The world health organisation in its document on the fundamental rights for the individual, including the right to sexual health, stated that we all have the right of "freedom from organic disorders, disease and deficiencies that interfere with sexual and reproductive function".

Rights do not come without responsibility, so it is pertinent to ask whether the responsibilities of health care professionals to deliver these rights are being compromised by the Department of Health as a result of Schedule 11. In October 2001 the DoH admitted that after taking 220 submissions from "manufacturers, health professionals and patients" the majority were against the restrictions. The advice was ignored, which left unanswered the question "why bother to ask?". Evidence-based medicine is what we are encouraged to practice - it would be helpful if we also had, and could rely on, evidence-based politics.

Sex and the Heart

The heart is not unduly stressed during sex between couples in a long-standing relationship. The effect on the heart rate and blood pressure is approximately the same as walking one mile in 20 minutes on the flat. Heart attacks during sex are not common, with the incidence less than one per cent. This risk can be reduced by half by taking regular physical exercise. Similarly sudden death during sex is rare - less than one per cent of all sudden deaths, but of these 75 per cent are during extramarital sex! There are many myths about sex and the heart which lead to unnecessary fears. The heart sees sex as just another relatively brief form of exercise with a maximal stress for only three to four minutes out of the average duration of intercourse (5-15 minutes).

Erectile Dysfunction

The failure to develop and sustain an erection to allow penetrative sex is known as erectile dysfunction or ED. The commonest cause is vascular disease - hypertension, coronary disease, diabetes and other heart diseases. ED increases in frequency with age, affecting up to 40 per cent of men aged 40-70 years, and 70 per cent of men in their 70s and 80s. As we are an ageing population the management will be an ever increasing challenge. It is a distressing condition which is not usually psychological - though anxiety, depression and loss of self-esteem compound the problem as a consequence.

Viagra

Viagra (sildenafil) began as a drug for angina, became a drug for ED, and is now being evaluated once more as a form of heart disease therapy with exciting new findings. The incidence of death, heart attack or stoke is not increased by Viagra - indeed Viagra may be of benefit to the heart. Advice needs to be given on its use (it is not an aphrodisiac) and how and when to take it. It reacts with nitrate drugs (blood pressure may fall dramatically) which are absolutely contraindicated, but no other therapy has restrictions other than a more cautious dosing in HIV patients due to drug (Viagra) potentiation. It does not always work and it may not work at first, which is why advice and support are essential or desperation and depression will follow.

The NHS and ED

ED is common and distressing, but treatable with a much higher success rate than many NHS approved therapies. ED can identify silent heart disease, giving us a major opportunity to prevent it causing deaths and disability. An NHS that does not recognise the importance of maintaining and facilitating a healthy sexual relationship is not fulfilling its duty and responsibility to the individual, partner and family.

By relieving the suffering that results from ED we can rekindle loving relationships and cement their foundations. It is one of the most rewarding of treatments and to deny therapy to the majority of NHS patients who have ED is shameful. In a caring society we should embrace all manifestations of disease and not use the arguments that fail to justify Schedule 11. Schedule 11 is unfair, cruel and heartless and should not be a part of any political, medical or social philosophy

Some important facts about ED: