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Doctors' Answers to "Frequently Asked Questions" - Sexual Dysfunction

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An indi vidual patient is always advised to consult their own physician.

[posted 07/7/2000]
Question: My girlfriend and I are both healthy, sexually healthy and neither of us take any medication.
My girlfriend can orgasm from oral sex, manual sex, and masturbating - but has never orgasmed through intercourse in her entire life.
She gets close, but it never happens. I am very confident that the problem is psychological in some way.
I have read about the side-effects of viagra in men of all ages and old and/or hysterectomied women and it doesn't sound risky at all.
I think that if we were to try her taking viagra a couple of times, she'd be able to orgasm either through some physiological increase or some placebo affect (or both).

Is there any real reason not to try?
if you respond with an email address and a positive opinion, I'll let you know how it goes.
Thanks for your time


Answer: Should be ok, but I would not expect an orgasm since she is orgasmic without the viagra. Instead focus on intercourse where she gets stimulation of the "G spot". This is an area of the vagina that seems instrumental in stimulation to an orgasm. Check out the sexual information section of any book store, lots of books about this area and options in intercourse to find/stimulate this area.

[posted 03/25/2000]
Question: sexual dysfunction (anorgasmia) since neurontin- stop neurontin horrendous pain in hip & leg returns. What happened to that 'orgasm pill' that was in the news app 1 year ago I believe it was in England. I'm depressed because I don't even respond to myself not dysfunctional because of depression. Are there any other Rx's I should be asking my Dr about?

Answer: Occasionally ritalin on the day you want to have sex works, also Ambien can be of help occasionally. Viagra is occasionally of help. I'd try each to see which is the best option.

[posted 03/9/2000]
Question: I am a female suffering from reiters disease, the first time i had a sexual experience with a man that was infected i got arthritis, conjuctivitis. I got over it but the second time my sex life was ruined, i have over 100 orgasms and my clit doesnt go down, it stays like that for hours, i cant sleep it stays erect and i have to take valium to eventually to sleep. I would like to be studied to understand why this is happening to me. i cant have kids till i fix this problem

Answer: I would see a specialist in sexual dysfunction. A urologist who specializes in this area or an endocrinologist. Reiter's will not give you this variation of priapism(continual sexual engorgement).

[posted 02/16/2000]
Question: I'm not sure if this is a proper question for this forum - but wasn't sure where to go. I'm wondering why I am unable to be clitorally stimulated. I find that the "normal" type of manual stimulation to this area, even basic touching does absolutely nothing. In fact, it tickles and is more of an annoyance. Is there anything to explain this? Is it less unusual than I think it is? I'd be most appreciative for any response. Thank you.

Answer: Not very common, but usually continuation of masturbation will fix the problem. Finding your erogenous triggers is usually necessary. Some women do experience more stimulation internally, especially around the "g" spot. This is about 1-2 inches from the cervix on the anterior of the vaginal wall. Also, viagra is often very helpful for this. If these do not work, I would see a professional sex therapist.

[posted 02/6/2000]
Question: I am currently taking Estratest (Total Hysterectomy), Have absolutely no interest in sex. I am also taking Paxil. What is the best hormone therapy to take, if any?

Answer: Hard to know if it is the Paxil or if you need some testerone. You have two options, 1. add a little testerone to your steroid replacement. Testerone is responsible for male and female sex drive and a deficiency will give low sex drive. 2. stop the Paxil or switch to another anti-depressant that is usually better with sex drive(Celexa would be my pick initially, there are others).

[posted 12/1/1999]
Question: I have been on Wellbutrin SR and noticed some diminished libido. After being prescribed Levsin, Propulsid, and Prilosec to treat
delayed gastric emptying and Irritable Bowel Syn., my sex drive seemed to decrease even more. I just recently got married and this is
causing me a lot of distress. I went back to my doctor and was prescribed Serzone in place of the Wellbutrin. I researched this on the internet
beforehand and found Propulsid and Serzone should not be combined, but my doctor said it wasn't really dangerous when I brought this up. I'm very leery
about doing so and want to know if this is a dangerous combination and, if so, ist here another option to Serzone that won't adversely affect libido

Answer: The problem is building up levels of propulsid which can cause cardiac irregularites. If you have no history of cardiac irregularities and reduce the dosage, you would probably be ok. Celebrex is another alternative in place of Serzone. I am not aware of Propulsid interactions,but this is pretty new. I'd check with the manufacturer of Propulsid, Janssen 800-Janssen.

