When you look at the Internet forums that discuss delayed ejaculation (DE), you can quickly see that there are many different causes, theories, and treatment ideas flying around.
Social Media And Ejaculation Problems
Regrettably I don’t think many of them are particularly accurate or effective. But it might just be a good idea to take a look at some of these accounts of people’s personal experiences, and see what might or might not be causing delayed ejaculation for different men.
So I’m looking at the forums on www.WebMD.com and what I see is a post by a man who says he’s 52 and he’s been married 32 years.
He’s always been able to enjoy sexual intercourse to its usual (and normal) end-point – orgasm and ejaculation, and he’s also never had a problem masturbating.
However, he says that recently he’s not been able to ejaculate at all while masturbating, and as far as sex with his wife is concerned, he appears to be lasting much longer than normal — which he describes as five to twenty minutes, depending.
Now here’s the thing! In his case there’s no mystery at all about what is causing his delayed ejaculation.
The fact is, he was started on Zoloft and trazodone for mild depression, and he’s also been on a high blood pressure medication called Lisinopril.
The interesting thing, though is that his doctor doesn’t think the dosage level he’s on is going to produce DE. Needless to say, his wife is very upset about this and so is he – because he can’t masturbate normally, let alone make love as he previously could.
And the responses to this post flooded in! The first guy who responded was 64 and said he’d been married 44 years. He’d always had a very active sex life with his wife, and could always masturbate to orgasm and ejaculate normally without any delay. Until two years ago.
Because, two years ago he developed BPH – benign prostatic hyperplasia – and because of it contracted a number of urinary tract infections.
Now, all men with BPH will know that not being able to empty the bladder completely is a leading cause of urinary tract infections in men.
And so the story goes like this: his urologist put him on a drug called Jalyn which has effectively prevented urinary tract infections – but unfortunately it has also inhibited his ejaculation since he started taking it.
Now, when he masturbates, or when he has sex with his wife, there’s no ejaculation. He says that he has the feeling of coming which is still pleasurable, and from time to time he does possibly have some seepage of pre-ejaculatory fluid or possibly semen, but when he masturbate or has sex — there’s no ejaculation. He’s done research on this drug and has found that this is indeed one of its side-effects.
Apparently his condition is retrograde ejaculation, where semen enters the bladder instead of going out through the urethra.
This happens because the drug relaxes the neck of the bladder and changes the ejaculatory process so that semen flows into the bladder rather than out of penis.
Lack of ejaculation may be distressing to the man
who has difficulty ejaculating and his partner too.
Now if you have BPH and suffer from urinary tract infections, this is very much the lesser of two evils.
Even so, as the guy observes, he misses the wonderful feeling of his semen flowing out of his penis — it’s a fundamental part of masculinity, and hearing a guy talking about it like this explains why delayed ejaculation can be such a problem.
(Even though this guy has retrograde ejaculation, he is still impacted in a similar way to men with delayed ejaculation.)
There’s a response from a guy who says that he can tell you “from his personal experience that medications definitely cause delayed ejaculation”.
He has had a number of operations on his spine to fuse the discs, and has continued to use medication to manage the pain after the operations.
Unfortunately, what he’s found is that the medication he’s on has delayed his ejaculation so long that he can now make love for between 20 minutes in one hour… without ejaculating.
I agree with his observation that he thinks the first man’s doctor is “off-base” as the medications certainly do cause ejaculatory delay.
Another guy responds: “I strongly suspect Zoloft is the primary cause of the problem.”
He observes that thing he thinks Zoloft is one of the best antidepressants available, but it does have this side-effect. He himself has had the same experience of delaying ejaculation. And indeed so do the next three men who respond.
One of the great powers of the Internet is the way that it can bring together men who are experiencing problems they would not otherwise understand: the side-effects of medication being a very good example of this.
And a man responds with sympathy to the frustration of the original poster. He talked about being 43 years old, and in 2002 being put on Paxil for depression.
As he rightly observes, the TV adverts for this medication include a whole list of side effects which are recited so quickly that you can barely understand them. However, if you slow it all down, it transpires that one of them is “sexual side effects”.
So what this turns out to mean, at least for this man on the Internet, was that Paxil can cause prolonged erections without ejaculation.
What’s more interesting yet is that this guy claims that even nine years later he still suffering from delays in ejaculating because of this medication — in other words, the effect of taking the medication was permanent.
I must say that this is the first time I’ve heard of this particular possibility, and I’m not sure whether I completely believe this to be true. Even so, I would be very interested to hear from anybody else who is experiencing similar difficulties.
He also makes the observation that sometimes when he does manage to reach orgasm and ejaculate, his erection persists so that he can come a second time!
Later in the thread another individual responds that his own experience with antidepressants and anxiety medications is that they certainly do affect sexual function.
