Question: My wife has suffered from mouth thrush for the last 12 months, and on three occasions, has been told by her GP that it would clear up by itself, which it hasn't. Recently our dentist said tests were available – what are they and how could she get them?
Answer: Mouth thrush is caused by the fungus Candida albicans. It is often described as an ‘opportunistic’ infection, which accurately describes the fact that it needs particular circumstances to grow and cause symptoms. In a healthy person it is unusual to find it occurring in the mouth, particularly as a recurring infection, although it’s relatively common in other parts of the body, such as the vagina. Your dentist is correct to suggest that repeated infections warrant further tests but if your wife has other medical problems which could be making thrush infection more likely, your GP may not think these are necessary. Diabetes is one common cause of thrush infections and can be diagnosed with a simple test. Anything which reduces the body’s normal response to infection can also be responsible; the most serious would include chemotherapy treatment, autoimmune diseases and diseases causing weight loss and poor dietary intake. Less serious causes are areas of local surface damage in the mouth which thrush takes the opportunity to invade. This could be poor dental hygiene, damage from oesophageal reflux or surgery in the mouth.
Three recent infections should certainly prompt the search for a cause; this would involve examination, then blood testing for the diseases and problems mentioned above. There’s no real need to wait for it to clear up on its own as there are some simple and effective treatments.
Question: My prostate was removed at the age of 68 and the surgeon told me that I would lose my erections but the problem could be helped by Viagra. However, even the strongest dose (100mg) doesn’t produce the slightest lift. Will the erections ever come back? I have been discharged from hospital except for a PSA once a year.
Answer: I presume you had a radical prostatectomy, where the whole prostate is removed. This is normally performed for cancer of the prostate and one of the known side effects is a loss of erections, which your surgeon warned you about. Although better surgical techniques (nerve sparing operations) and treatment regimes with Viagra and associated drugs have improved the rates of erection recovery, this is still a major problem in up to 50% of men. The reported rates vary a lot as erection problems increase with age anyway and there are many other issues which may affect sexual function after surgery for cancer. You do not say how long ago you had your surgery but some men do experience a very slow recovery of erections; however if your treatment was many years ago then it is unlikely this will happen.
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