Sexual dysfunction in men

Mitchell JE, Popkin MK. Antidepressant drug therapy and sexual dysfunction in men a review. J Clin Psychopharmacol 1983 3(2) 76-9. 

Despite occasional reports of reduced libido and erectile dysfunction, lithium causes little in the way of sexual dysfunction in men or women (425). In a brief review of the sexual adverse effects of psychotropic drugs, reduced libido and arousal with lithium were mentioned in passing, particularly when it was combined with other drugs (which, of course, makes it difficult to implicate lithium) (426). 

Sleep disturbances (insomnia, nightmares) Prolongation of hypoglycemia Sexual dysfunction in men... 

Quoted in Emil A. Gutheil, Sexual Dysfunctions in Men, in Silvano Arieti (Ed.), American Handbook of Psychiatry, Vol. I, pp. 708-726 p. 711. Alfred C. Kinsey, Wardell B. Pomeroy, and Clyde E. Martin, Sexual Behavior in the Human Male, p. 513. 

Male patients taking clomipramine should be informed of sexual dysfunction as a side effect associated with antidepressants having significant serotonergic activity. Sexual dysfunction in men appears as ejaculatory incompetence, ejaculatory retardation, decreased... 

Basson R, Weijmar Schultz WCM, Binik YM, Brotto L A, Eschenbach DA, Laan E, Utian WH, Wesseknann U, Lankveld Van J, Wyatt G, Leiblum S, Althof SE, Redmond G, Woman s sexual desire and arousal disorders and sexual pain. Lue TF, Basson R, Rosen R, Giuliano F, Khoury S, and Montorsi F. Sexual Medicine. Sexual dysfunctions in men and women. 2nd ed. Paris Health Publications 2004, pp. 851-990. 

Palmer BE. (2003). Sexual dysfunction in men and women with chronic kidney disease and end-stage kidney disease. Adv Ren Replace Ther 10, 48-60. 

FIGURE 14-30. Psychopharmacology is beginning to identify new therapies that are sex-specific and related to sexual functioning. These include treatments for the human sexual response, especially for erectile dysfunction in men, as well as a better appreciation of the role of hormones in managing mood and cognitive disorders in women. 

There is a higher incidence of impaired sexual function in men who take finasteride compared with placebo (58,59). The incidence of erectile dysfunction has been estimated at 5% (60), but it is difficult to estimate, since in many users of the drug other causes are present, including advanced age, heart disease, diabetes, hypertension, smoking, and hypercholesterolemia. Benign prostatic hyperplasia itself can also aggravate or even induce erectile dysfunction. A questionnaire study in New Jersey... 

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. 

The SSRIs (paroxetine, fluoxetine, sertraline, fluvoxamine, citalopram) and SNRI (ven-lafaxine) have an impressive side-effect profile, and this has contributed to their widespread use. Possible adverse effects include nausea, insomnia, and agitation, but these are generally manageable and diminish over time. More significant is the association of the SSRIs with sexual dysfunction, in both men and women. These effects are longer lasting, and can occur in up to 40% of patients (79). A withdrawal syndrome has also been observed with the SSRIs, characterized by dizziness, headache, and irritability upon abrupt discontinuation. This is much less serious than that observed with benzodiazepines. 

Sexual dysfunction in both men and women is also common in MS, and counseling should be offered to both partners. Sildenafil citrate (Viagra), tadalafil (Cialis), and vardenafil (Levitra) are very effective for men with MS who have erectile dysfunction. Viagra is currently being studied in the female population with MS and sexual dysfunction. 

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. 

Antipsychotics can cause sexual dysfunction in women and men, so this should be discussed by the nurse. 

Diabetes may result in a number of sexual problems in men reduced libido, premature ejaculation and erectile dysfunction. Diabetes may result in a number of sexual problems in women reduced or absent libido, problems with arousal, absence of orgasms and genital pain. Generally, diabetic sexual problems in women are of a more complex and multifactorial nature than that of men and is not well described and understood. 

Erectile dysfunction in men is defined as the inability over a minimum of 3 months to achieve and maintain an erection sufficient for sexual intercourse. The mechanism resulting in an erection is complex and depends on a number of factors. By sexual stimulation (smells, sounds, visual inputs, tactile sensations or sexual thoughts) the brain generates signals, primarily from the hypothalamus via the medulla and nerve tracts to the penis resulting in... 

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. 

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