Do I need a new hip to relieve pain...and get my sex life back?

FOUR years ago, I was diagnosed with a degenerative hip problem. The joint started clicking and became painful if I moved my legs apart. Thanks to yoga, the clicking has disappeared, but I now find I can’t put my legs very far apart at all. This is having a profound impact on my sex life, as it makes intercourse agonising. My consultant says I shouldn’t have a hip replacement, as I can still exercise.

WHETHER to have a hip replacement is a very personal decision. I have patients who aren’t necessarily immobile because of their joint problem but who are unable to play the sport they love, so they see a replacement as essential.

The extent to which the symptoms impact a relationship is just as important a consideration. But the main question is whether a hip replacement will be the answer.

Surgeons should always discuss the benefits of any operation and weigh them against the risks. This helps patients decide if a procedure is right for them.

One risk is that the operation may be unsuccessful. While a joint replacement could improve your sex life, there are other factors related to the operation that might hinder it. For instance, there could be weeks of recovery time while you wait for the wounds to heal.

Usually, doctors would advise patients to wait for about six weeks after a hip replacement before having sex. But some movements will be limited for at least three months, due to the risk of dislocating the new joint.

Surgeons should be able to offer advice about which positions are a no-go following the operation, however, some have limited knowledge on this, so it may be worth seeking advice from a physiotherapist. They can also suggest movements and exercises to speed recovery.

A physiotherapist may also have more detail as to how much of a difference the operation will make to your range of movement, to help you decide.

I HAVE had ringworm for about five months. It appears as three small pink patches on an ankle, calf and elbow. I have been treating it with Canesten cream but it doesn’t seem to be working. The pharmacist said it should have cleared by now.

DESPITE the name, ringworm has nothing to do with worms. It is a fungal infection in the skin and is especially common in children and young adults. It usually causes pink, raised, ring-shaped patches that can be itchy. Sometimes they may appear up to 5cm in diameter.

A range of anti-fungal creams is available both over the counter and on prescription, as are anti-fungal tablets. It is also important to wash clothes and bed linen to get rid of the fungal spores.

It is normal for fungal infections to take a while to clear, even with treatment. If a GP is concerned, they may send a skin-tissue sample to a hospital laboratory for testing.

There is always a possibility that the rashes are not ringworm at all but a sign of a different problem. Ringworm can mimic other skin conditions, such as dermatitis or psoriasis, as well as the little-known granuloma annulare. The latter is often mistaken for ringworm because the patch also appears in a ring shape, but it also tends to get better on its own in a few months.

It might be worth asking your GP about granuloma annulare, as this could be the true diagnosis.

SINCE my wife died last year, I have suffered slight speech loss. It manifests as a dry, scratchy throat and makes conversation awkward, although never painful. Specialists have examined me but found no obvious cause, or cure. A brief cold seemed to improve things temporarily.

Can anything help me to speak normally again? I am 87.

SPEECH problems can be very distressing. If speech returns when patients develop a cold, it usually means that mucus in the throat has helped somehow.

Most importantly, a change in voice could be a sign of cancer in the voice box, or larynx.

This is usually what specialists focus on if patients suffer speech loss, in order to rule out the worst-case scenario.

Next, perhaps a referral to an adult voice therapy service would be helpful. These are dedicated healthcare professionals trained to deal with a whole range of voice disorders, from complete voice loss to chronic hoarseness.

These clinics are often available on the NHS across the country.

Expert staff there will try to pinpoint the cause of the problem and provide exercises for improving it. Many specialist vocal exercises, designed to improve the workings of the vocal cords, might help.

Sometimes, emotional distress manifests as a physical symptom. It sounds odd, but it’s not unusual for grief to trigger a host of physical problems, including breathing difficulties, a dry throat, hoarseness or a complete loss of voice.

Doctors sometimes call this psychogenic voice disorder or a functional dysphonia.

In this case, speech and language therapy and bereavement counselling should ease some of the symptoms.

It is important that patients mention emotional problems that coincide with physical symptoms to a GP. The two are often linked.