Archive for December 31, 2015

Antidepressants & Ejaculation Problems

Q. I am 59, and my wife and I have experienced very good sex for 40 years. A few months ago, I experienced an extreme attack of acid reflux and passed out. Our family doctor gave me Paxil and Prevacid. Now I have no erection. The doctor gave me Viagra, and it works, but I have not experienced ejaculation since I started the Paxil and Prevacid. We need help. My wife is beginning to feel that she no longer can satisfy me. I’m glad I “last” longer, but an hour (or all night) is too much! What can I do to ejaculate?

A. Your situation is not uncommon. The medication Paxil, typically prescribed for depression or anxiety, has been known to cause inability to ejaculate. As an antidepressant, it changes chemical activity in the central nervous system, which is the key center controlling ejaculation. That means your penis will stay hard longer and you will be sexually aroused and full of pleasure, but you will not be able to have an orgasm. When I have a patient with similar complaints on Paxil, I suggest asking the prescribing physician to change the Paxil.

Interestingly, Paxil and related drugs are sometimes used to treat premature ejaculation. Men with this common problem ejaculate very quickly with minimal genital stimulation. In such a case, the antidepressant’s side effects can be a benefit.

Top Steroid Products on Sale

Primobol Inj

Primobol Inj Online
Substance: Methenolone Enanthate
Manufacturer: Balkan Pharmaceuticals
Unit: 5 x 1 mL amp (100 mg/mL)

Buy GP Test U500

Order GP Test U500 on Sale
Substance: Testosterone Undecanoate
Manufacturer: Geneza Pharmaceuticals
Unit: 10 mL vial 500mg/mL

Generic Aldactone 25 mg

Order Generic Aldactone 25 mg
Substance: Spironolactone Administration: Oral
Manufacturer: Generic
Unit: 100 pills (25 mg/pill)

Abundant Ejaculation from Genital Massage

Q. My husband and I are both 28. We were both virgins when we married three years ago. He has always experienced delayed ejaculation even after prolonged foreplay and intercourse, which has frustrated him. Recently, I have been giving him “hand jobs” with startling results — instead of the usual one or two teaspoonfuls of ejaculate, copious amounts of a translucent liquid come out, and I am also able to give him multiple ejaculations. This surprise discharge ONLY occurs after prolonged lovemaking, followed by my hand job with lubricant. However, my husband is worried that he’s urinating on me during these awesome orgasms, and this has tempered his enjoyment. I say he’s ejaculating semen, but he says he has trouble believing this because of the great volume of discharge. Could you please calm his fears? These genital massages are a delicious tool in our lovemaking.

A. I can assure you men do not urinate during orgasms. Neurologically, the pathways for urination and ejaculation are different. The nerves that control ejaculation cause the bladder to relax and the bladder outlet (bladder neck) to stay closed. Therefore men do not have to worry about urinating while they have an erection — physiologically it is not possible.

Commonly couples have this concern about the pre-ejaculate fluid, which is clear and watery. It usually precedes the orgasm and semen ejaculation. Normally a man produces varying amounts of this fluid from secretions in the seminal vesicles and periurethral glands. This is normal, and it may contain sperm. During the ejaculation itself, about 3-5 milliliters (about a teaspoon) of semen is projected.

Large amounts of ejaculate can be collected from men depending on the nature of the orgasm. The natural process might occur as follows. First, there is stimulation of the erect penis, which starts production and secretion of fluid from the periurethral glands and prostate. This fluid accumulates in the prostatic urethra, which can hold up to 75 milliliters (15 teaspoons) of this fluid. Only a small amount of the fluid leaks out before the man reaches orgasm. The amount of fluid produced depends on the amount of stimulation and the time to orgasm. For instance, most men reach climax in 90 seconds, so only a small amount is produced. However, when there is prolonged intense stimulation, there is prolonged secretion. Then, when the man reaches climax and all the fluid is ejected out of the prostate and seminal vesicles, there can be large amounts of watery ejaculate.

Legal Steroid Products on Sale

Jintropin 10 IU

Buy Jintropin 10 IU for Sale
Substance: Human Growth Hormone
Manufacturer: GenSci China
Unit: 5 vials x 10 IU/vial

Best Synthroid T4 75 mcg Online
Substance: Levothyroxine Sodium
Manufacturer: Generic
Unit: 100 pills (75 mcg/pill)

Danabol DS

Order Danabol DS
Substance: Methandrostenolone
Manufacturer: Body Research
Unit: 100 pills (10 mg/pill)

Yohimbe Bark for Impotence

Q. I bought an over-the-counter herbal supplement called yohimbe bark for impotence. Is it safe? Are there any side effects?

A. The herb yohimbe is the bark from the Pausinystalia yohimbe tree that grows in West Africa. It contains the alkaloid yohimbine, which is also available as a prescription medication. Yohimbine blocks receptors in the sympathetic nervous system and has been prescribed to treat impotence. It is also a monoamine oxidase inhibitor.

Legal Steroid Products for Sale

Buy Testodex Enanthate 250

Buy Testodex Enanthate 250
Substance: Testosterone Enanthate
Manufacturer: Sciroxx Laboratories
Unit: 10 mL vial (250 mg/mL)

Boldenon 500

Purchase Boldenon 500 (5ml) from Legit Supplier
Substance: Boldenone Undecylenate
Manufacturer: Gen-Shi Laboratories
Unit: 5 mL vial (100 mg/mL)

Buy Fertomid (Clomid)

Purchase Fertomid 50mg (Clomid) from Legit Supplier
Substance: Clomiphene Citrate
Manufacturer: Cipla
Unit: 50 pills (50 mg/pill)

Will Sex Supplement Harm Prostate?

Q. I am 53 and have the general symptoms of benign prostate enlargement. A year ago my PSA was less than 4. I have been taking an over-the-counter herbal prostate pill twice a day for about two years, with no side effects. I’d like to know if it’s safe to also take a testosterone-precursor type of herbal supplement. I see several products advertised for increasing libido, but I have not seen any discussion as to the effect on the prostate. I am hesitant to consider such a pill at my age, due to my concern with prostate enlargement.

A. I can assure you, you are not alone. You see, as a man ages, his prostate continues to grow, due a variety of hormonal changes in the prostate gland itself. Most experts agree that increasing the amount of testosterone in the gland will cause an increase in growth of the gland and a worsening of the urinary problems that often occur with prostate enlargement. A form of testosterone called dihydrotestosterone (DHT), which is made in the prostate, is particularly thought to cause such growth. To complicate things further, prostate cancer grows in the presence of testosterone. Any man taking testosterone supplements needs to be aware of the risk of promoting and spreading prostate cancer.

Legit Steroid Products Online

Testo-C 1250 for Sale

Best Testo-C 1250 (5ml) from Legal Supplier
Substance: Testosterone Cypionate
Manufacturer: Gen-Shi Laboratories
Unit: 5 mL vial (125 mg/mL)

Synthroid T4 125 mcg

Synthroid T4 125 mcg from Legit Supplier
Substance: Levothyroxine Sodium
Manufacturer: Generic
Unit: 100 pills (125 mcg/pill)

Buy Durabolin 500

Purchase Durabolin 500 Online
Substance: Nandrolone Phenylpropionate
Manufacturer: Gen-Shi Laboratories
Unit: 5 mL vial (100 mg/mL)

Viagra after Spinal Cord Damage

Q. Thank you for your information on the use of a pump for erectile dysfunction. My friend, age 42, had a bad construction accident and suffered spinal damage some 10 years ago. We enjoy each other sexually, and he achieves an orgasm without the pump. We only used the pump once due to pain on his part. Would Viagra help him? I have not read anything on Viagra for men with spinal injury. He is otherwise healthy and active in every other way. This is hard on him emotionally, as you can imagine.

A. The erectile reflex mechanism is so complex, involving so many pathways up and down the spinal cord and brain stem, that we as urologists are just beginning to understand it. It is interesting that no two patients are alike in their ability to achieve and maintain an erection after spinal cord damage.

Nonetheless, in the initial trials of Viagra, there was a group of patients with spinal cord injury that did benefit from the drug. I encourage your friend to see his doctor to try Viagra.

Best Steroid Products for Sale

Winstrol Injectable for Sale

Order Winstrol Inj on Sale
Substance: Stanozolol
Manufacturer: Dragon Pharma
Unit: 10 mL vial (50 mg/mL)

Legal Testo-C 1250

Order Testo-C 1250 from Legal Supplier
Substance: Testosterone Cypionate
Manufacturer: Gen-Shi Laboratories
Unit: 5 mL vial (125 mg/mL)

Cutaxyl 150 for Sale

Buy Cutaxyl 150 for Sale
Substance: Drostanolone Propionate, Trenbolone Acetate, Testosterone Propionate
Manufacturer: Kalpa Pharmaceuticals
Unit: 10 mL vial (150 mg/mL)

Viagra & Fertility

Q. Does Viagra have any effect on sperm in a man trying to have a child? Does it affect the sperm count, mobility, etc.?

A. Viagra has no known effects on sperm production, morphology (shape), motility (movement) or count.

If a man has organic impotence — meaning the problem is due to a medical rather than psychological condition — then Viagra may improve the chances for achieving conception simply by restoring potency. Remember, though, that while Viagra can improve rigidity, it does not necessarily bring about ejaculation. Many men with impotence may have diabetes or other conditions that affect the penis. In this situation, the muscular sphincter that constricts to help ejaculate the sperm may not close properly. In such a case, retrograde ejaculation occurs: The sperm are shot into the bladder rather than out through the penis to begin their journey to find an egg. For more information, see my column on No Semen Comes Out during Intercourse.

If your partner is concerned about his fertility, I would suggest that he consider a semen analysis, regardless of whether Viagra helps his performance. If he has psychological impotence, counseling may be very helpful to ensure that pregnancy is advisable.

Best Steroid Products Sales

TestaPlex C 200

TestaPlex C 200 from Legal Supplier
Substance: Testosterone Cypionate
Manufacturer: Axiolabs
Unit: 10 mL vial (200 mg/mL)

Tren-E 500 for Sale

Order Tren-E 500 (5ml) Online
Substance: Trenbolone Enanthate
Manufacturer: Gen-Shi Laboratories
Unit: 5 mL vial (100 mg/mL)

Buy Testoxyl Propionate 100

Order Testoxyl Propionate 100 Online
Substance: Testosterone Propionate
Manufacturer: Kalpa Pharmaceuticals
Unit: 10ml vial (100 mg/ml)

Overcoming Premature Ejaculation

Q. I’m a 34-year-old man. I’m in good shape, and I watch my diet. However, I’ve always had a problem of early ejaculation. I used to think it was because I was young, but it has gotten so bad that I am sometimes afraid of having sex because I may not “do the job well.” I don’t talk about it because I sometimes feel it’s just petty, but it has obviously been bothering me for some time. Do you have any suggestions?

A. Let me congratulate you for sharing such a difficult situation with me. You are going to be fine, since you just took the first step — talking about it.

In fact, many men have this problem. It’s called premature ejaculation, and there are many good treatments available. The best treatment starts with telling someone who cares about you. Keeping it a secret only adds to your frustration and stress, generating fear of failure or performance anxiety that only makes the problem worse. On top of that, your own ego is hurt, which can cause embarrassment and guilt. Your partner, on the other hand, may not know what happened and take the blame personally. All of that can be avoided.

Traditionally, premature ejaculation has been seen as a psychological problem — a learned response in which the ejaculatory reflex is activated sooner than desired. It has therefore been treated with a variety of behavioral techniques to help your body learn new patterns.

