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DEAR DR. ROACH: How do I approach a problem my husband has without embarrassing him? I'm not sure why lately, but during sex, he just goes soft. I'm not sure if it's me who he's not attracted to anymore or what's going on. We have been married for over 20 years. He is 39 and in good health otherwise. I don't want to make a big deal of this, but now I'm starting to think it is me. -- Anon.

ANSWER: In my now fairly extensive experience, issues with male sexual function can be due to poor blood flow (from blockages in a blood vessel, for example), which is a potentially serious problem. At age 39, this is unlikely, but it is one thing a physician considers when a man identifies this issue.

While diseases of the nervous system (such as multiple sclerosis) can cause loss of erectile function, it is unlikely that erectile dysfunction (ED) is the presenting symptom of a neurological problem. ED usually occurs in a person with a known neurological disease. Hormone changes, especially low testosterone but also high prolactin levels, are also a well-known cause of male sexual dysfunction.

It is easy to check these hormone levels as long as a person sees their provider and is honest about the issue, which some men have difficulty with. There are anatomical issues (such as a venous leak) that can cause the loss of an erection during sex.

It is true that relationship issues can also have effects on sexual function. My approach is typically to look for medical issues, and if they aren't there, I sometimes recommend couples' counseling. But I must admit that sometimes it is difficult for one or both partners to consider this problem.

Psychological issues, including anxiety, are another common cause of ED. However, none of these issues can be considered unless they are brought up. While I understand it can be difficult to do so, I recommend you bring it up at a time when both of you are comfortable and not stressed -- not around the time of intercourse. If you make it clear that his well-being is your interest, I think this would help.

There are many times when, despite a diligent search, no cause can be identified. In this case, treatment with one of the medications like Viagra can have a beneficial impact. Viagra and similar drugs are helpful for many causes of ED, including performance anxiety. If men know that they have something they can take that will work, sometimes the problem simply goes away.

DEAR DR. ROACH: I underwent the first of the two doses of Shingrix and almost immediately became short of breath, and my tongue swelled up. Luckily, I was near my physician's office, where I was given a cortisone shot, and the swelling subsided. She advised that I forego the second dose, so I did. Will I benefit from any protection against shingles with just the one dose? -- B.L.

ANSWER: The effectiveness of a single dose of the recombinant shingles vaccine, Shingrix, is about 70% in the first year. Unfortunately, without the second dose, the immunity is partially lost, down to about 50% after three years. However, 50% is a lot better than nothing.

The type of reaction you had to Shingrix is extremely rare, but I agree with your doctor that a second dose would be unsafe.

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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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