Dr. Keith Roach

DEAR DR. ROACH: I’ve been seeing a man — he’s 75, and I’m 77. He uses the blue pill; however, he can’t orgasm. I don’t want him to feel insecure if I were to ask him questions, so could you explain his problem to me? — Anon.
ANSWER: The “blue pill,” Viagra (sildenafil), is a treatment for erectile dysfunction, and it works by increasing blood flow. It is not more effective than a placebo pill to treat low libido (interest in sex) in either men or women, and is also not effective in anorgasmia, the inability to orgasm. There are many misconceptions about this class of medication.
Anorgasmia is not uncommon in men and has many possible causes. In my experience, the most common causes are medications (especially antidepressant medicines, but also recreational drugs) and mental health disorders (especially depression and anxiety). In addition, several medical conditions and surgeries may also cause this problem. Low testosterone is a common and treatable condition. The older a man is, the more likely he is to have this problem.
I appreciate your consideration for his feelings, but talking about it is more likely to lead to a better outcome than not talking about it. His primary care provider is a good place to start, but they might refer him to an expert, such as a urologist.
DEAR DR. ROACH: My ENT prescribed fluticasone nasal spray to unblock my ears. I am an 83-year-old female in good health. I take medication to treat high blood pressure and atrial fibrillation. Will using this nasal spray adversely affect my blood pressure or my AFib? — D.B.
ANSWER: It’s wise to be concerned. Some nasal sprays contain medications that can affect the blood pressure. Phenylephrine (Neo-Synephrine and others) is absorbed enough that even at recommended doses, it can affect the blood pressure and pulse. Such types of medicines (they are called “alpha agonists,” and oxymetazoline is another) can also speed up the pulse, which, with atrial fibrillation, can be uncomfortable and potentially dangerous. I advise against these over-the-counter medications in people with high blood pressure or atrial fibrillation unless specifically advised to do so by the doctor who manages these conditions, such as your cardiologist.
Fluticasone is a different type of medication entirely. It’s a steroid, and it is poorly absorbed into the system, so it does not significantly affect blood pressure or pulse. Unlike the medicines I mentioned above, which start working within seconds to a minute or two, steroids take at least two weeks to reach full effectiveness, so you need to be patient with these medications. But they are much safer and, for most people, more effective if given enough time to work. Further, they do not lead to the rebound effect of worsening symptoms if you try to stop the medication the way alpha agonists frequently do. I recommend alpha agonists only for a brief period of time for that reason, but never in a person with uncontrolled hypertension, and with great caution in a person with well-controlled hypertension.
DR. ROACH WRITES: A recent column on Ehlers-Danlos syndrome misstated the old nomenclature for hypermobile EDS, which used to be called Type 3. Type 4 is the old term for vascular EDS.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.
(c) 2022 North America Syndicate Inc.
All Rights Reserved


Only subscribers are eligible to post comments. Please subscribe or login first for digital access. Here’s why.

Use the form below to reset your password. When you've submitted your account email, we will send an email with a reset code.

filed under: