Q. My fiance is 49 and has liver cirrhosis and is positive for the hepatitis C virus. His erection is short-lived and very weak, and it is not easy for me to get orgasm with him. He was a heavy alcoholic, but he stopped drinking completely six months ago. Do you think there is a possibility of improvement in his case? What medication or advice can you suggest? I am shy about telling him my problem with this, as he thinks he is perfect.

A. From what you are describing, your fiance has a very serious problem. First, hepatitis C is permanent, incurable and contagious. If you are not already infected, then please realize that unprotected sex puts you at risk for getting this dangerous virus. Hepatitis C causes end-stage liver failure requiring a transplant in up to 50 percent of the people it infects.

Secondly, cirrhosis damages the liver. Unfortunately, liver failure changes a person’s hormone metabolism. The liver controls the conversion of testosterone (the male hormone) to estrogen (the female hormone). A man with liver failure experiences excess estrogen and less sexual drive. Also, his body fills with toxins that affect cell metabolism throughout the body, not just in the liver. Unless and until his liver problem is corrected, there is no medication that will help his sexual function.

For cases such as this, some men use a vacuum erection device. The man puts this on the penis when he wants a erection. The device draws blood into the penis, allowing it to become hard. Once it is hard, a constriction band is released at the base of the penis that squeezes it tight to keep the blood in it. This not only provides erection, it can also help for some playful foreplay.

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