These comments are made for the purpose of discussion and should NOT be used as
recommendations for or against therapies or other treatments. An individual patient is
always advised to consult their own physician.
Reproduction and effects of
Clonazepam and Paxil [posted 1/14/99]
Question: I currently take 10 mg Paxil once a day and 0.5 mg of Clonazepam twice a
day. I am a male, 30 years old and my wife and I are currently trying to have a baby. I
was wondering what effects these drugs have on my sperm count as well as the effects they
may have on the sperm. Is my child more likely to have a birth defect due to either or
both of these drugs?
Answer: None apparent.
Lack of sex drive and problems
conceiving [posted 1/13/99]
Question: Can a supplement with wild yam extract and/or natural progesterones from
soy extract help to increase my sex drive and possibly help to change my hormone levels to
aid in increasing my chances in becoming pregnant? My husband and I have already had
physicals and I have already miscarried once in the 7th week. My OBGYN says I am fine, but
my progesterone level may be low. I have not been back to the doctor since January 1999
for my annual. After doing my own research and looking at my symptoms, I seem to fit in
the category of low level progesterone. However, I don’t care to take a synthetic form, so
I was wondering if an over-the-counter pill/cream would be sufficient? Also, are they
safe?
Answer: I wouldn’t make these decisions without discussing them with
your doctor. The “natural” estrogens don’t have a significant estrogen impact
from my prospective, and I doubt they would have a major contribution to your problem.
However, I’m no an ob-gyn and I would discuss it with them. Offhand, I doubt it would make
much difference one way or the other. However, if you are to supplement the progesterone
you’d be better off knowing the amount you’re receiving, difficult to impossible with
“natural ” sources.
Reducing Sex Drive [posted
11/25/98]
Question: Is there a safe and effective drug to eliminate or at least significantly
reduce the male sex drive? If there is would it be prescribed in Canada? Can you give me
the name of some of these drugs?
Answer: Lupron is given as a shot every 4 weeks and effectively
eliminates sex drive. Some of the SRI antidepressants(Paxil and the like) will lower it,
Lupron abolishes it.
Loss of Libido [posted 11/13/98]
Question: Does the drug Accolate alone or in combination with aerobid,serevent and
albuterol cause lack of libido and fatigue?
Answer: ot usually, check your liver functions however.
Loss of Libido [posted 11/11/98]
Question:Over the last 2 years I have noticed a steady decline in my libido, to
such an extent that I no longer have any interest in having sex and if I do, I do not feel
any sensations of arousal. I am female and 29 years old. I am sure this is not normal and
I am quite concerned about it. I feel slightly embarassed about discussing this problem
with my physician. What should my next move be??
Answer: On any medications? If not then you need an endocrine check out. This
would include thyroid levels, prolactin levels and possibly estrogen levels. Are your
periods regular? You need to find a physician who you can discuss this with without undue
embarassment.
Can Paxil Treat Premature Ejaculation
[posted 11/5/98]
Question: I’ve recently heard that paxil can be used to treat premature
ejaculation, and I was wondering if this was true, and if it was common practice ?
Answer: Yes, and works pretty well since the side effect of this class of drugs
is to decrease or eliminate orgasms.
Concerns About Infrequency of Wet
Dreams [posted 10/28/98]
Question: I have a question and I hope you can help me. I am 15 (almost 16) years
old. I have reached puberty, but there is something that worries me. I had my first ‘wet
dream’ at age 13. I now 15 as i said before and now I rarely have them. It has been about
6 months since I last had a ‘wet dream’. I am very active. I play sports, am pretty built
and healthy. I am still a virgin, don’t get involved in pornography, drugs or any of that
negative stuff. I have never masturbated and I plan to wait until i am married before I
have sex. I am not preoccupied with sex as some guys I know are. I hardly think about it
(if at all), and I dont have a girlfriend. I have never kissed a girl, have never dated or
any of that stuff. I have never been physically or sexually abused. I am a very happy
teen. My parents are divorced but that doesn’t bother me. I am giving you all this
(perhaps unneccesary) information just in case it may be of some help in you telling me
why it is that my ‘wet dreams’ are so infrequent. Is there something physically or
emotionally wrong with me?
Answer: Do you want more? Most wet dreams come from erotic sexual dreams. The
frequency of wet dreams is often over stated and most men have only several a year.
Nocturnal erections are common, wet dreams less so. I wouldn’t worry about it sounds
pretty normal to me.
Medicines Reducing Sex Drive
[posted 8/14/98]
Question: Is there a medicine that reduces the sex drive (libido) or the sexual
tension, but not as a side effect?
Answer: Most of the SRI antidepressants will do this.
Prolonging Erections [posted
8/14/98]
Question: What drug therapies are currently available to delay ejaculation /
prolong erections?
Answer: The SRI antidepressants sometimes do this, but often have decreased
sexual drive as well.
Penile Implant [posted 8/11/98]
Question: I have a penile that is not successful. Would the new drugs sildenafil,
apormorpyhine orphentolamine help improve my erection?
Answer: I’d try sildenafil. Very positive clinical tests, but I have no direct
experience.
Increasing Sex Drive [posted
8/7/98]
Question: My wife heard of a new drug coming out that increases women’s’
sex drive, but she doesn’t know the name. Have you heard of this drug? and what are the
side effects?
Answer: I’m not aware of any specific drug for this purpose. In general, men’s
and women’s sex drive is due to testosterone levels. In women, estrogen is metabolized to
testosterone in the adrenal glands and in fat tissue. Consequently, women with low
estrogen levels will generally have lower sex drives.
Intercourse and Pregnancy [posted
8/7/98]
Question: Is it possible to get pregnant without actually having intercourse?
Answer: Yes, but low risk depending on one’s activity – penis around vagina,
etc.
Drugs Used To Control Sex Drive In
Men [posted 7/30/98]
Question: Recently I heard a talk show mention a drug used by the military for its
soldiers to control their sex drive while at war. Is there such a drug? If so, do private
citizens have access to this? Can you tell me a little about this drug and its effects?
Answer: Several drugs reduce sex drive, but I am unaware of any systemic effort
by the military to blunt their soldiers sex drive. Write to the show and get the name of
the drug and I’ll be happy to give further information.
Penis Enlargement [posted
7/27/98]
Question: I am a 45 year old male and I want to enlarge my penis. They say to use
pumps to enlarge it. Then I heard about stretching and weight bearing. Do any of these
work are there any health problems related with the above questions. Most importantly, is
it possible to happen at my age?
Answer: Nice fantasy, but nothing works that is not very dangerous to long term
function of your penis. Work on technique.
Shyness and Sexual Repression
[posted 7/23/98]
Question: I’m 19 years old and I haven’t had a date with a woman, or had a sexual
experience with a woman. I’m quite bright, and not what you would call ugly. I do have
acne and that is one factor of my humiliation. Also, I need a slight surgery regarding my
penis, as the skin under it has grown so that at full erection the skin is overly
stretched if I pull the skin off it to reveal the head, this could also be adding to the
shyness. My libido is to some extent overpowering. I masturbate 4-5 times each day and I
am quite obsessed with the female body in the sexual content, and if I read anything about
how to excite a woman sexually I take it to heart to use later, but until this moment
there hasn’t been any later. I would describe myself as a pleasant, rather dull person
whose character is a bit like the character described under his starsign, the cancer. I
look upon women as somewhat of a higher stature and respect them. I was wondering what
could be the problem, how to solve it, and if I did in the end enjoy the company of the
opposite sex some night how would I react to it? Would I deflate, sexually, or would my
appetites continue to grow? I am pretty sure I haven’t been abused sexually, but sexual
experience of a certain kind has taken place, both when I was about 4-5 years old (with a
girlfriend of a same age) and with my two step sisters when I was 12 (my mother and father
divorced when I was 7, a silent and clean divorce, and my mother kept me and my sister in
touch with our father). I felt my stepsisters breast while she was sleeping (she has
enormous mammaries and she is the daughter of my stepfather and a year older than me) and
the other one I played a game and got her out of everything, but I didn’t penetrate her
orifices because of last minute guilt (she was 8 and I twelve). Also, I feel somehow
speechless around women, like I can’t find anything to say to them. I had friends of both
sexes all through childhood. I’ve moved quite a lot since I was 11-12 as at that time I
moved to another part of the town, where I also made friends of both sex, but there I was
teased for about half a year. I stayed there for two years. Then I moved to a different
country until I was 16 years old. I’ve stayed at three different places within the first
country since then and I’ve met women who might have taken interest. One was even hinting
for a closer relationship, but I found her too ugly to accept her as a partner even though
she was a wonderful person, but something about her wasn’t acceptable to me. So, could you
please answer the questions which I asked earlier. Also, might I have a problem concerning
my mental health, or do I just have too much imagination for my own good?
