Review Of Prevalence, Causes And Treatment Of Delayed EjaculationAnd information about a novel treatment - anal stimulation |
||
Definition of male orgasmic disorderIn the DSM IV diagnostic manual, male orgasmic disorder has been defined as a recurrent delay in achieving orgasm, or the inability to achieve orgasm during a timescale that would be regarded as normal taking into account a person's age, level of sexual focus, and the intensity and duration of the sexual experience. You can see that this seems to mean there is some subjective judgment involved in the definition of what constitutes delayed orgasm, but in fact the condition is easy to identify in practice, since most men who present with it simply cannot ejaculate during sexual intercourse. It's been claimed that most men who seek treatment for delayed ejaculation or inhibited orgasm present with a pattern of situational rather than universal anorgasmia. This claim is certainly not borne out by the experience that I have had over several years dealing with sexual problems in men. Indeed, most men who have this problem report that they have always experienced difficulty in reaching orgasm inside any vagina, not just their current partner's. Often the men report that they are able to experience orgasm occasionally, and generally speaking they are having sex fairly frequently. And for men who are in their more mature years, reassurance that ejaculation does not necessarily happen every time a man over the age of 50 has intercourse may be sufficient. But to put this forward as a treatment strategy for delayed ejaculation the majority of men is extremely unhelpful. Most men with delayed ejaculation simply cannot reach orgasm intravaginally and this causes both them and their partners considerable distress. It's also been claimed that most men with the condition find that it has developed later in life after a series of normal sexual experiences. I would refute this claim also, because in my experience most of the men who come to me asking for help report that they have always experienced difficulty in reaching orgasm and ejaculating inside a woman's vagina. This misinformation may well be indicative of the lack of knowledge in the medical profession around the problem. It is also untrue that delayed ejaculation is most often the result of hypoactive sexual desire disorder (a low sex drive). The thinking here is that a man simply does not wish to have sex and is only doing so because his partner is coercing him into sexual intercourse. In such cases a man may not be sexually aroused, or at least not sexually aroused sufficiently to reach the point of orgasm and ejaculation in his sexual response cycle. He is sufficiently aroused, so the thinking goes, to maintain an erection, but not sufficiently aroused to reach the normal outcome of sexual arousal, i.e. ejaculation. Although it's true that not much research has been done on male orgasmic disorder, the fact remains that most of the men who come for treatment or who seek help report that their masturbation is normal, a fact which mitigates against the idea that delayed ejaculation is the product of low sexual desire. Nonetheless, it is clearly advantageous that any man who does have this problem is given a thorough check by medical practitioners skilled in the diagnosis of male hormonal disorders. It's also good practice to ensure that if a man has both erectile failure and male orgasmic disorder, then he should be given treatment for his erectile dysfunction before any other aspect of his sexual physiology is addressed. One of the major aspects of my orgasmic disorder is the possibility of a pharmacological origin of the condition. There is now a vast body of evidence which implicates many modern pharmaceuticals in the inhibition of male orgasm and ejaculation. One of the first things to look at is whether or not a man is taking any drug which is known to have an inhibitory effect on male orgasm. In many cases it possible to alleviate the condition by offering an alternative medication. Prevalence of male orgasmic disorderConventional wisdom claims that male orgasmic disorder is the rarest male sexual dysfunction. Studies have suggested a prevalence of up to 10%, although most studies report around 3 to 5% of men as being affected. I estimate that delayed ejaculation or some degree of delayed ejaculation affects about one in twelve of the male population; it is a seriously under-reported condition, one does not receive the attention it merits either in epidemiological studies of male sexual health, or in terms of the distress and destruction to relationships that it can cause between men and their partners. There seems to be an opinion widespread in medical writing that because this is the rarest male sexual dysfunction it is somehow unimportant. Certainly that's a view that would seem to be borne out by the limited amount of research which has been conducted into retarded ejaculation. However, the emotional and psychological impact on those who experience it is profound and even allowing for the fact that 10% of men or less experience the condition there is still a huge body of men who require help and assistance: even 10% of men in America would mean a figure of around 10 million adult males requiring treatment. And even if the figure is inflated by the inclusion of inhibited orgasm which is caused by hypoactive sexual desire disorder the principle is still the same: men require treatment. In particular, men with low sex drive may require investigation of hormonal levels as well as potential problems with their sexual response cycle. This is especially true of men over the age of 50 who may be experiencing the male andropause, or declining testosterone levels with associated symptoms. In other cases, the best treatment is effective psychotherapy and counseling, involving both sexual psychotherapy and relationship therapy if this is necessary. So what causes delayed ejaculation?While low male hormone levels can be responsible for lack of sexual desire and loss of erectile capacity, I personally think that the possibility of hormonal disorders causing male orgasmic disorder is rather low. I'd rather see it as a condition in its own right, which is usually caused by psychological factors such as self-criticism, performance anxiety, and taking the role of spectator rather than engaging fully in the sexual act. The concept of the spectator role during sex is a recent one, and it has been emphasized in recent writing about sexual therapy. In essence, the man is focused on achieving orgasm rather than attending to his own arousal or his participation in sexual activity with his partner. This leads him into a psychological position where he becomes a highly self-critical and sexually unaroused performer or observer. It's also possible that one of the reasons why this happens is that men who do not reach orgasm are in failing relationships or have levels of anxiety, hostility, anger, guilt, shame or some other pernicious emotional syndrome which are so high that their arousal is inhibited and they are prevented from engaging fully with their own sexual arousal or participating in the sexual act with their partner in a relaxed and engaged fashion. There has been little scientific research on this condition, but those who work with men in the field have repeatedly observed that this emotional profile appears to be fairly common in either the man or his partner or both. Physiological etiology of retarded ejaculationHaving said all of that, it is certainly true that we should not overlook the physiological conditions which are capable of inhibiting a man's orgasmic response. Endocrinologists report that excessive prolactin levels can interfere with orgasm, so that the presence of a pituitary disorder may need to be considered. Similarly, neurological diseases, especially those which have an impact on the peripheral sensory nervous system, or which affect the functioning of the sympathetic nervous system, or any injury to the spinal-cord, can certainly affect a man's ability to ejaculate. It's actually possible for man to lose the ability to reach orgasm and ejaculate even though he can maintain erectile function. The ejaculatory reflex appears to be more sensitive to disruptions that the erection reflex. Inhibition of orgasm and ejaculation can also be observed after surgery in some areas of the abdomen including procedures such as abdominoperitoneal or anterior resection of the rectum, sympathectomy, retroperitoneal lymphadenectomy, aortoiliac reconstruction, and surgery for bladder cancer. The common operation for benign prostate enlargement -- transurethral prostatectomy -- produces a slightly different condition known as retrograde ejaculation although orgasm itself proceeds normally. It is also known that any drug which has a sedating effect or inhibits sympathetic arousal, or raises serotonin levels in the brain, may markedly inhibit or even totally prevent orgasm and ejaculation. Interestingly enough, these agents include alcohol antidepressants, antihypertensives, antipsychotic, and antianxiety medications. Because male orgasmic disorder is not subject to much investigation, there's little systematic research or data available regarding the outcome of any kind of therapy treatments. Nonetheless, anecdotal evidence from men who have received the right kind of therapy suggest that psychotherapy can actually be very effective in dealing resolving this problem, although it goes without saying that a man must be willing to look at his deepest issues and possibly also the implications for his relationship with his partner. So what does psychotherapeutic treatment for male orgasmic disorder actually entail?The usual treatment adopted for delayed ejaculation is around reducing and eliminating performance anxiety and establishing a high level of sexual self-confidence. The self-critical observer needs to be disempowered, and the man needs to be taught how to engage fully in sexual activity with his whole presence (emotional, physical and spiritual) so he is focused on the sensations that he's experiencing in the moment, and not on the achievement of orgasm - in either himself or his partner. Clearly the provision of adequate levels of physical stimulation so that the man is sufficiently sexually aroused to allow him to achieve orgasm and ejaculation is a vital part of the treatment. Simply issuing instructions to the couple that they should stimulate his penis manually and/or orally until he has an erection, while stopping the stimulation as he approaches the point of no return is a futile treatment strategy, since the man is usually unable to approach the point of no return anyway. The objective is to reduce anxiety about the goal on which the man is focused, which is usually around orgasm, either his own or his partner's and to enable him to enjoy sexual pleasure from caressing and stimulation. The only effective treatment methodology that I'm aware of which encompasses these objectives is the process of sensate focus to ensure that the man is actually more in connection with his own body, more aware of his own arousal, and more relaxed with his partner. Clearly it is necessary to ensure that the man is on a medical regime which does not interfere with his ability to ejaculate. The most common medications which are implicated in this respect are SSRI antidepressants that do not also block the 5-hydroxytryptamine type 2 (HT2) receptor. One study has reported that there are five treatment strategies which can limit the side-effect of these antidepressants. The first is to wait for the accommodation to the side-effect to occur, although this is only 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 (Ashton et al. 1997; Balogh et al. 1992; Shrivastava et al. 1995), cyproheptadine (Ashton et al. 1997; Feder 1991; McCormick et al. 1990; Segraves 1993), stimulants (Bartlik et al. 1995), bupropion (Ashton and Rosen 1998b; Labbate and Pollack 1994), buspirone (Landen et al. 1999; Norden 1994), and sildenafil (Ashton 1999; Ashton and Bennett 1999; Nurnberg et al. 1999). Another approach that may be overlooked is simply to provide more physical stimulation to enable man to achieve orgasm more easily. This may include some method of increasing physical stimulation of the sexual and genital areas, including the scrotum, penis, perineum, and anus. One effective method of doing this is to use an anal stimulation probe which may provide extra simulation through application of a mild electric current or through vibratory stimulation. A traditional treatment method for delayed ejaculation has involved the patient learning to masturbate. In the cases where the man himself is actually able to achieve orgasm during masturbation, this traditional treatment has involved his partner using manual stimulation on his penis, with a prohibition on intercourse. That's because intercourse is the very activity that causes the man to be more goal-focused than self-focused during sexual activity. The man needs to be in a mental space where he is simply enjoying the sensations of stimulation and arousal without any overt attempt to reach orgasm. The theory is that if the man approaches the point of no return, he or his partner is to discontinue stimulation and relax until his arousal has dropped. However, as I observed before, the problem with this approach is that most men with male orgasmic disorder cannot reach orgasm through stimulation by their