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Dr. Phil, MD
Dr. Phil, MD, Medical Doctor
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Lantus 50 Units at bedtimeHumalog 20-30 Units with mealsAspirin

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Lantus 50 Units at bedtime Humalog 20-30 Units with meals Aspirin 325mg once daily Klonopin 4mg at bedtime Klonopin 2mg morning Seroquel 200mg at bedtime Trilipix 135mg evenings Simvastatin 80mg evenings Metformin 500mg TWICE daily ranitidine 300 mg as needed Coreg 12.5mg TWICE daily Benicar 20mg TWICE daily Digoxin 125mCg Gabapentin 800mg at bedtime Gabapentin 400mg mornings (Temporarily taking for congestive heart failure-swelling of LEFT foot & ankle...Furosemide 20mg daily AND Spironolactone 25mg) Amitriptilyne 50mg mornings **DEpresssion **Injection Fraction is 15-20%...Cardiologist says I have a VERY, VERY weal heart** I workout 3-4 day a week at the health club with weight machines and free weights..I have a SOLID Muscular body..only fat is stomach. Body Fat is 15% (always HAVE worked out since I was 14 yrs old..NO smoking or substance abuse EVER) I am 53 yrs old. Type I Diabetic since age 39. Doctors say a VIRUS hit my pancreas in 1999 AND my heart in March 2012. I use a CPAP machine to sleep & try Viagra which now Viagra 25-50mg does NOT seem to help like it use to. My question is: I seem to have a low sex drive..feel like I could do without sex. I DO get horny watching "some" porn, but erections are not good. Too much desensitizes me. Tried to have intercourse with a woman I just met and could not get fully erect OR have an orgasm. With watching porn, I can mentally choose what scenes I watch and therefore monitor which ones arouse me to orgasm by masturbation.

Submitted: 1 year ago.
Category: Medical
Expert:  Dr. D. Love replied 1 year ago.
Could you clarify what question that you have about the low sex drive?
Are you asking what are the possible causes of the low sex drive?

Customer: replied 1 year ago.

Why do I have a low sex drive and libido?? Is it my age and these medications and the bad heart and the sleep apnea??

Customer: replied 1 year ago.

I get 3/4cc Testosterone Cyp weekly and take Proviron 50mg daily to help.

 

Why won't the Viagra help like it use to?? Is it because of my age and these medications and the bad heart??

I am told by a male friend that he doesn't function with overweight women and that's what I tried recently.
My whole life I have done best when I had "Feelings of affection and love" for the woman and then I could get erect and perform and orgasm. Do i need a woman who weighs less and looks better?? I'm ALL upset & confused & depressed over all of this!!

 

Expert:  Dr. D. Love replied 1 year ago.
There are two separate but related issues present - the low sex drive/libido and erectile dysfunction.

Of the medical problems that you have, the heart disease (low ejection fraction) and the depression are the most likely cause of a low sex drive and poor libido. It is true that erectile dysfunction can have a psychologic impact that can affect sex drive, but the heart disease and depression can affect sex drive directly.

Sleep apnea typically only will affect sex drive if it causes heart problems. Testosterone deficiency certainly can also contribute to poor sex drive.

Diabetes is a common medical cause of erectile dysfunction, both because of its effect on small blood vessel disease, but also because of the effect of diabetes on nerve function. If you are taking the gabapentin for diabetic neuropathy, then a similar neuropathy can affect erections. In diabetics with neuropathy, there is a significantly greater risk of erectile dysfunction. Diabetes does not typically directly affect sex drive, but chronic problems with erectile dysfunction may affect sex drive because of the psychologic impact noted above.

It is also possible that the medicines that you are taking could contribute to the poor sex drive. It is not a common side effect to any of these drugs, but it has been more reported with the Coreg, amitriptyline, and Seroquel. If the poor sex drive started after starting any particular medicine, it would be appropriate to suspect that medicine.

Therefore, the heart disease and the depression would be the most likely cause of the low sex drive and poor libido, although there could be the other factors noted above. Testosterone replacement is usually only effective if there is testosterone deficiency. Medicines for erectile dysfunction will typically not help poor sex drive. The usual approach to poor sex drive related to these conditions is to optimize treatment for those conditions.

If you have any further questions, please let me know.

Customer: replied 1 year ago.

When I was 30, even 40 yrs old I was wanting sex almost every day and often 3-4 times a day with an attractive partner.

Now I'm 53 and have almost no desire.

I hear what you have said....do these Beta Blockers not kill a sex drive??

Gabapentin I take is for a Siatic Nerve, not for neuropathy from Diabetes.

I am told by a male friend that he doesn't function with overweight women and that's what I tried recently.
My whole life I have done best when I had "Feelings of affection and love" for the woman and then I could get erect and perform and orgasm. Do i need a woman who weighs less and looks better?? I'm ALL upset & confused & depressed over all of this!!

