I would like to continue enjoying a sex life, but in recent years erectile dysfunction has made this impossible. I have tried all the usual pills and alprostadil injections. You mentioned a treatment called Trimix earlier – would it be worth trying, or should I accept the inevitable at 93?
Name and address provided.
Dr. Scurr replies: I applaud your intentions, and do not believe that you are yet at the stage where you have to accept the inevitable: age should not be a barrier.
Trimix is a cocktail of three drugs – alprostadil, papaverine and phentolamine – that help relax the muscles around the blood vessels that supply the penis and improve blood flow, thus helping to achieve an erection.
The advantage of the triple mix is that each of the medications works in different ways, maximizing the benefit. Plus, the effects are usually stronger and last longer than Viagra-like medications alone.
There is a risk of side effects – especially priapism, an erection that lasts four hours or more, or the development of scar tissue. I recommend consulting your doctor. The other disadvantage is that patients prescribed Trimix usually require a lesson in administration, because the drug is given as an injection into the base of the penis about 15 minutes before sex.
Trimix – a mix of three drugs – helps relax the muscles around the blood vessels that supply the penis (photo taken by models)
A prescription for this injection usually requires a referral – via your GP – to a urologist who has an interest in the treatment of erectile dysfunction. Trimix is usually only offered to people for whom Viagra-like medications do not help, and is effective in 85 percent of men.
It’s also important to have a blood test to check that you don’t have undiagnosed type 2 diabetes or low levels of the hormone testosterone, both of which can cause erection problems. If the blood test reveals either, treatment for that underlying cause may help.
However, if Trimix is suggested, I sincerely hope that you will find that it helps.
My husband was diagnosed with Parkinson’s disease 18 months ago and prescribed co-careldopa. His problem is sleep. At night it takes him a while to fall asleep, but during the day he suddenly falls asleep and can sleep for England! Is there anything we can do to help him sleep through the night while he stays awake during the day?
Paula Ritchie, London.
Dr. Scurr replies: Patients with Parkinson’s disease often experience disturbed sleep due to the neurological changes caused by the condition.
Sleep problems associated with this include rapid eye movement (REM) sleep behavior disorder, where the affected person is not paralyzed (as is normal when dreaming), but instead acts out dreams – which may involve talking, shouted or kicked out.
Other conditions include insomnia, restless leg syndrome (an uncomfortable feeling, usually in the legs, that is often temporarily relieved by exercise), and excessive daytime sleepiness, which your husband suffers from.
The pattern you describe is known as day-night reversal. This is where the body clock is disrupted due to degeneration of the nerve pathways in parts of the brain that control our sleep-wake cycles.
Your husband has been prescribed co-careldopa to control Parkinson’s symptoms, but this can cause excessive daytime sleepiness and sudden falling asleep. It’s possible that changing his medications could alleviate the sleep disturbances you describe.
I suggest you need input from his neurologist, possibly in addition to advice from experts at a Parkinson’s sleep clinic.
I hope that your husband’s illness is regularly assessed by a specialist. If this is not the case, you should insist on a referral from your GP.