partner. While the theory is fine, the practice is rather lacking. The idea is that the man will go through several cycles of stimulation and relaxation without any orgasm and ejaculation at the end of the session. This is supposed to behaviorally condition the man so that he is unable to prevent himself from having an orgasm during sexual stimulation at some point in the future. When he does reach orgasm the therapy methodology is adapted so that the man then only reaches orgasm when he feels it's going to happen despite the lack of intention on his part. It's fair to say that this is a poorly defined treatment strategy and it's also fair to say that it probably does not work. Those men who can masturbate orgasm on their own, but cannot with a partner, are given a modified treatment strategy which is designed to overcome their inhibitions about displaying the loss of control associated with orgasm. For example, a man may be asked to role-play having an orgasm in a very dramatic fashion, acting as though he was out of control, or engaging a partner in the role-play as though she were out of control. When men fear loss of control it's possible that such exaggerated role-play can be effective in reducing embarrassment and shame and lowering man's inhibition about letting his partner see him having a real orgasm. However, it will not have escaped your notice that none of this addresses any emotional dynamic in the relationship such as hostility, shame or guilt between the partners. As the man is able to establish orgasm more reliably, the sexual repertoire that the couple engage in can be expanded to encompass oral sex, passive containment of the penis in the vagina, intercourse and thrusting by the man, and synchronous thrusting by both partners. As before, any attempt to reach orgasm is initially prohibited, being allowed only when the man finds that he is approaching orgasm spontaneously. The problem is that most of the men who seek help need considerable assistance with reducing performance anxiety and achieving greater arousal. This means that they need a more sophisticated methodology than the one described above. One method that has been used to achieve this is instruction in "orgasm triggers", which is a method used to help women who are anorgasmic achieve orgasm more easily. I quote: "Orgasm triggers are physiological events that tend to occur spontaneously and involuntarily when a person has orgasm. With experience, many people come to perform the orgasm triggers voluntarily when they are highly aroused, both to initiate their orgasm and to heighten its intensity. Orgasm triggers include arching the foot and pointing the toes, tensing the thigh muscles, contracting the pubococcygeal muscle and bearing down in the pelvis, caressing and squeezing the scrotum against the perineum, holding the breath in a Valsalva maneuver (i.e., attempting to exhale against a closed glottis), and throwing the head back to displace the glottis. However, telling a patient to perform all of these maneuvers at once to trigger an orgasm would certainly interfere with arousal and would lead to a performance-oriented spectator role! To avoid this negative effect, orgasm triggers are introduced sequentially over a few sessions, with each one described as a way to heighten pleasure and not initiate orgasm." A novel treatment method for retarded ejaculationAnother powerful method of achieving greater physiological stimulation is to use anal stimulation. Many men have a problem with this because they naïvely believe that this is somehow associated with homosexual orientation. However stimulation of the anus can in fact trigger a reflex orgasmic response. Anal stimulation can be achieved by a finger or an anal vibrator, and this actually is very effective (much more effective than applying a vibrator to the penis, a method which has limited effect). If the couple wish to include anal exploration and stimulation as part of sexual activity then they should start in the shower so that concerns about hygiene can be reduced. Althof SE: Pharmacologic treatment of rapid ejaculation. Psychiatr Clin North Am 18:85-94, 1995 Althof SE, Levine SB, Corty EW, et al: A double-blind crossover trial of clomipramine for rapid ejaculation in 15 couples. J Clin Psychiatry 56:402-407, 1995 American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, DC, American Psychiatric Association, 1994 Ashton AK: Sildenafil treatment of paroxetine-induced anorgasmia in a woman. Am J Psychiatry 156:800, 