
Type 2 diabetes and erectile dysfunction: How one couple revived their intimacy
'Many men feel embarrassed when I meet them, the term 'erectile dysfunction' rarely leave their lips. Instead they come in saying things like, 'it's not like it used to be, doctor' or 'it's not working properly down there'. There's often a feeling that they've somehow let themselves or their partner down,' says Ralph.
'It's my job to explain that ED is extremely common – particularly with age and underlying health conditions like diabetes – and that it's a medical issue, not a personal failing.'
Why this occurs, says Ralph, is because prolonged high blood sugar can damage the small blood vessels and nerves which are essential for an erection. 'This reduces blood flow and sensation in the penis. Men with diabetes are also more likely to have low testosterone, which further lowers sexual desire,' he adds.
Ralph also points out that psychological factors such as anxiety or low mood can worsen the problem. While other diabetes-related health problems, such as heart or kidney disease, may also play a role in reducing sexual desire and contributing to erection problems.
A midlife diagnosis that changed the marriage
Sara and Arion first met in 2008, moved in together within two months and welcomed their first child a year later. But their whirlwind romance stood the test of time, as they married and went on to have five sons together, now aged 16, 14, 12, nine and three.
'After so many years together we both know sex isn't the be-all and end-all, but it's certainly the important glue, and I'd say we connected this way three to four times a week' says Sara, who helps run Arion's restaurant. 'Having friends who haven't had passion that actually lasts, we always felt very fortunate in that area.'
A routine check-up a few years ago showed Arion was pre-diabetic. 'Diabetes is more prevalent in the South East Asian community, and in my line of work I'm constantly surrounded by delicious chapatis, naan, and we cook with ghee – admittedly not ideal for insulin levels,' he says.
According to Ralph, pre-diabetes is a 'warning sign' and prompt action – modifying lifestyle factors such as weight loss – can minimise the risks by getting the sugars controlled.
Determined to reverse the condition naturally, Arion improved his diet, installed a treadmill in the front room, and played football with his sons. But despite these efforts, by 43, he'd tipped into full Type 2 diabetes. This too, alas, is common says professor Ralph. 'Many patients progress to full blown diabetes, and all of the cardiovascular complications including ED.'
That's when things started to change in the bedroom.
'For someone who is naturally full of beans, Arion became more lethargic,' describes Sara. 'His erections were weaker, and intercourse became a struggle.'
The psychological impact of ED on a relationship
Sara admits she worried Arion had stopped finding her attractive. 'After five babies my body had changed, however many kegel exercises I did. There were tense evenings, and the longer it carried on, the more Arion lost his confidence. His enthusiasm for sex waned, I'm sure he feared it would result in failure.' She knew they needed to talk about it – but not during sex.
'I didn't want to bring it up while in bed, with all that pressure. So instead, the two of us we went out for a walk and I said, 'I love you, come on, let's talk about this.' Arion seemed relieved I'd raised it. 'Of course I still fancy you,' he reassured me. And I cried, 'Of course I don't think you're letting me down.' That initial conversation was an important first step.
Together, they focused on non-penetrative ways to stay intimate. 'We tried massages, different positions, using sex toys, and yes – forgive me if this is frank – we practised more oral sex,' admits Sara says. 'It was worth us both improving our technique, and just lightening up a little if things didn't work out.'
What are the treatment options and technical advances for ED?
When Arion decided he wasn't ready to stop having sex in the way they were used to, he went to the GP, who suggested Viagra.
PDE5 inhibitor oral medications – like sildenafil (Viagra) or tadalafil (Cialis) – remain the first-line treatment according to Ralph. These work by temporarily improving blood flow.
'However, they don't address another key issue that many men with ED face – the problem of blood leaking back out too quickly, which can make it hard to maintain an erection. Studies indicate that around half of men stop taking them within a year. Patients often report side effects like headaches or flushing and do not like having to plan sex around a pill.'
Treatments for ED have advanced considerably, says Professor Ralph, with far more available today than 10 years ago. Second-line options include NHS-provided mechanical vacuum devices, which help draw blood back into the penis. 'While these are effective and non-invasive, many men find them inconvenient or uncomfortable long-term,' admits Professor Ralph.
Penile injections are another alternative. 'Alprostadil injections (which relax the blood vessels in the penis) are used when oral treatments fail and are effective in the majority of cases, but drawbacks include pain, priapism risk (an unwanted erection lasting hours), and the need for self-injection,' says Professor Ralph.
