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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by ed_uk on December 25, 2004, at 19:19:32
Has anyone had success with Viagra (sildenafil) for the treatment of premature ejaculation?
Have a read of this.......Int J Impot Res. 2001 Feb;13(1):41-5.
Assessment of as needed use of pharmacotherapy and the pause-squeeze technique in premature ejaculation.The objective was to compare the efficacy and safety of the as needed use of clomipramine, sertraline, paroxetine, sildenafil (Viagra) and the pause-squeeze technique in treatment of primary premature ejaculation. A prospective double blind randomized crossover study involving 31 patients was performed. Treatment phases comprised five 4-week consecutive treatment periods, each separated by a two-week washout period. Patients were randomly assigned to receive each of the 4 drugs and use pause-squeeze on an as needed basis. Drugs were administered 3 to 5 hours before anticipated coitus. Anxiety score and ejaculation latency time were measured before treatment, after each treatment, and during washout periods. Sexual satisfaction score was measured after each treatment. The median ejaculation latency time was significantly increased from the pretreatment median of 1 minute to 4 minutes, 3 minutes, 4 minutes, 15 minutes and 3 minutes during treatment with clomipramine, sertraline, paroxetine, sildenafil (Viagra) and pause-squeeze technique, respectively (all P 0.0001). Sildenafil was superior to other modalities in terms of ejaculation latency and satisfaction (P = 0.0001). The three antidepressants were comparable to each other in terms of efficacy (P > 0.05). Paroxetine was superior to the pause-squeeze technique in terms of efficacy (P < 0.05). In conclusion, sildenafil (Viagra) appears to be superior to other modalities and a valid alternative in treatment of premature ejaculation. The 3 antidepressants were equivalent to each other in terms of efficacy and safety. Paroxetine was superior to pause-squeeze technique in terms of efficacy.
Posted by ed_uk on December 27, 2004, at 18:05:27
In reply to Viagra, posted by ed_uk on December 25, 2004, at 19:19:32
........ it might make me feel better about my own..........
........ ok, so I guess you are all anorgasmic on SSRIs?
..... or does no one want to admit to being sexually dysfunctional?
Sorry I was feeling sarcastic....
Ed.
Posted by ed_uk on December 27, 2004, at 18:14:36
In reply to Re: Come and tell me your sexual problems, posted by ed_uk on December 27, 2004, at 18:05:27
OK, so everyone on babble has a fantastic sex life?
I don't...... I'm mildly sexually dysfunctional while on SSRIs and a lot more dysfunctional while not on SSRIs. In my experience, SSRIs are more effective for prem ejac than they are for anything else. Hmmm, now where did I put the Viagra?
Ed.
PS. If you have a good sex life please don't tell me. It's bad enough hearing my friends taking about all night sex sessions.
Posted by Phillipa on December 27, 2004, at 19:41:28
In reply to Re: Come and tell me your sexual problems, posted by ed_uk on December 27, 2004, at 18:14:36
No one wants to address this outright. It's mentioned all the time as a side effect of SSRI's in other Threads. I don't think anyone out there has a "Great Sex Life" and remember it's what's between your ears that really matters, especially as you get older. I did have a pdoc who wanted to give me Viagra about 5 years ago, and I'm glad I said no, because it's just for men from what I've read. Phillipa
Posted by ed_uk on December 27, 2004, at 20:08:44
In reply to Re: Come and tell me your sexual problems » ed_uk, posted by Phillipa on December 27, 2004, at 19:41:28
Hello,
Everyone seems happy to talk about SSRI-anorgasmia but what about all the millions of people who have sexual problems unrelated to medication? We are happy to talk about our mental health problems so why can't we talk about our sexual problems? Sexual problems often worsen people's mental health.
Ed x
PS. I am embarassed now. Everyone knows that I have sexual problems and no on else has mentioned theirs.
Posted by ed_uk on December 27, 2004, at 20:53:53
In reply to Re: Come and tell me your sexual problems » Phillipa, posted by ed_uk on December 27, 2004, at 20:08:44
....... I would rather have anorgasmia than PE any day. I am not kidding, it makes me feel like a failure. I suffered anorgasmia for a short while on Paxil 60mg but it was a very minor problem in comparison to PE.
Paxil 60mg/day was particularly effective for PE but the side effects were a big problem.
Ed.