1999 Ashton AK, Bennett RG: Sildenafil treatment of serotonin reuptake inhibitor-induced sexual dysfunction. J Clin Psychiatry 60:194-195, 1999 Ashton AK, Rosen RC: Bupropion as an antidote for serotonin reuptake inhibitor-induced sexual dysfunction. J Clin Psychiatry 59:112-115, 1998a Ashton AK, Rosen RC: Accommodation to serotonin reuptake inhibitor-induced sexual dysfunction. J Sex Marital Ther 24:191-192, 1998b Ashton AK, Hamer R, Rosen RC: Serotonin reuptake inhibitor-induced sexual dysfunction and its treatment: a large scale retrospective study of 596 psychiatric outpatients. J Sex Marital Ther 23:165-175, 1997 Assalian P: Clomipramine in the treatment of premature ejaculation. J Sex Res 24:213-215, 1988 Balogh S, Hendricks SE, Kang J: Treatment of fluoxetine-induced anorgasmia with amantadine (letter). J Clin Psychiatry 53:212-213, 1992 Balon R: Antidepressants in the treatment of premature ejaculation. J Sex Marital Ther 22:85-96, 1996 Bancroft J: Human Sexuality and Its Problems. New York, Churchill Livingston, 1989 Bartlik BD, Kaplan P, Kaplan HS: Psychostimulants apparently reverse sexual dysfunction secondary to selective serotonin reuptake inhibitors. J Sex Marital Ther 4:264-271, 1995 Beck JG, Barlow DH: Current conceptualizations of sexual dysfunction: a review and alternative perspective. Clin Psychol Rev 4:363-378, 1984 Bennett D: Treatment of ejaculatio praecox with monoamine oxidase inhibitors. Lancet 2:1309, 1961 Beretta G, Chelo E, Fanciullacci F, et al: Effect of an alpha-blocking agent (phenoxybenzamine) in the management of premature ejaculation. Acta Europaea Fertilitatis 17:43-45, 1986 Berkovitch M, Keresteci AG, Koren G: Efficacy of prilocaine-lidocaine in the treatment of premature ejaculation. J Urol 154:1360-1361, 1995 Blay SL, Ferraz MPT, Calil HM: Lithium-induced male sexual impairment: two case reports. J Clin Psychiatry 43:497-498, 1982 Buffum J: Prescription drugs and sexual function. Psychol Med 10:181-198, 1992 Choi HK, Seong DH, Rha KH: Efficacy of Korean red ginseng for erectile dysfunction. Int J Impot Res 7:181-186, 1995 Cooper AJ, Magnus RV: A clinical trial of the beta blocker propranolol in premature ejaculation. J Psychosom Res 28:331-336, 1984 Cooper AJ, Cernovsky ZZ, Colussi K: Some clinical and psychometric characteristics of primary and secondary premature ejaculators. J Sex Marital Ther 19:276-288, 1993 De Amicis LA, Goldberg DC, LoPiccolo J, et al: Clinical follow-up of couples treated for sexual dysfunction. Arch Sex Behav 14:461-483, 1985 Dekker J: Inhibited male orgasm, in Handbook of Sexual Dysfunctions. Edited by O'Donohue W, Geer J. Boston, MA, Allyn & Bacon, 1993, pp 297-301 Eaton H: Clomipramine (Anafranil) in the treatment of premature ejaculation. J Int Med Res 1:432-434, 1973 Feder R: Reversal of antidepressant activity of fluoxetine by cyproheptadine in three patients. J Clin Psychiatry 52:163-164, 1991 Fein RL: Intracavernous medication for treatment of premature ejaculation. Urology 35:301-303, 1990 Forster P, King J: Fluoxetine for premature ejaculation (letter). Am J Psychiatry 151:1523, 1994 Girgis SM, El-Haggar S, El-Hermounzy S: A double-blind trial of clomipramine in premature ejaculation. Andrologia 14:364, 1992 Glass RM: Ejaculatory impairment from both phenelzine and imipramine, with tinnitus from phenelzine. J Clin Psychopharmacol 1:152-154, 1981 Goodman RE: An assessment of clomipramine (Anafranil) in the treatment of premature ejaculation. J Int Med Res 8 (suppl 3):53-59, 1980 Gospodinoff ML: Premature ejaculation: clinical subgroups and etiology. J Sex Marital Ther 15:130-134, 1989 Gross MD: Reversal by bethanechol of sexual dysfunction caused by anticholinergic antidepressants. Am J Psychiatry 139:1193-1194, 1982 Guthrie ER: The Psychology of Learning. New York, Harper, 1952 Haensel SM, Rowland DL, Kallan KT: Clomipramine and sexual function in men with premature ejaculation and controls. J Urol 156:1310-1315, 1996 Haensel SM, Klem TM, Hop WC, et al: Fluoxetine and premature ejaculation: a double-blind, crossover, placebo-controlled study. J Clin Psychopharmacol 18:72-77, 1998 Harrison WM, Stewart J, Ehrhardt AA, et al: A controlled study of the effects of antidepressants on sexual function. Psychopharmacol Bull 21:85-88, 1985 Hawton K: Sex Therapy: A Practical Guide. New York, Oxford Medical Publications, 1985 Hawton K, Catalan J, Martin P, et al: Long-term outcome of sex therapy. Behav Res Ther 24:665-675, 1986 Heiman JR, LoPiccolo J: Becoming Orgasmic: A