Q: I am a healthy person, 76 years old, and I started online dating after my divorce. However, during sexual relations it is difficult for me to maintain an erection. Furthermore, when I climax, I experience a pleasurable sensation but produce nothing. Should I be worried about my prostate?
Dr. Ellie answers: Men often experience sexual problems later in life due to an enlarged prostate or its treatment. The prostate is a small gland located at the base of the bladder, around the tube that carries urine. It is often described as the size of a walnut, but as men age, it can become much larger.
Regular exercise, quitting smoking, and reducing alcohol consumption have been shown to help combat erectile dysfunction.
Of course, men can get prostate cancer too. An enlarged prostate will make it more difficult to urinate, due to the proximity of the prostate to the bladder, and will trigger sexual problems.
These problems are usually erectile dysfunction and difficulty ejaculating. There are treatments that can combat an enlarged prostate, but it is important to know that they can also cause sexual problems.
A commonly used medication for prostate problems is called finasteride, a daily tablet that can make it easier to pass urine.
However, more than one in 100 men who take it will have problems getting an erection or problems ejaculating.
Men who do not respond to medications are often offered a transurethral resection of the prostate, known as TURP, which involves cutting out sections of the prostate.
It is thought that up to three quarters of men who receive TURP will have difficulty ejaculating due to damage to the nerves and muscles in the prostate region.
Similarly, surgery to remove the prostate often causes dry orgasms (where nothing comes out) as the gland is involved in semen production.
There are things you can do yourself to reduce the severity of your symptoms.
Regular exercise, quitting smoking, and reducing alcohol consumption have been shown to help combat erectile dysfunction.
If the problem continues (or worsens), you should talk to your GP about treatment.
Q: I am a woman in her 70s. In 2018 I was prescribed alendronic acid after a fall and broken wrist. I have heard that you should take a break from this medication after five years, but my GP says I should continue taking it. I also requested another bone density scan but she said she didn’t need it. Is this correct?
Dr. Ellie answers: Alendronic acid is the medication we most often use for osteoporosis, a bone-thinning condition, and it is generally safe to take long-term.
It is taken as a tablet or weekly drink and reduces the risk of further interruptions. Our bones are constantly broken down and rebuilt thanks to specially adapted cells found within them. Osteoporosis occurs when there is too much breakdown of bones, causing them to weaken. Alendronic acid slows down this process. Typically, after five years of treatment, you will have a review of your medication to decide if you still need it. This would often involve a bone density scan, also known as a Dexa scan. A patient can continue taking the medication for another five years or take a “treatment vacation” and stop taking it for a few years.
Alendronic acid has some common side effects including constipation, dizziness, and headaches.
Alendronic acid has some common side effects including constipation, dizziness, and headaches.
If treatment causes too many problems or fails to keep osteoporosis under control, patients may be offered a new medication. However, it is difficult to make this decision without an additional Dexa scan.
The Royal Osteoporosis Society offers excellent support – you can speak to one of their specialist nurses on 0808 800 0035. After this, it would be worth requesting a conversation with your GP to establish why you are continuing your medication.
Q: My GP recommended I take statins, but ten days after starting the pills I felt severe tingling in my feet and hands. I immediately stopped taking the medication, but two months later, the tingling turned into a painful throbbing sensation throughout my body. My feet feel like they are on fire.
Despite this, my GP refuses to see me for an appointment because he says it is a matter for a pharmacist. That I have to do?
Dr. Ellie answers: This is not the standard of care someone should receive from an NHS GP. Anyone experiencing new symptoms or possible side effects from medications should be offered an appointment.
It might be worth considering registering with a new practice, so you can more easily access a doctor. Tingling is a rare side effect of statins. The fact that the feeling has continued after stopping the pills could suggest that it is unrelated. An electric shock or burning sensation, especially in the feet, may be a condition called peripheral neuropathy in which the nerves do not function properly. Peripheral neuropathy is usually triggered by a vitamin B12 deficiency and can be reversed. That is why it is essential that you consult a doctor.
If statins are involved, a GP may recommend other ways to treat cholesterol, such as diet and lifestyle changes, or other medications.
Back Pain Sufferers Are Being Misled
The latest figures suggest a staggering 2.8 million Britons are “economically inactive” due to health problems.
That’s double what it was ten years ago, and includes an increase of nearly three-quarters of a million since the pandemic. This is probably because it is very difficult to receive treatment today, even for serious problems.
Mental illness and respiratory illnesses top the list of reasons for long-term illnesses. The other most common is “musculoskeletal problems”, often back problems. But back pain can be resolved quickly with advice, exercise and a physical therapy assessment.
It frustrates me that even if I refer my patients for the latter, it is simply not available: they are misled with phone appointments and brochures. Have you had difficulty getting help with your back pain? Write to me and let me know.
Do you have any questions for Dr. Ellie Cannon? Email DrEllie@mailonsunday.co.uk
Dr. Cannon cannot engage in personal correspondence and her responses should be taken in a general context.