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
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
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
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.
Now, all men with BPH will know that not being able to empty the
bladder completely is a leading cause of urinary tract infections
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.
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
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
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
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
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
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
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 andclomipramine,
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
as needed (mg)
100-400 for 2 days before coitus
75 mg-1 00 mg bd or tds
75 mg bd or tds
5-15 mg bd
5.0 mg tds
Other factors in treating ejaculation
The most common medications known for delaying ejaculation are
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
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.