Reproduced with the kind permission of Dr Stuart Neilson, a.k.a. Xazoylhs

Sex and Antidepressants

Many antidepressants list sexual problems as a side-effect and sexual problems (e.g. lack of libido or erectile dysfunction) are also a symptom of depression. The most frequent sexual problem with SSRIs is referred to as:

"Abnormal ejaculation / orgasm" (Effexor XL, generic Venlafaxine)

"Change in sex drive or function e.g. ejaculatory delay" (Lustral, generic Sertraline)

In men, these symptoms are also called "retarded ejaculation", "ejaculatory failure", "ejaculatory incompetence" and so on. Put bluntly, it means "I get an erection, but nothing comes out". Searching for any of these terms on Google will provide plenty of useful references for further reading. This page is primarily aimed at ejaculatory problems for men or their partners, but if anyone wishes to add the female perspective then please email. Here are a few distilled points:

1 in 6 men on antidepressants experience sexual problems as side-effect, that is about half a million British men at some point in their life;

These problems are strongly related to self-image, occur at a time of low self esteem and men are poor seekers of help;

The patient advisory leaflets often describe the side effect in extremely unhelpful terminology that is not meaningful or helpful;

Any man seeking informal advice through, e.g. Google, will find that the problem is generally describeed in terms ("retarded", "delayed", "failure" or "incompetence") which do not build self-esteem;

Patient-oriented (North American) websites - try www.(drugname).com - do not offer any useful advice or guidance for sexual dysfunction;

Most importantly, affected men are usually able to have normal arousal, sustain an erection and experience pleasure during sex - it is the goal (ejaculation) oriented expectation of Western men that creates the problem, not the drug. A short course of simple (but unfamiliar to most men) exercise rapidly restores ejaculatory "competence". In addition, accepting a more feminine approach to sex is deeply satisfying. The major sexual function drug, Viagra, has merely exacerbated our current masculine, goal oriented sexuality.

The prevailing Western consensus on male sexuality does not distinguish between male orgasm and ejaculation. Women as well as men often approach sex with an increasingly intense and localised focus on the genitals and, ultimately, on the glans during ejaculation. Ejaculation is often regarded as the end-point (and the goal) of most sexual activity - ejaculation is in any case usually followed by a refractory period in which erection and further ejaculation are impossible. Because male arousal is so apparent and because ejaculation is often easily attained and almost invariably accompanied by male orgasm, the male sexual response is regarded as simple, reasonably reliable and fairly primitive.

This need not be so, as evidenced by the effects of intervention with selective serotonin re-uptake inhibitors (SSRIs) and by various Eastern approaches to sexuality. Male orgasm can occur without ejaculation (and can do so spontaneously in response to some SSRIs). Male orgasm without ejaculation does not affect erection so sex can continue and multiple male orgasm is possible. Ejaculation is rarely reported without orgasm and is generally reported to be painful.

For more explicit information, see a guide to Lingam Massage or here

By learning to separate the higher cognitive function of orgasm from the lower autonomic function of ejaculation, men are able to remain on that "point of no return", to reverse it and with practice to slide ever more sensuosly into orgasm without ejaculation. Whilst SSRIs can be helpful in this learning process, they are not essential. Three things greatly assist.

Firstly, strength and greater voluntary control of the pubococcygeus (pc) muscle through pelvic floor exercises or "Kegels" - these exercises are promoted for health during and after pregnancy but are as important for men's sexual health. Good pelvic floor tone prevents urinary incontinence and reduces the risk of prostate cancer.

Secondly, relaxation during sexual activity to defocus attention from the genitals and to the sensuality of the rest of the body, especially the mind.

Thirdly, in regard to cognitive activity, continuous communication with your sexual partner through speech and touch, throughout sexual activity, arouse the mind.

Two practical guides which you may find very helpful are "The multi-orgasmic man" by Mantak Chia & Douglas Abrams Arava (Thorsons, 2001) and "Tantric sex: Making love last" by Cassandra Lorius (Thorsons, 1999), available from Thorsons, Amazon and local bookshops.