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Dear Dr. Roach: I had a radical prostatectomy in 2012 and two subsequent inguinal hernias. Due to having three surgeries in eight and a half months and the recovery from them, my desire for intimacy was very low. My understanding is that the longer you delay intimacy, the greater the chance of erectile dysfunction.

Am I correct?

Daily pills did not work; Muse was successful, but painful. The Trimix injections were somewhat successful, but my essential tremors really inhibited the injection process. I am now using a pump, which is awkward and not very successful; I am still in the learning stage. Next month will be four years since my prostatectomy, and I thank God I am cancer-free. I am thinking of an implant.

What percentage of men get ED after prostatectomy and can recover? Did the hernias enhance the ED? Do many men have issues like this? Do you have comments about the implant, especially after four years?

Anon.

Dear Anon: About 60 percent of men identify moderate-to-severe problems with sexual function two months after radical prostatectomy, and 40 percent two years after surgery. The older a man is at the time of surgery, the more likely he is to develop erectile dysfunction.

My colleagues who perform implant surgeries tell me that without erections, the penis can develop fibrosis, making it a more difficult surgery and lessening the likelihood of success. For this reason, some centers recommend early treatment with oral or injection medications or a vacuum device to preserve sexual function. I’ve had quite a few men undergo surgical placement of the implant, and the vast majority have been happy with the results. Most studies have shown 90 to 95 percent satisfaction.

Dear Dr. Roach: A man in his 70s wrote he was bothered by the need to get up to urinate two or three times a night. It was suggested he take 200 mg of ibuprofen before bed, which cut his nocturnal urination to one trip. I tried it with the same result, but the next day suffered my first attack of gout, experiencing painful swelling in the toes of both feet. Did the ibuprofen cause me to retain too much uric acid?

J.W.R.

Dear J.W.R.: I can’t explain that one. Ibuprofen is a standard treatment for gout. I’ve never heard of it triggering a gout attack. Aspirin occasionally can trigger gout. As far as I can tell, your situation was just coincidence. However, I don’t like coincidences. Sometimes, beginning treatment to lower uric acid levels in the blood (such as with the drug allopurinol) can trigger gout, but I haven’t read about or seen it with ibuprofen.

Email questions to ToYourGoodHealth@med.cornell.edu.

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