Penile implants are available too, but this surgical option tends to be reserved for more complex or persistent cases. They're irreversible but associated with high satisfaction rates.
'More recently, there's been growing interest in treatments that aim to restore function more naturally – especially among men (such as Arion) who want longer-term solutions or don't like the idea of planning sex around a pill.'
One example is low-intensity shockwave therapy which is a private treatment that uses sound waves to stimulate blood flow and encourage new blood vessel growth.
'It can benefit some, particularly those with mild ED, but the clinical results are mixed, and it requires multiple clinic visits, and can cost up to £3000 ($6,800),' explains Professor Ralph.
'Another option is Vertica, a handheld, at-home device, using radiofrequency energy to improve blood flow and reduce venous leak, a common cause of ED,' he adds.
A peer-reviewed study in the International Journal of Impotence Research reported that 85% of users experienced improvement at four weeks, and 93% had erections sufficient for penetration by 12 weeks.
It's approved by the MHRA (Medicines and Healthcare products Regulatory Agency) though is not available on the NHS and costs approximately £1250-£1500 ($2,800 - $3,400) , depending on the model.
Interestingly, says Ralph, the device worked just as well in men with diabetes 'who are typically harder to treat'.
'Around 40% of men in the trial had Type 2 diabetes – given how often ED and diabetes go hand in hand that's encouraging.'
Finding a way forward their sex life – what finally worked
For Arion personally, 'who doesn't even like taking paracetamol' it was the drug-free solution, Vertica, that worked.
'After about a month of using the device three to four times a week consistently we noticed a difference,' says Arion. 'My morning erections returned, full sex was mostly possible, and crucially my confidence improved,' says Arion. 'It felt like turning back time in a way we didn't think possible.'
Today, the couple feel closer than ever. 'It's just like normal again, before his diabetes diagnosis,' Sara says. 'We laugh more, talk more, touch more. We came through this hurdle together, and who knows, we're not ruling out baby number six in the future...'
The diabetes red flags to watch out for
The symptoms for both Type 1 diabetes and Type 2 can be similar, but Type 1 diabetes usually develops more quickly and is more common in younger people. The most common symptoms of Type 2 diabetes are:
Feeling very tired
Peeing more than usual
Feeling thirsty all the time
Losing weight without trying to
Other symptoms can include:
Blurred vision
Cuts or wounds taking longer to heal
Itching around your penis or vagina, or you keep getting thrush
Erectile dysfunction
These symptoms are the same for both adults and children. If you get symptoms (not everyone gets them), they may develop gradually and if concerned speak to your GP.
How to recognise ED
Early signs include reduced firmness, especially during morning erections, and difficulty maintaining an erection during intercourse.

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Scoop
3 days ago
- Scoop
Effective Partnerships Can Stop The Next Pandemic
21 July 2025 Dr. Ibrahim Abubakar, a professor of infectious diseases at University College London, issued this warning at a recent meeting of the UN Economic and Social Council (ECOSOC) in New York. It is not a question of if but when, and Dr. Abubakar believes the answer is sooner than anyone wants in part because the global healthcare system remains drastically siloed. This is a problem because, intrinsically, a pandemic cannot be stopped by one country alone. 'Infectious diseases will not respect borders. Therefore, health systems to ensure equity, dignity and universal access must also be agile to implement policies across borders,' Dr. Abubakar said. Rather, stopping pandemics — and promoting broader global development — requires robust partnerships and consistent investment in multilateral systems as a practice, not just an ideal. 'If we are to meet the ambitions of the 2030 Agenda, we must reimagine cooperation, not as a transactional action but as a dynamic, inclusive and future-ready partnership,' said Lok Bahadur Thapa, vice president of ECOSOC. A goal to unite all goals The High-Level Political Forum (HLPF) on Sustainable Development is convening at UN Headquarters in New York to discuss progress – or lack thereof – towards the globally agreed 17 Sustainable Development Goals (SDGs). The first 16 SDGs deal with specific aspects of development — such as poverty, gender equality and climate change — but the 17th puts forward a path to achieve the others. And this path lies in embracing global partnerships between State governments, civil society organizations, communities and the private sector. However, with an annual financing gap for the SDGs which exceeds $4 trillion, the partnerships of today are not sufficient to realize the goals for tomorrow. 