Ask The Doctor: August 2021
Q. Can high blood pressure cause sex problems?
A. Sexual function can potentially be affected by hypertension and cardiovascular disease. In men, erectile dysfunction (ED) can develop when arteries supplying blood to the penis become blocked by cholesterol (atherosclerosis). Because the smaller arteries in the penis are impacted before the larger coronary arteries, ED is now considered a harbinger of heart disease. Men with ED should consider having a cardiovascular risk assessment, which includes measurements of blood pressure and cholesterol levels. No man wants to have ED, but the diagnosis may be a lifesaver. In addition to the hypertension-ED connection in men, there is some evidence that hypertension is associated with a greater likelihood of sexual dysfunction in women. However, the mechanism underlying this relationship is less clear. In one study of 417 sexually active women, sexual dysfunction was reported in 41% of the 216 women with high blood pressure, but only 19.4% of women the same age with normal blood pressure. The encouraging news from the study was that hypertensive women who successfully controlled their blood pressure reduced their likelihood of sexual dysfunction.
Q. Is Lyme disease a problem in California?
A. While the black-legged ticks which transmit Lyme disease are more prevalent in the coastal Northeastern United States, we do have them in California. Cases have been rising in recent years. The problem peaks in summer, roughly May through July. That is when the ticks are in their nymph stage and more likely to be biting. That’s also, unfortunately, when they are quite small, about poppy seed size. They may be around in the fall season as well. Not every bite results in Lyme disease, but when it does occur, there’s usually a bullseye-shaped red rash that forms within a week. The rash may become as large as 12 inches in circumference. It may become warm, but doesn’t typically itch. Flu-like symptoms, such as fatigue, muscle aches, chills, fever and joint pain, are common. Tell your doctor about these symptoms and that you suspect a tick bite. Antibiotics can treat the infection. Lyme disease is not contagious. According to the Centers for Disease Control and Prevention, about half a million Americans develop Lyme disease every year. Serious complications can arise if the condition is not properly diagnosed and treated. A vaccine, currently in phase 2 trials, may be available in 2023, if it proves to be safe and effective. Meanwhile, if you enjoy hiking, try to stay out of tall grassy areas with lots of leaf litter. Avid gardeners should also take precautions. Wear long sleeves and pants tucked into socks and boots. Use tick repellent that contains DEET on exposed skin. Permethrin can be applied to clothing and footwear. Some outdoor outfitters make hiking clothes embedded with this repellent.
Q. Is it OK to take Aleve before a biopsy?
A. It’s generally recommended that you do not take naproxen sodium (Aleve) and other nonsteroidal anti-inflammatory products (NSAIDs), such as aspirin and ibuprofen (Motrin, Advil) for at least 24 hours before such procedures. These products can interfere with normal blood clotting and cause excessive bleeding. It’s also usually recommended to avoid these products and others that thin the blood before more invasive surgical procedures. However, every patient is unique, and the timing of medication discontinuation varies based on individual factors. There are also other exceptions. For example, a 2019 study published in the Journal of Fertility and Sterility showed that pre- or postmenopausal women undergoing outpatient endometrial biopsy experienced less pain if they took naproxen sodium before the procedure, suggesting it could be safe to do so. A 2020 study also concluded that NSAIDs in general provided effective pain control for the diagnostic procedure. Before using, it’s best to discuss it with your physician.
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