****I can't figure out WHICH is causing my problems with sex drive and libido loss.

*** You addressed the different things that COULD BE the cause.

What's the botXXXXX XXXXXne doctor??

WOULD a thinner woman help instead of a 5'3" 225lb woman?? I think it would, but not 100% sure.

Expert:  Dr. D. Love replied 1 year ago.
Yes, the Coreg can affect sex drive, as I noted above. Statistically, it is less likely to be a cause than the low ejection fraction and depression, but it could be contributing to the problem.

Poor sex drive is usually not overcome by a change in partners, for the same reason that you find that porn is not as effective as previously. It is true that anyone's sex drive can be affected by a caring partner, but that would be true regardless of the appearance of the partner.

The usual approach is to treat the underlying medical problems that can be affecting he sex drive.

Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 13709
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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Customer: replied 11 months ago.

OK, I'm back....I'm still taking the meds I mentioned before.....I find my sex drive and erections while watching quote, "REAL sex" happening between 2-people helps me get an erection because I can CONNECT--make the CONNECTION because it's real, not from the porn world where you have porn stars and too much of the same hum-drum boring "doing all the positions possible" which NO couple that cares and loves each other does. Normal people don't do all the positions and normal couples the guy doesn't always have a 10 inch penis like porn stars do AND the women in real life don't always have breast implants like female porn stars.

So, I need the attraction and the connection (chemistry they call it if there is such a a thing, is there??? Is there such a thing as "CHEMISTRY"??

(Please comment on all the above)

Question #2--Why do I feel like I'm going to urinate BAD just when I am about reach orgasm??

{ Please pardon all the talk about having to watch porn...I just can't fantasize or get aroused like when I was 13 to 40 years old. I'm 53 now and I need VISUAL to get to climax now.]

Customer: replied 11 months ago.

I am still waiting a reply!!

Expert:  Camille-Mod replied 11 months ago.
Hello,
I'm Camille, and I’m a moderator for this topic. I sent your requested professional a message to follow up with you here, when they are back online. Unfortunately I do not know when this may be, as the professionals come on line as they are available. You don't have to stand by, you will get an email telling you when you have received a response. If I can help further, please let me know. Thank you for your continued patience.
Best,
Camille
Expert:  Dr. Phil, MD replied 11 months ago.
Hello. I'm Dr. Phil, licensed and practicing Internal Medicine Physician. Excellent service is my goal.

Do you still need help on this one?
Customer: replied 11 months ago.

Yes. I posted it again per the advice of the Customer Support last night. Now it's showing up here too.

Expert:  Dr. Phil, MD replied 11 months ago.
can you list all your meds for me?
Customer: replied 11 months ago.

Lantus 50 Units at bedtime Humalog 20-30 Units with meals Aspirin 325mg once daily Klonopin 4mg at bedtime Klonopin 2mg morning Seroquel 200mg at bedtime Trilipix 135mg evenings Simvastatin 80mg evenings Metformin 500mg TWICE daily ranitidine 300 mg as needed Coreg 12.5mg TWICE daily Benicar 20mg TWICE daily Digoxin 125mCg Gabapentin 800mg at bedtime Gabapentin 400mg mornings (Temporarily taking for congestive heart failure-swelling of LEFT foot & ankle...Furosemide 20mg daily AND Spironolactone 25mg) Amitriptilyne 50mg mornings **DEpresssion **Injection Fraction is 15-20%.

Expert:  Dr. Phil, MD replied 11 months ago.
It's quite clear to me that your meds are causing these symptoms
Customer: replied 11 months ago.

But the online intimate videos help often. Is that just a fluke, or do I need CHEMISTRY with someone?? Like I aked, Is there such a thing as "CHEMISTRY"?

Expert:  Dr. Phil, MD replied 11 months ago.
I think it is just a matter of your preference

Some people need that "chemistry" to become aroused.

Many people don't

That is just how you are "wired" for lack of a better term
Customer: replied 11 months ago.

How come certain sexual scenes really get me going? MANY, MOST do not....I have to come across a certain scene to get aroused good. I don't sleep around or go to bars, so I do this as it's better and safer and I REFUSE to me a male-slut by going to bars and sleeping around like some people do. So there really is such a thing as CHEMISTRY??

Expert:  Dr. Phil, MD replied 11 months ago.
I think chemistry is just a term.

It is the right type of sexual arousal for you.

So everyone is different and this is your "chemistry"
Customer: replied 11 months ago.

Thank you so much for getting back to me so quick.

Expert:  Dr. Phil, MD replied 11 months ago.
No problem. :)

Please don't forget a rating for me.

I appreciate it.
Dr. Phil, MD, Medical Doctor
Category: Medical
Satisfied Customers: 43419
Experience: Medical Doctor Trained at a Top Academic Institution
Dr. Phil, MD and 5 other Medical Specialists are ready to help you
Customer: replied 10 months ago.

