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Suffering from erectile dysfunction. Taking paroxetine and sustimax. Looking for effective solution

Dec 2014
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Answered by

Practicing since : 2007
Answered : 4151 Questions
dear dr. sir

I,XXXXXX Age 33/M have been suffering a lot of sex problems related to Erectile Dysfunction. I was married in Nov 2010. Since then I am not able to sex with my wife even a single time. I am writing point wise details to my advise me a best solution.

1. I began masturbation at the age of 13 yrs. Since than I masturbate regularly during the age 19-22 I masturbate 4 times in a day. After this my frequency reduced to 2 times in a day. I enjoyed good erection during theses days.

2. I got married on Nov 2010. Since than I am experiencing Erectile Dysfunction. For over last 2 yrs. I did not enjoy penetrative sex with my wife even a single time.

3. I consulted Doctos twice in Lucknow. 1 st time I took Zenisper capsulesTwice daily for 1 month along with manforce 50. It gave me some relief and my penis regain some erection.2 ndly I visited same Doctor to Lucknow again. He advised me to visit a psychiatarist. After hearing my problems The psychiatarist told me that I am a patient of Anxiety Neurosis. He prescribed me Nexito-10(Daily one tablet in night), Bupron XL-150(Daily one tablet in morning) apart from this I am taking Amlodipine 2.5 mg daily morning for Blood pressure and Diabend-M half tablet daily afternoon for diabetes. My Blood pressure and diabetes is under control.I recent test my Bp after medication was 130/86 and HbA1c was 5.8.

4. For last 4 months I am taking these medicines.

5. I visited another Doctor and he prescribed me to take Paroxetine CR 25 once in a day & also to take Sustimax 250 injection once in a week for 6 weeks.I have not started to take these medicine till now.

I need a proper and accurate solution to my sex problems especially Erectile Dysfunction.

I will be glad to receive any advice from your end.
Posted Wed, 1 May 2013 in Erectile Dysfunction
Answered by Dr. Seikhoo Bishnoi 1 hour later
Welcome to Health Care Magic

I have read details of your problem. You are a 34 year old male with history of Diabetes Mellitus and Hypertension. You used to masturbate for 3-4 times a day during your young age, and you had good erection till your marriage. After marriage you developed the problem of Erectile Dysfunction. You are not able to gain proper erection and are not able to penetrate properly. You have used medicines like Manforce but gain only minimal benefit. After that you consulted a psychiatrist and you were prescribed Escitalopram and Bupropion for anxiety and erectile dysfunction. You are on these medicines since last 4 months with almost no improvement. Your BP and Diabetes are under control.

First of all I would like to tell you that masturbation has nothing to do with this problem. Masturbation is a healthy and safe method to get self gratification. But excess of every thing is bad and excessive masturbation may cause injury to penis or impairment in social and occupational functioning. It is not the cause of erectile dysfunction.

Most likely the cause of your erectile dysfunction is Non specific and Psychological. Let me explain the origin of this problem in your case. Some time due to stress or work load or due to cultural beliefs any individual fails to get proper erection. Due to failure he starts to have feeling of inferiority, feelings of rejection, anticipatory anxiety of poor performance, low confidence, stress and tension. These things further potentiate the problem and ultimately a vicious cycle is formed in which problem get on increasing in severity. For proper treatment we have to break this cycle.

The cycle can be broken by two steps-
- Either to decrease stress, tension, anticipatory performance anxiety and to improve confidence.
- Second step is to increase erection to improve confidence and to decrease stress and tension. So both steps are interrelated.

Now coming to treatment-

- First of all I would advise you to visit a good Psychiatrist again and consult about medicines again. As per my opinion Nexito (escitalopram) is a good anti anxiety medicine but it may increase sexual dysfunction. It usually cause delayed ejeculation but poor libido, poor erection are also reported as main side effects with this drug. Paroxetine is also a drug of same group. So they may decrease anxiety but will not help in erectile dysfunction.
Sustinax is dapoxetine and it is mainly used about 2 hours before sexual intercourse in patients of premature ejeculation. As per my opinion it is not useful in erectile dysfunction.
Bupropion is really a good drug for anxiety and it has no sexual side effect. In some studies it has been reported to give benefit in sexual dysfunction.

- Other medicines like Trazodon can be used in your case. Trazodon is an antidepressant drug with benefit in anxiety also. It will improve your mood and confidence. It has promising results in erectile dysfunction. Only 50 mg dose has potential to cause improvement.

- As your BP and sugar are under control, I would still advise you to get your ECG done to rule out any cardiac abnormality. If ECG comes normal you can take Sildenafil (viagra) or Tadalafil for erectile dysfunction. These drugs are usually taken about 2 hour before intercourse and have good results.

- Exercise daily and learn Yoga and Meditation to keep yourself relaxed. This will improve your self confidence.

- You are getting some erection but not able to penetrate your wife. I would like to know few things like- Are you able to masturbate? If you have spontaneous early morning erection? If you have erection on watching adult movies or in adult fantasies?

Hope I cleared your doubt, you can contact me again in follow up question.

Dr. Seikhoo Bishnoi, MD
(Consultant Psychiatrist)
Above answer was peer-reviewed by
Follow-up: Suffering from erectile dysfunction. Taking paroxetine and sustimax. Looking for effective solution 27 hours later
Dear Dr. Saheb
1. I have done my ECG also and that report was also normal.
2.Before starting medicines I daily masturbate 2 times in a day morning and evening but after starting medicines I masturbate only twice in a week. Erection is goog during masturbation.
3. Some times on awakening on morning or nights I get very good erection that is usually need to penetrate that hard erection that I got before 3 yrs., 2 months before marriage.
4.For over last 4 months i am taking Nexito-10 and Bupron xl-150.
5. My family doctor advised me to take sustanon 250 injection once in a week for 6 weeks, 1 tab. paroxee cr 25 during night and sustimax tablet 3 hrs. before intercourse. Yet I have not started to take these medicines.
6. I need a proper solution for erectile dysfunction problem.
Answered by Dr. Seikhoo Bishnoi 17 minutes later
Hello again

You are getting enough erection for masturbation and I assume you have good orgasm also. You have good desire or libido for sex. This means that you have almost normal levels of hormone testosterone. So as per my opinion there is no need for Sustanon (Testosterone) injections.
I have already mentioned that you have problem of erectile dysfunction and not of premature ejeculation so Nexito, Paroxetine or Sustinax will not help much in your case.

For poor ejeculation Trazodon 50 mg should help you. It relieves anxiety and low mood, as well as it cause erection of penis as its side effect. The side effect is used therapeutically in erectile dysfunction. Bupropion is also a good medicine and it will definitely help.

Second taking Sildenafil will definitely help in getting good erection before intercourse. If you don't want to take sildenafil then you can take Cyproheptadine syrup. It is a medicine for poor appetite, but taking 4 tsp about 2 hours before sexual intercourse will help to boost erection.

As your all parameters are normal and clinical history is also normal so most likely it is Psychological impotence. Try to talk with your wife regarding the problem. Engage more and more time in fore play, talking clearly about sexual intercourse will definitely increase your confidence. You just need to change your attitude and thinking. Proper couple counseling by a Psychologist will also help.

Hope I cleared your doubt, you can contact me again in follow up question.

Dr. Seikhoo Bishnoi, MD
(Consultant Psychiatrist)

Above answer was peer-reviewed by
Follow-up: Suffering from erectile dysfunction. Taking paroxetine and sustimax. Looking for effective solution 17 hours later
dear dr. XXXXXXX
1.Is there any tests that can be done to check the testosterone level in body.
3.What is anxiety neurosis? what is the best treatment for this? can a person who is taking treatment of anxiety neurosis with aforesaid medicines do good sex with hard penetration? is this non curable? as my wife is saying.
4.Can any tests of penis or mental tests be done in order to ensure what is my correct disease and where to do?
pl. solve my these queries in order to do tests and best treatment for this.
Answered by Dr. Seikhoo Bishnoi 1 hour later
Hello again

- Yes definitely there are tests for testosterone levels in blood. Blood Testosterone level, Serum LH levels, Serum Prolactin levels and Thyroid function tests are all needed to be done to rule out any hormonal abnormality in erectile dysfunction. These tests are easily available with common labs.

- TSH of 2.1 is normal so there is no need to worry

- Anxiety neurosis is a psychiatric condition. It is curable with medicines as well as Behavior therapy. Anxiety itself may potentiate the problem of impotence and erectile dysfunction. Mere treatment of anxiety will help to improve your condition.

- If all the hormonal tests come normal then you can go for Doppler Test. In this test a XXXXXXX is injected into the penis and then this is detected by doppler handheld device. This test is done to check blood flow as well as to check any nerve abnormality in penis.

Hope I cleared your doubt, if you have more questions you can ask again in follow up.

Dr. Seikhoo Bishnoi, MD
Above answer was peer-reviewed by
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