But women recovering from breast cancer surgery can have reconstruction work done through the medical card, while reductions are also carried out when there is a medical need.

The HSE was responding to Clare county councillor Brian Meaney, a member of the HSE West Forum, who has queried the nature of procedures paid for by the HSE under the GMS scheme.

Last week, he called on the HSE to reduce the amount of money it spends prescribing Viagra and other erectile dysfunction drugs to medical card holders in this region.

Cllr Meaney said these costs had to be reviewed at a time when patients who “have immediate medical needs or are in real pain” faced long waits for treatment and disability and community services were being slashed.

He believes some medical card holders were being prescribed Viagra simply to spice up their relationships and it was his “strong assertion” many were getting the magic blue pills where there was “no real medical need”.

Cllr Meaney said he also intended getting to the bottom of anecdotal claims that the HSE might be paying for breast operations for medical card holders and “not just in cases where there was a medical need”.

But the HSE said such procedures for purely cosmetic purposes were not provided free of charge in the Mid-West.

“Breast augmentation is done in the Mid-Western Regional Hospital for cancer patients who are post-surgery. Breast augmentation surgery takes place as part of breast reconstruction to rebuild a breast’s shape after a mastectomy. This, of course, is provided to public patients and medical card holders as a public service which is free of charge to cancer patients,” a HSE spokesperson explained.

“Some of what could be considered as breast augmentation surgery takes place in St John’s Hospital for non-cancer patients who clinically require the surgery for medical reasons only in the form of breast reduction surgery. As this surgery is performed to relieve a medical problem, rather than to improve appearance, it is provided to medical card holders free of charge. Breast augmentation in the cosmetic sense, for example breast enlargement, is not provided free of charge to medical card holders in the Mid-Western region,” the spokesperson stated.

Cllr Meaney was commenting on figures which showed the bill for Viagra and other erectile dysfunction drugs in the HSE West had climbed from €1.25 million to €1.42 million between 2009 and 2010. Limerick accounted for the highest bill in the region in 2010, at €324,000

The HSE said the drugs could also be used to treat pulmonary arterial hypertension although it was not possible to quantify the amount it spent on medical card holders with this rare condition. In relation to this and other cardiovascular conditions, erectile dysfunction drugs other than Viagra are being prescribed for teenagers, the figures show.