From the Guidelines
To enhance pleasure, focus on both physical and psychological aspects of intimacy, and consider a multidimensional treatment plan that addresses underlying issues, as guided by the specific type of problem, as recommended by the NCCN Survivorship Panel 1.
Methods to Enhance Pleasure
- Improving communication with your partner about desires and preferences to create emotional connection and reduce anxiety
- Engaging in extended foreplay (15-20 minutes minimum) to increase arousal and natural lubrication
- Using water-based lubricants like K-Y Jelly or Astroglide to reduce friction and increase comfort
- Considering topical products containing L-arginine or menthol, applying a small amount to erogenous zones 15-30 minutes before intimacy
- Practicing mindfulness techniques to maintain focus on physical sensations rather than performance concerns
- Regular Kegel exercises (3 sets of 10-15 contractions daily) to strengthen pelvic floor muscles, potentially intensifying orgasms for all genders
- Experimenting with different positions, speeds, and techniques to discover what provides maximum pleasure
- Modifying lifestyle factors, such as smoking cessation, weight loss, increasing physical activity, and avoiding excess alcohol consumption, as recommended by the NCCN Survivorship Panel 1
Medical Therapies
- PDE5i treatment, which has been shown to improve the symptoms of ED and be well tolerated, as recommended by the NCCN Survivorship Panel 1
- Testosterone therapy, which may relieve symptoms of ED, problems with ejaculation, or problems with orgasm for survivors with hypogonadism, as recommended by the NCCN Survivorship Panel 1
- Selective serotonin reuptake inhibitors (SSRIs) or on-demand clomipramine, which may be used to treat problems with ejaculation, as recommended by the NCCN Survivorship Panel 1
Referrals to Specialists
- Referrals to specialists, such as psychotherapy, sexual/couples counseling, urology, or sexual health specialist, should be made if appropriate and available, as recommended by the NCCN Survivorship Panel 1
From the Research
Methods to Enhance Pleasure
The following methods have been studied to enhance pleasure, particularly in the context of sexual dysfunction induced by antidepressant medication:
- Pharmacological approaches:
- Phosphodiesterase inhibitors such as sildenafil and tadalafil have been shown to improve erectile function in men with antidepressant-induced erectile dysfunction 2
- Bupropion has been found to be effective in treating sexual dysfunction in both men and women, with benefits seen in desire, arousal, and orgasm 2, 3, 4, 5
- Switching to an alternative antidepressant:
- One study found that switching to nefazodone was significantly less likely to result in the re-emergence of sexual dysfunction than restarting sertraline 2
- Testosterone replacement therapy:
- May be an effective treatment for depressive symptoms in hypogonadal men, and may also improve sexual function 6
Key Findings
- The addition of sildenafil or tadalafil to antidepressant medication appears to be an effective strategy for treating erectile dysfunction in men 2
- Bupropion has been shown to be effective in treating sexual dysfunction in both men and women, with benefits seen in desire, arousal, and orgasm 2, 3, 4, 5
- Testosterone replacement therapy may be an effective treatment for depressive symptoms in hypogonadal men, and may also improve sexual function 6