Personal and Sexual Growth Program for Women. New York, Simon & Schuster, 1988 Heiman JR, Gladue BA, Roberts CW, et al: Historical and current factors discriminating sexually functional from sexually dysfunctional married couples. J Marital Fam Ther 12:163-174, 1986 Hollander E, McCarley A: Yohimbine treatment of sexual side effects induced by serotonin reuptake blockers. J Clin Psychiatry 53:207-209, 1992 Hong LK: Survival of the fastest. Journal of Sex Research 20:109-122, 1984 Hunt M: Sexual Behavior in the 1970's. Chicago, IL, Playboy Press, 1974 Jacobsen FM: Fluoxetine-induced sexual dysfunction and an open trial of yohimbine. J Clin Psychiatry 53:119-122, 1992 Kaplan HS: The New Sex Therapy. New York, Brunner/Mazel, 1974 Kaplan HS: PE: How to Overcome Premature Ejaculation. New York, Brunner/Mazel, 1989 Kaplan PM: The use of serotonergic uptake inhibitors in the treatment of premature ejaculation. J Sex Marital Ther 20:321-324, 1994 Kara H, Aydin S, Agargun M: The efficacy of fluoxetine in the treatment of premature ejaculation: a double-blind placebo controlled study. J Urol 156:1631-1632, 1996 Kedia K: Ejaculation and emission: normal physiology, dysfunction and therapy, in Male Sexual Dysfunction. Edited by Krane RJ, Siroky MB, Goldstein I. Boston, MA, Little, Brown, 1983, pp 37-54 Kim SC, Seo KK: Efficacy and safety of fluoxetine, sertraline and clomipramine in patients with premature ejaculation: a double-blind, placebo controlled study. J Urol 159:425-427, 1998 Kindler S, Dolbert OT, Cohen H, et al: The treatment of comorbid premature ejaculation and panic disorder with fluoxetine. Clin Neuropharmacol 20:466-471, 1997 Kinsey AC, Pomeroy WB, Martin CE: Sexual Behavior in the Human Male. Philadelphia, PA, WB Saunders, 1948 Klug B: Clomipramine in premature ejaculation (letter). Med J Aust 141:71, 1984 Kosteljanetz M, Jensen TS, Nogard B, et al: Sexual and hypothalamic dysfunction in the post concussion syndrome. Acta Neurol Scand 63:169-180, 1981 Labbate LA, Pollack MH: Treatment of fluoxetine-induced sexual dysfunction with bupropion: a case report. Ann Clin Psychiatry 6:13-15, 1994 Landen M, Eriksson E, Agren H, et al: Effect of buspirone on sexual dysfunction in depressed patients treated with selective serotonin reuptake inhibitors. J Clin Psychopharmacol 19:268-271, 1999 Laumann EO, Paik A, Rosen RC: Sexual dysfunction in the United States. JAMA 281:537-544, 1999 Lee HS, Song DH, Kim CH, et al: An open clinical trial of fluoxetine in the treatment of premature ejaculation. J Clin Psychopharmacol 16:379-382, 1996 LoPiccolo J: Treatment of sexual dysfunction, in International Handbook of Behavior Modification and Therapy, 2nd Edition. Edited by Bellak AS, Hersen M, Kazdin AE. New York, Plenum, 1990, pp 547-564 LoPiccolo J: Sexual dysfunction, in Cognitive Behavioral Interventions. Edited by Craighead CW, Craighead WE, Kazdin AE, et al. New York, Pergamon, 1994, pp 169-182 Ludovico GM, Corvasce A, Pagliarulo G, et al: Paroxetine in the treatment of premature ejaculation. Br J Urol 77:881-882, 1996 Masters WH, Johnson VE: Human Sexual Inadequacy. Boston, MA, Little, Brown, 1970 McCormick S, Olin J, Brotman AW, et al: Reversal of fluoxetine-induced anorgasmia by cyproheptadine in two patients. J Clin Psychiatry 51:383-384, 1990 McGilp R: Case report (2): paroxetine and delayed ejaculation - a treatable side effect. J Drug Dev 5: 65-266, 1993 McHale S, Phanjoo AL: SSRIs to treat sexual dysfunction (letter). Br J Psychiatry 164:854, 1994 McMahon CG: Treatment of premature ejaculation with sertraline hydrochloride: a single-blind placebo controlled crossover study. J Urol 159:1935-1938, 1998 Mendels J: Sertraline for premature ejaculation. J Clin Psychiatry 56(12):591, 1994 Mendels J, Camera A, Sikes C: Sertraline treatment for premature ejaculation. J Clin Psychopharmacol 15:341-346, 1995 Montejo-Gonzalez AL, Llorca G, Izquierdo JA, et al: SSRI-induced sexual dysfunction: fluoxetine, paroxetine, sertraline and fluvoxamine in a prospective, multicenter and descriptive clinical study of 344 patients. J Sex Marital Ther 23:176-194, 1997 Murphy J, Lipshultz L: Infertility in the paraplegic male, in Contemporary Management of Impotence and Infertility. Edited by Tanagho E, Lue T, McClure R. Baltimore, MD, Williams & Wilkins, 1988 Ninninger JE: Inhibition of ejaculation by amitriptyline. Am J Psychiatry 135:750-751, 1978 Nitenson NC, Cole JO: Psychotropic-induced sexual dysfunction, in Current Psychiatric Therapy. Edited by Dunner