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June 2023 Advice to Be Well From Dr. Mark Bornstein and Dr. Paul Benson

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I’m a 74-year-old male.  I have a healthy sex drive and have multiple partners.  I have difficulty maintaining erections and cannot have sex unless I use Viagra.  On multiple occasions I have passed out after ejaculation.  It is only for a moment or two.  It has freaked out my partners.  I’m fine afterwards.  I am on high blood pressure medications and have some other minor heart problems.  My cardiologist says this is dangerous and that I should not use any erectile medications any longer. I don’t want to stop having sex and I don’t want to die.  Do you have any suggestions for me?

JR

Dear JR,



Your cardiologist is right.  PDE-5 Inhibitors, (Phosphodiesterase-5 Enzyme Inhibitors) of which Viagra is, can lower blood pressure as well as have other adverse effects.  Depending on your cardiac status, this can lead to a significant cardiac event like chest pain, a heart attack, or passing out.  Nitrates (commonly referred to as Poppers) are absolutely contraindicated with Viagra. So are certain medications commonly used to treat HIV.  Concomitant medications can potentiate the vasodilation effects of Viagra or even increase the blood concentrations of Viagra which can increase risk.  Visual and auditory impairments are relatively common with PDE-5 inhibitors as well.  It’s important the prescribing physician is aware of your health and medications before prescribing PDE-5 Inhibitors.  You should not take these medications if given to you by a friend without seeking medical advice.

A new alternative for treatment of erectile dysfunction is available and a great option for many men.  Shock wave therapy (SWT) works by delivering delicate sound waves to stimulate tissue regeneration. This includes the formation of new blood vessels improving circulation, as well as collagen and elastin production. When applied to the penis, this strengthens and restores the natural mechanisms that cause erections. 

You can learn more about SWT by going to our website at DoctorBeWell.com, selecting Sexual Health, and then click on the tab Defeat ED.

 

 

 

It’s PRIDE MONTH!! I’m very excited and plan on celebrating all month. I did have a question that is important for me to know when I go out and meet people. Recently friends have been telling me they have syphilis and I am worried about contracting this STI. My friend was recently treated and I want to know if it is okay to have sex with him.

BA

Hi BA.

Ahh, syphilis in my opinion is the most confusing sexually transmitted infection (STI) so I am glad you asked this question. There are different types of syphilis and depending on the type or stage of syphilis would determine if you are at risk of contracting the STI. The main way for men to contract syphilis is through sexual contact with the mucus membrane during the primary syphilis stage. Primary syphilis is determined when an individual has a chancre. A chancre is a single, sharpy demarcated, PAINLESS ulceration. The reason why is it important to know that a chancre is painless, is that the lack of pain is precisely the reason why individuals do not realize they have a chancre and then transmit it. Sexual contact with the chancre or mucus membranes is the main way syphilis spreads. Alternatively, syphilis can also be spread from microscopically abraded skin. This is typically from the sloughing of skin from warts that are from syphilis. This way of transmission is likely much less common.

Let’s go back to the chancre. A chancre can be present in multiple locations. Commonly people here about a chancre on the penis. This is the place that is easiest to see so people tend to come in for treatment when they see this. Be sure to check the back of the penis as well. The more tricky places that chancres can present is in the anus or even in the proximal urethra (peephole, for lack of a better term). These are the areas that many people do not realize they have a lesion in because it is painless and typically goes unnoticed. When someone has sex when they have an unknown chancre, he/she can transmit the STI.  During other stages of syphilis, it is typically not transmitted. When someone comes in the office and tests positive for syphilis with zero symptoms, we call this latent syphilis. During latent syphilis, someone does not have a chancre or warts so it is not transmitted during this stage. Another important piece of information to know, is that if someone comes into contact with syphilis, the incubation period (time it takes for the infection to show up), is anywhere from 9-90 days! That is a very long time. During the incubation period, syphilis also is not transmitted.

This answer was jam packed with information! I hope you got what you needed out of this answer. As aforementioned, syphilis is one of the most complicated STIs. We can always talk more about this topic if you need further clarification.

 Since 1980 Dr. Paul Benson’s Be Well Medical Center has been an inclusive medical center celebrating diversity. Do you have a health related question for Dr. Paul Benson and Dr. Mark Bornstein? Submit your questions to [email protected]. This article is a sponsored editorial produced in collaboration with Be Well Medical Center. Between The Lines’s journalism is made possible with the support and partnership of advertisers like Be Well. Learn more about Be Well here.



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