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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Joanie on March 5, 2002, at 11:32:04
Can having a hysterectomy kill your sex drive? I don't know if it's that or the clonazepam and prozac that's doing me in, but I just don't feel the urge anymore. Not to be too personal or anything, but I did have a great sex life. Now, blah. I'm really beginning to worry and I know it's not good for my husband's ego. I'm only 37 - help! Any suggestions on something that may help - no skin flicks please. I take hormones every day, do you think they possibly may not be the right strength/dose? Thanks!
Posted by TSA West on March 5, 2002, at 13:39:27
In reply to Sex After a Total Hysterectomy???, posted by Joanie on March 5, 2002, at 11:32:04
The addition of a small dose of mirtazapine or buproprion may help you greatly in this regard: http://www.dr-bob.org/tips/split/Mirtazapine-for-SSRI-ADRs.html
Guidelines for sexual dysfunction:
Bupropion †
- 75-150 mg/d, qd or bid divided doses
- For SSRIs or venlafaxine, fluoxetine may raise bupropion levels; usual precautionary measures for bupropion
- Libido, arousal, orgasmMirtazapine †
- 15-45 mg/d
- For SSRIs, venlafaxine
- OrgasmMethylphenidate †
- 5-40 mg/d
- For SSRIs or venlafaxine
- Libido, arousal, orgasmDextroamphetamine †
- 5-40 mg/d
- Avoid night dosing (insomnia)
- Libido, arousal, orgasmPemoline †
- 18.75-75 mg/d
- Check liver function
- Libido, arousal, orgasmGinkgo biloba extract †
- 180-240 mg/d, tid, divided doses
- Potential increased clotting time, possible flatulence
- Libido, arousal, orgasmBethanechol †
- 10-50 mg prn 1 hour before sex
- Used for anticholinergic side effects (TCAs, paroxetine); produces cholinergic side effects
- ArousalNeostigmine †
- 200 mg/d, tid divided doses
- Used for anticholinergic side effects (TCAs, paroxetine); produces cholinergic side effects
- ArousalEstrogen creams or lubricants
- As needed
- For vaginal dryness, atrophy of vaginal tissue
- ArousalAmantadine
- 100 mg bid
- Caution in patients predisposed to psychosis
- OrgasmCyproheptadine
- 4-12 mg qhs
- MAOIs, TCAs, SSRIs, venlafaxine; watch for reemergence of depressive symptoms; sedating
- OrgasmBuspirone †
- 30-60 mg/d, bid divided doses
- Libido, orgasmNefazodone †
- Start 50 mg/d, up to 150 mg/d
- SSRIs, venlafaxine
- OrgasmGranisetron †
- 1 mg prn
- ? Use of other 5-HT3 antagonists
- OrgasmSildenafil
- 50-100 mg/d
- Contraindicated with nitrates
- Libido, arousal, orgasmYohimbine †
- 5.4 mg tid
- Can be anxiogenic; ? safety with MAOIs
- Libido, arousal, orgasm
Posted by Joanie on March 6, 2002, at 9:12:12
In reply to Re: Sex After a Total Hysterectomy??? » Joanie, posted by TSA West on March 5, 2002, at 13:39:27
Dear TSA West - thank you so much for your time and effort put forth in your answer. Problem is, I don't really understand it. Could you simplify? Are these all prescribed medications I can get from my doctor? You sound like a doctor. Are you? Sorry, don't mean to be so simple, but which if any of these medications might you think would be the best to try? Thanks
Posted by Roo on March 6, 2002, at 9:57:53
In reply to Sex After a Total Hysterectomy???, posted by Joanie on March 5, 2002, at 11:32:04
I've read that yes, definitely, a total hysterectomy
can kill your sex drive...and of course prozac (or any
SSRI's) kill it as well. So the combination is probably
what is causing it. I'd talk to your doctor about it. I take
prozac and it killed my sex drive, and was prescribed a
testosterone cream (very low dose)...I have noticed a
definite increase in sex drive, although I don't know if
it really helps with the delayed orgasm thing that prozac
causes. But it is nice to at least FEEL like having sex!
You might want to ask your gyno-doc about it, or maybe see
an endocrinologist.
Posted by Joanie on March 6, 2002, at 10:57:41
In reply to Re: Sex After a Total Hysterectomy???, posted by Roo on March 6, 2002, at 9:57:53
Thanks Roo, good advice!
Posted by Beliala on March 7, 2002, at 14:54:26
In reply to Sex After a Total Hysterectomy???, posted by Joanie on March 5, 2002, at 11:32:04
I don't know what hormones you're on, but the author of SCREAMING TO BE HEARD (excellent book, I highly recommend it) recommends 17-beta-estradiol and natural testosterone. I'm not sure, but I think you might need to get the testosterone from a compounding pharmacy - the usual form, methyltestosterone, isn't quite the same and the dosage is too high for most women. The estradiol sensitizes brain receptors to testosterone; thus a little goes a long way. Premarin contains very low amounts of estradiol and doesn't have quite the same effect.
This is the end of the thread.
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