Libido, Sexual Function

Androgens are important for general sexual function and libido, but testosterone supplementation is only effective in patients with documented low serum testosterone levels. 

The International Index of Erectile Dysfunction (IIED) is the most widely used questionnaire to assess the severity of ED.10 It consists of 15 questions with 5 domains erectile function, libido, orgasmic function, sexual satisfaction, and overall satisfaction. The erectile function domain has a maximum score of 30 with a score of less than 26 indicating some degree of ED. 

Androgens are important for general sexual function and libido, but testosterone supplementation is only effective in patients with documented low serum testosterone levels. In patients with hypogonadism, testosterone replacement is the initial treatment of choice, as it corrects decreased libido, fatigue, muscle loss, sleep disturbances, and depressed mood. Improvements in ED may occur, but they should not be expected to occur in all patients.23 The initial trial should be for 3 months. At that time, re-evaluation and the addition of another ED therapy is warranted. Routes of administration include oral, intramuscular, topical patches or gel, and a buccal tablet. 

The adverse effects of these agents may include occasional diarrhea, nausea, vomiting, variable loss of sexual function and decreased libido. 

Mental changes (such as anxiety, depression), decreased sexual function or libido, diarrhea, swelling of breasts, nausea, vomiting, light-headedness, paresthesia, rhinitis... 

SSRIs and venlafaxine can cause of variety of sexual dysfunctions including delayed ejaculation, anorgasmia, and decreased libido ( Table 7-24). For two reasons, the adverse effect of these medications on sexual function was underestimated during the early clinical trials. First, such trials rely on spontaneous reporting by participants. Second, these adverse effects appear to take several weeks to develop. These adverse effects develop in approximately 30% to 40% of patients on adequate doses of SSRIs and venlafaxine. Although all manufacturers of these medications endeavor to suggest that their product is less likely to cause these effects, there is no compelling evidence to indicate that is true. Comparisons of rates across studies are not fair comparisons because they may differ based on how these problems were assessed. 

Adverse effects are reported with an incidence of 1-3%. The most common include gastrointestinal upset, hypertension, decreased libido, abdominal pain, impotence, back pain, urinary retention, and headache. In comparison to tamsulosin and finasteride, saw palmetto was claimed to be less likely to affect sexual function (eg, ejaculation). 

Androgens Testosterone Testes, adrenals Sexual differentiation, fertility, secondary sex characteristics, sexual function, libido... 

Levodopa (L-dopa) is a natural intermediate in the biosynthesis of catecholamines in the brain and peripheral adrenergic nerve terminals. In the biologic sequence of events it is converted to dopamine, which in turn serves as a substrate of the neurotransmitter norepinephrine. Levodopa is used successfully in the treatment of Parkinson s syndrome, a disease characterized by dopamine deficiency. When levodopa is administered to an individual with this syndrome, the symptoms of Parkinson s disease are ameliorated, presumably because the drug is converted to dopamine and thereby counteracts the deficiency. Individuals treated with levodopa, especially older men, have been observed to experience a sexual rejuvenation. This effect has led to the belief that levodopa stimulates sexual powers. Consequently, studies with younger men complaining of decreased erectile ability have shown that levodopa increases libido and the incidence of penile erections. Overall, however, these effects are short lived and do not reflect continued satisfactory sexual function and potency. Thus, levodopa is not a true aphrodisiac. The increased sexual activity experienced by parkinsonian patients treated with levodopa may reflect improved well-being and partial recovery of normal sexual functions that were impaired by Parkinson s disease. 

Fluoxetine was the first SSRI to reach general clinical use. Paroxetine and sertraline differ mainly in having shorter half-lives and different potencies as inhibitors of specific P450 isoenzymes. While the SSRIs have not been shown to be more effective overall than prior drugs, they lack many of the toxicities of the tricyclic and heterocyclic antidepressants. Thus, patient acceptance has been high despite adverse effects such as nausea, decreased libido, and even decreased sexual function. 

In a chart review of 22 adolescents who were taking SSRIs for a variety of indications and who had been systematically questioned about the effect of their illness and its treatment on their sexual function, five reported significant sexual dysfunction (three cases of anorgasmia, and two of reduced libido), probably attributable to the SSRI (60). This small sample suggests that the rate of sexual dysfunction associated with SSRI treatment in adolescents is very similar to that seen in adults. Issues of sexuality are particularly important in adolescence, but may be difficult to discuss. This study shows the importance of tactful and sensitive enquiry and the probable benefit of clear information about the sexual adverse effects of SSRIs. 

Sexual function Decreased libido Impotence Ejaculation disorder Anorgasmia... 

In addition to the effects on the reproductive functions of the female, there has been some study of the effects of tropic acid esters and related compounds on sexual function In che male. One paper on this topic (125) has been mentioned above. Horowitz and Goble (143) have reviewed the literature on drug-induced sexual dysfunction In the male and have concluded chat any drug with acroplne-llke effects may Interfere with penile erection. (They pointed out that Impotence induced by anclmuscarl e drugs may occur without reduction of libido and may thus be particularly frustrating to the male.)... 

