Digest of recent discussions on ISSM mail (Sept 2009 - Dec 2009)

II

KEVAN WYLIE

Tibolone

20 Sep 2009:  10 Messages

1

Does anyone have experience of prescribing tibolone above 2.5mg? This lady has good desire and good lubrication (++), but orgasm remains difficult to achieve. She finds it painful to sit down, and localised erythema is relieved by triamcinolone cream. T is 1.4nmol/L, E2 82pmol/L, LH 51 and FSH 73.6.

 Kevan Wylie (k.r.wylie@sheffield.ac.uk)

2

If she has good desire and lubrication, and the problem is the orgasm, it´s important to know if it´s primary or secondary, total or partial, always or situational. I believe the causes may be mainly  
psycho-sexological: perhaps poor or inadequate sexual stimulation, anxiety, etc.  A psycho-sexological approach for her and her partner may help them.  

Teresita Blanco Lanzillotti (blanter@montevideo.com.uy)

3

I haven't used tibolone over 2.5mg but in this situation I would try a PDE5I plus a vibrator.

Phillip Redelman (redels@medemail.com.au)

4

To reach orgasm is not a matter of drug supply. There is a lot to obtain through sexological treatment.

Esben Esther Pirelli Benestad (esben.esther@sexologi.com)

5

I agree with Margaret. If desire and lubrication are fine, then increasing tibolone is unlikely to help but almost certain to cause side effects. I would have thought that a `rabbit type’ vibrator would be the obvious step, with possibly a PDE5I, but there are difficulties with prescribing these in the UK, and with normal lubrication, less likely to produce orgasm than a vibrator.

Geoff Hackett (geoff.hackett@virgin.net)

6

I work in Mumbai, India, and have seen some young males who fail to furnish semen samples during assessment of sub-fertility, though they claim to be able to ejaculate normally at other times. Perhaps it is anxiety. I have used some local battery-powered vibrators with good results. The patients buy these and are encouraged to use it at home to facilitate future collections. Can anyone please tell me what kinds of vibrators are available for males? Are the ones used for males and females alike ?

Sanjay Pandey (sanjaypdr@hotmail.com)

7

One of my students from Denmark, who works with physically disabled clients, reported success with the use of the Ferticare vibrator.

Patricia Weerakoon (p.weerakoon@usyd.edu.au)

8

Her T level is not high enough. It may be adequate for desire but not for full arousal. She is not getting fully aroused. Also, her pain issues need further assessment and her own or partner technique needs discussion. Please read the Goldstein book on Pain Disorders.

Ruth Hallam-Jones (ruth.hallam-jones@virgin.net)

9

I have seen a very useful one at Beecourse.com. You’ll need the high frequency one with a flat surface. Try Mary Clegg.

Ruth Hallam-Jones (ruth.hallam-jones@virgin.net)

10

Have you tried the Milex condom ? It allows the man to collect a sample during sex. For a reliable vibrator for men try Ferticare. Many US insurance companies cover it.

Nachum Katlowitz (nkatlowitz@siuh.edu)