Dr. Roach

Dr. Keith Roach

DEAR DR. ROACH: I have a question I hope you can help me with. I’m a 70-year-old man with benign prostatic hyperplasia (BPH). My urologist, who I see every six months, put me on finasteride and Flomax to help with my enlarged prostate and with emptying my bladder. Both have been effective. Over the past several years, I have had both a negative prostate biopsy and a negative MRI, which was done in 2019.
Recently, I started experiencing some pain when ejaculating. I am wondering if this is normal, given the two medications I am taking. It is a little embarrassing to ask this to a doctor who is also a friend. I appreciate your thoughts. — H.M.
ANSWER: Pain with ejaculation isn’t normal, but it isn’t rare. An enlarged prostate is a common cause, but there are others, including infection of the prostate or urethra, abnormal anatomy (especially after surgery), and some medications such as older antidepressant drugs. An evaluation should look for these possibilities. Pain isn’t common with either finasteride or Flomax.
You can be friendly with your doctor, but I don’t think it’s a great idea to have one of your friends be your doctor. It can cause the doctor to lose some objectivity and, as evidenced by your case, keep you from being perfectly honest. If you can get over your embarrassment (and honestly, there is nothing to be embarrassed about), then by all means, go see your urologist friend. Otherwise, it might be prudent to find a different urologist and tell your friend why. They will understand.
DEAR DR. ROACH: Please write about shingles. I am a 77-year-old woman who’s been married for 30 years, and I have shingles on my face and head. I am being treated with acyclovir. I have no idea what happened. How did I get this?
After two days of treatment, my face isn’t much better, and my eye is still swollen. When I get asked what I have and I say shingles, I get a weird look. So, I looked up some information and read that shingles is a form of herpes. I do not have herpes, or my doctor would have told me, right? I did not sleep around before marriage. Please be frank with me. — K.H.
ANSWER: The herpesvirus family is a diverse group of viruses that can cause significant disease and affect many different organ systems. When people hear “herpes,” they often think of herpes simplex, which causes cold sores and genital blisters. But there’s a lot more to the herpes family.
Shingles is caused by one of the eight herpesviruses that affect humans, called varicella-zoster virus. Shingles is caused by an activation of the virus that a person gets when they catch chicken pox (or when they get a live vaccine). It happens commonly as we get older and our immune system slows down.
Varicella-zoster virus is related to herpes simplex virus, but it is not the same thing. Chicken pox is spread by very small respiratory particles and is extremely contagious. Herpes simplex viruses are spread through close contact, such as kissing or sexual contact. Kissing is also a common way to transmit Epstein-Barr virus, cytomegalovirus, and human herpesvirus 6, which are all herpesviruses that cause mononucleosis syndromes.
Chicken pox and shingles have nothing to do with herpes simplex viruses. They are also largely preventable with vaccination. Nearly everyone over 50 should get the shingles vaccine.
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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 ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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