Sexual function

Nifedipine (Table 3) is a potent vasodilator that selectively dilates resistance vessels and has fewer effects on venous vessels. It does not cause reflex tachycardia during chronic therapy. Nifedipine is one of the first-line choices for black or elderly patients and patients having concomitant angina pectoris, diabetes, or peripheral vascular diseases. Nifedipine, sublingually, is also suitable for the treatment of hypertensive emergencies. Nifedipine does not impair sexual function or worsen blood Hpid profile. The side effects are flushing, headache, and dizziness. 

Perret M. (1992). Environmental and social determinants of sexual function in the male Lesser Mouse Lemur (Microcebus murinus). Folia Primatol (Basel) 59, 1-25. 

Evaluate the patient for symptoms, such as headache, visual disturbances, menstrual cycles in women, and sexual function in men, to assess clinical response to therapy. 

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

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. 

Larson TR. Current treatment options for benign prostatic hyperplasia and their impact on sexual function. Urology 2003 61 692-698. 

Cunningham M. 1986. Chronic occupational lead exposure The potential effect on sexual function and reproductive ability in male workers. American Association of Occupational Health Nursing Journal 34 277-279. 

FSH and hCG also find application in the treatment of male subfertility or related conditions. Both are administered to males exhibiting hypogonadotrophic hypogonadism to stimulate sperm synthesis and normal sexual function. hCG has found limited application in the treatment of prepubertal cryptorchidism (a condition characterized by failure of the testes to descend fully into the scrotum from the abdomen). The ability of this hormone to stimulate testosterone production also caught the attention of some athletes, and, as a result, the International Olympic Committee has banned its use. 

Modugno F, Ness RB, Exing S, Cauley JA (2003) Effect of raloxifene on sexual function in older postmenopausal women with osteoporosis. Obstet Gynecol 101 353-361... 

Table 2. Possible hormonal effects on sexual function...

Sexual function One of the potential benefits of hypericum is the apparent reduced or lack of adverse effects upon sexual function, compared to pharmaceutical antidepressants. The SSRIs are particularly notorious for inhibition of sexual function, whereas antidepressants with dopaminergic actions (e.g., bupropion) do not, and may actually enhance sexual function (Rosen et al. 1999 Piazza et al. 1997). Anecdotal reports and the fact that there are no clinical reports of sexual dysfunction with hypericum is encouraging, but it remains to be tested empirically. 

Piazza LA, Markowitz JC, Kocsis JH, Leon AC, Portera L, Miller NL, Adler D. (1997). Sexual functioning in chronically depressed patients treated with SSRI antidepressants a pilot study. Am J Psychiatry. 154(12) 1757-59. 

Rosen RC, Lane RM, Menza M. (1999). Effects of SSRIs on sexual function a critical review. J din Psychopharmacoi. 19(1) 67-85. 

In cases where the antidepressant response has not been resounding, we prefer switching antidepressants to avoid sexual side effects. The options include bupropion, nefazodone, and mirtazapine, which all effectively treat depression but produce minimal effects on sexual function. Sometimes, if a patient has responded well to one antidepressant but experiences a side effect such as sexual dysfunction, switching within the same class can be a useful approach. 

Fluoxetine, along with sertraline, fluvoxamine, and paroxetine, belongs to the more recently developed group of SSRI. The clinical efficacy of SSRI is considered comparable to that of established antidepressants. Added advantages include absence of cardiotoxicity, fewer autonomic nervous side effects, and relative safety with overdosage. Fluoxetine causes loss of appetite and weight reduction. Its main adverse effects include overarousal, insomnia, tremor, akathisia, anxiety, and disturbances of sexual function. 

The term reproductive toxicity is sometimes used exclusively to describe toxic effects on male and female sexual function and fertility. More commonly, and in this book, reproductive effects are considered to include adverse effects on sexual function and fertility in males and females as well as developmental toxicity. 

Human sexual function and fertility disorders include, e.g., spontaneous abortions, impaired spermatogenesis, menstrual disorders, impotence, and early menopause. 

Human studies on altered sexual function/fertility provide the most direct means of assessing risk, but data are often unavailable (WHO/IPCS 2001b). 

Sexual dysfunction Atomoxetine appears to impair sexual function in some patients. Changes in sexual desire, performance, and satisfaction are not well assessed in most clinical trials because they need special attention and because patients and physicians may be reluctant to discuss them. Accordingly, estimates of the incidence of untoward sexual experience and performance cited in product labeling are likely to underestimate the actual incidence. 

Adrenergic Alpha lA receptor ADRAIA Agonism Smooth muscle contraction (prostate in particular, effects on the lower urinary tract) and cardiac positive ionotropy, arrhythmia. Antagonism Orthostatic hypotension and other blood pressure related adverse effects and impact on various aspects of sexual function. 

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