This subject is surrounded by myth and innuendo.
Size is a source of great angst, and understandably leads to some men trying a range of mysterious concoctions.
However, the evidence for these potions is usually lacking — as is the case with these pills.
You have been kind enough to send me the leaflet, in which the manufacturers claim the tablet will add length and thickness by increasing the capacity of the spongy tissue in the penis to hold blood.
This spongy tissue — the corpora cavernosa — fills with blood to create an erection, and the pills are said to help by increasing the number of cells in the tissue.
The manufacturers say the formula is a ‘closely guarded secret’, but the ingredients include a range of herbal extracts, including saw palmetto and nutmeg.
Research suggests nothing can make this tissue ‘grow’ — indeed, impotence drugs, such as sildenafil, tadafil or vardenafil, do nothing to increase the size of the penis.
They work instead by creating an imbalance between blood being pumped in and blood flowing out, so holding more blood in, and allowing a more satisfactory erection.
There is no change in the size of the penis, either in the flaccid or erect state — but the erection may be firmer, which may make it appear larger.
For most men with concerns about penis size, the issue in the background is lack of confidence.
CONTACT DR SCURRTo contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — including contact details.Dr Scurr cannot enter into personal correspondence.His replies cannot apply to individual cases and should be taken in a general context.Always consult your own GP with any health worries.
This breeds anxiety, which interferes with normal processes of the body — this can reduce the firmness of an erection or switch it off altogether.
(It is thought anxiety causes the release of hormones that tell the body to send blood to the major organs — preparing it for flight or flight — which reduces blood flow to the extremities.)
However, talking to many patients over the years about their fears and concerns has shown me that women do not relate sexual satisfaction to the size of their partner’s penis.
As we used to say as naive medical students, it is not how big it is, it’s what you do with it that counts.
Since I received your letter I have spoken to a number of my female medical colleagues and all are agreed that action and function are more important than anatomy.
After all, we are all different shapes and sizes, and what really matters is to be a good and compatible match for each other.
The manufacturers who promise a change in your physique with a herbal preparation are selling a dream, but a dream that you do not need to have.
I think the capsules are a waste of money.
Despite having an active lifestyle as a keen golfer and gardener, I tend to feel light-headed by around 2pm or 3pm, and have to rest for a number of hours. I have been diagnosed with low iron levels, but I was unable to take iron tablets, as they caused terrible heartburn. I was previously taking aspirin (following the insertion of a stent to clear blocked arteries), but this was stopped after it was found to cause bleeding from my stomach. Other than eating an iron-rich diet, which I do, is there any other way Ican increase my iron levels? I am 79. Margaret Laney, Stoke Bishop, Bristol.
I applaud your energy, and hope that when I am your age I can be as active.
You are correct to assume low iron levels — anaemia — are responsible for your fatigue.
Iron is essential for the formation of haemoglobin, the pigment contained in red blood cells that carries oxygen around the body.
A lack of it leads to low oxygen levels, hence your tiredness.
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You tell me that you are taking the blood thinner clopidogrel, after aspirin triggered gastric bleeding.
You were prescribed these drugs after the insertion of your stent to make blood cells less sticky and less liable to form clots, as this could lead to a heart attack.
However, clopidogrel is also associated with the loss of small amounts of blood from the stomach lining or small intestine.
Iron tablets are necessary to replace iron lost in this way, but, as you say, these can cause the unpleasant side effects of gastric irritation or bowel upset.
Very properly you have been prescribed these to bring up your iron levels, but if this is against the continuing but microscopic blood loss due to clopidogrel, it may be a losing battle.
If you are unable to tolerate even one or two doses of iron orally each week, then another strategy must be incorporated.
An iron-rich diet — foods such as dark-green leafy vegetables, meat and wholegrains — is important, but will not be enough to counteract blood loss from the gut.
One option is to give iron as a weekly injection into the muscle for a few months.
The dose of iron needed can be calculated from knowing your haemoglobin level.
Injecting straight into muscle seems to enable the body to use iron more effectively, and send it into stores in the body.
If the injections are inconvenient or unacceptable, a haematologist at your local hospital might, after referral, agree to treat you with what is called a total dose iron infusion.
This is an injection, using a drip into a vein, of exactly the correct amount of iron for you. Unlike the intramuscular injections, this needs to be given only once.
Some people used to have an allergic response to this, but more recent modern preparations have minimised that complication. Whether your GP will refer you will depend upon how low your iron levels are.
Once normal levels are achieved, who knows what you might be able to weave into each day!
By the way . . . We may lose out if consultants work all hours A health service that works only Monday to Friday is not fit for our 24/7 societyMy friend and mentor David Rosen always did a Sunday morning ward round at St Mary’s Hospital, London, to check the patients upon whom he had operated on the Friday list.
Latterly he did this without his junior staff, who were not permitted to be present on account of the EU legislation restricting their hours.
Chucked out of the NHS at 65, he cracks on as professor of surgery in the West Indies — on a seven-day week, as always.
There has been much attention recently on the hours doctors work — especially after research suggested there is a greater risk of medical complications, even death, in patients who are admitted as emergencies at weekend or night.
The simplest explanation for this is that the most experienced doctors are not there, and out-of-hours work is in the hands of junior hospital doctors, who are still technically in training.
This points to one conclusion: a health service that works only Monday to Friday is not fit for our 24/7 society.
This sentiment was echoed recently by Sir Bruce Keogh, medical director of the NHS Commissioning Board, who said that it is no longer acceptable to have a health service that operates for the convenience of the doctors at the expense of the patients.
To achieve a 24-hour health service requires major alterations to working practices. The first is to ensure the presence of senior, experienced consultant staff most of the time.
But on top of shrinking budgets and over-stretched wards, hospitals also have to deal with the European Working Time Directive, which dictates no doctor can work more than 48 hours a week.
Despite this, many consultants are universally available to their junior staff — 168 hours a week if necessary.
But once Sir Bruce has them in the building on Saturday and Sunday conducting routine clinics, I suspect that much goodwill may be lost — and it is goodwill that keeps the NHS going for the most part — unrecognised, unmeasured, never subject to audit, but pure goodwill of which most of our political masters are unaware.
As well as tackling the effect of the European Working Time Directive, politicians need to acknowledge that pushing for consultants to be present at night and at weekends is robbing Peter to pay Paul — consultants will just be decanted out of week-day working time.
Politicians must tread warily or risk making it all even worse.