[posted 11/15/1999]
Question: Lipitor at 10mg or 20mg clearly slows my sexual drive down. What other cholesterol lowereing drug would you recommend which might not have this side effect?

Answer: Try Tricor or Lopid, different class of drug and don't seem to have this problem.

[posted 11/9/1999]
Question: I am a 46 year old female. I have been taking Calan SR 240 mg. once per day for the past 6 years. Ever since I started taking this medication my sex drive has taken a nose dive. I did not have a problem before, so I assumed this was the problem. I asked my doctor about it and he didn't think the medication was the problem. However I asked the nurse before I talked with him and she said several patients who were on this medication had this complaint, especially men. I am pretty sure I will have to be on this medication for the rest of my life. I'm very frustrated. Could it be something else causing the loss of sex drive other than the medication? Also, I am having the beginning stage of menopause, but was not having menopausal problems when my sex drive plummeted. I am interested in estrogen replacement therapy and if that will help this problem of sex drive. My husband and I are very frustrated. What should I do?

Answer: I'd get your estrogen replaced first and see what happens. Calcium channel blockers can interfere with libido,but this is not very common. Check your thyroid levels and prolactin levels if this doesn't work. However, it is an easy fix to try some other blood pressure pill in the meantime, I mean there are only about 50 other drugs available.

[posted 11/9/1999]
Question: I am currently on paxil 30 mg. and having trouble with libido and profound sleepiness. My husband and I have both heard that a combo of paxil & wellbutrin may alleviate some of the known symptoms of paxil. Any info. would be appreciated. I am 41 years old. Thank you.

Answer: Worth a try, but I'd try Serzone or Celexa first. This usually helps the sexual problems. The sleep disorder may or may not be better. If this doesn't help try the combo.

[posted 08/15/1999]
Question: I was prescribed a testosterone cream called testosterone propionate 2% to increase my sex drive. I wasn't given any directions with the prescription. Is it safe to use while I am also using birth control pills? Will it interfere in any way with the effectiveness of the birth control pill?
Kim Guymon

Answer: Safe and shouldn't interfere with the birth control pills unless used in very large doses. Usually applied once, occasionally twice a day.

[posted 10/10/1999]
Question: About 2 years ago I took 20mg prozac for depression. The drug eliminated my libido and made sensitivity/orgasm difficult to achieve. I had taken the drug before and new that it might do this to some degree. However, this time it was much more dramatic effect. I also take temormin and vasotec for hypertension(10years). After about 4 months I discontinued the prozac, but my libido and certain sexual functions have not returned completely(1.5years later). My erections and ability to orgasm are ok, but I have seemed to have lost a great deal of sensitivity (e.g. tactile). Does prozac have any contraindications with tenormin? Can any sort of permanent neurological side-effects persist(sexually). Over the last 5 years I have been able to reduce my blood pressure medicines from 50mg tenormin, 20mg vasotec to 25 and 10 mg respectively. This seems to some degree to help with sexually function overall, but the sensitivity/libido issue remains. I have tried various types of blood pressure medicines over the years and recently tried norvasc alone. My blood pressure was not controlled and the sexual problems did not improve either. Any suggestions? Not sure whats going on here. Thanks in advance for your response.

Answer: The lack of sensitivity is not currently due to the Prozac. Might be the blood pressure pills, and might just be normal aging. There is no interaction for most patients between Prozac and Tenormin(atenolol). I suspect the blood pressure pills are a great deal of this. You need to work with your md to find ones that will work and allow normal sexual functioning.

[posted 10/9/1999]
Question: I have been taking antidepressants for ~ 12.5 years. Previous to taking 300mg of Effexor for 3.5 mos, I had been taking Prozac (100mg) for ~ 7 years.

Due all antidepressants cause a decrease in libido?
Are there any studies ongoing involving women taking antidepressants and decreased sexual drives?

