Select Committee on Health Third Report


222. The Strategy has very little to say about sexual dysfunction. Under the chapter "Better services" there are two paragraphs devoted to "psychological and sexual problems". The Department pledges to develop "consistent standards of care to ensure that all ... sectors manage their patients appropriately". The Department also says it will encourage the development of training to allow a wide range of practitioners to recognise and assess sexual health problems such as impotence.[199]

Anti-impotence treatments

223. The debate on the priority that the Government attaches to sexual dysfunction intensified during the controversy over the charges for the new impotence drug sildenafil (whose trade name is Viagra). Sildenafil was one of the first drugs to bring the concept of rationing the provision of expensive treatments on the NHS to prominence. Following its launch in 1998, the Government, along with health service managers and doctors, feared that the NHS would be swamped by requests for the drug from otherwise healthy people wanting to improve their sex lives. Despite a High Court ruling in May 1999 against the Government's interim restrictions, access to sildenafil (and a range of other anti-impotence treatments) on the NHS has been limited under regulations which came into force in July 1999. Men who have been treated for prostate cancer or kidney failure, those with severe spinal injuries, diabetes, multiple sclerosis, spina bifida, polio, Parkinson's disease or single gene neurological disease are eligible for anti-impotence drugs. Men who are impotent through psychological causes, and whose impotence causes them "severe distress", are eligible only in exceptional circumstances, after a specialist assessment. The Impotence Association estimate that only 10% of the estimated 2.3 million men suffering from erectile dysfunction in the UK receive treatment for it. GPs can prescribe such drugs privately, but the cost to a patient of six Viagra tablets can be around £75.

224. The controversy surrounding the availability of sildenafil has greatly raised awareness of sexual dysfunction. However, grey areas persist over how far erectile dysfunction through psychological causes should be viewed as a medical problem. 'Recreational' use of the drug has been widely reported, and there is a thriving black market for the drug, particularly on the internet and in London bars and clubs.

225. We asked the Public Health Minister how she responded to a consultation that the Government had carried out in which 98% of those who responded had said that access to anti-impotence drugs should be widened. We also asked whether she had examined any research on the potential savings accruing in terms of a reduction in the costs of treating depression if such preparations were more widely available.

226. She acknowledged that this was "quite a difficult area of policy making when decisions were originally adopted ... we have certain circumstances in which the products are available but we take into account the priorities and pressures that are on the National Health Service and have made the decision accordingly."[200] She told us she was not aware of any cost-benefit analysis in this area of the type we had described.


227. The controversy over sildenafil has perhaps served to mask the wider issues relating to sexual dysfunction. Dr Pat Munday felt this was a very serious problem. Her work had convinced her that:

228. Jackie Rogers, a clinical nurse specialist in GUM, told us that sexual dysfunction therapy was very time consuming and expensive. Most therapists would see a patient for an hour and would have contact with them over a long period of time. While a few clinics had taken on therapists they were generally regarded as a "luxury".[202] Chris Ford confirmed that a therapist in a PCT adjoining hers had a year's waiting list, obliging her to muddle through with whatever advice she could give. If GUM services were the Cinderella of the NHS, then, in her view, services for sexual dysfunction represented "the Cinderella of Cinderella services".[203] The resources around dysfunction were "almost non-existent" in her area.

229. For the Department, Cathy Hamlyn, Head of Sexual Health and Substance Abuse, affirmed that the Action Plan contained a clear commitment to the development of psycho-sexual services, that include sexual dysfunction".[204] There is scant mention of sexual dysfunction in the Strategy and our evidence suggests that the Action Plan commitment is not yet a reality for those people suffering from serious sexual dysfunction.

230. We fully accept that any Government has to balance competing priorities and pressures in respect of public expenditure. We do, however, find it indicative of the priority accorded to sexual health, and sexual dysfunction services in particular, that access to anti-impotence services and drugs is so restricted. Effectively, the Government is dealing with this more as a lifestyle issue than a health issue, and that seems to us to be wrong. It is simply not appropriate that so many men and women with a clear medical and psychological need are not having access to these treatments, leading to a situation where only those who can afford it are likely to use them. This seems to us contrary to the fundamental principles of the NHS. We therefore recommend that access to anti-impotence treatments should be reviewed. We also think it would be helpful if the Department commissioned research to establish the costs and benefits of a more liberal prescribing regime, given the likely savings which might accrue in areas such as the treatment of depression, infertility, and dealing with the consequences of marital breakdown. Given the lack of development of sexual dysfunction services, and the fact that social pressures are such that those suffering will often be shy and unwilling to articulate their case, we call on the Department to include sexual dysfunction within the wider sexual health strategy.

199   Strategy, p 28 Back

200   Q 1108 Back

201   Q 619 Back

202   Q 621 Back

203   Q 621 Back

204   Q 7 Back

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