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Tailored pharmacy support can ensure better outcomes for patients when it comes to sexual health matters such as contraception and erectile dysfunction

With council-run sexual health services under strain, the role of pharmacies in providing good quality advice and treatment for a range of sexual health queries is becoming even more important.

This is reflected in recent developments like the Pharmacy Contraception Service in England, as well as the wider availability of erectile dysfunction treatments following MHRA reclassifications. 

June saw reports that sexual health services in England are now facing unprecedented pressure, which means that pharmacy has an opportunity to help pick up some of the slack by offering contraceptive and sexual health services. 

Recently reported figures from the UK Health Security Agency show there were a record 4.5 million sexual health consultations in 2024, an increase on the 2.9 million consultations that took place in 2013.

In response, the Local Government Association (LGA), which represents councils responsible for commissioning sexual health services, warned that existing services are struggling to manage this demand, and saying that if action isn’t taken people will have to wait longer for consultations and face reductions in access to much-needed sexual healthcare. 

Without sustainable funding and strategic planning, the system risks becoming overwhelmed, according to David Fothergill, chairman of the LGA’s Community Wellbeing Board.

Fothergill says the statistics show how local sexual health services are grappling with significant increases in demand, and pointed out that “without adequate investment, people will face growing barriers to accessing expert and timely care”.

He adds: “Councils have worked hard to promote regular testing and early detection, which are both vital for preventing the spread of infections and improving public health outcomes. Investing in sexual health services not only reduces long-term illness and unplanned pregnancies but also eases pressure on the NHS and enhances the wellbeing of our communities.” 

The LGA is urging the government to develop a national sexual health strategy that addresses the rising rates of sexually transmitted infections (STIs), long-term funding for local services, better access to tests and treatment and improved workforce planning.

The call comes amid growing concern that without coordinated national leadership, local services will continue to struggle, putting public health at risk. 

Untapped potential

Pharmacies are already involved in this area through providing emergency and routine contraception, testing, basic treatment and vaccines such as Hep B and PrEP.

Henry Gregg, chief executive of the National Pharmacy Association, believes the move from treatment to prevention that was set out in the recent 10-year plan carves out a space for pharmacies in sexual health, with many already well-established providers of walk-in services. Gregg says: “Pharmacies have long supported the sexual health of their populations with walk-in access to advice on anything from contraception, STIs including chlamydia testing, fertility to menopause symptoms and erectile dysfunction. 

“They have also taken part in the trial of PrEP services but there is much untapped potential still to be fulfilled.”

Gregg is hopeful that the commissioning of a national emergency contraception service will end the postcode lottery of local authority commissioning, making it easier for the public to understand what pharmacies can offer.

 “Pharmacists will always be able to have a conversation about long term contraceptive needs and options and can initiate and supply the contraceptive pill in the pharmacy,” he says. “The role of pharmacy is to keep people well, and we believe community pharmacies are best placed to support the sexual health of the nation.”

Contraception access

Access to contraception - emergency or otherwise - has been available from pharmacies for some time, but emergency contraception is currently still only available from pharmacy at a cost. In March 2025, however, the Department of Health and Social Care (DHSC) and NHS England (NHSE) announced important updates to the Pharmacy Contraception Service (PCS). From October 2025 the PCS will also be extended to include Emergency Hormonal Contraception. 

Once formal updates are made to the service specification and relevant regulations by NHSE and DHSC, trained and competent pharmacy technicians will also be allowed to deliver the service, enabling pharmacies to make more effective use of their skill mix. A start date for this change hasn’t yet been confirmed. 

“It’s a huge step forward for access,” says Anna Maxwell, CEO of Maxwellia, manufacturer of progestogen-only contraception pill Lovima. “But we know from talking to women that time, privacy and choice still play a critical role in their decision-making.”

Announcing that the morning after pill will be available without charge on the NHS from English pharmacies, pharmacy minister Stephen Kinnock said: “Women across England face an unfair postcode lottery when seeking emergency contraception, with access varying dramatically depending on where they live. 

“By making this available at community pharmacies, we will ensure all women can access this essential healthcare when they need it, regardless of where they live or their ability to pay.”

Alastair Buxton, director of NHS services at Community Pharmacy England (CPE), agrees. “The introduction of the national PCS was a fantastic move for widening access and convenience for patients, and was something that CPE had long been advocating for. The expansion to include emergency contraception is a natural step and we’re pleased to be rolling out this important new provision to further support women.”

A range of materials is available to help pharmacy owners promote the service in CPE’s Pharmacy Contraception Service hub, including posters in different formats and languages. Further resources are also under development. 

“Looking ahead, the commissioning of further pharmacy sexual health services has the potential to benefit both local communities and reduce pressure on other NHS providers,” says Buxton.  

“The newly published 10-year plan announces that, from 2026, community pharmacies will also provide a catch-up service for the HPV vaccination, but we believe pharmacy’s role could go much further. PCS should be developed into a more comprehensive women’s health service, such as offering long-acting reversible contraception and menopause advice, with prescribing of hormone replacement therapy.”

Men’s health services 

Dr David Edwards, men’s health specialist and chair of the primary care testosterone advisory group at Besins Healthcare suggests that pharmacy teams also have a role to play in advising on sensitive sexual health concerns, including testosterone deficiency (TD), which can significantly affect men’s quality of life, mental health, and relationships but often remains untreated due to limited awareness and social stigma.

 “Pharmacists can serve as essential partners, together with clinicians, in ensuring diagnosis and creating a bespoke management plan,” says Edwards, pointing out that resources like the Androgen Deficiency in Ageing Males (ADAM) questionnaire, a screening tool to help pharmacists and clinicians assess potential TD in men, can help to identify those who may need further evaluation with blood tests. 

“To help men get the advice and support they need on sensitive health conditions like TD, pharmacists and dispensers can confidentially and sensitively provide proactive support and education to men who may be at greater risk, ie middle-aged and older men, particularly those with obesity or type 2 diabetes. 

“Men presenting with erectile dysfunction (ED) or loss of spontaneous erections, or those with reduced sexual desire, may also benefit and should be screened for TD. Men taking long-term opiate or other pain medications including co-codamol, antipsychotic or anticonvulsant medication are also at risk.”

Edwards suggests that as more pharmacies have facilities to see men in privacy there’s more opportunity for patients to talk about potentially embarrassing conditions. “It’s important that pharmacists know how to engage patients in having these sensitive discussions. 

“Pharmacists know what medications their patients are taking, so they could consider adding a note inside the prescription bag, discreetly letting the patient know that it is not unusual for patients with their diagnosis, or taking the medication that they have been prescribed, to develop ED or TD. If this is something the patient would like to discuss privately, they can ask their pharmacist for an appointment.”

This approach opens the door to a conversation without putting the patient on the spot. Partners can also be powerful ambassadors, so inviting the patient for a private consultation with their partner can help men to feel more comfortable. 

“In my experience, patients are not insulted if a healthcare professional asks them about ED or TD, in fact the opposite can be true as they are relieved that the HCP has raised the topic,” Edwards maintains.

Erectile dysfunction (ED) and testosterone deficiency (TD)

ED specifically refers to the inability to get or maintain an erection sufficient for sexual intercourse, whereas TD encompasses a wider range of symptoms including fatigue and low energy, decreased libido, mood changes and reduced muscle mass and strength. 

While ED can be a symptom of low testosterone, it’s not the only one, and many men with ED do not have low testosterone. Any red-flag symptoms beyond ED should prompt further investigation and pharmacists can play an important role in encouraging men to speak with their GP for advice if they are experiencing these symptoms, to arrange blood tests and refer to secondary care if necessary.