'We must forge truly transformative partnerships that break traditional silos: governments, civil society, the private sector and multilateral institutions all have roles to play in an inclusive coalition for sustainable development,' Dima Al-Khatib, director of the UN Office for South-South Cooperation (UNOSSC) said at an HLPF event. Prioritize prevention, not reaction Right now, the current health system, which includes pandemic preparedness, is oriented towards halting health emergencies once they emerge as opposed to proactively preventing them, according to Dr. Abubakar. Member States recently adopted a pandemic prevention treaty which endeavours to do just this — limit the likelihood of future pandemics. But for many, this emphasis on prevention extends beyond pandemics to issues like rehabilitation services and primary care, both of which experts say are critical investments not only in human well-being but also in peace and security. Moreover, these types of preventative medicine are cheaper than reactive medicine, according to Mandeep Dhaliwal, the Director of Health at the UN Development Programme (UNDP). 'It's important to invest in prevention as much as it is in treatment, and it is more cost-effective because … you're turning off the tap,' Ms. Dhaliwal said. However, convincing investors to support preventive care can be difficult because, when done correctly, tangible results are not necessarily visible. Health is in every system Nevertheless, investing in preventive medicine like primary care and the socioeconomic determinants of health — such as climate and nutrition — can help ensure that health systems are holistically supporting people before a crisis begins. 'Health is not a silo… the factors that influence health are often outside the health sector,' Ms. Dhaliwal said, citing the example of air pollution which is a climate problem that inherently influences health. This sort of holistic investment requires robust partnerships which work to ensure that every initiative — no matter how seemingly distanced — considers health implications. 'We have too often treated [health] as a downstream issue, something that improves only if other systems are working. But we now understand that health and well-being is not simply the result of good developments. It's the starting point,' said Tony Ott, a professor of agricultural sciences at the Pennsylvania State University. The weak link in the health system Migrants and displaced people tend to be among those least likely to have access to preventive medicine and often those most impacted by the social determinants of health. 'Migration and displacement, whether it's driven by conflict, climate change or economic factors, are defining factors in terms of our health,' he said. By the end of 2024, 123.2 million people were forcibly displaced worldwide, a decade-high number which proves that in the 10 years since the SDGs were adopted, the world has regressed in relation to displacements. For Dr. Abubakar, these displaced people — and the millions more voluntary migrants — embody why the health system simply cannot continue to silo itself and must instead embrace cross-border partnerships. 'Health systems must ensure access to essential services regardless of immigration status … Any community without access is that weak link that may mean we are all not protected,' Dr. Abubakar said, referring to the next pandemic. Communities at the centre The idea of partnerships as foundational to achieving the SDGs is logical for many people. After all, the goals are universal in nature and demand global collaboration. But this collaboration, especially for health, must do more than just engage experts — it must engage the people who seek out healthcare. Dr. Abubakar said that all health policies must be culturally appropriate to local contexts, something which can only happen if communities are placed at the centre of healthcare. 'The new future that I see would embrace global partnership, including countries irrespective of income level, public and private sector, academic and civil society. And within this framework, communities must be at the centre… not just as recipients but as co-creators of solutions.'


NZ Herald
14-07-2025
- NZ Herald
Type 2 diabetes and erectile dysfunction: How one couple revived their intimacy
'It's one of the most common complications of the disease – yet it's also one of the least discussed,' says consultant urologist professor David Ralph, of University College London. 'Many men feel embarrassed when I meet them, the term 'erectile dysfunction' rarely leave their lips. Instead they come in saying things like, 'it's not like it used to be, doctor' or 'it's not working properly down there'. There's often a feeling that they've somehow let themselves or their partner down,' says Ralph. 'It's my job to explain that ED is extremely common – particularly with age and underlying health conditions like diabetes – and that it's a medical issue, not a personal failing.' Why this occurs, says Ralph, is because prolonged high blood sugar can damage the small blood vessels and nerves which are essential for an erection. 'This reduces blood flow and sensation in the penis. Men with diabetes are also more likely to have low testosterone, which further lowers sexual desire,' he adds. Ralph also points out that psychological factors such as anxiety or low mood can worsen the problem. While other diabetes-related health problems, such as heart or kidney disease, may also play a role in reducing sexual desire and contributing to erection problems. A midlife diagnosis that changed the marriage Sara and Arion first met in 2008, moved in together within two months and welcomed their first child a year later. But their whirlwind romance stood the test of time, as they married and went on to have five sons together, now aged 16, 14, 12, nine and three. 