Healthy young men after easy telehealth scripts for recreational sildenafil, GP warns
Healthy young men are misusing prescriptions for sildenafil (Viagra) to offset the impact of party drugs on sexual performance, a GP sexual health expert warns.
Dr George Forgan-Smith says men have long used illegal sildenafil or sometimes tadalafil (Cialis), but telehealth corporates have now allowed them to source legitimate but clinically unnecessary prescriptions.
“Many online-based medical practices are apparently happy to prescribe these drugs at the end of a simple phone call,” the Melbourne GP told AusDoc.
He said that heterosexual and homosexual men wanted erectile dysfunction (ED) treatments so they could have sex after using illicit psychostimulants such as MDMA.
“MDMA, ecstasy, amphetamines, and in particular methamphetamines, can give people a particularly high sexual appetite,” he said.
“But they absolutely make erections near impossible, so drugs like Viagra can counter the side effects of this substance use.”
Bodybuilders with steroid-induced ED were also seeking easy prescriptions, he said, as were young men who had performance anxiety from watching pornography’s “unrealistic and photoshopped body shapes and forms”.
“Anxiety, I put to you, is one of the biggest causes of ED,” he said.
“If you are worried about losing your erection, guess what? Your body will happily comply.”
He urged doctors not to prescribe the medications based on a short telehealth consultation with an unknown patient when the risks included psychological dependence, dangerous drops in blood pressure and harmful interactions with prescribed or recreational drugs.
“Healthy young people have healthy young blood pressure, so taking a medicine that will lower their blood pressure could lead to fainting,” he said.
“Drugs like MDMA and ecstasy can interact with sildenafil because both are metabolised through a similar pathway in the liver, which can lead to very high levels of these drugs in the system.”
He warned that clinically unnecessary sildenafil or tadalafil could be a stepping stone to more dangerous treatments.
“Penile injections are considered the next step,” he said.
“If they are using methamphetamine and partying for 72 hours straight, then it’s not beyond their scope to do penile injections.
“Let me tell you, a whole world of pain can happen there.”
Studies have also identified increasing recreational use of ED treatments, while Dr Forgan-Smith said that understanding these trends enabled effective opportunistic screening of young men.
“To do a proper screening, say to patients, ‘Let’s look at your heart and check your blood pressure,’ then ask them if there are any problems with erections.
“Ask, ‘Do you ever take any Viagra or Cialis recreationally? Because if you do, it can affect your blood pressure.’
“I say to my patients, ‘If you need ED drugs occasionally because of sexual performance anxiety, let’s have that conversation. If you need them because you’re using party substances, let’s have a chat about that too’.”
He urged GPs to “tread lightly but don’t be afraid to tread”.
“These are conversations that we, as GPs, should be having with our patients.
“I’m a doctor who doesn’t blink. I offer medical care to people who are involved in BDSM kink and fetish.
“So it’s a normal conversation in my room, but I don’t think it’s a normal conversation in every GP’s room.”
