DEAR DR. ROACH: I am a 64-year-old male in reasonably good health. I’m a moderate drinker, and I lift weights every other day. I have always been sexually active, as I’ve been married for 23 years to a beautiful woman I love, who is 19 years younger than me. In the past two years, I have had a very difficult gallbladder operation, along with bleeding ulcers and a stomach hernia operation. My sex drive has diminished greatly, and I have tried Viagra, Cialis and penile injections. Nothing gives me an erection!
My wife has been understanding, but after all, she is still a young woman. I am willing to do anything to regain my function. I am extremely depressed. — R.C.
ANSWER: You’re asking about a common sexual health issue for both men and women, which is low libido (or decreased interest in sex), but you’re also asking about erectile dysfunction. In men, the two are often linked; there may be two separate reasons, or it may be that there is just one cause affecting both. Low libido can lead to erectile dysfunction, and the opposite can happen as well. Depression and treatment for depression can lead to both erectile dysfunction as well as low libido.
Having had multiple surgeries can result in both psychological and physical effects. This can frequently lead to low libido, but it usually comes back once a person feels better physically. Since you have been dealing with this for a long time, it’s definitely worth looking into more. Low testosterone levels are a frequent cause of both ED and low libido, so these should be checked. Treatment of ED without treatment of low libido may not be effective.
As you can see, the causes and effects of male sexual problems in men with medical issues are complex, and treatment of multiple different issues may be required for good function.
It is concerning that you aren’t getting an erection with penile injections. These are normally highly effective. The most effective treatment in your situation is likely to be a penile implant. You should speak to a urologist with special expertise in this surgery.
DEAR DR. ROACH: In 1952, as a 9-month-old, I contracted polio. My case was severe enough to leave me with partial paralysis of one arm. I have since assumed that I have lifelong immunity to polio and have not gotten the polio vaccination. Am I protected against all the strains of polio, and do you recommend I receive a vaccination? — B.O.
ANSWER: There were three types of poliovirus in the 1950s, and two of these have been eradicated worldwide. Infection from one does not provide protection against the others: You are not fully protected against all types of polio after a polio infection. However, it is extremely rare to get poliomyelitis a second time.
Just as with my recommendation for a person who was vaccinated many years ago, unless you were likely to have an exposure (such as travel to an area where there is still transmission or exposure to a known case), I do not recommend vaccination. I contacted several experts, none of whom recommended vaccination.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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