Dr Fred Kavalier: A Question of Health

I am 81 years old and have found that, over the years, my penis seems to have shrunk so that it is now only about a third of the length it was during my prime. I have a good sex life, but this has some serious down sides. When I pass water, it is sometimes difficult to get a reasonable grip on my penis, and this has led to an embarrassing wetting of my trousers. I have seen a urological specialist, who said my penis has not shrunk. He thought the problem was that I had gained weight in the surrounding tissues. My wife, who has experience of my penis of more than 40 years, thinks it has shrunk. The actor David Niven, in an autobiography, said that his penis had shrunk "so that it resembled an acorn". This is exactly the description of mine. Is there anyone who could help me with this problem?

I am 81 years old and have found that, over the years, my penis seems to have shrunk so that it is now only about a third of the length it was during my prime. I have a good sex life, but this has some serious down sides. When I pass water, it is sometimes difficult to get a reasonable grip on my penis, and this has led to an embarrassing wetting of my trousers. I have seen a urological specialist, who said my penis has not shrunk. He thought the problem was that I had gained weight in the surrounding tissues. My wife, who has experience of my penis of more than 40 years, thinks it has shrunk. The actor David Niven, in an autobiography, said that his penis had shrunk "so that it resembled an acorn". This is exactly the description of mine. Is there anyone who could help me with this problem?

The problem is undoubtedly caused by a combination of factors. I'm sure that weight gain is one important factor. When you put on weight, the tissues of the groin get bigger and floppier. They envelope the base of the penis, making it "disappear" into the surrounding flab. But the penis itself may well have shrunk as an effect of both ageing and falling hormone levels. Several different types of tissue contribute to the anatomy of the penis – skin, blood vessels and, most importantly, connective tissues. These are the stretchy fibrous tissues that form the basic architecture of the penis. With age, these lose some of their resilience and elasticity. The effect of this is that the underlying architecture of the penis does indeed shrink. The same thing happens to other tissues in the body. There is no simple solution, but losing weight and trying to strengthen and tone the muscles of your lower abdomen may help a bit.

I am 15 and I can't sleep with sounds such as a loud ticking clock or people snoring. I have to share a room with my sister who snores. Sometimes, I get out of bed and pull the quilts over her head. This hardly works, in fact it makes her snore more loudly. I have my GCSEs soon. Do you have any suggestions?

As you have discovered, pulling the quilt over your sister's head doesn't work, and I wouldn't recommend it as it may also be dangerous for her. Some people snore because they sleep on their backs, so perhaps you should suggest to your sister that she sleeps on her side or front. Another possible solution is to wear ear plugs to block out the sound of her snoring. Perhaps if you slept with your head at the other end of the bed, the snoring would be less troublesome. You may just be a very light sleeper. Try to get yourself in a very relaxed mood before you go to bed. Have a warm bath, listen to some calming music, and make sure that you don't eat or drink anything that contains caffeine. That includes coffee, tea, chocolate, Coke and Pepsi.

I contracted my first bladder infection when I first had sexual intercourse. An antibiotic drug cured it, but it came and went over the years, until a few years ago when the drug I had been taking stopped working. I now use another antibiotic, Macrobid (also known as nitrofurantoin), for the problem, which now is caused even by just taking a bath. It still flares up after intercourse. I have given up coffee, wine and baths. It definitely limits my sex life. Don't tell me that urinating after intercourse or wearing cotton pants will help – they don't. I have heard that there is a vaccine being developed to prevent bladder infections. Is it available yet?

Bladder and urinary-tract infections are common, particularly in women. Dozens of medical and home remedies are used to treat and prevent them, including two of the suggestions that don't seem to help you. Most infections are caused by E coli bacteria that live in the intestine. These bacteria find their way into the bladder and grow and multiply, causing the usual symptoms of cystitis. This variety of E coli is different from the more virulent variety that sometimes causes death and serious illness among hospital patients. Antibiotics are effective in treating urinary-tract infections, but they have side effects and the bacteria tend to become resistant to the antibiotics. Researchers in Wisconsin have recently tried out a vaccine against E coli. The vaccine is given as vaginal suppositories – once a week for three weeks, and then once a month for three months. More than half of the women who used the vaccine suppositories had no infections at all over six months. Unfortunately, the vaccine is still in the experimental stage, but it may represent a big step forward for millions of women if its initial promise is confirmed. Some people swear by drinking a glass of cranberry juice daily, and there is some scientific evidence that it is effective in preventing E coli from attaching themselves to the wall of the bladder.

Have your say

The Question of Health postbag and e-mail box regularly fill up with readers' answers to the questions that appear on this page. Not everyone agrees with me. Readers often propose different ways of solving difficult health problems. Keep your questions ­ and answers ­ coming, and we will continue to publish the best of both. This week, MR suggests a novel way of preventing swollen legs during aeroplane journeys:

The "Push Cush" really works. This is a small inflatable two-chambered cushion that you put on the floor of the airplane beneath your feet. You press it with your feet, and this exercises the calf muscles and prevents swelling.

The cushion is manufactured in Australia, and it took us a year to track it down. It is now available from some travel clinics in the United Kingdom. We think it should be given out free on all planes. Another similar product, called the Airogym, is available on the internet at www.airogym.com for £10.99, or telephone 02392 631 177.

Please send your questions and answers to A Question of Health, 'The Independent', Independent House, 191 Marsh Wall, London E14 9RS; fax to 020-7005 2182 or e-mail to health@independent.co.uk. Dr Kavalier regrets that he is unable to respond personally to questions