'After so many years together we both know sex isn't the be-all and end-all, but it's certainly the important glue, and I'd say we connected this way three to four times a week' says Sara, who helps run Arion's restaurant. 'Having friends who haven't had passion that actually lasts, we always felt very fortunate in that area.' A routine check-up a few years ago showed Arion was pre-diabetic. 'Diabetes is more prevalent in the South East Asian community, and in my line of work I'm constantly surrounded by delicious chapatis, naan, and we cook with ghee – admittedly not ideal for insulin levels,' he says. According to Ralph, pre-diabetes is a 'warning sign' and prompt action – modifying lifestyle factors such as weight loss – can minimise the risks by getting the sugars controlled. Determined to reverse the condition naturally, Arion improved his diet, installed a treadmill in the front room, and played football with his sons. But despite these efforts, by 43, he'd tipped into full Type 2 diabetes. This too, alas, is common says professor Ralph. 'Many patients progress to full blown diabetes, and all of the cardiovascular complications including ED.' That's when things started to change in the bedroom. 'For someone who is naturally full of beans, Arion became more lethargic,' describes Sara. 'His erections were weaker, and intercourse became a struggle.' The psychological impact of ED on a relationship Sara admits she worried Arion had stopped finding her attractive. 'After five babies my body had changed, however many kegel exercises I did. There were tense evenings, and the longer it carried on, the more Arion lost his confidence. His enthusiasm for sex waned, I'm sure he feared it would result in failure.' She knew they needed to talk about it – but not during sex. 'I didn't want to bring it up while in bed, with all that pressure. So instead, the two of us we went out for a walk and I said, 'I love you, come on, let's talk about this.' Arion seemed relieved I'd raised it. 'Of course I still fancy you,' he reassured me. And I cried, 'Of course I don't think you're letting me down.' That initial conversation was an important first step. Together, they focused on non-penetrative ways to stay intimate. 'We tried massages, different positions, using sex toys, and yes – forgive me if this is frank – we practised more oral sex,' admits Sara says. 'It was worth us both improving our technique, and just lightening up a little if things didn't work out.' What are the treatment options and technical advances for ED? When Arion decided he wasn't ready to stop having sex in the way they were used to, he went to the GP, who suggested Viagra. PDE5 inhibitor oral medications – like sildenafil (Viagra) or tadalafil (Cialis) – remain the first-line treatment according to Ralph. These work by temporarily improving blood flow. 'However, they don't address another key issue that many men with ED face – the problem of blood leaking back out too quickly, which can make it hard to maintain an erection. Studies indicate that around half of men stop taking them within a year. Patients often report side effects like headaches or flushing and do not like having to plan sex around a pill.' Treatments for ED have advanced considerably, says Professor Ralph, with far more available today than 10 years ago. Second-line options include NHS-provided mechanical vacuum devices, which help draw blood back into the penis. 'While these are effective and non-invasive, many men find them inconvenient or uncomfortable long-term,' admits Professor Ralph. Penile injections are another alternative. 'Alprostadil injections (which relax the blood vessels in the penis) are used when oral treatments fail and are effective in the majority of cases, but drawbacks include pain, priapism risk (an unwanted erection lasting hours), and the need for self-injection,' says Professor Ralph. Penile implants are available too, but this surgical option tends to be reserved for more complex or persistent cases. They're irreversible but associated with high satisfaction rates. 'More recently, there's been growing interest in treatments that aim to restore function more naturally – especially among men (such as Arion) who want longer-term solutions or don't like the idea of planning sex around a pill.' One example is low-intensity shockwave therapy which is a private treatment that uses sound waves to stimulate blood flow and encourage new blood vessel growth. 'It can benefit some, particularly those with mild ED, but the clinical results are mixed, and it requires multiple clinic visits, and can cost up to £3000 ($6,800),' explains Professor Ralph. 'Another option is Vertica, a handheld, at-home device, using radiofrequency energy to improve blood flow and reduce venous leak, a common cause of ED,' he adds. A peer-reviewed study in the International Journal of Impotence Research reported that 85% of users experienced improvement at four weeks, and 93% had erections sufficient for penetration by 12 weeks. It's approved by the MHRA (Medicines and Healthcare products Regulatory Agency) though is not available on the NHS and costs approximately £1250-£1500 ($2,800 - $3,400) , depending on the model. Interestingly, says Ralph, the device worked just as well in men with diabetes 'who are typically harder to treat'. 