Q: I have slow-progressing prostate cancer, diagnosed eight years ago, and have had several TURP procedures. For the past two to three years, I've been suffering from erectile dysfunction. None of the pills (Viagra, Cialis etc.) have any effect. My urologist says there's nothing else he can do. Is my sex life over? I'm 67 and still have urges and wish to make love to my wife. It is so painful knowing I can't. I don't want injections or pumps!
Name and address supplied.
Dr Martin Scurr replies: I applaud your openness in writing to me about an issue that will affect many who will be too shy to seek help.
The loss of sexual function is most likely to be the legacy of your prostate treatment. The low grade of the cancer explains why your entire prostate gland wasn't removed.
Rather, you've undergone transurethral resection of the prostate (TURP) — where sections of prostate tissue are removed in order to maintain your urinary function (a risk with removing the gland entirely).
I suspect you may be taking hormone suppressants to lower testosterone, which can fuel cancer growth. These can affect erectile function (but it's reassuring your libido has not suffered).
Other factors include anything that affects blood supply to the penis — such as cardiovascular disease, high blood pressure and smoking.
Erectile dysfunction (ED) can also be linked to nerve damage from surgery; medication, including blood pressure pills and hormone suppressants used to treat prostate cancer; and alcohol.
You mention in your longer letter the adverts offering to cure ED with this or that pill or drink. I'd not pay any attention to these: 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's one option that might prove successful. Trimix, which is injected directly into the penis using an ultra-fine needle (so causing minimum discomfort), contains three drugs, alprostadil, phentolamine, and papaverine, which boost blood flow to the penis and will produce a rapid erection. True, drugs such as Viagra also boost blood flow but they have to work their way around your whole body rather than working in situ as jabs do.
Another option is Muse, a tiny pellet of alprostadil which you insert into your urethra using a thin, disposable applicator. This pellet dissolves and is absorbed in the immediate area, producing an erection.
While you might not find these strategies appealing, they will be effective and might enable you to retain an active sex life.
Q: My wife is 70 and active but her fingers are gradually becoming twisted, swollen and painful. Is there anything she can do, or take?
Ian Cross, England.
Dr Martin Scurr replies: It sounds very much like she has osteoarthritis, a mostly aged-related condition which can cause swelling of the joints, distorting them and affecting mobility. Treatment is aimed at minimising pain — the main medications used are non-steroidal anti-inflammatory drugs (NSAIDs), a class of drugs that includes aspirin and ibuprofen.
But because of the risk of side-effects, such as gastric bleeding, these should not be used long-term. Separately research suggests that paracetamol is not much use 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 while the evidence is scant, I certainly wouldn't dissuade your wife from trying any of these.