Answer: You probably don’t have any problems any different from any other normal
19 year old. Most children engage in sexual experimentation at some time, common and of no
consequence. Most children will also engage in some homosexual experience, common and of
no consequence. You might benefit from counseling to overcome your shyness. Also, there
are licensed sexual surrogates available, but I doubt that this would be necessary. Find a
counselor that specializes in sexual dysfunction. You don’t have a dysfunction currently
that I can ascertain, but this won’t be the first time that sexual abuse as a child is
repressed and manifests itself in different behavior. However, I suspect you only need to
air out your anxiety and you will be fine (pretty common by the way). I am a physician, MD
type.
Problems with Penis
Question: I have a boyfriend who is very self conscious about his penis and he
tells me that something happened to it shortly after birth – something that alters the
appearance of it – but he is too embarrassed to tell me if it is a disease, or something
natural. I really need to know what it could be – if it’s something serious, or just
something that he is over-reacting to.
Answer: It’s hard to tell without more information. It could be a
congenital deformity which was surgically fixed or mumps which affected his testicles.
Mechanical trauma is also a possibility. Sounds like he could use some counseling to help
with his feelings concerning his penis.
Male libido elimination
Question: Is there a safe and effective drug or herb to eliminate or at least
significantly reduce the male sex drive? If there is, what side effects are there and
would it be prescribed in Canada?
Answer: There are testerone blocking drugs which will reduce male sex drive.
These are prescription only. Also, most of the SRI antidepressants have this side effect
but not usually used to reduce sex drive per se. There may be an herb, but I’m not well
educated in herbal medicine.
Sex
Question: I had a baby 2 years ago. Since then, I have had no interest in any sort
of sex. I do not think this is healthy for me since I am only 24. I am a little upset but
not nearly as upset as my husband. Please help.
Answer: Several possibilities. First, how much time do you have available for
fun/sex? Excess work and worry are the most common killers of sex drive. Second, what
medications are you taking? Birth control pills will kill sex drive in many women, and
alcohol is also a notorious depressant. Finally, do you feel depressed? Unrecognized
post-partum depression is usually accompanied by lack of sex drive.
Vasectomy
Question: Is it possible to cause pregnancy after a vasectomy?
Answer: After the surgical procedure, pregnancy can result in several ways. 1.
There is residual sperm in the system for about 3-4 weeks after the procedure. Intercourse
too soon after the surgery can result in pregnancy. 2. Improper tying of the tubes can
lead to small numbers of the sperm migrating from one cut end to the other and then into
the penis. There were cases of this at first until the procedure was perfected. However,
there is always a small chance of reconnections occurring or sperm migration. 3. Surgical
procedures can be performed with microsurgery to reconnect the spermatic cords resulting
in restored fertility about 80% or so. There are many babies born to men in second or
third marriages who need surgical correction.
