This is a distressing situation, and a common one — more than 50 per cent of diabetic men in your age group have some degree of erectile dysfunction (ED).
This must be eroding the joy and optimism you feel at the prospect of impending marriage, and although your tactic so far has been avoidance, this may be stacking up greater pressure for the future.
The cause of your erectile dysfunction lies with your diabetes.
Long-term diabetics can suffer nerve damage, possibly because of the combined effect of high blood sugar levels damaging both the nerves themselves and the blood vessels that carry oxygen and nutrients to the nerves.
As well as the nerves that control erection being affected, those in the feet are also damaged, which is why diabetics often suffer lack of sensitivity or burning sensations in their feet.
Diabetes can also trigger the arteries to become furred with cholesterol, which can disrupt blood supply to the penis (an erection is maintained by chambers in the organ filling with blood).
This can be diagnosed by a specialist carrying out an ultrasound of the artery in your pelvis.
For this you will need a referral to an ED expert, most commonly a urologist with a special interest in the subject.
Your GP has been, it seems, less than involved in your predicament, so there are definitely grounds for seeking this referral.
Once you have been referred, an expert can also carry out further tests to help identify any other factors that could be causing your condition.
There has been some research linking diabetes to low testosterone in men, so your levels should be tested.
Your specialist should also discuss the possibility of you visiting a psychologist or therapist who can give advice on how to share the problem with your fiancée.
This may be essential for defusing the damaging effects of anxiety (when you’re anxious, the body diverts all blood to the major organs — so even less goes to the groin).
In addition to this, intensive and diligent control of your diabetes is vital to prevent your condition worsening. Indeed, this may be why you have noticed the Viagra becoming less effective.
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.
There are also medications that may help you.
One drug — called Cialis, a member of the Viagra family — has been re-formulated especially for men with diabetes, and is taken on a daily basis.
It is a much longer-acting drug than Viagra, and it has been found that drip-feeding a very small but regular daily dose (rather than the usual one-off 10mg or 20mg dose) is very effective for those in your situation, with minimal side-effects.
If this does not work, another treatment option — albeit one that is used less often — involves placing a tiny pellet of the drug alprostadil into the urethra (the tube through the penis).
You would be shown how to do this for yourself and it this is mostly very effective.
Finally, if these do not work, there are other non-drug treatments available. These include constrictive bands around the base of the penis, vascular surgery to improve the blood supply, or the implantation of rigid prosthetic devices.
All is not lost — there are reasons to be cheerful.
My 45-year-old daughter was recently diagnosed with fibromyalgia, and is constantly in severe pain, mostly affecting the arms, hands and shoulders.Despite being prescribed a range of painkillers, nothing seems to help. Is there anything else she can try? Mrs J. Churcher, by email.Fibromyalgia triggers widespread chronic pain, but unfortunately there are no tests for the condition, and it is usually only diagnosed when all other possibilities have been excluded.
The condition is common, however — seven times more so in women than men, with about 8 per cent of women having the syndrome by the age of 70.
It is also associated with a number of other conditions, including irritable bowel syndrome, chronic fatigue, premenstrual syndrome and unexplained chest pain.
Although we don’t know what causes it, we think it might be triggered by a malfunction in the complex but poorly understood relationship between the nervous system, fatigue, pain perception, and mood disturbance (depression and mood change are commonly associated with the condition).
One possibility is that fibromyalgia is a disorder of the way the brain processes pain impulses: a maladaptive response to what in others may be quite minor discomfort.
More from Martin Scurr... How can I get this heavy feeling off my chest? 03/06/13 Ask the doctor: Bad breath is ruining my self-confidence 27/05/13 Ask the doctor: Will my shingles pain ever go away? 20/05/13 Ask the doctor: Is blood in my urine a reason to worry? 13/05/13 Ask the doctor: Why am I seeing stars in my eyes? 07/05/13 Ask the doctor: What has caused my unbearable leg pain? 29/04/13 Ask the doctor: Why are my teeth starting to crumble? 22/04/13 Ask the doctor: Simple steps for easing a hormone headache 08/04/13 Ask the doctor: Why do my wife's hands bruise so easily? 01/04/13 VIEW FULL ARCHIVEThe problem is that the absence of concrete laboratory tests for fibromyalgia has made the condition controversial, and has led to the suggestion that the symptoms may have a psychological element.
A cornerstone of successful treatment is the GP accepting that fibromyalgia is a real illness.
Simple painkillers are usually found to be ineffective, as your daughter has found.
However, antidepressants in small doses have been recommended, and there is much evidence of benefit (three drugs commonly used for it are amitriptyline, fluoxetine, and moclobemide).
There are some other options. The best known, and possibly most valuable, is pregabalin — a drug that helps settle unstable nerve cells.
There is also tropisetron, an anti-sickness drug normally used with chemotherapy; and pramipexole, a pill used for treating some patients with Parkinson’s disease.
Non-drug options include exercise in a heated pool, cognitive behavioural therapy and aerobic exercise, all of which have been found to be useful in some patients.
As you can tell, trial and error is important here, but there are a number of options available that may yet alleviate your daughter’s pain.
This will involve specialist expertise — experience is everything here — but the decisions about this must rest with her GP.
By the way . . . Screening for dementia makes no senseFools rush in where angels fear to tread: Health Secretary Jeremy Hunt has stated that health workers — and he singled out GPs — are not testing patients for dementia because they think it’s pointless when there’s no cure.
He’s also said that too many health care professionals are ignorant of the symptoms.
In the same week as Mr Hunt made his observations, a group of GPs and other medical experts sent an open letter to the British Medical Journal expressing their concerns about the possible consequences of a government initiative to promote screening for dementia.
Detecting dementia in routine daily practice may not be easy, especially as patients with it do not complain of memory lossThis initiative would mean doctors would have to deliberately look for dementia — and flies in the face of the National Screening Committee, which advised in 2010 that ‘screening (for dementia) should not be offered’.
Dementia is a disorder in which there’s a major impairment in memory as well as at least one of the following: loss of ability to handle complex tasks, defective reasoning, impaired language, and loss of spatial ability and orientation (getting lost in familiar surroundings).
Detecting this in routine daily practice may not be easy, especially as patients with dementia (in contrast to those of us who are well) do not complain of memory loss.
Often it is information from the family that proves most useful.
It can be that the patient has little insight and does not see what the fuss is about.
I don’t think ignorance of the symptoms is the problem, as Mr Hunt suggests. However, he is right that GPs despair about what to do when we see it.
Although some drugs can help, slightly, a statement from the World Health Organisation says it all: ‘No treatments are currently available to cure or even alter the progressive course of dementia.’
The task of the family doctor is to refer for specialist attention when there is doubt about the diagnosis, and to provide resources and support when patients or their families recognise and accept that there is an emerging problem and come seeking help.
Precious funds should not be wasted on trying to unearth and then persuade patients of their diagnosis, or prescribing largely ineffective medication.
If, as it’s often suggested, diagnosis helps get the patient’s affairs in order, I suspect the truth is you don’t need a GP to tell you your elderly parent needs help.
Let’s spend the money not on screening, but on research into better medication.