'Around 40% of men in the trial had Type 2 diabetes – given how often ED and diabetes go hand in hand that's encouraging.' Finding a way forward their sex life – what finally worked For Arion personally, 'who doesn't even like taking paracetamol' it was the drug-free solution, Vertica, that worked. 'After about a month of using the device three to four times a week consistently we noticed a difference,' says Arion. 'My morning erections returned, full sex was mostly possible, and crucially my confidence improved,' says Arion. 'It felt like turning back time in a way we didn't think possible.' Today, the couple feel closer than ever. 'It's just like normal again, before his diabetes diagnosis,' Sara says. 'We laugh more, talk more, touch more. We came through this hurdle together, and who knows, we're not ruling out baby number six in the future...' The diabetes red flags to watch out for The symptoms for both Type 1 diabetes and Type 2 can be similar, but Type 1 diabetes usually develops more quickly and is more common in younger people. The most common symptoms of Type 2 diabetes are: Feeling very tired Peeing more than usual Feeling thirsty all the time Losing weight without trying to Other symptoms can include: Blurred vision Cuts or wounds taking longer to heal Itching around your penis or vagina, or you keep getting thrush Erectile dysfunction These symptoms are the same for both adults and children. If you get symptoms (not everyone gets them), they may develop gradually and if concerned speak to your GP. How to recognise ED Early signs include reduced firmness, especially during morning erections, and difficulty maintaining an erection during intercourse.


NZ Herald
03-06-2025
- NZ Herald
Vaping has created a toxic monster: Here's what it does to your body and how to quit
He highlights the rise of vapes with a refillable pod which 'look exactly the same as the disposable [products] and maintain a lot of the features which are appealing to kids, including the different colours, crazy flavours, design and pricing'. He therefore believes the impact on youth vaping will be 'minimal' as many simply turn to the reusable products instead. Before the ban even began, researchers from University College London (UCL) believed disposable vape users were already switching to refillable and rechargeable devices in preparation, instead of giving up. Doctors and scientists are continuing to explore the long-term effects of vaping. 'There is growing evidence that e-cigarettes are harmful to health because some include carcinogens such as formaldehyde, [and] some have higher concentrations of nicotine than the cigarettes they are attempting to replace,' says Dr Cary Adams, the chief executive of the UICC. 'Nicotine is also highly addictive, which makes users more susceptible to dependency, and more likely to smoke throughout their lifetime.' What are the risks? People who vape as well as smoke have a greater risk of: Cardiovascular disease Stroke Chronic lung disease Asthma Oral disease While vaping is still significantly better for your health than smoking, charities are particularly concerned because research is suggesting that a significant proportion of people both smoke and vape. According to the Action on Smoking and Health organisation, 39% of current vapers in the UK also smoke. 'It's estimated that electronic cigarettes are 95% less harmful than conventional cigarettes,' says Dr Silvano Gallus, the head of the Laboratory of Lifestyle Epidemiology at the Mario Negri Institute for Pharmacological Research in Milan. 'But studies are showing that a significant proportion of electronic cigarette users are dual users, and data suggests this leads to a greatly increased risk of disease.' Last year, a major study in the prestigious New England Journal of Medicine called for a reassessment of the widely held assumption that vaping can prevent cigarette-related diseases, largely because of the risk of people becoming addicted to both. The study found that dual users had a greater risk of cardiovascular disease, stroke, chronic lung disease, asthma and oral disease compared with people who just smoked. Gallus and others feel that because of this, there is a need for better strategies for helping people transition away from all forms of nicotine, including vapes. How can you quit? So how can you go about quitting vaping? Last week, the first ever Cochrane review – a systematic examination of randomised controlled trials – was published, looking at the evidence for helping people quit nicotine-containing vapes, which is admittedly rather limited. 'From the data, it seems that it's easier to stop vaping than it is to stop smoking, which is good,' says Sairah Salim-Sartoni, a health psychologist who spent 16 years working clinically in NHS stop smoking services. 'But we still don't have any official guidance. I'd love to be able to give a blueprint for how to help people quit vaping, but we don't have those studies yet.' However, from tapering and distraction to apps and drug treatments, there are a number of strategies which can be used to try and break a potent vaping addiction. 1. Tapering While many smokers use vaping as a way of transitioning away from conventional cigarettes, Salim-Sartoni says that it is possible to become completely nicotine-free. 