The two most common approaches are the stop-start technique and the squeeze technique. In the stop-start technique, you and your partner work together to delay ejaculation. Every time you feel like ejaculating, both of you stop; when the sensation subsides, you restart. You can try this on your own or with the help of a behavioral therapist. The squeeze method involves using your hand to squeeze either the head of the penis or the base of the penis anytime you get the urge to ejaculate. Or you can use a constriction band, sold through most pharmacies, called the Actis ring. This squeezes the base of the penis for a more prolonged erection.

Studies have shown a 60-90 percent success rate in overcoming premature ejaculation using such behavioral techniques. However, you must be patient, as these methods may take up to six months to work completely. More important, you can take advantage of this time to develop new approaches to making love and to learn to satisfy your partner in many ways.

The use of medication to treat premature ejaculation is relatively new, but it can provide excellent, immediate responses with minimal side effects. These agents alter the metabolism of serotonin and other neurotransmitters in the brain to inhibit the ejaculatory reflex.

One such medication is clomipramine (Anafranil), an antidepressant. Urologists at Case Western Reserve University found good response to this drug in a carefully selected group of men — specifically, patients who were in stable relationships and who had a lifelong history of premature ejaculation, no evidence of erectile dysfunction, and no evidence of psychological disorders. The researchers noted some side effects, including hot flashes, headaches or nausea. Still, 79 percent of the men in the study were able to tolerate the drug. Later studies found that 25mg of clomipramine, given daily, increased time to ejaculation by 249 percent, and higher doses produced an increase of 517 percent. Because of side effects at those dosages, most doctors advise using the drug less frequently or only in anticipation of intercourse.

Men with a history of psychiatric disorders or who are taking other antidepressants should not be given clomipramine, as it may interact with other medications. One study demonstrated changes in sperm, perhaps affecting fertility, that may reflect such interaction.

Another group of antidepressant medications, the selective serotonin re-uptake inhibitors (SSRIs) also work well, with infrequent side effects (such as loss of appetite and headache). I have prescribed the SSRI sertraline (Trazdone, Zoloft) with excellent results, but only after a careful examination and a medical/social history to make sure the patient really has premature ejaculation; otherwise, the drug might cause priapism (prolonged erection). Two other SSRIs — paroxetine (Paxil) and fluoxetine (Prozac) — are now under investigation for this use.

Best Steroid Products on Sale

HUCOG INJ 5000iu

Buy HUCOG INJ 5000iu
Substance: Human Chorionic Gonadotropin
Manufacturer: Bharat Serums and Vaccines
Unit: amp (5000 IU)

Buy Synthroid T4 25 mcg

Synthroid T4 25 mcg on Sale
Substance: Levothyroxine Sodium
Manufacturer: Generic
Unit: 100 pills (25 mcg/pill)

Primodex 100

Primodex 100
Substance: Methenolone Enanthate
Manufacturer: Sciroxx
Unit: 10 mL vial (100 mg/mL)

Orgasm without Direct Stimulation

Q. I have suffered from premature ejaculation for years. Recently, I have even had orgasm and ejaculated without any direct penile stimulation, just heavy kissing and nipple play. Is this normal? I didn’t think it was possible. It’s quite embarrassing! How can I overcome this?

A. Orgasm is a learned response. In a man who suffers from premature ejaculation, the trigger mechanism for orgasm is very sensitive. The stimuli to climax can be visual, auditory or physical (direct penile stimulation). Regardless of which form of stimulus is involved, the man’s brain learns to interpret it in such a way that the orgasm is triggered.

To overcome your problem of premature ejaculation, you must see your doctor. Your doctor can offer several solutions, either behavioral therapy or medications. For more information on the options, see my earlier column on premature ejaculation. The most important thing is not to worry — medication or therapy can correct this problem.