Posted by ed_uk on December 27, 2004, at 21:13:13
In reply to Re: My sexual problems, posted by ed_uk on December 27, 2004, at 20:53:53
I feel like an idiot
Posted by Phillipa on December 27, 2004, at 21:19:42
In reply to Re: My sexual problems, posted by ed_uk on December 27, 2004, at 21:13:13
Come on guys! Ed helps everyone else, how about responding to his Thread that he is obviously concerned about! Where are all you SSRI users and non-users ? Phillipa
Posted by KaraS on December 27, 2004, at 21:40:36
In reply to Re: Come and tell me your sexual problems » Phillipa, posted by ed_uk on December 27, 2004, at 20:08:44
> Hello,
>
> Everyone seems happy to talk about SSRI-anorgasmia but what about all the millions of people who have sexual problems unrelated to medication? We are happy to talk about our mental health problems so why can't we talk about our sexual problems? Sexual problems often worsen people's mental health.
>
> Ed x
>
> PS. I am embarassed now. Everyone knows that I have sexual problems and no on else has mentioned theirs.
Ed,I don't think you look foolish or should be embarrased at all. I think you're very brave! It's a legitimate issue. Others here have said things in other posts but they don't have the courage to draw attention to them specifically in a post just about sexual issues.
Besides, we don't really "know" you. We could bump into you on the street and never know you're the poster "ed-uk". I realize you are aware of this but sometimes I find it helps to remind myself of that.
Kara
Posted by lars1 on December 28, 2004, at 5:40:50
In reply to Re: My sexual problems, posted by ed_uk on December 27, 2004, at 20:53:53
There's no need to feel like a failure. This problem is very common, especially among young men. In fact, probably the majority of men have it during their first experiences of intercourse, so it would be "abnormal" not to have had it!
I've tried pretty much every known class of antidepressant, and of all the AD's I've tried, Nardil seemed to be the one that had the most effect of delaying orgasm while having little impact on erection ability. (I haven't tried any other MAO inhibitors, so I can't compare them.) However, this isn't necessarily a benefit. Delayed orgasm can easily progress to inability to have an orgasm no matter how long you try, which can be very frustrating for you and your partner.
For that reason and others, medication would not be my first choice in dealing with this problem. Instead, you can learn to develop voluntary control over ejaculation. It's not difficult, but it takes some practice. A book that helped me tremendously with this is "Male Sexuality", by Bernie Silbergeld. (This book is also great at countering some of the toxic myths that we men pick up about sex. I recommend it highly.) In this book, you will find a series of exercises in which you will learn to sense your level of arousal during sex and make adjustments to what you are doing so that you keep your level of arousal high, but not so high that you go over the top and have an orgasm. You can then maintain high arousal for an extended period, which can be very pleasurable. There is too much in the book for me to effectively summarize it here, but I can tell you that I have tried the exercises myself, and they definitely work. (BTW, the book was recommended by Dr. Ruth Westheimer for this problem.)
Another useful technique, which isn't explained much in the book but which I have been practicing lately, is to manipulate the pubococcygeus (PC) muscle. This is the muscle that runs along pelvic floor, that is, along your crotch. This muscle is the source of the rythmic contractions you experience during orgasm. You also contract it when you stop urinating in midstream or when you tighten the anal sphincter. You relax it when you relax the anal sphincter or when you bear down to pass a bowel movement. Therefore, you can voluntarily contract or relax it by imagining that you want to do these things. (With practice, you don't have to imagine anything, you just will it to happen.)
As I mentioned above, the PC muscle is involved in orgasm. If you contract it and hold the contraction, it will tend to suppress orgasm. The same thing happens if you "force" it to stay relaxed. You can practice with both methods and see what works best for you. I suggest that you do this by yourself before trying it with a partner. It also may help to relax the rest of your body (or just your abdominal muscles) at the same time. Eventually you can learn to surf right on the edge of orgasm for an extended period. It feels great!
I picked up some of this while reading about tantric sex. Here is the URLs for a couple of articles that discusses some of the same things:
http://www.luckymojo.com/tkbiologicalbasis.html
http://www.luckymojo.com/tknorthaustin.htmlLars
Posted by ed_uk on December 28, 2004, at 6:29:49
In reply to Re: My sexual problems » ed_uk, posted by lars1 on December 28, 2004, at 5:40:50
Hello,
Thank you everyone for your advice. Thank you lars for the links. I feel a bit better now but I still wish I hadn't started this thread. What was I thinking?