This question was never answered from last time:


Question #2--Why do I feel like I'm going to urinate BAD just when I am about reach orgasm??

Expert:  Dr. Phil, MD replied 10 months ago.
ever have any kind of pelvic or testicular surgery?
Customer: replied 10 months ago.

I have had a vasectomy 10-years ago. That's all though. What do you think is causing this?? Right when I am about to ejaculate I feel the STRONG sense that I am going to PEE BAD!


You have all of my history in this FEED here...our back and forth answer and replies....so you know what medications I am taking.


I hope you can help with an answer on this. It is a problem for me...I can't orgasm normal. My family doctor is out a lot....fixing to retire.

Expert:  Dr. Phil, MD replied 10 months ago.
yes, I absolutely think the vasectomy is related.

That is a common complaint after
Customer: replied 10 months ago.

Why is it just now showing up 12-years later?? I never ever had this problem.


2.) Question-- What do I do to fix it?

Expert:  Dr. Phil, MD replied 10 months ago.
That is a good question

I don't know but I have heard this commonly in vasectomy people

You might also want to get your prostate checked

I would try kegel exercises for men

This will help strengthen the pelvic floor

http://www.webmd.com/urinary-incontinence-oab/kegel-exercises-treating-male-urinary-incontinence
Customer: replied 10 months ago.

Prostate may be enlarged??

Expert:  Dr. Phil, MD replied 10 months ago.
Yes that is possible. It needs checked
Customer: replied 6 months ago.

Thank you for your great help in days past.


I want to ask another question please.....


I am still on the meds listed above in our conversations.


I still get aroused with the online sex videos, but get desensitized it seems.


I am with a lady now that I love but I can't get an erection. I take Viagra 50mg (25mg then wait 1/2 an hour and take another 25mg as 50mg all at once gives me a headache, but it has done better in the PAST years splitting it into 2-doses) but it doesn't help.


Do I need counseling for this so I once again function HARD as a rock with my partner??

Customer: replied 6 months ago.

Relist: Other. Dr. Phil is not ONLINE and I need an answer.

Expert:  drn.iqtidar replied 6 months ago.
Hi, I am dr.iqtidar and will try my best to answer your question. There are a few explanations for your problem which is called delayed ejaculation or ejaculation dysfunction. It could be due to diabetes, pressure of achieving orgasm or helping your partner achieve it. Simply aging can also affect and cause ejaculation dysfunction. In diabetes the autonomic nervous system is affected that can cause sexual problems and loss of libido. The problem here could be problem in maintaining a sustained erection caused due to diabetes or some underlying condition. If you have problems in urination such as frequency of urine or any problems it could be due to benign prostate hypertrophy so I think you definitely should get this condition assessed by a doctor and get a referral to a sex therapist if there is no medical problem.

The good thing and positive aspect of this scenario is that you are able to achieve and maintain erection and an orgasm while masturbating which a lot of people cannot achieve. Now you are with a partner so there may be issues on both sides as this can clearly affect a relationship. Why you achieve orgasm is again as you clearly described due to controlled conditions during masturbation and most of all being relaxed and no pressure at all. As you have asked about Counselling, it would be a good idea to help you and another option is medications such as dappxitine sold as priligy which can be tried and you can get it prescribed. It does work in delayed ejaculation but sometimes counselling alone can help.

Regarding watching sex and then getting aroused this means that perhaps changing your strategy might help. One thing that usually is recommended by sex therapists is to replace the idea of to people having sex with the idea of you and your partner doing the same acts as you get aroused by and fantasising about them during foreplay it's your partner. You could even discuss the fantasies with your partner which could make you more excited and in a position of power. If this technique doesn't work a sec therapist may be able to suggest you what to do during foreplay or even in advance to help you achieve orgasm with your partner. One technique could be to masturbate slightly to the point that you desire orgasm and then initiate sex. You could get your partner to even stimulate you manually which you may have tried but may not have worked if it wasn't long enough and you weren't fully relaxed.

Another technique could be encouraging your partner to sit on top of you first or be in a dominant position and then ditch positions. This often helps in delayed ejaculation.

I think a sex therapist would offer you even more professional advice and priligy may be needed just to help you with your symptoms. I think you should go for the sex therapy and if it doesn't work you can try priligy which is an approved drug for ejaculation dysfunction. Hope this advice helps. Any questions please ask. If you are satisfied with my answer please give me a positive rating.
Customer: replied 6 months ago.

I thought I was suppose to pay you but it says I already RATED this Expert and there is no place to pay you.

Expert:  drn.iqtidar replied 6 months ago.
Hi, I think you have already rated the expert that was answering your questions before me and payed the expert. I won't get credited but it's my mistake I didn't realise the question had been rated as it appeared available so it doesn't matter. We get paid according to rating. Best wishes.

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