Legal Steroid Products for Sale

Buy GP Oral Tren

Order GP Oral Tren for Sale
Substance: MethylTrienolone
Manufacturer: Geneza Pharmaceuticals
Unit: 100 tabs (250 mcg/tab)

Buy Serpafar

Best Serpafar from Legit Supplier
Substance: Clomiphene Citrate
Manufacturer: Faran Laboratories
Unit: 10 pills (50mg/pill)

Buy Pentadex 300

Purchase Pentadex 300 for Sale
Substance: Sustanon
Manufacturer: Sciroxx
Unit: 10ml vial (300 mg/ml)

No Semen Comes Out During Intercourse

Q. I have no problem with erection, but no semen comes out from either masturbation or even intercourse. A doctor has checked for prostate problems and it is negative. I used to be able to produce semen. I am diabetic.

A. You probably have a common condition called retrograde ejaculation, which is frequently seen in people with diabetes. The semen enters the penis via the ejaculatory ducts, which pass through the prostate. At the time of ejaculation, a muscle at the opening to the bladder squeezes shut. With each muscle contraction, the semen is propelled down the urethra and out the opening of the penis. However, if there is nerve damage due to diabetes, the muscle at the opening to the bladder will not close off properly, and the semen enters the bladder instead of shooting out the end of the penis.

Your urologist can diagnose this condition easily by checking your urine for semen after ejaculation. If this is the problem, you may try medication to strengthen the function of the muscle that closes the bladder. Or you may have sperm collected from the bladder to use for insemination or for in vitro fertilization.

Top Steroid Products for Sale

Buy Primo 500

Order Primo 500 (5ml) on Sale
Substance: Methenolone Enanthate
Manufacturer: Gen-Shi Laboratories
Unit: 1 X 5 ml (100 mg/ml)

Susta 500 for Sale

Best Susta 500 (2ml) from Legit Supplier
Substance: Testosterone Blend
Manufacturer: Gen-Shi Laboratories
Unit: 2 mL vial (250 mg/mL)

HMG Gen-Shi 75 IU for Sale

Best HMG Gen-Shi 75 IU
Substance: Human Menopausal Gonadotropin
Manufacturer: Gen-Shi Laboratories
Unit: 75 IU/vial

No Ejaculation, Just Prolonged Oozing

Q. When I am fortunate enough to have an orgasm, very little ejaculate comes out. The problem is that after an orgasm, the ejaculate oozes out over the next five to 10 minutes. Without the discharge of semen, this reduces the intensity of the orgasm as well. I know that jumping up and urinating will solve most of the problem, but on occasion it will continue to ooze even after urination (though not in the same quantity). Can you offer any advice?

A. I have only seen one patient with the problem of orgasm without ejaculation (squirting of semen), followed by a slow release of semen. In that case, the man had a blockage, called a stricture, in the urethra (the tube in the penis that carries urine and semen out of the body). The semen was released, but it couldn’t get out of the penis during orgasm. Instead, it would slowly drip out afterward.

Such a stricture may also cause difficulty in urinating. The stream would be weak and may require straining to get started. In addition, my patient had urinary frequency (the need to urinate often) and a lot of dribbling.

Diagnosis of a stricture can be made either with an X-ray exam called a urethrogram or with a cystoscopy. The urethrogram consists of putting a tube in the opening in the tip of the penis and slowly filling the urethra up with a special fluid while taking X-rays of the penis. Cystoscopy involves putting a miniature viewing device into the opening and advancing it up the urethra looking for the blockage. If this is done in the operating room, then once the blockage is found it can be treated at the same time.

Top Steroid Products on Sale

Clenbutaxyl

Purchase Clenbutaxyl from Legal Supplier
Substance: Clenbuterol Hydrochloride
Manufacturer: Kalpa Pharmaceuticals
Unit: 100 pills (40 mcg/pill)

Legal DNP

DNP from Legal Supplier
Substance: Dinitrophenol
Manufacturer: Gen-Shi Laboratories
Unit: 30 caps (100 mg/cap)

Legit Ultradex 150

Ultradex 150
Substance: Trio Blend
Manufacturer: Sciroxx Laboratories
Unit: 10 mL vial (150 mg/mL)

« Older Entries