Dear Dr. Roach: I am an 84-year-old man in good health. I have been taking tamsulosin (Flomax) for the past six months for my enlarged prostate, and it works fine for problems with urination. However, it causes reduced libido and reduced ejaculation. Is there an alternate medicine to treat the urinary urgency without this side effect? Or should I forget about sex?
P.S.
Sexuality is an important part of life, and there may be a way to improve your symptoms without sexual side-effects. Tamsulosin commonly causes decreased ejaculation (in up to 20 per cent of men), but decreased libido is less common (two per cent). An often-used alternative treatment, finasteride (Proscar), is about as likely to cause these problems, although its related compound, dutasteride (Avodart), may have fewer side- effects.
Also, medicines such as tamsulosin start working immediately, while it takes weeks to months for finasteride and dutasteride to reach full effectiveness.
Many men find relief from the herb saw palmetto, despite the fact that trials have not shown consistent benefit for this compound.
Since tamsulosin is mostly eliminated by the body in a day or so, you might consider going without for a day to see if it improves your symptoms.
Dear Dr. Roach: My wife is plagued by terrible nightmares. She is 69 years old. Each night, she has horrible dreams that make her moan out loud. I wake her, but she goes back to the same type of dreams. She has done this for years. It really affects the quality of her sleep, and mine. She is exhausted during the daytime. Her father and aunt had the same symptom.
C.F.
The only times in my career that I have heard this complaint have been in the following situations: patients experiencing side effects from medications, those with sleep disorders and those suffering from psychological issues. Medications, especially those prescribed for depression and high blood pressure, can cause this side-effect. If she takes any medication, read the literature on it to see if it might be causing her nightmares. 听
Sleep disorders 鈥� obstructive sleep apnea particularly, but also restless leg syndrome 鈥� can be associated with sleep disturbances. 听
Finally, anxiety disorders, such as post-traumatic stress disorder, may frequently include nightmares.
However, the family history suggests a distinct disorder, nightmare disorder, which tends to run in families. In nightmare disorder, there are no other known causes. Exercise, such as yoga, is recommended for this. The most effective treatment, as far as I am able to tell, seems to be a form of cognitive behavioural therapy. Psychologists or other mental health professionals would be most likely to do this.
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 [email protected].
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