Sperm abnormalities
Question: I’m a 35 year old male and I have noticed in the last year or so,
discoloration and an unusual texture/clumpiness in my sperm during ejaculation. Is this a
serious problem?
Answer: This probably represents a low grade bacterial infection of your
prostate. Most of the fluid in ejaculate is supplied by the prostate. I would get your
physician to check this.
Erection
Question: My penis, when erect, is bent sharply downwards. Is there anyway of
straightening this problem out?
Answer: What you are probably describing is Peyronnie’s Disease of the
Penis. This is an inflammatory condition of one or both of the chamber of the penis.
Consequently, they do not engorge symmetrically and the penis deviates to one side. In
severe cases this can prevent intercourse. I would consult an urologist for treatment
options. Unfortunately, they do not make major differences.
Dark spot on skin of penis
Question: Hello, I’m a 26 year male and have a concern about a dark spot located on
the foreskin of my penis. It is located directly underneath where the non-circumcised skin
meets the circumcised part (where the skin bunches up), and looks almost like a bruise,
but doesn’t hurt at all. I have intercourse quite often and was wondering if that might
have something to do with it, but I’m not sure. I also thought it might be where my penis
rests against my leg primarily, but am unsure. It seems to be just a discoloring of the
skin, but I thought I would check here to see if anyone might know how I can make it go
away.
Answer: If this spot hasn’t been present your entire life it needs to be
looked at. Penile cancer is uncommon but treatable in early stages. Other possibilities
are different sexually transmitted diseases.
Decreased libido
Question: I have been on paxil and benzodiazepines, and since the beginning of the
treatment I have felt no interest in sex.
Answer: This is a common problem with SRI antidepressants. There are two
orations: 1) Try a drug called Serzone. It is similar, but more selective binding. I have
several patients who have better sex drive on this drug and adequate treatment of
depression. 2) Some recent literature implicates the use of low level amphetamines with
SRI antidepressants to blunt the effect on sexual drive and performance.
Strange urology/sexual problem
Question: I have a strange, puzzling problem. After ejaculation, I get pain in my
lower abdomen and testicles. This is aggravated when I lift weights. I have had a hernia
operation and a vericoselectomy, all to no avail. Is it my prostate? Also, I tend to
ejaculate prematurely. I am a virgin and do not have any kind of STD.
Answer: Ejaculation pain is not usually seen in hernias. This can occur with
epidymitis – an infection of the collecting system for sperm (common in men and may or may
not be related to STD). A trial of antibiotics would be the best way to decide if it is an
infection of this system.
Penis enlargement
Question: Are there any health risks in using an over the counter pump for penis
enlargement?
Answer: Mainly local trauma, otherwise nothing special.
Sex Drive
Question: I was wondering if there were any over the counter medication that could
be used to repress the biological sex drive? Or if there aren’t any drugs for that express
purpose, are there any that repress the sex drive as a side effect that would not be too
harmful if not used for its actual intended purpose?
Answer: Many drugs depress the sex drive or sexual ability. Over the counter the
most common is alcohol. Inability to become sexually aroused is notorious for this drug.
Some people are sexually depressed with anti-histamines; although, less commonly. Among
prescription drugs, there are two different sexual effects. The first is impaired sexual
arousal-not being able to get an erection or vaginal lubrication. Many blood pressure
drugs are responsible for this effect. Second is the actual suppression of sexual drive.
Serotonin Reuptake lnhibitors(SRI) like prozac, paxil etc are notorious for this effect.
Some seizure medications also can have this effect occasionally.
Decrease in Sexual Drive
Question: Is there a drug (or drugs) on the market that is specifically designed to
decrease sexual drive in men? If so, are they safe and can the effects be easily reversed?
Answer: Testerone is about the only one. However, long term use is not safe and
is not recommended for this purpose. It tends not to have reversible side
effects-depending on the side effect. Common side effects are acne(reversible), liver
damage(not rev), elevated blood counts(rev) and cancer of the prostate(not rev).