Also what are the dangers of taking prescription diet drugs and antidepressants?

Answer: Most anti-depressants will affect sexual libido. Studies are hard however since depression also causes decrease in sexual interest/libido. Studies are in progress of women but, they experience similar complaints. As to diet drugs and anti-depressants, no studies. The SRI class appears relatively safe with any drugs so I doubt it would be a problem. What drug were you interested in?

[posted 10/9/1999]
Question: I am a 43 year olf male. I am currently taking Prinivil, 10mg daily, for the treatment
of high blood pressure. I have been experiencing difficulty
in maintaining an erection during sex. It will be stay hard for only a
short while. It then will become a soft erection at best.
I was interested in trying Viagra to see if it would help me
maintain erections longer, but I was concerned about taking it
while taking Prinivil at the same time. Are you aware of any
adverse reactions to taking these at the same time?

Answer: No obvious interactions. You also might check your blood pressure closely to ensure you are not being overdosed blood pressure wise with the prinivil. Lastly, often one bp pill causes erectile dysfunction and a drug from another class won't. Worth discussing with your md.

[posted 08/13/1999]
Question: I have been on paxil now for 4.5 years. The sexual drive side effects ( lack thereof ) has interefered with my development of fully sexually satisfying relationships with women. I have the capability to get an erection but there is no "primal urge" that wants me to have sex. I have to "kickstart" the urge by self stimulation and other types or mutual foreplay. Will testerone treatment help? Is there a possibility I have low levels of testerone as well. My doctor has never mentioned receiving testerone treatment.

Answer: No, but there is one publication that suggests that taking "uppers" like amphetamines the day you want to have sex is helpful. I haven't tried this with my patients to date due to my reluctance in using this class of drugs. Another option, and probably better is to try Serzone or Celexa in place of the Paxil. They are different than Paxil and some patients have markedly better sexual drive and orgasm patterns on these drugs.

[posted 08/12/1999]
Question: I am a 37 year old male.I would like to know whether various
symptoms that I have been experiencing over the past year
could be related to prior prednisone or ibuprofen use. The
persistent symptoms are hip stiffness, intermittent extreme
coldness of my lower legs and feet (especially brought on by
exposure to cold), and generalized sexual dysfunction
(reduced sensation, desire, ejaculatory volume and force,
and weaker erections). All of these problems began at the
end of a month in which I had taken for a nerve inflammation
8 days of prednisone (40mg for 2 days and then tapered
down to five mg) and then one week of ibuprofen (1200mg/day).
There was a week's pause in between the two. As I recall, I
first began to notice some loss of sexual sensation right
after the prednisone use. I then began to feel a warmth and
heaviness in my knees and lower legs half way through the
ibuprofen. These symptoms continued and within a week were
accompanied by knee and hip stiffness and the leg and feet
coldness already described. At that time, all of the other
sexual problems mentioned appeared. Within a few months the
knee stiffness faded, but the other problems have remained.
I have seen a variety of doctors, but they all have
discounted a connection between my symptoms and the drugs -
based on their experience with their own drug taking
patients. None of their tests have shed any light either.
Still, the timing of onset makes me very
suspicious. Moreover, I know that some effects can be
rare and therefore easily missed by those not well steeped
in the relevant pharmacological literatre. Could you please
tell me if any of my symptoms could possibly be related to
the medications, and if so how. Also, I have read in this
and similar forums that only higher doses and longer courses of
prednisone are associated with risk of significant long
term side effects - such as necrosis, incipient osteoporosis,
and so forth. But no one has ever specified the doses and
time frames (i.e. - how much of a dose and for how long).
Could you please do so, and could you tell me whether the
type of course that I took is known to be potentially
dangerous (and for what problems). Thank you very much.

Answer: The drugs are not the problem. You either have a vascular supply problem to your legs or a neurologic problem. Get your doctor to do a non-invasive arterial test of your legs. This symptom complex would be consistent with occlusion of the large arteries in the pelvis. Also, a peripheral neuropathy or neuropathy of the sympathetic nervous system could do this. If the vascular studies are normal, I'd recommend a neurologist.

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