DR ELLIE CANNON: Viagra has not worked after several prostate ops. What CAN I try?

I have slowly progressing prostate cancer and have had several procedures to have parts of it removed. I have also suffered from erectile dysfunction for a few years now. I have tried all available pills, including Viagra, but to no avail. Are there any other options? It’s painful to think that at 67 my sex life is over.

More than two-thirds of men undergoing treatment for prostate cancer suffer from erectile dysfunction – a problem that can significantly affect self-esteem, relationships and quality of life.

But according to the charity Prostate Cancer UK, fewer than half receive effective treatment.

There are options. Medications such as Viagra can be tried ‘as often as needed’, but we also prescribe a low dose of a similar drug, tadalafil, daily for men with prostate cancer. Some prostate surgeons recommend an ‘as and when’ dose, but it’s important to consult with a doctor before embarking on something like this.

Vacuum pumps – which induce an erection – may put men off, but they are a recognized treatment and worth investigating. About 70 percent of men who use them find them effective. For someone with prostate cancer, they are often available free of charge at NHS-funded clinics.

Injections sound scary, but in reality many find that they do not hurt. A very thin needle is used and men can learn this themselves. They often work best in men with an active libido.

There are many advertisements for creams and pills to treat erectile dysfunction. Unfortunately, few work and some can even be risky – products online may not be subject to the same strict regulations as prescription drugs.

It has been proven that quitting smoking and drinking less alcohol reduces the problem. Men can also contact their GP for a referral to a local erection clinic, psychosexual clinic or care provider.

It’s also important to know that your sex life doesn’t have to be over even if none of the above works. It may mean redefining what sex means to you.

I recently had surgery to treat stage 2 breast cancer. I now need radiotherapy and will have to take tamoxifen for the next five years, but I have heard that the side effects can be similar to those of menopause. At 66, I’ve already experienced it once and have no desire to do it again. My doctor said the benefits of these two additional treatments are small, so I decided not to take them. Is that the right decision?

We do not take a one-size-fits-all approach to cancer treatment. Instead, we outline the risks and benefits of different aspects of care, let patients weigh them up, and come to a decision.

Tamoxifen is a hormone drug used to suppress the effects of estrogen – which can drive some tumors – during breast cancer. The side effects can mimic menopause, such as hot flashes, nausea and fatigue.

That said, many women use tamoxifen and tolerate it very well, especially if they have already gone through menopause. So I might recommend trying it before dismissing it.

Radiotherapy can be debilitating. So before it is offered, the benefits must be worth it. I can understand why patients would opt out of this, but in my experience the vast majority would opt out.

Part of the reason for that is to be able to live comfortably with your choice in the future.

Cancer treatment decisions are usually about quality of life, so there is no point in forgoing treatment because of the side effects only to spend months or even years wondering if it was the wrong decision.

I am completely deaf in my left ear. A few months ago I paid £50 to have my ears evacuated – the suction method alternative to spraying – and it worked to an extent. I asked if my GP could perform the same procedure and was told: ‘The NHS won’t do anything about earwax.’ Do I have to pay £50 every time my ears need attention?

There is a huge amount of discussion within the NHS these days about earwax.

Until recently, many general practitioners offered a service to remove it with a syringe or irrigation. This has changed due to shifts in funding, and also due to concerns that the process may damage the ear. As a result, many people suffer from excessive earwax and no treatment is possible.

It can cause a number of serious symptoms, such as deafness, pain, tinnitus and dizziness.

If deafness is someone’s main symptom, I would always recommend an examination with the doctor to ensure that it is indeed earwax causing this.

Often, and especially in old age, there are other causes of deafness and a hearing test may be advisable.

For most people, earwax falls out naturally through normal jaw movement. We can help this process by using olive oil or almond oil drops to soften the wax. This may take a few days to work, but it can be incredibly effective.

A pharmacist can advise you on treatments, including sodium bicarbonate ear drops that dissolve and help the earwax shift.

If the earwax buildup causes regular deafness or other serious symptoms and does not respond to home remedies, a GP may make a referral to the hospital’s microsuction department for more intensive treatment.

Something to sneeze…

Is there such a thing as autumn sneezing syndrome?

I was asked this by a colleague who sneezed incessantly – as often as during hay fever season. My answer was no, it’s probably a cold – but he had no other symptoms. And he wasn’t the only one who suffered like this.

Other possible causes may include allergies: Mold spores can grow outdoors in damp areas, such as piles of leaves. Likewise, when the central heating is turned on and clothes are dried indoors, mold thrives and floats around the house, causing respiratory irritation and… sneezing!

Dust mite allergies also get worse as it gets colder and we spend more time indoors with windows closed.

Over-the-counter antihistamines would be a simple way to test if this was the answer. Otherwise, I would like to know whether you suffer from autumn sneezing and do not think it is due to a cold.

Email the address on the right and let me know.

Are you on an endless waiting list for crucial operations?

Reports suggest that a depressing 11 million people are now on NHS waiting lists, hoping for operations and treatment. I see the difficulties with my own eyes.

And I’m sorry to say it, but there’s very little a GP can do to help. After Covid, the problems piled up. The misuse of all resources to tackle the virus was something that I and many other GPs felt very vocal about in their efforts to alert the government. Now it has come home to sleep.

I have elderly patients who have been waiting for more than a year for cataract surgery – some of whom are at risk of falling every day due to poor vision. Falls in this age group can be a catastrophe.

Hernia surgery also seems difficult to achieve. I just had to sign a young man off work after waiting ten months.

Are you stuck on a waiting list? Write and let me know.