Sexual function is reduced after trauma. Men lose their libido and women experience amenorrhea until convalescence is established. Detailed reports of gonadal function at this time are scanty. Initial studies of urinary gonadotropins following injury suggest that their secretion is diminished (S6). 

The adverse effects of thiazide and thiazide-like diuretics on male sexual function include reduced libido, erectile dysfunction, and difficulty in ejaculating. The exact incidence of sexual dysfunction in patients taking diuretics is poorly documented, perhaps because of the personal nature of the problem and the reluctance of patients and/or physicians to discuss it. However, these abnormalities have been reported with incidence rates of 3-32%. The true incidence of sexual dysfunction probably lies closer to the lower end of this range (119). In a meta-analysis of 13 randomized, placebo-controlled trials conducted over a mean of 4 years the NNH (number needed to harm) for erectile impotence with thiazide diuretics in hypertension was 20 and the relative risk was 5.0 (120). 

The mechanisms by which thiazides affect erectile dysfunction or libido are unclear, but it has been suggested that they have a direct effect on vascular smooth muscle cells or reduce the response to catecholamines. Sexual dysfunction does not appear to be mediated by either a low serum potassium concentration or a low blood pressure. Since sexual dysfunction can adversely affect the quality of life of hypertensive patients, physicians or health-care providers should take an accurate baseline sexual history and monitor sexual status for changes during therapy. If there are significant changes in sexual function, diuretic therapy can be withdrawn and an alternative drug class substituted. However, not uncommonly sexual dysfunction will persist despite withdrawal of the diuretic, suggesting that elements of the hj pertensive state itself contribute to the process. 

Sexual function in men can be compromised by cisplatin + vinblastine + bleomycin chemotherapy. Of 54 patients, 29 had disorders of sexual function 2 years after completion of treatment (234). Ejaculatory dysfunction was tentatively linked to chemotherapy in 30% of those affected. There was reduced libido, usually reversible, in 40 at the time of chemotherapy. 

When libido is decreased, a patient may not develop erections. The relationship between erectile dysfunction and serum testosterone levels is a complicated one. Patients with normal serum testosterone levels may have erectile dysfunction, and patients with subnormal serum testosterone levels may have normal sexual function. ... 

There is indirect evidence that reproductive outcomes might be affected (decreased libido, impotence, and sexual dysfunction have been observed in manganese-exposed men). The available studies on the effect manganese has on fertility (as measured by birthrate) is inconclusive. Two studies in men occupationally exposed to manganese show adverse effects on reproductive parameters one measured sexual dysfunction, the other measured semen and sperm quality, but neither measured birthrate in wives of affected workers. Impaired sexual function in men may be one of the earliest clinical manifestations of manganism, but no dose-response information is currently available, so it is not possible to define a threshold for this effect. There is a lack of information regarding effects in women since most data are derived from studies of male workers. 

In men, occupationally exposed to fluoric intoxication, was observed an easing of sexual function (infringement of libido, erection and ejaculation). Laboratory parameters of these men were characterized by reduction of ejaculate volume, spermatozoa concentration in it, and increase in motionless and degenerated forms of spermatozoa. These changes were 3-4 times more frequent, than in control group. 

Despite the widespread belief that alcohol can enhance sexual activities, the opposite effect is noted more often. Many drugs of abuse, including alcohol, have disinhibiting effects that may lead initially to increased libido. With excessive, long-term use, however, alcohol often leads to a deterioration of sexual function. While alcohol cessation may reverse many sexual problems, patients with significant gonadal atrophy are less likely to respond to discontinuation of alcohol consumption. 

Sexual function in alcohol-dependent women is less clearly understood. Many female alcoholics complain of decreased libido, decreased vaginal lubrication, and menstrual cycle abnormalities. Their ovaries often are small and without follicular development. Some data suggest that fertility rates are lower for alcoholic women. The presence of comorbid disorders such as anorexia nervosa or bulimia can aggravate the problem. The prognosis for men and women who become abstinent is favorable in the absence of significant hepatic or gonadal failure. 

Sexual function SSRIs can cause sexual dysfunction, particularly reduced libido, impaired orgasm in women, and inhibition of ejaculation or erectile difficulties in men. There have been two reports of unusual male sexual dysfunction. In two cases of spermatorrhea (excessive emission of semen without orgasm or erection) in men taking fluvoxamine, the problem resolved on drug withdrawal [IS ]. Spontaneous ejaculations occurred daily in a 27-year-old man after he had taken citalopram for 2 weeks [16 ]. They were unrelated to sexual fantasies, arousal, erection, or any sensation of orgasm and resolved on drug withdrawal. They did not recur when he took paroxetine. 

Sexual function A study of 100 men with psychotic disorders found that the rate of sexual dysfunction was highest for risperidone, followed by trifluoperazine and olanzapine, measured on three different scales [73 ]. Rates of sexual function varied according to the scale used decreased libido was the most prevalent except for orgasmic disorders for risperidone on the ASEX scale. 

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