DR. MARTIN SCURR: I have erectile dysfunction, but Viagra doesn’t work for me. Is my sex life over?

Q: I have a slowly progressing prostate cancer, diagnosed eight years ago, and undergoing several TURP procedures. I have been suffering from erectile dysfunction for the past two to three years. None of the pills (Viagra, Cialis etc.) have any effect. My urologist says there is nothing else he can do. Is my sex life over? I am 67 and still have the urge and desire to make love to my wife. It’s so painful to know I can’t. I don’t want injections or pumps!

Name and address provided.

Dr. Martin Scurr replies: I applaud your openness in writing to me about an issue that will affect many who are too shy to seek help.

The loss of sexual function is most likely the result of your prostate treatment. The low grade of the cancer explains why your entire prostate gland was not removed.

Instead, you have undergone a transurethral resection of the prostate (TURP), in which parts of the prostate tissue are removed to preserve your urinary function (a risk with completely removing the gland).

I suspect you are taking hormone suppressants to lower testosterone, which can encourage cancer growth. These can affect erectile function (but it’s reassuring that your libido hasn’t suffered).

Other factors include anything that affects blood flow to the penis, such as cardiovascular disease, high blood pressure and smoking.

Erectile dysfunction (ED) can also be linked to nerve damage from surgery; medications, including blood pressure pills and hormone suppressors used to treat prostate cancer; and alcohol.

You mention in your longer letter the advertisements offering to cure ED with some pill or drink. I wouldn’t pay attention to this: I think it’s just clever marketing aimed at exposing the vulnerable.

I would ask you to reconsider your reluctance to try injections, as there is one option that could prove successful. Trimix, which is injected directly into the penis using an ultra-fine needle (causing minimal discomfort), contains three drugs, alprostadil, phentolamine and papaverine, which stimulate blood flow to the penis and cause a quick erection. It’s true that drugs like Viagra also stimulate blood flow, but they have to work throughout your body instead of working on the spot, like needle sticks do.

Another option is Muse, a small pellet of alprostadil that you place in your urethra with a thin disposable applicator. This pellet dissolves and is absorbed into the immediate area, causing an erection.

While you may not find these strategies appealing, they are effective and can allow you to maintain 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 H. Cross, Chichester.

Dr. Martin Scurr replies: It sounds very much like she has osteoarthritis, a usually age-related condition that can cause swelling of the joints, deforming them and affecting mobility. The treatment is aimed at minimizing pain; the main medications used are nonsteroidal anti-inflammatory drugs (NSAIDs), a class of drugs that also includes aspirin and ibuprofen.

But due to the risk of side effects, such as stomach bleeding, these should not be used long-term. Separately, research shows that paracetamol is not of much use for osteoarthritis pain.

Many people opt for ‘natural’ remedies, such as glucosamine, chondroitin, vitamin D or fish oil supplements.

There’s a lot of interest right now in curcumin (the active ingredient in turmeric) and Boswellia serrata – better known as frankincense – for arthritis pain, and while the evidence is scant, I certainly wouldn’t stop your wife from trying either of these .

Long Covid continues to take a heavy toll on British health, as today’s cover story shows.

Many report memory problems, as well as concentration problems. Now further confirmation of the effect on brain function has emerged in intriguing research from scientists at Imperial College London, published in the New England Journal of Medicine.

It found that patients who had persistent symptoms for 12 weeks or more experienced an IQ loss of six points – nine points if the initial infection was so severe that they ended up in intensive care.

Furthermore, the researchers also found that early variants of the virus caused more severe cognitive impairment than later variants such as Omicron.

The question is: will these negative effects eventually disappear? What could their long-term impact be? There is still much to learn, but our specialist teams are already making progress.

Another positive point, I think, is that the study also showed that those with a long Covid-19 period who had had two or more vaccinations suffered less from brain dysfunction. This was even if they were infected with the virus, revalidating the immunization program.