Brief Answer:
sexual side effects are common with paxil,age also matters

Detailed Answer:
Hello,

Thanks for writing to us.

Paroxetine is responsible for sexual side effects in 1-10% of the patients. 50 mg is higher dose and at this dose sexual dysfunction is likely. The most common side effect is delayed ejaculation. If your ejaculation is prolonged and you become exhausted, there is difficulty in achieving orgasm/ejaculation. If this is happening in your case paxil is likely responsible. We can confirm the same by reducing the dose and ultimately stopping the same.

Considering your age I also want to confirm other aspect. You should go for serum testosterone level.Low level of the same also can cause such problem.

Also let me know is there any problem in urinating?

And what exactly happens during sex, also let me know.Is there delayed ejaculation,erection difficulty, reduce libido or ejaculation without orgasm feelings?

I will be happy to help further.

Regards,

Dr.Chintan Solnaki.

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Brief Answer:
5- PDE inhibitor group of medicines should be used

Detailed Answer:
Hi XXXXXXX

Thanks for follow up and sorry for delayed response.

There is no possibility of reduce paxil, some medicines for orgasm should be needed.

5- PDE inhibitor group of medicines like sildenafil or tadalafil(cialis) are used. One of them should be used 2 hours prior to sex. They causes headache,stuffy nose nausea and gastric discomfort like common side effects. Proper physical check up of cardiac system should be done by a doctor before starting the same.These are prescription medicines and you need to consult doctor/psychiatrist/sexologist for the prescription.
Tadalafil is preferred in patients with blood pressure.

You can use another medicine cum vitamin supplement containing pyridoxal-5-phosphate, mecobalamin and l-methylfolate (trade name tetrafol plus)is very helpful in my patients. It has shown improvement in 50-60% patients of mine with ED.You should take it after meal twice a day. If you feel some improvement in 15 days you should continue for at least 1 month. You may get this medicine over the counter as it is vitamin product.

There are some natural lifestyle measures which help to improve blood flow to penis and overall sexual performance.

- The most important factor is healthy heart. Blood is pumped in to body by heart.So regular exercise and avoidance of fatty fast food are important measures to prevent heart disease. Regular walking, swimming or running overall improves blood flow to whole body circulation including penis and keep the mind fresh.

- Avoid smoking and alcohol. Low amount of alcohol can help in increasing blood flow but more amount can cause opposite effects. So better to avoid the same.

Hope this answers your concern.

Feel free to discuss further.

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Brief Answer:
SSRI induced lack of orgasm treated by 5-PDE inhibitor

Detailed Answer:
Hello,

Thanks for query.

5-PDE inhibitor group of medicines are not only used for erectile dysfunction. SSRI(Paxil) induced sexual dysfunction as well as anorgasmia are also treated by it.

I have already mentioned to go for testosterone level. If it is low, supplement can be given.

There are many case reports suggesting effectiveness of 5-PDE inhibitor medicines in anorgasmia as well as my clinical experience says the same.

There are other neurological and physical causes of anorgasmia (diabetic neuropathy, multiple sclerosis, genital mutilation, complications from genital surgery, pelvic trauma, spinal cord injury, cauda equina syndrome). In your case though possibility of it less , they should be ruled out through proper history, examination and required investigations.

Cyproheptadine, buspirone, stimulants such as amphetamines (including the antidepressant bupropion), Nnefazodone and yohimbine have also been used to treat SSRI-induced anorgasmia.

Hope you are now clear about your concern.

All the best and take care.

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