My husband’s Viagra has stopped working… it is a sign something’s wrong: DR SCURR has the answer
My fit 85-year-old husband has taken Viagra for many years. It has recently stopped working and he’s considering buying some pills he saw on the internet. I’m not happy about this but don’t like to see him so sad. What do you advise?
Name and address supplied.
Dr Scurr replies: Erectile dysfunction can have a huge effect on quality of life – for both partners – and it’s also vital that the cause is addressed as it can be a sign of a health problem.
There are two main possibilities. The first is that it’s related to cardiovascular disease, and you mention in your longer letter that your husband had a heart attack 12 years ago.
Heart attacks are typically caused by a build-up of fatty deposits impeding blood supply to the heart. The same can happen to the blood supply to the genital area, affecting erections.
Type 2 diabetes can also increase the likelihood of erectile problems, partly by damaging the nerve supply to the penis. Certain medications, including some antidepressants, antihistamines and high blood pressure treatments, can affect erectile function, too.
Your husband will inevitably be taking several medicines to reduce his risk of a second heart attack. These drugs, while essential for his health, can reduce blood flow to the penis.
I suggest your husband asks his GP about the cause of his erectile dysfunction and to prescribe an alternative to Viagra – options include tadalafil (brand name Cialis) which, like Viagra, increases blood flow to the penis.
There are alternatives to Viagra available, such as Cialis, which stays in the body for longer
It can take longer to work than Viagra but stays in the body for longer, making it possible to achieve an erection a day or two after a dose. (But be assured it doesn’t cause a long-lasting erection – it only works when a man is sexually aroused.)
I urge your husband to talk through the options, rather than buying a treatment on the internet that may not work and may even be dangerous.
I’ve been suffering from trigeminal neuralgia for ten days. It causes a throbbing ache on one side of my face, stabbing pains, heat and swelling. Painkillers and cooling face packs do not touch the pain. I’ve also avoided hot or cold drinks and not eaten on that side. What else can I do?
Mrs Terry Munn, Aldershot, Hants.
Dr Scurr replies: I’m sorry to hear about your symptoms. The stabbing facial pain you describe can be excruciating, even if each wave lasts for only a few seconds. These episodes can be triggered by light touch, talking, chewing or even a draught of air.
Trigeminal neuralgia is caused by pressure on the trigeminal nerve. It sends signals between your brain and parts of your face. The compression is generally caused by an artery or vein squashing the nerve, but why this suddenly happens is not clear.
The condition normally resolves itself, though in some cases this can take months. Treatment involves medication to reduce the pain and prevent further attacks. The first-line choice is carbamazepine, which slows nerve impulses, starting at 100mg twice daily and gradually increasing it over weeks until it provides relief. This slow increase minimises side effects such as nausea.
Most patients require at least 600mg daily. If this proves inadequate, alternative treatments include the anticonvulsant drugs gabapentin and lamotrigine, which calm nerve impulses.
The condition does tend to recur, so a further round of treatment may be needed. Patients whose pain cannot be controlled by drugs may be offered neurosurgery – there are a number of procedures available.
I hope that by the time you read this your symptoms will finally have settled. The next issue to address will be whether you need to be on a long-term prevention treatment, such as one of the anticonvulsants.