Loss Of Ejaculate
Question: I am a 23 yr. old male who has been on about 3 – 6 week cycles of
sustanon 250 (testosterone mixtures) with weekly injections of 250 mg. only. Presently I
am 238 lbs. at 6’1″ and my gains have been great at this dosage but my problem is
with my erections. They are as strong as ever and perhaps more frequent but it is harder
to ejaculate than ever before. When I eventually do climax, my ejaculate is much less than
before I used steroids. I went to a urologist, without telling him about my steroid use,
and he told me that my prostate was enlarged. What does this mean? I thought that such a
small dose would not be that bad. I thought this was the recommended doctor’s prescribed
amount.
Answer: Different people have different responses to steroids. Testerone clearly
will stimulate prostate enlargement. I’m not sure why it should affect your ejaculate in
volume or ability to reach orgasm. Steroids can cause severe side effects in some patients
and need to be monitored closely when administered. Clearly, the person giving you the
steroids has not explained the potential risks and there is no monitoring of potential
problems-let the buyer beware.
Estadiol
Question: I am a transsexual and I am currently taking 6 mg Estadiol daily. I would
like to start taking an Androgen blocker, but the one my doctor prescribed cost over $200
per month and as I am paying for this “out of pocket” it is prohibitive. He did
some research, but nothing was any less expensive, so: Do you know of an Androgen blocker
that is in the 50-75 dollar per month range? I also would appreciate any other info you
might have in this area or perhaps a web site that might help (I’ve spent many hours and
days stumbling through the web).
Answer: Unfortunately, all expensive and few alternatives. Castration might be
an option to reduce long term costs. There really aren’t many effective testerone
blockers-we usually use them in prostate cancer and all are expensive.
Ejaculatory Pain
Question: My husband and I have a real stumper. We’ve seen our regular GP and a
respected Urologist with no success. During ejaculation my husband gets a vertical sharp
pain under his left arm. The site would suggest heart problems, but there was no
“glitch” on a heart monitor worn during ejaculation. My husband is 47 with no
history of heart disease. He has prostatis and frequent urinary infections. Can you help?
Answer: Does this occur with any ejaculation or just with intercourse? Also, how
long has it been present. How long does it last? During ejaculation there is a major
sympathetic neuro outpouring. I suspect this is the answer; but, would appreciate any
input on the above questions.
Breast Discharge
Question: My girlfriend had a white milky liquid come out of here nipple during
sex, what is this stuff?, what does it mean?
Answer: This is called galactorrhea and is the usual “milk” formed by
the breast. Does she have it at other times? There are several conditions which produce
these, estrogen(birth control pills), excessive prolactin secretion, anti-depressants,
depression itself-etc. I would bring it to her physician’s attention; but, it may not turn
out to be anything of consequence.
Broken Condom
Question: My girlfriend and I were making love the other night and my condom broke.
What are the chances of her getting pregnant?
Answer: Depends on the timing of her period and her natural fertility.
Mathematically about 5% per intercourse. The next time this happens douse with a
spermacidal solution. Also, taking 4-5 birth control pills at once will usually block
fertility(but, she will be a little nauseous). Many couple use a spermicidal vaginal
insert along with the condom to prevent this problem. Lastly, when you put the condom on,
it should be slightly floppy at the top-not tight to your penis. This will reduce the risk
of further breaks.
Venereal Warts
Question: Are there any over the counter medications sold that will eliminate
venereal warts? What is available over the counter that will relieve the discomfort of
venereal warts?
Answer: These are difficult enough to eradicate with prescription
medications-I’m not aware of any that will work and will not damage the sensitive tissues
where these warts occur.
Loss of Erection
Question: I am a 43 yr. old male and have suddenly have suffered with the lack of
the rock hard erection I had a yr. ago. Since this time I have also been diagnosed with
mild low risk diabetes and take medications (Zestril 5mgx1 and glyburide2.5mgx2 each day).
