The condition of anorgasmia cannot be solved with Viagra

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Dr. Keith Roach

Dear Dr. Roach: I saw a man — he’s 75 and I’m 77. He uses the blue pill; however, he cannot have an orgasm. I don’t want him to feel insecure if I ask him questions, so could you explain his problem to me?

— Anon.

Dear Anon. : The “blue pill”, Viagra (sildenafil), is a treatment for erectile dysfunction, and it works by increasing blood flow. It is no more effective than a placebo pill for treating low libido (interest in sex) in men or women, nor is it effective for anorgasmia, inability to achieve Orgasm. There are many misconceptions about this class of drugs.

Anorgasmia is not uncommon in men and has many possible causes. In my experience, the most common causes are medications (especially antidepressants, but also recreational drugs) and mental health conditions (especially depression and anxiety). Moreover, several medical conditions and surgeries can also cause this problem. Low testosterone is a common and treatable condition. The older a man, the more likely he is to have this problem.

I appreciate your consideration for his feelings, but talking about them is more likely to lead to a better outcome than not talking about them. Their primary care provider is a good place to start, but they could refer them to an expert, such as a urologist.

Dear Dr. Roach: My ENT prescribed me a fluticasone nasal spray to unclog my ears. I am a healthy 83 year old female. I take medication for high blood pressure and atrial fibrillation. Will using this nasal spray negatively affect my blood pressure or atrial fibrillation?

— DB

Dear DB: It is wise to worry. Some nasal sprays contain medications that can affect blood pressure. Phenylephrine (Neo-Synephrine and others) is absorbed enough that even at recommended doses it can affect blood pressure and pulse rate. These types of drugs (they’re called “alpha agonists,” and oxymetazoline is another) can also cause your heart rate to increase, which with atrial fibrillation can be uncomfortable and potentially dangerous. I do not recommend these over-the-counter medications for people with high blood pressure or atrial fibrillation, unless the physician who manages these conditions, such as your cardiologist, has specifically advised it.

Fluticasone is a completely different type of medicine. It’s a steroid, and it’s poorly absorbed into the system, so it doesn’t significantly affect blood pressure or pulse rate. Unlike the drugs I mentioned above, which start working within seconds to a minute or two, steroids take at least two weeks to reach their full effectiveness, so you have to be patient with these drugs. But they are much safer and, for most people, more effective if given enough time to work. Also, they do not have the rebound effect of worsening symptoms if you try to stop the drug as alpha agonists frequently do. I recommend alpha agonists only for a short period of time for this reason, but never in someone with uncontrolled hypertension, and with great caution in someone with well-controlled hypertension.

Dr. Roach writes: A recent chronicle on Ehlers-Danlos Syndrome has twisted the old nomenclature for hypermobile EDS, which was once called Type 3. Type 4 is the old term for vascular EDS.

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