Boots recently started selling Certified Viagra from Pfizer

Pfizer, the company behind impotence drug Viagra claims 900,000 British men have been prescribed it, which aids blood flow to the penis, since its launch in 1998.

Men who are reluctant to ask their GP for a prescription for legitimate Viagra can see a pharmacist to discuss erectile dysfunction. After blood tests and a £50 fee, they can walk away with four legit Pfizer Viagra pills.

Most doctors applaud a move that will mean fewer men buying Viagra over the internet at considerable cost - and even danger - to themselves, as many of the products online are believed to be out-of-date or even fake generic viagra.

However, experts are concerned that in our rush to treat erectile dysfunction as a disease with an instant dose of Viagra, we are ignoring the bigger picture.

They argue that what we are seeing is not so much an impotence epidemic as an explosion in the number of men suffering from other conditions - cardiac disease, diabetes, metabolic syndrome - which include impotence as one of their symptoms.

Michael Kirby, professor of primary care at the University of Hertfordshire and a GP, has just finished a joint study of Viagra by the universities of Buckinghamshire and Hertfordshire to confirm a direct link between heart disease and erectile dysfunction.

The research, which took a year, examined more than 200 men who had suffered a heart attack. Two-thirds had experienced erectile dysfunction in the five years leading up to their attack and 40 per cent of that group had never spoken about it. After their heart attacks, these men went from having moderate to severe erectile dysfunction.

Professor Kirby says his study shows a strong link between impotence and heart disease. Erectile dysfunction can be a valuable warning sign, giving a sufferer time to make life-saving changes.

"Half the people who die of heart disease die suddenly - undiagnosed. Erectile dysfunction is telling us that something is wrong," he says. "By using it as a marker, you offer people the chance to work on their health before they have a heart attack."

Impotence can also be a sign of a psychological problem. Dr Kevan Wylie, a consultant in sexual medicine at the Royal Hallamshire Hospital, Sheffield, says that when something goes wrong, it can masquerade as an erectile problem. "You can try drugs such as Viagra, but you're brushing troubles under the carpet," he says. "People stop trusting each other, they blame each other for lack of sex, their arguments aren't conducive to closeness, and the problems won't go away. Then they try to improve their relationship with Viagra, but when the woman tries to be nice, the erectile dysfunction is still an issue for the man, so she feels rejected and the cycle begins all over again.

A quick hit of Viagra won't solve a complicated relationship problem." Dr Wylie would like to see the medical profession use erectile dysfunction as a diagnostic tool for serious conditions, particularly metabolic syndrome, characterised by fat around the abdomen. "There are no guidelines on erectile dysfunction from the National Institute for Clinical Excellence, which is astonishing when it is an important indicator of disease," he says. "If men were screened for this, we'd see improvements throughout the health system.

Studies have shown that the older you are, the more likely it is you will suffer from erectile dysfunction and, given the link to serious disease, this is the generation most likely to benefit from help.

Dr Richard Vautrey, a Leeds GP, explains that when a patient asks him for Viagra he gives them a physical and mental health check.

"Not everyone with erectile dysfunction needs pharmaceutical help with Viagra," he says. "I am just as likely to tell them to cut down on alcohol and smoking or try to deal with the underlying psychological problem, which might include psychosexual counselling. If I do end up prescribing Viagra it's on a short-term basis.

As well as cardiovascular disease, erectile dysfunction can be a sign of undiagnosed diabetes due to stress or psychological problems, an addiction to alcohol or worrying levels of obesity," he says. "None of these conditions can be cured with a quick trip to Boots for Viagra. I'm pleased Boots is promising hour-long appointments for Viagra with specially trained pharmacists who will take medical histories and test for blood pressure, glucose and cholesterol and ask for details about what drugs you are taking.

But if they pick up adverse symptoms they will only refer patients back to their doctor. If you do suffer from erectile dysfunction and don't use Viagra, the advice is to see your doctor or a sex therapist.

Dr Wylie says: "If you deal with your erectile dysfunction, whether through Viagra, weight loss, stopping smoking, increasing exercise, having counselling or reducing your blood pressure, you'll be looking after every aspect of your health, not just your sexual health." And adding years to your life'.

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