Ed.
Posted by ed_uk on December 28, 2004, at 10:28:28
In reply to Re: What was I thinking?, posted by ed_uk on December 28, 2004, at 6:29:49
Case Report from the Canadian Journal of Psychiatry.........
Mr X, aged 40 years, has a DSM-IV diagnosis of PE, lifelong situational type attributable to combined factors. Stop-pause, stop-squeeze coital alignment techniques and the use of a condom with topical anesthetic (5% lidocaine) were associated with limited response. Conventional pharmacotherapies were also minimally effective and had dose-limiting side effects. Treatment with paroxetine, sertraline, and to a lesser extent, venlafaxine was associated with restless legs, gastrointestinal disturbance, headache, decreased libido, and erectile dysfunction. Trazodone and lorazepam caused sedation and cognitive slowing, while bupropion accelerated ejaculation. Mr X had previously found that alcohol produced satisfactory ejaculatory delay with no loss of erectile capacity, but clearly this was not a feasible regular option. A trial of gabapentin 300 mg taken 1 to 2 hours prior to intercourse resulted in a similar effect with no side effects. Higher doses of 600 mg resulted in further retardation of ejaculation but also in somnolence.
Posted by MM on December 29, 2004, at 11:05:52
In reply to Re: What was I thinking?, posted by ed_uk on December 28, 2004, at 10:28:28
I have had sexual side effects with SSRI's (every one that I tried as far as I can remember). I would either be unable to achieve orgasm, or no interest in sex, or delayed/diminshed etc. I was on Lexapro a week or 2 ago (and am now done with it) and it was horrible because I had interest in sex, increased...arousal/sensation (it seemed like) yet unable to achieve orgasm (SUCKS!). Serzone was kind of mixed. I was able to orgasm, but it was less strong, and the other side effects made it not worth it (found out about the liver problems after I stopped taking it). I don't have any problems with Wellbutrin, and maybe things would be that much better with um that new Wellbutrin...CL?? The other meds I have taken have not affected my sexual functioning I don't think, or at least not the recent ones (my memory is gettin worse every day I think). Soooo, hope this helps. Sex is a huge part of people and their lives and when meds cut that out, it's hard to accept, so I don't think talking about it should be embarrassing (although, I don't think I'll ever be able to bring up the probs with my pdoc...or even my female doctor). Good luck.
Meg
Posted by gromit on December 31, 2004, at 6:05:41
In reply to Re: Come and tell me your sexual problems, posted by ed_uk on December 27, 2004, at 18:14:36
I quit my 20 mg of lexapro because of complete inability to have an orgasm. There was a silver lining of sorts, my wife would actually have to make me stop. That was nice for the ego but I like having orgasms too. Plus we are trying for another baby.
So I started desipramine and within two days total system failure! I mean sometimes you are tired or feeling a little sick or whatever, but holy s**t, nothing, nada, zilch. So I got some levitra samples from my doctor and they did the trick. That side effect seems to have gone away, but it was a very unpleasant surprise.
I seem to have the same experience as you, somnolence, apathy and anorgasmia are not side effects of SSRIs, they are the only effects. I guess low dose SSRI + Viagra/Levitra/Cialis might be worth a shot.
Rick
Posted by ed_uk on December 31, 2004, at 7:40:31
In reply to Re: Come and tell me your sexual problems, posted by gromit on December 31, 2004, at 6:05:41
Hi Rick!!
Thank you for sharing your sexual problems :-)
>somnolence, apathy and anorgasmia are not side effects of SSRIs, they are the only effects
He he.... it's funny how SSRIs are approved for depression when they're actually a lot more effective for PE. I hope dapoxetine gets approved in the UK because it can be taken 'as needed' for the treatment of PE (rather than every day).
>Plus we are trying for another baby.
Good Luck!
Ed.
Posted by gromit on December 31, 2004, at 9:51:41
In reply to Re: Come and tell me your sexual problems » gromit, posted by ed_uk on December 31, 2004, at 7:40:31
> >Plus we are trying for another baby.
>
> Good Luck!Thanks
> Thank you for sharing your sexual problems :-)
Well I didn't want to leave you hanging.
Rick
This is the end of the thread.
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