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A directive from Great Britain’s National Health Service (NHS) on how physicians should prescribe sildenafil citrate (Viagra) has drawn fire from the British Medical Association (BMA).

The NHS proposal, issued in late January, suggested that the erectile dysfunction drug be made available through the NHS only for men with specified conditions: diabetes, spinal cord injury, multiple sclerosis, or single-gene neurological disease, or for those who have had radical pelvic surgery or a prostatectomy. The government said estimates showed that Viagra’s availability could boost the cost of treatment for erectile dysfunction tenfold. However, the NHS plans no increase in expenditures for treating the condition.