fill it discreetly. A pharmacist can also review whether one of your existing medications is contributing.

Can my other medications be causing it?

Yes — this is common and often overlooked. Some antidepressants, blood pressure medications, antipsychotics and other drugs can contribute. It is not a reason to stop anything on your own, but it is a very good reason to have your full list reviewed. Sometimes an alternative within the same class resolves the problem without giving up the treatment you need.

Are online ED medications safe to buy?

Products sold without a prescription are a genuine risk — counterfeit ED medications are among the most commonly seized fake drugs, and they have been found to contain incorrect doses or entirely different substances. There is also a real safety issue being bypassed: PDE5 inhibitors must never be combined with nitrate medications, and that check is part of why a prescription exists. If cost is the concern, ask us about generic options.

Does erectile dysfunction go away?

Often it improves, particularly when there is a treatable cause — a contributing medication, untreated diabetes or blood pressure, heavy alcohol use, or anxiety. Treatment addresses the symptom while the underlying cause is dealt with, and for many people the two together resolve it. Persistent ED with no assessment is the version least likely to improve.

Related conditions

Type 2 Diabetes High Blood Pressure High Cholesterol

This one starts with an assessment

Erectile Dysfunction needs a physician or nurse practitioner to assess before treatment, and the medications used are prescription-only in Canada. Our virtual clinic connects you with a BC-licensed physician — register once and you can book yourself. A pharmacist can review your current medications in the meantime.

Book a doctor Review my medications How the virtual clinic works

Pill4Me Pharmacy is at 5625 Promontory Rd Unit 101, Chilliwack, BC. We deliver free to Chilliwack, Sardis, Promontory, Vedder and Yarrow, and you can reach a pharmacist directly at 604-705-3644.