Q After having cirrhosis diagnosed, my husband has been unable to sustain his erection. Will a liver transplant help or is this problem with us for ever?

DR THOMAS STUTTAFORD

A The major concern about a woman who has a husband suffering from liver failure, or any other potentially fatal disease, shouldn’t be the strength of his erections but whether he will remain alive and, sex apart, whether they will continue to have a good quality of life together. There is no sex in the grave, and not much either while waiting to die.

The primary intention of any treatment for end-stage liver disease is to restore a patient to reasonable health so that they will be spared the crippling tiredness, swollen limbs and general burden of chronic liver failure. Make certain that patients are once again able to enjoy the company of friends, colleagues and family and forget the bedroom romps.

Untreated liver failure is associated with both loss of libido and impotence. Once a liver begins to fail, as when a man begins to age, he will start to show signs of feminisation as the balance between his oestrogen and testosterone is changed. This change results in the redistribution of fat and loss of muscular strength – and a reduction in virility. A masculine figure loses strong limbs and muscular chest and the abdomen becomes paunchy as breasts enlarge. Testes and genitalia shrivel and the patient becomes less able to sustain erections.

Unfortunately, many people assume that cirrhosis of the liver is inevitably related to alcoholism and is therefore the patient’s fault. Although continued heavy drinking is a common cause, even arguably the most common cause of this condition, it is only one of many.

Transplantation of the liver is one of the most successful transplant operations that can be carried out, but there is a shortage of livers for transplanting. Once one has been successful, the patient is restored to a remarkable level of health. About 85 per cent of patients who have had a transplant from a living donor are alive after a year; 78 per cent are still going strong at three years and 72 per cent at five years.

However, the effect of the immunosuppressant drugs will have to be taken into account and the damage that has been done to the hormonal system while in liver failure when assessing a patient’s chances of having erections. But the evidence is that a man’s sex life improves, despite the side-effects of immunosuppressant drugs, after a transplant.

Impotence is a problem in many progressive diseases. It is an early sign of heart, arterial, lung and kidney disease and of diabetes. Erectile dysfunction is a side-effect of many neurological diseases, for example, 40 per cent of men with MS suffer impotence. For far too long, doctors were so influenced by psychologists that they were led to believe that most impotence was psychological in origin. It is now realised that in the majority, probably at least in 80 per cent of cases of impotence, a physical cause, or the drugs used to treat the physical condition, are the primary reason for impotence.

Important as penetrative sex may be, successful sexual congress is far more closely related to the emotional bond between people than the physical strength of a transitory erection. It may well be that our reader is dwelling on her dying husband’s potency as this is a marker for all the grief she feels for his potential loss. She should reassess her values.

Dr Thomas Stuttaford, The Times doctor, spent many years working in a genitourinary clinic

SUZI GODSON

A If your husband has advanced cirrhosis it is important to acknowledge that sex may be low on his list of priorities. Liver disease is described as a “silent killer” because it often doesn’t show any symptoms until it is too late. It is the fifth biggest killer in the country and only 30 to 50 per cent of patients with chronic cirrhosis survive five years after diagnosis. And, although alcohol is not the only cause of liver disease, drink consumption has doubled since the 1960s and about 40,000 people a year are now admitted to hospitals in Britain with alcoholic liver disease.

Any chronic illness can be associated with sexual dysfunction but, in men with advanced liver disease, declining testosterone and increased oestrogen levels play havoc with sexual function. Liver disease is also associated with fatigue and depression. Throw in medication, anxiety, fear and, possibly, a sense of failure and erectile dysfunction is an absolute given.

You don’t say how advanced your husband’s cirrhosis is but Sarah Matthews from the British Liver trust explains that a “liver transplant is a major operation and by no means an answer to a problem such as the one you describe. Liver organ donations are limited in this country so transplants are used only to save lives.” (The British Liver Trust helpline is 0800 6527330.)

Even if your husband was eligible for a transplant, he might have to wait up to a year for the right match and then would only be considered for the procedure if doctors thought he was fit enough to withstand surgery, plus he would then have to take medication for the rest of his life to stop his body rejecting the donor liver.

In the meantime, pharmaceutical solutions such as Viagra, Levitra and Cialis may be an option for him although, if his doctor was prepared to try this treatment, your husband would need to be closely monitored. A vacuum pump might be a safer alternative. Studies suggest that about 50 per cent to 80 per cent of men are satisfied with the results of using a vacuum pump to achieve erection but the mechanical nature of the process and the fact that it takes the average man between 10 and 20 minutes to obtain an erection rigid enough for penetration takes away a degree of spontaneity.

Some couples dealing with erectile dysfunction find that sex toys alleviate the pressure to perform. If you haven’t explored the wonderful world of vibrators before, the Hitachi Magic Wand (about £60) is reliable, effective and won’t offend if discovered by the cleaning lady.

Bearing this in mind you would be wise to remember that although sex is important, there are other ways of sustaining intimacy. Skin-to-skin contact, kissing and gentle massage will keep you connected, particularly when your husband is feeling unwell.

Without wishing to sound morbid, death is not something that any of us are prepared to acknowledge, but having just lost my own mother unexpectedly, I would urge you and your husband to focus on what you have, rather than what you feel you have lost. Use your time, whether that proves to be months or years, to do all the things that you promised you would do together. Most of all, tell your husband that you love him, every day, every hour even, and make each day count while you still can.

Suzi Godson is author of The Sex Book (Cassell, £16.99) and The Body Bible (Penguin, £16.99)

timesonline.co.uk/love

E-mail your sexual dilemmas to body&soul@thetimes.co.uk or write to Body&Soul, The Times, 1 Pennington Street, London E98 1TT

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