Hi! I believe I can be of help with this issue. To give you the most authoritative answer, it would be best if I could have some more information: Have you discussed this problem with your prescribing doctor? Is the prescribing doctor a psychiatrist?
When you say you have ed, could you specify more what is going on? Are you having any erection of any type? Is the problem premature ejaculation?
Do you currently have one sexual partner or more than one?
Thanks, XXXXX XXXXX help give you the best answer. Dr. Mark
Hi! Okay, I think we can go forward with your answer now. There are two parts to your specific problem and so there are going to be two parts to my answer. And to make it even a bit more interesting, there are two people involved: you and your sexual partner.
It is certainly true that many psychotropic medications have side effects that include sexual dysfunctions of various types and degrees. But to base your decision on whether to discontinue a particular medication because of this side effect, even as important in our lives as sex is, would be very harmful. Why?
Because managing your Bipolar Disorder (BD) is your #1 job. Without the BD well managed, your stability is in jeopardy; and without stability, any sexual partner is going to be unable to handle the relationship to begin with.
So, there are perhaps alternative meds you could be trying but that depends on what your psychiatrist and you come up with in terms of how many you've already tried, dosages, and what is working to manage the BD. This means that you have to discuss with your psychiatrist the side effect and whether adjusting the meds is an option. And you need to know that the adjustment may not resolve the issue.
Okay. So you need to know there are a number of medical "solutions" available today if the goal is to please your partner. The most popular is Viagra. Another is a penile pump. I'm not sure you are interested in these type of solutions, but I cannot exclude them as some men find them helpful. The positives are that medications like Viagra can delay ejaculation. However, Viagra makes many men feel like they're hard but not really enjoying themselves that much. They also don't work for everyone and you need to get approval from your psychiatrist in terms of drug interactions. Pumps allow for an erection to be maintained but that problem of enjoyment is also prevalent with that solution. That you are writing for an answer makes me think you want a more emotionally satisfying answer. And that is going to require you to do some looking into your emotional self as much as your sexual self. To do this, you may want to seek an experienced sex therapist. By that I mean a psychologist or psychotherapist who is certified by either the AASECT (http://www.aasect.org/) or the American Board of Sexology (http://www.americanboardofsexology.com/). This is a more demanding solution for you but it is the most comprehensive with the greatest chance of success for the long term in getting this problem solved if it is a manifestation of your emotional difficulties as well as side effect of medications. But there are also some self-help techniques that you most likely want to try first. And this is the heart of my answer to you. So, I'm going to give you to try first a quick technique that the great psychiatrist Viktor Frankl came up with for this problem of premature ejaculation in his practice: it is called paradoxical intention. You can learn a little about it here:
The way it works is: when you need to sexually perform, that is, from when you first know that you are going to have sex that day/night, you tell yourself: "Okay penis, I dare you to come quicker than you have ever come before!!!! Go ahead, you are going to be lightening fast!!! You're going to come even before you get inside her (him)!!!" Do you get the idea? It seems kind of silly, but you will be surprised how many people this simple technique has helped!! The idea is that you have to challenge your premature ejaculation. You have to be bold and dare it. You have to make fun of it and you have to trash talk to it. Serious! Read the chapter on it in the link I gave you above for a bit more detailed explanation. Okay, that's one simple technique that has helped many with premature ejaculation. Next, here are books that you should read and see if you connect with: 1. She Comes First: the Thinking Man's Guide to Pleasuring a Woman by Ian Kerner. This is a classic and I've seen many men helped by it. Amazon: http://www.amazon.com/She-Comes-First-Thinking-Pleasuring/dp/0060538260/ref=sr_1_9?s=books&ie=UTF8&qid=1283987398&sr=1-9 2. How to Overcome Premature Ejaculation by Helen Singer Kaplan. Those who connect with this book find it SO helpful! Amazon: http://www.amazon.com/Overcome-Premature-Ejaculation-Singer-Kaplan/dp/0876305427/ref=sr_1_2?s=books&ie=UTF8&qid=1283987398&sr=1-2 3. This third book is good for the many areas it explores for how to treat this yourself: Coping with Premature Ejaculation by Michael Metz. Amazon: http://www.amazon.com/Coping-Premature-Ejaculation-Overcome-Partner/dp/1572243406/ref=sr_1_1?s=books&ie=UTF8&qid=1283987398&sr=1-1 Okay, I've given you three approaches here to explore: 1) counseling, the long-term approach.. 2) Paradoxical intention, a quick self-help technique. 3) Self-help books. And don't rule out the Viagra option either, though in my practice the men have not found it emotionally satisfying, which is why I haven't included it in the three options. You're young and if you try paradoxical intention and the books first, you may find that these will be enough to help you get over the problem without counseling.
But now we have to come to the problem that probably bothers you more than even the premature ejaculation: not remaining hard when you're with your girlfriend. And this is the answer that you need to follow so that you can continue to manage your BD and have pleasure. But you have to agree that you aren't going to feel like a failure if you don't succeed. So, I want you to print my answer out and you and your girlfriend discuss this over coffee at a Starbucks or some such venue where you can just talk. Because this is the key to this approach: The two of you have to not make your having an orgasm in intercourse or how you have an orgasm SUCH a big deal for any self-help approach to work. You have to accept, okay, may not stay hard and may not have an orgasm. This is not the end of the world. Why? Because the self-help I'm trying to teach you two is that the key to sex you have to work on is: PLEASURE and not ORGASM! I need you and her to instead of identifying how you can have orgasms simultaneously instead reorient both of your views to how you both can have pleasure. Let me switch to talking to her for a minute: So, the key: when it stops being pleasurable; when he's tired of it, that's when he's had enough. End of story until he feels like having pleasure again. If that means he changes focus to your pleasure, fine. If that means the two of you watch a movie and then go to sleep or have some more pleasure, fine. If it means just you coming and he can relax while you stroke his back, fine. Do you both see the picture? You're too focused on this stereotype and you need to get out of that box right now because he's not there. How you have an orgasm is fine and doesn't have to be the same way each time. If sometimes it happens in intercourse, fine. Other ways fine. Again, you can have pleasure and he can have pleasure and that is the goal right now. And pleasure doesn't have to be such a stereotype...
I wish you the very best!
Please remember to click the green accept button. Feel free to continue the discussion; my goal is to get you the best answers possible. Bonuses are always appreciated! If I can be of further help with any issue, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX