What can I do about my erectile dysfunction? DR KAYE replies

I suffer from erectile dysfunction and tadalafil doesn’t work. What should I do?

Dr Philippa Kaye answers: It’s not uncommon for tadalafil to be ineffective. The good news is that there are other ways to tackle erectile dysfunction.

The stigmatising problem – where men struggle to maintain an erection during sex – will affect around half of men aged between 40 and 70 at some point.

It’s also more than a sexual performance problem. Doctors tend to consider erectile dysfunction as the canary in the coal mine for multiple potentially life-threatening conditions.

This is because erectile dysfunction can often be due to blood flow problems brought on by high blood pressure, high cholesterol or diabetes.

These conditions, which are typically triggered by poor diet and a lack of exercise, all markedly raise the risk of a fatal heart attack or stroke.

They can usually be diagnosed via blood test or a blood pressure check that a GP can order.

GPs would typically advise that erectile dysfunction patients take part in regular exercise, lose weight if necessary, stop smoking and limit their alcohol consumption. 

There are also drug treatments – such as statins for high cholesterol – that can help manage the effects of these underlying conditions.

All of these measures should improve blood flow and boost erections.

There are also psychological factors that make erectile dysfunction worse. Stress, anxiety, grief and relationship problems are all known triggers. Research shows that talking therapy and counselling can help in these situations.

However, many men will require medication to enable them to sustain erections.

Tadalafil, also known as Cialis, is one of the most commonly used in the UK. It’s a type of drug called a PDE5, which boosts blood flow to the penis.

It’s a slow-release drug, meaning its effects last for up to 36 hours. But it’s not effective for everyone.

Instead, some men find that they have a better response when taking sildenafil, or Viagra. This tablet only works for about four to six hours, meaning it has to be taken in the hours leading up to sex.

But this shorter, fast-release dose often has a more noticeable impact on the strength of erections.

For those who fail to respond to any medication, there are vacuum erection devices – also known as penis pumps. These work by drawing blood into the penis, which is then kept there using a constriction ring, placed around the base of the organ.

I have irritable bowel syndrome. I’ve been told the FODMAP diet might help. However, it seems very restrictive and I’m worried I wouldn’t be able to stick to it. Is it worth it?

Dr Philippa Kaye answers: The FODMAP diet can be game-changing for patients with irritable bowel syndrome (IBS), and patients only need to stick to it for a few months.

Irritable bowel syndrome is a very common long-term condition of the digestive system that often causes symptoms such as stomach cramps, bloating, diarrhoea and constipation.

Unfortunately, there are no approved treatments that can cure it. Many patients rely on drugs that help calm the worst of the symptoms.

One of these is a medicine called mebeverine, or Colofac, which relaxes the muscles in the gut to ease cramps brought on by the condition.

There is also evidence that probiotics – drinks containing so-called healthy bacteria – as well as regular exercise, both seem to help with symptoms.

However, one of the most effective ways of tackling IBS is a diet called FODMAP, short for fermentable oligosaccharides, disaccharides, monosaccharides and polyols, which are certain types of carbohydrates that are poorly absorbed in the gut and can ferment, leading to IBS symptoms.

The diet involves eliminating these foods, which includes carbohydrates such as pasta, bread, pastries and cereals; onions and garlics; dairy products; pulses and legumes including chickpeas and beans; and certain fruits like apples and pears.

It’s a pretty exhaustive list of foods, meaning that the diet can be both boring and challenging.

However, crucially, the FODMAP diet is designed to be temporary. Most patients follow a strict restriction diet for up to eight weeks. At this point, they begin to reintroduce foods, one at a time, to try to identify which ones lead to symptom flare-ups.

Anything that causes a flare-up should be avoided in future. The key is to create a personal diet plan that limits uncomfortable symptoms while also allowing patients to eat a balanced and varied diet.

• Write to Dr Philippa Kaye at Health, Daily Mail, 9 Derry Street, London, W8 5HY or email: health@mailonsunday.co.uk – include contact details. Dr Kaye cannot enter into personal correspondence. Replies should be taken in a general context. Consult your own GP with any health worries.