'A lot of the smokers I know do want to get rid of their dependence on using anything, and it takes time to do that,' she says. 'The number one thing which people can try is to slowly reduce their nicotine strength.' She describes one particular patient who went from smoking to vaping and then eventually nicotine-free, through tapering down in steps, for example from 20mg/ml nicotine to 18mg/ml, 12mg/ml, 9mg/ml, 6mg/ml, 3mg/ml and then to zero. 'That is very feasible, and there's different ways you can do that,' she says. 'You could either vape less often, or go to a nicotine pouch or a nicotine replacement therapy gum, and then slowly reduce your intake.' However, she says that it's important to make sure that as you reduce your nicotine strength, for example through switching to lower strength vapes, you're not vaping more often. 'Unfortunately sometimes when people try and reduce their nicotine strength, they just vape more and more because they're [subconsciously] still trying to get to the level they had before, and they actually end up consuming more nicotine,' she says. 2. Identify your triggers Dr Sharon Levy is a Harvard Medical School associate professor who also heads the addiction medicine division at Boston Children's Hospital. She says the initial symptoms of nicotine withdrawal persist for somewhere between two and four weeks after completely stopping vaping. However the cravings last significantly longer, up to two months for most people, although they tend to fade over time. 'Making it through the first three months after quitting is a major milestone,' says Dr Levy. 'Though unfortunately people are not entirely out of the woods at that point because they are still at risk of being triggered if they are stressed, in a situation that they'd previously associated with nicotine use, or if they see other people using nicotine.' Because of this, Levy recommends meeting with a behavioural therapist to help identify triggers which you can recognise and avoid, as well as working on healthy stress management techniques. 'When someone becomes addicted to a substance, it's as if their brain mistakes the substance use as a behaviour that's critical for survival,' she says. 'So it takes a lot of money and energy for them to prevent themselves from defaulting to using it. Behavioural health counsellors can help people to unlearn this automatic defaulting.' Some vapes contain more nicotine than traditional cigarettes. Photo / 123RF 3. Set boundaries A key component of behavioural management is not only identifying your triggers but setting boundaries. 'They're very similar tactics you would use for stopping smoking that you can apply to vaping as well,' says Salim-Sartoni. 'You can set rules for where you do and do not vape, so basically saying I'm only using my vape when I'm outside, but the home and car, I do not vape. Lower the nicotine, extend the time between vaping and set rules for where you do and don't vape.' Because this isn't always easy, Salim-Sartoni says that finding 'a buddy' who is also attempting to quit vaping can provide a vital support network which can make the whole process of setting boundaries much easier. 4. Distraction Finding a way to distract the brain is a key aspect of breaking any substance addiction. Salim-Sartoni says that there are all kinds of methods you can use to disengage your brain from the nicotine cravings, such as going to drink water, going to the toilet, playing a game on your phone or going for a walk. One surprisingly effective means of distraction is having a boiled sweet. 'The glucose receptor is very close to the nicotine receptor,' says Salim-Sartoni. 'And so the nicotine receptor feels that it's had something. The science steadily emerged to show this, but in our stop smoking clinics, we realised early on that people were eating a lot of sweet stuff when they were trying to quit, and this is why.' 5. Try apps or text message interventions According to the recent Cochrane review, some trials have found that text message-based interventions, which provide regular support and advice on quitting vaping can be effective. One study which examined a text message-based quit-vaping programme showed that users who used the programme were 35% more likely to quit vaping nicotine within seven months. As well as text message services, Levy says that there are a number of freely available apps and chatbots such as This is Quitting, which provide regular tips and encouragement, which have been shown to be effective in increasing quit rates. 6. Drug therapies For more powerful nicotine addictions, there are also pharmacological therapies such as the prescription drugs varenicline and cytisine. Varenicline binds to the nicotine receptors in the brain and blocks them, preventing the nicotine in vapes from binding to them, and so reducing withdrawal symptoms and cravings. Cytisine mimics the effects of nicotine and so tricks the brain into thinking it has ingested nicotine, which also reduces cravings. Finally, Salim-Sartoni emphasises that the most important thing of all for people looking to quit vaping, particularly ex-smokers, is that they don't return to smoking cigarettes again. 'Smoking is uniquely deadly, and some people can't stop nicotine or don't want to,' she says. 'If that's the case, then it is much better that they switch to e-cigarettes, particularly with the Government's ambition to reduce smoking rates in the UK to 5% or less by 2030.'