When It Stops Working

Read This First

Danger now?

Chest pain after taking an erection pill: call an ambulance (999 or 112 in the UK and Kenya, 911 in the US). Tell them you took an erection pill and what it was. Nitrates (the spray or tablet often given for chest pain) can drop your blood pressure dangerously on top of it.

An erection that has lasted more than 4 hours: go to an emergency department now. Waiting can permanently damage the penis.

Sudden loss of vision in one or both eyes, or sudden loss of hearing: stop taking the pill and get urgent medical help.

The full list is on the Go Now card at the back of this book. Photograph it.

You probably didn't pick this book up in public.

Maybe it's late and the door is shut. Maybe the last few times didn't go the way you wanted, and you've started planning around it: drinking a bit less, drinking a bit more, avoiding the moment altogether. Maybe there's a strip of pills in your drawer that came from a chemist who didn't ask a single question, or from a friend, or from a website that looked convincing enough.

You're not the only one. Not even close. You'll see the numbers in Chapter 1, and they're bigger than most men guess. What's rarer is a man who talks about it. That silence is what this book is for.

What this book is

This is a frank, practical guide to erectile dysfunction, usually shortened to ED: trouble getting or keeping an erection firm enough for the sex you want, often enough that it's a problem for you.

It does three jobs:

1. It shows you what an erection problem can be telling you. Your penis has some of the smallest arteries in your body. When they struggle, it can be an early warning of trouble in your heart, your blood sugar, your sleep or your blood pressure. That warning can come years before anything else shows.
2. It tells you exactly what the pills can and can't do, and what they must never be mixed with. Sildenafil (sold as Viagra and many cheaper versions), tadalafil (Cialis and others), vardenafil and avanafil are real medicines that work for many men. They are also dangerous next to certain heart medicines, poppers and some other drugs. "Herbal" and street "power" products often contain the same drugs, hidden, in unknown amounts.
3. It gets you ready for the conversation you've been avoiding, with a doctor, a pharmacist or a partner, with the exact words to use.

We're not going to tell you that you don't need help, or that you should "just relax". We're also not going to pretend the pills are sweets. If you're going to take something anyway, you'll know how to make it as safe as it can be, and what an emergency looks like.

What this book is not

It is not medical advice for you personally, and it can't replace an assessment by a clinician who can examine you, check your blood pressure and run your bloods. It never gives doses or tells you how to change one. That decision belongs to a prescriber who knows your heart and your other medicines. Every number in this book has a source, listed at the back.

Why we use plain words

This book says penis, erection, ejaculation, orgasm and sex, because those are the words you'd use with a doctor, and the words a doctor needs to hear. It names drugs by their real names and the names people use on the street. Clinical, frank, never crude. If the words make you wince a little, that's normal. By the end of the book they should feel ordinary enough to say out loud in a consulting room.

Pick your path

You don't have to read in order. Start where you are, then come back for the rest.

• I'm buying pills now, quietly, and haven't seen anyone — Chapter 5 (who must never take them) and Chapter 7 (fake and "herbal" pills) — Chapter 3 (why your heart needs checking)
• The pills "don't work" for me — Chapter 6 (using a prescribed pill properly) — Chapter 4 (what may be underneath), Chapter 9 (other treatments)
• I have heart disease, diabetes, high blood pressure or I snore badly — Chapter 3 and Chapter 4 — Chapter 5 (your medicines and the pills)
• I'm young, my body seems fine and I'm anxious about it — Chapter 10 (the head) — Chapter 2 (how it works), Chapter 13 (partners)
• I use the pills for fun, for confidence or at parties — Chapter 8 — Chapter 5 (poppers and other drugs)
• Someone sold me testosterone for this — Chapter 11 — Chapter 3
• My problem is coming too fast, or not wanting sex — Chapter 12 — Chapter 10
• I'm the partner — Chapter 13 — Chapter 1 and Chapter 3

Everything comes together in the ED Check-Up Plan at the back: the tests to ask for, your medicine list, the pill-safety check, how to buy safely, and the words for your doctor, your pharmacist and your partner. Fill it in as you go.

About the stories

Some chapters open with real, documented cases from regulators, courts and medical journals; those are cited. Other stories are composites; names and details are changed. A composite is built from common patterns, never from one real person, and never carries a real clinic's name or a quote from a real person.

About this book

This book is educational. It is not medical advice, and it is not a substitute for a clinician who knows your history. If you have warning signs now, use the Go Now card or call your local emergency number. For everything else, take the questions in this book to a doctor, nurse or pharmacist.

MediQuestAI does not prescribe, sell or supply any medicine mentioned in this book.

If you remember one thing from this page: if something stopped working, the reason matters more than the pill. Turn the page.

Why Men Don't Say It

It's Thursday, a little after six. Peter is 47 and he has driven past the chemist twice.

On Saturday he and his wife are going away for the weekend: two nights at a lodge, the first time without the children in years. She booked it. She's excited. He is too, mostly. But for about a year, things haven't worked the way they used to. Sometimes it's fine. Sometimes it starts and then fades halfway. Twice it didn't start at all, and he blamed the beer and the long week, and she said it didn't matter, and they both lay there pretending to sleep.

He waits until the young man ahead of him has paid for his cough syrup. Then he leans in and says, quietly, "Do you have the blue ones?"

The pharmacist's assistant doesn't blink. He puts a small strip on the counter. Peter pays cash. Nobody asks about his heart, his blood pressure, or what other tablets he takes. Nobody asks how long this has been going on. He's back in the car in under two minutes, and the main feeling is relief: it's handled.

Peter is a composite; names and details are changed. But everything in that scene happens every day, in chemists, at kiosks, on websites and in WhatsApp chats, all over the world.