I do have mild numbness in my toes and finger tips, but no numbness in my penis. I have a
large desire or sex drive, and my wife says I satisfy in every way but intercourse. If she
masterbates my penis it feels fantastic and I eventually will get semi hard and even
orgasm. However my wife and myself as well are very frustrated and I am afraid this may
become a fatal issue in our marriage. I guess the Zestril is for high blood pressure and
the glyburide is for the blood sugar which I have been taking for 6 months, and my doctor
says he feels all of this is very mild or low risk. I have not spoken to the doctor about
this condition but will soon. I am responding to you as it seems you are the specialists
in this area of concern or treatment. My wife sees ads for male sexual disorders and
thinks I should inquire ,but I told her that I have heard stories of rip-offs and things
such operable procedures gone foul etc. I have promised her my next visit w/ my Doc it
will be addressed. I do not feel this is a psychological problem as my wife first thought
( tired of marriage or sexual sat w/ her) as I have a great desire for her and I now have
to find other ways to please her. But it is very frustrating/embarrassing to know a year
ago this thing was rock hard and now is limp? I have read of a drug or herb called muira
puama that has claims to work? Do you have suggestions or advice, I sure could use it!!!
Answer: The current most common cause of erectile dysfunction are medications.
First, stop the Zestril for 2-3 days(watch your blood pressure) and see if the erections
return. Zestril is a blood pressure medication; but, is also used in Diabetics to reduce
long term renal failure, so it is difficult to know why you are on it. If the erections
return, bring it up with your physician and work on another blood pressure pill(unless it
is not being used for hypertension). Secondly, if the erections show no sign of return you
will need several hormones checked. These are prolactin, TSH, testerone. Imbalance in any
of these can cause erectile dysfunction and is easily correctable. Also, diabetics tend to
have other hormone imbalances commonly-so check these. Finally, will be the mechanical
solutions. Diabetes Mellitus commonly will affect erections; but, usually only if the
diabetes is present for in excess of 5-8 years. Smoking will accelerate this problem, if
you are smoking it is important that you stop.
Lower Stomach Pain
Question: I have been having a pain in my lower stomach every time I have sexual
intercourse. I only have the pain when the penis hits a certain spot. I don’t know if
maybe I have a cyst or if its going to deep and hitting something it should not be.The
pain feels like someone is punching or pulling on the inside of my stomach. I have had the
pain for a couple of months now and it is starting to scare me. If you could please tell
me what you think I would greatly appreciate it.
Answer: Several possibilities, all of which will need a pelvic exam and /or an
ultrasound. You are probably accurate about the cyst, other possibilities include low
grade infection of the tubes.
Loss of Sex Drive
Question: I just turned 40, am married to a 33yr old MAN. and have a four yr old
girl. I am suffering from a complete loss of sex drive I am taking trazadone for sleep and
depression, which is not helping much anymore.I have been on it for about 3 and a half
years now. I just had an angigram done on my heart because of chest pains, but everything
was OK. The doctor put me on Lorazepam 0.5mg two times a day. When I take this I feel more
confused and depressed. My question is there anything I can take for the loss of sex drive
with these meds? Hurry my husband said soon he will go elsewhere.
Answer: Antidepressants that don’t affect the sex drive tend to be Serzone and
St. John’s Wort(although the effectiveness of this herb is still being researched.
Wellbutrin also may have less effect than the SRI antidepressants.
Inhibition
Question: I am unable to let loose during sex with my husband. I would like to know
why I am this way or what I can do to change?
Answer: This will require some ongoing counseling. Usually, this problem is
rooted in attitudes and issues from childhood. Often, there is a history of sexual
abuse(which may not be remembered). Other possibilities are approaches or attitudes by
your husband which trigger emotional memories of your father. I would contact a
psychiatrist who specializes in sexual dysfunction. This may take some time and money,
but, will be the best investment of your life.