Glossy magazines for men are rarely without racy features on "what really turns women on" or "how to have the best sex ever". For increasing numbers of men, though, the most avidly read accounts are those about how Viagra and other new drugs can restore potency.
Five years ago, erectile dysfunction - the more accurate medical name for impotence - was largely a taboo subject, but all that changed with Viagra. "Suddenly, here was a drug that worked, was basically safe and could help about 60 per cent of those with a problem," says Tim Whittlestone, consultant urological surgeon at Bristol Royal Infirmary.
Estimates of how many men are affected vary widely. "About half of men over the age of 50 will suffer," says Mr Whittlestone. "Some have no erections, others become increasingly less powerful. Most have suffered for at least 12 months and many as long as 10 years before seeking help."
Erectile dysfunction is often not an isolated condition. In more than 70 per cent of cases, there is an underlying condition, such as heart disease, diabetes, the effect of long-term smoking, excessive alcohol or raised blood pressure. All these can damage the blood vessels in the penis. A new study from Brussels found that even cycling can increase the likelihood of impotence.
This is leading a number of urologists to view the dysfunction in a wider context. "It can be a very good screening test," says Mr Whittlestone. "We can predict that up to 70 per cent of men in their fifties with a potency difficulty will also have some narrowing of their coronary arteries."
He and colleagues have formed a group called Bristol Urology Associates, based at Bupa Hospital, Bristol. "We believe we are the first group of urologists to get together to focus on men's health issues in general, although our main aim is to make sure patients get the best treatment to help them achieve a satisfactory sex life," says Mr Whittlestone.
"We check cholesterol and other blood fats, weigh patients and check blood sugar levels. We treat the erectile problems, but also encourage patients to improve their general health."
He also advises any man over 45 who has failing erections to have his prostate checked. In some cases, impotence is an early sign of cancer.
GPs should ask more patients if everything is all right with their sex lives, says Dr Graham Jackson, consultant cardiologist at Guy's and St Thomas' Hospitals, London, who takes a special interest in the link between heart health and sexual potency. "About 15 per cent of patients with untreated high blood pressure have erectile dysfunction."
A recent American study of 50 men referred to a urology clinic disclosed previously undetected heart disease in almost half, says Emma Martin, sexual advice sister in the cardiovascular unit at Guy's. "Our unit is now receiving many more letters from urologists who find their patients with erectile dysfunction have cardiovascular risks as well."
During the recent Men's Health Week, men, young and old, were urged to tell doctors about worrying sexual matters. "Unfortunately, research shows that six in 10 men with failing erections do not believe they will be taken seriously," says Dr Jackson. He welcomes the growing interest among "progressive urologists" in detecting silent disease, but adds: "We need urgent action from the Health Department to encourage much wider recognition of fading erections as an early warning sign of diabetes and heart disease."
One reason for the department's silence could be the cost of treating an ageing population with Viagra-like drugs or mechanical implants and pumps. At present these treatments are limited. Controversially, some doctors, including Mr Whittlestone, predict over-the-counter pharmacy sales of Viagra within two years. Dr Jackson, however, argues firmly against easier access. "These are safe drugs, but those using them need to be aware of possible side effects or interactions with other drugs.
"Already, Viagra is easily available through the internet and at street level alongside ecstasy and cannabis. They are best prescribed in a safe, regulated manner."