This man was put on Lexapro, which he describes as a very useful medication at the right dose — except for the fact that he too had sexual problems.
He got aroused, he got an erection, he got to the point of no return, and then … nothing at all. He lost all sensation, his heart would race, and — nothing. So presumably he was experiencing some kind of suppressed or repressed ejaculatory reflex which prevented him from ejaculating.
In this case he went back to the doctor and convinced him that the dosage should be reduced by 50%.
As a result of that, he says “I’m now doing great, and my sex life is fabulous”. And he makes an another interesting and valuable point, which is that doctors don’t necessarily always know best, and in the end the responsibility for an individual’s health certainly lies with the individual concerned.
Where drugs affect sexual function, and in particular where they cause delayed ejaculation, it may be necessary for the patient — that’s you — to take control of the situation.
Brain Chemistry and Delays In Reaching Orgasm
Many studies have shown changes in brain chemistry – in serotonin levels, in fact – affect the delay before a man ejaculates. This implies that some men may actually have brain chemistry which predisposes them to ejaculate more slowly or quickly than average.
(Though whether low or high serotonin is the cause or the effect of delayed ejaculation is still open to speculation.)
And this is important – because a lot of medicines actually cause delayed ejaculation. And SSRI anti-depressants are high on the list of suspects.
Prescription Medicines As A Cause Of Delayed Orgasm
So what should you do if you have trouble ejaculating because of the medication you are taking?
A common cause is drugs prescribed for medical conditions such as depression. While it may be possible to use fewer drugs or use them less often, generally there are alternatives available.
A small retrospective study of SSRI-associated sexual dysfunction in men used amantadine, cyproheptadine and yohimbine to reverse the men’s ejaculatory problems. Amantadine induces the release of dopamine centrally: several reports have come in about using amantadine to treat fluoxetine-induced retarded ejaculation.
Bupropion is a serotonin/norepinephrine/dopamine re-uptake inhibitor and has been studied in men with SSRI induced ejaculatory dysfunction, but the results are unclear. Even so, bupropion has been used in the reversal of SSRI-induced retarded ejaculation.
Buspirone, a 5HT1A agonist, is another drug that has been reported as capable of reversing the sexual dysfunction side-effects of SSRIs including retarded ejaculation.
Cyproheptadine is a serotonin and histamine agonist again apparently capable of reversing the retarded ejaculation caused by fluoxetine, fluvoxamine and clomipramine, imipramine and nortryptiline. Cyproheptadine has also been reported to reverse citralopram-induced retarded ejaculation.
Yohimbine, which is an alpha-2 adrenergic antagonist, appears to be capable of reversing delayed ejaculation caused by clomipramine, fluvoxamine, ertraline, paroxetine and fluoxetine.
Adjunctive pharmacotherapy for SSRI-induced retarded ejaculation
|Drug||as needed (mg)||Daily|
|Amantadine||100-400 for 2 days before coitus||75 mg-1 00 mg bd or tds|
|Buproprion||75-150||75 mg bd or tds|
|Buspirone||15-60||5-15 mg bd|
|Yohimbine||5.0-10.0||5.0 mg tds|
Other factors in treating ejaculation problems
The most common medications known for delaying ejaculation are SSRI antidepressants.
One study has reported that there are several treatment strategies which can limit the side-effect of these antidepressants.
The first is to wait for adaptation to the side-effect to occur, although this is likely to happen in fewer than one patient in ten. Clearly a better strategy is to switch to a different medication with fewer side-effects. A drug holiday is also possible, as is reducing the dosage.
Another option is to apply a pharmacological antidote to the side-effect of the antidepressant although this clearly has implications for further side-effects.
Yohimbine has been suggested as one candidate for this role, although a number of other compounds have been suggested including amantadine, bupropion, buspirone, and sildenafil.
Some evidence exists that that amantadine, Yohimbine and cyproheptadine have a limited impact on drug-induced delayed ejaculation.
Amantadine promotes dopamine release centrally, while Yohimbine is an alpha-2 adrenergic antagonist.
Cyproheptadine is a serotonin and histamine agonist. Cyproheptadine has been successful in reversing retarded ejaculation caused by clomipramine, nortryptiline, fluoxetine, imipramine, nortryptiline and fluvoxamine.
Some reports suggest men with delayed ejaculation caused by antidepressants can be cured with Bupropion, but the evidence is very patchy. For example, a randomized controlled double blind study of SSRI-induced sexual dysfunction of 32 men who were given a low dose of Bupropion (150mg daily) showed no benefit over placebo over three weeks.
Even though much of the work which has been done has been lacking in rigorous controls, the use of Cyproheptadine, Yohimbine and amantadine are the methods favored for the treatment of the condition in the international guidelines.