I would like to continue to enjoy a sex life, but over the last few years erectile dysfunction has made this impossible. I have tried all the usual pills and alprostadil injections. You previously mentioned a treatment called Trimix – might it be worth trying, or at 93 must I accept the inevitable?
Name and address supplied.
Dr Scurr replies: I applaud your intentions, and do not believe you are yet at the stage where you must accept the inevitable – age should be no barrier.
Trimix is a cocktail of three drugs – alprostadil, papaverine and phentolamine – which help relax muscle around the blood vessels supplying the penis and improve blood flow, so helping to achieve an erection.
The advantage of the triple mix is that each of the drugs acts in different ways, so maximising the benefit. What’s more, the effects are usually stronger and last longer than Viagra-like medication alone.
There is a risk of side-effects – most notably priapism, an erection that will last four hours or more, or the development of scar tissue. I suggest consulting your GP. The other downside is that patients who are prescribed Trimix usually require a lesson in administration as the medication is given as an injection into the base of the penis around 15 minutes before having sex.
Trimix – a mix of three drugs – helps relax muscle around the blood vessels supplying the penis (picture posed by models)
A prescription for this injection usually requires a referral – via your GP – to a urologist who has an interest in treating erectile dysfunction. Trimix is usually offered only to those for whom Viagra-like drugs are not helpful, and it is effective in 85 per cent of men.
It is also important to undergo a blood test to check that you do not have undiagnosed type 2 diabetes or low levels of the hormone testosterone, both of which can cause erection difficulties. If the blood test reveals either, then treatment for that underlying cause may help.
However, if Trimix is suggested then I very much hope you find it helps.
My husband was diagnosed with Parkinson’s disease 18 months ago and prescribed co-careldopa. His problem is sleep – it takes him a while to nod off at night, but during the day he falls asleep suddenly, and can sleep for England! Is there anything we can do to help him sleep through the night while keeping awake during the day?
Paula Ritchie, London.
Dr Scurr replies: Patients with Parkinson’s disease often experience disrupted sleep as a result of the neurological changes caused by the condition.
Sleep problems linked to it include rapid eye movement (REM) sleep behaviour disorder, where the person affected is not paralysed (as is normal during dreaming) but instead acts out dreams – which can involve talking, shouting or kicking out.
Other disorders include insomnia, restless leg syndrome (uncomfortable sensations usually in the legs, often temporarily relieved by moving) and excessive daytime sleepiness, which troubles your husband.
The pattern you describe is known as day-night reversal. This is where the body clock is disturbed, due to degeneration of the nerve pathways in areas of the brain that control our sleep-wake cycles.
Your husband has been prescribed co-careldopa to manage his Parkinson’s symptoms, but it can cause excessive daytime sleepiness and sudden onset of sleep. It’s possible that changing his medication may ease the sleep disturbances you describe.
I’d suggest you need the input of his neurologist, possibly alongside advice from experts in a Parkinson’s sleep clinic.
I hope your husband’s disease is being regularly reviewed by a specialist. If not, you should press your GP for a referral.
