Q: I have a slowly progressing prostate. cancer, diagnosed eight years ago, and has undergone several TURP procedures. For the last two or three years I have suffered from erectile dysfunction. None of the pills (Viagra, Cialis, etc.) have any effect. My urologist says he can’t do anything else. Is my sex life over? I am 67 years old and I still have the desire and desire to make love with my wife. It’s so painful to know that I can’t. I don’t want injections or pumps!
Name and address provided.
Dr Martin Scurr responds: I applaud your candor in writing to me about a topic that will affect many who will be too shy to seek help.
Loss of sexual function is most likely the legacy of your prostate treatment. The low grade of the cancer explains why the entire prostate was not removed.
Rather, he has undergone a transurethral resection of the prostate (TURP), in which sections of prostate tissue are removed to maintain urinary function (a risk when removing the gland entirely).
Erectile dysfunction (ED) may be related to nerve damage due to surgery; medications, including blood pressure pills and hormone suppressants used to treat prostate cancer; alcohol; cardiovascular disease; high blood pressure and smoking
I suspect he may be taking hormone suppressants to reduce testosterone, which can fuel cancer growth. These can affect erectile function (but it’s reassuring that your libido hasn’t been affected).
Other factors include anything that affects the blood supply to the penis, such as cardiovascular disease, high blood pressure, and smoking.
Erectile dysfunction (ED) may also be related to nerve damage due to surgery; medications, including blood pressure pills and hormone suppressants used to treat prostate cancer; and alcohol.
You mention in your longer letter the advertisements that offer to cure erectile dysfunction with this or that pill or drink. I wouldn’t pay them any attention: I think it’s just clever marketing aimed at fleecing the vulnerable.
I would ask you to reconsider your reluctance to try injections as there is an option that could prove successful. Trimix, which is injected directly into the penis with an ultra-fine needle (so it causes minimal discomfort), contains three medications, alprostadil, phentolamine and papaverine, which increase blood flow to the penis and will produce a quick erection. It’s true that medications like Viagra also increase blood flow, but they have to travel throughout the body instead of acting in situ like injections do.
Another option is Muse, a small pellet of alprostadil that is inserted into the urethra with a thin, disposable applicator. This pellet dissolves and is absorbed into the immediate area, producing an erection.
While these strategies may not appeal to you, they will be effective and could allow you to maintain an active sex life.
Q: My wife is 70 years old and active, but her fingers are gradually becoming sprained, swollen and painful. Is there anything she can do or accept?
Ian H. Cruz, Chichester.
Dr Martin Scurr responds: It appears that you have osteoarthritis, a primarily age-related condition that can cause inflammation of the joints, deform them, and affect mobility. Treatment aims to minimize pain; The main medications used are nonsteroidal anti-inflammatory drugs (NSAIDs), a class of medications that includes aspirin and ibuprofen.
But due to the risk of side effects, such as gastric bleeding, they should not be used long term. On the other hand, research suggests that acetaminophen is not very helpful for osteoarthritic pain.
Many people turn to “natural” remedies, such as glucosamine, chondroitin, vitamin D, or fish oil supplements.
There is currently a lot of interest in curcumin (the active ingredient in turmeric) and Boswellia serrata (commonly known as frankincense) for arthritis pain, and although the evidence is scarce, I certainly wouldn’t discourage your wife from trying either of these. .
Long Covid continues to take a heavy toll on Britain’s health, as today’s cover story explores.
Many report memory problems, as well as difficulty concentrating. Further confirmation of the effect on brain function has now emerged in intriguing research by scientists at Imperial College London, published in the New England Journal of Medicine.
This revealed that patients who suffered persistent symptoms for 12 weeks or more experienced a loss of six points in their IQ (nine points if the initial infection was so severe that they ended up in intensive care).
What’s more, researchers also found that early variants of the virus caused more severe cognitive impairment than later strains, such as Omicron.
The question is: are these negative effects finally resolved? What could be its long-term impact? There is much to learn but our teams of specialists are already making progress.
I think another positive is that the research also showed that those with long Covid who received two or more vaccines suffered less deterioration in brain function. This was true even if they were infected by the virus once again validating the immunization program.
