Dear Dr Mike,

Like a lot of middle-aged guys, my sex life owes a lot to Viagra. Lately it has not been working like it used to. I can still have intercourse but my erections aren't as hard as I would like. I'm not getting any complaints, but I am starting to worry. I take prescription Viagra 100mg about an hour before the event. Do any of the other forms work better or is there anything else I can do?

Jack,

Bangkok

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Dear Jack,

Since you're taking "prescription" Viagra, let's assume it is the real thing, not a copy and that you are under the care of a doctor.

I don't think switching to one of the other competing products will work any better though it won't hurt for you to try. Increasing your dose is not likely to help either and will probably just increase side effects.

There are a variety of reasons Viagra may not work.

One is damage from diabetes. Make sure you have ruled this out, although even most diabetics get good results.

Another is what's known as a venous leak. Basically, that means that blood leaves the penis faster than the arteries can supply it. This condition is not medically treatable.

You might be able to improve your erections by lifestyle changes, and supplements. Alcohol doesn't help. Neither does stress, fatigue or lack of exercise. A healthy low-fat, low carbohydrate, high-protein diet might.

Arginine is necessary for normal sexual function and a lot of urologists suggest it as a sexual aid.

Although the jury is still out, Carnitine, a natural substance, along with its analogues PLC and ALC, are thought to be beneficial to circulation, brain function, peripheral nerves and sexual function.

They are quite expensive in Bangkok but are widely available on the Internet and in speciality stores in the US at much lower prices.

I'm getting good reports from patients who have tried these supplements.

Daily Xpress/Asia News Network

- The information provided here is for reference purposes only. Please consult a physician before starting any treatment options.