DL. Philadelphia, PA, WB Saunders, 1993, pp 353-359 Norden MD: Buspirone treatment of sexual dysfunction associated with SSRIs. Depression 2:109-112, 1994 Nurnberg HG, Lauriello J, Hensley PL, et al: Sildenafil for iatrogenic serotonergic antidepressant medication-induced sexual dysfunction in four patients. J Clin Psychiatry 60:33-35, 1999 O'Donohue W, Letourneau J, Geer JH: Premature ejaculation, in Handbook of Sexual Dysfunctions. Edited by O'Donohue W, Geer J. Boston, MA, Allyn & Bacon, 1993, pp 303-333 Paick JS, Kilm SW: Self therapy with sertraline given prn at 5 pm in treatment of premature ejaculation (abstract). J Urol 159 (suppl):241A, 1998 Power-Smith P: Beneficial sexual side effects from fluoxetine. Br J Psychiatry 164:249-250, 1994 Quirk KC, Einarson TR: Sexual dysfunction and clomipramine. Can J Psychiatry 27:228-231, 1983 Rapp MS: Two cases of ejaculatory impairment related to phenelzine. Am J Psychiatry 136:1200-1201, 1979 Rosen RC, Lane R, Menza M: Effects of SSRIs on sexual function: a critical review. J Clin Psychopharmacol 19:67-85, 1999 Rothschild AJ: Selective serotonin reuptake inhibitor-induced sexual dysfunction: efficacy of a drug holiday. Am J Psychiatry 152:1514-1516, 1995 Schover LR, Friedman J, Weiler S, et al: A multi-axial diagnostic system for sexual dysfunctions: an alternative to DSM-III. Arch Gen Psychiatry 39:614-619, 1982 Segraves RT: Treatment of premature ejaculation with lorazepam (letter). Am J Psychiatry 144:1240, 1987 Segraves RT: Drugs and desire, in Sexual Desire Disorders. Edited by Rosen RC, Leiblum SR. New York, Guilford, 1988, pp 313-347 Segraves RT: Effects of psychotropic drugs on human ejaculation and erection. Arch Gen Psychiatry 46:275-284, 1989 Segraves RT: Overview of sexual dysfunction complicating the treatment of depression. J Clin Psychiatry Monograph 10(2):4-10, 1992 Segraves RT: Affective disorder, antidepressants and sexual dysfunction. Sexual and Marital Therapy 8:213-215, 1993 Segraves RT, Segraves KB: Medical aspects of orgasm disorders, in Handbook of Sexual Dysfunctions. Edited by O'Donohue W, Geer J. Boston, MA, Allyn & Bacon, 1993, pp 225-252 Segraves RT, Saran A, Segraves K, et al: Clomipramine versus placebo in the treatment of premature ejaculation: a pilot study. J Sex Marital Ther 19:198-200, 1993 Semans JH: Premature ejaculation: a new approach. South Med J 49:353-357, 1956 Shrivastava RK, Shrivastava S, Overweg N, et al: Amantadine in the treatment of sexual dysfunction associated with selective serotonin reuptake inhibitors (letter). J Clin Psychopharmacol 15:83-84, 1995 Simpson GM, Blair HH, Amuso D: Effects of antidepressants on genitourinary function. Diseases of the Nervous System 26:787-789, 1965 Spector IP, Carey MP: Incidence and prevalence of the sexual dysfunctions: a critical review of the empirical literature. Arch Sex Behav 19:389-408, 1990 Spiess WF, Geer JH, O'Donohue WT: Premature ejaculation: investigation of factors in ejaculatory latency. J Abnorm Psychol 93:242-245, 1984 St. Lawrence J, Madakasira S: Evaluation and treatment of premature ejaculation: a critical review. Int J Psychiatry Med 22:77-97, 1992 Strassberg DS, Kelly MP, Carroll C, et al: The psychophysiological nature of premature ejaculation. Arch Sex Behav 16:327-336, 1987 Strassberg DS, Mahoney JM, Schaugaard M, et al: The role of anxiety in premature ejaculation: a psychophysiological model. Arch Sex Behav 19:251-257, 1990 Strassberg DS, de Gouveia Brazao CA, Rowland DL, et al: Clomipramine in the treatment of rapid (premature) ejaculation. J Sex Marital Ther 25:89-101, 1999 Swartz DA: Sertraline hydrochloride for premature ejaculation (abstract). J Urol 151 (suppl):345A, 1994 Waldinger MD, Hengeveld MW, Zwinderman AH: Ejaculation-retarding properties of paroxetine in patients with primary premature ejaculation: a double-blind, randomized, dose-response study. Br J Urol 79:592-595, 1997 Waldinger MD, Hengeveld MW, Zwinderman AH, et al: Effect of SSRI antidepressants on ejaculation: a double-blind, randomized, placebo-controlled study with fluoxetine, fluvoxamine, paroxetine and sertraline. J Clin Psychopharmacol 18:274-281, 1998 Wise TN: Sertraline as a treatment for premature ejaculation (letter). J Clin Psychiatry 55:147, 1994 Yassa R: Sexual disorder in the course of clomipramine treatment: a report of three cases. Can J Psychiatry 271:148-149, 1982 Zilbergeld B: The New Male Sexuality. New York, Bantam, 1992 [ Delayed ejaculation - retarded ejaculation - how to ejaculate during sex ]
|
|
|
