Sexual function erectile dysfunction

The term impotence has been used to indicate the inability of the male to attain and maintain erection of the penis sufficient to permit satisfactory sexual intercourse. Erectile dysfunction (ED) is the preferred term. ED is a common problem, especially among older men. Perhaps a more precise term for ED is that used to signify inability of the man to achieve an erect penis as part of the multifaceted process of male sexual function. Overall, the process encompasses a variety of physical aspects with significant psychological and behavioral components. 

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. 

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... 

Anabolic steroids, antidepressants and drugs of abuse affect libido, potency, and ejaculatory function. Anabolic steroids are derivatives of testosterone, and have strong genitotropic effects. There is published evidence indicating that anabolic steroids increases sexual desire however, the frequency of erectile dysfunction is also increased. Treatment with the antidepressant fluoxetine has been associated with sexual side effects including delayed or nonexistent ejaculation and hyposexuality. Mice treated in utero with the anideukemic agent 5-aza-2/-deoxycytidine exhibit abnormal reproductive behavior and low reproductive capacity. 

There are many other ways in which SSRIs can interfere with sexual function, for example by causing loss of sexual interest and erectile difficulties. In an open, prospective study of 1000 Spanish patients taking a variety of antidepressants, there was an overall incidence of sexual dysfunction of 59% (15). The highest rates, 60-70%, were found with SSRIs (including fluvoxamine) and venlafax-ine. The lowest rates were found with mirtazepine (24%), nefazodone (8%), and moclobemide (4%). Spontaneous resolution of this adverse effect was uncommon - 80% of subjects had no improvement in sexual function over 6 months of treatment. 

A 49-year-old man with bipolar disorder had erectile dysfunction shortly after starting to take haloperidol 50 mg/day and lithium 1500 mg/day (38). Before this he had had normal sexual function. After 2 months, the dosage of haloperidol was reduced to 20 mg/day, but... 

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. 

Erectile impotence is particularly common in men with diabetes (16), who are likely to have difficulties because of autonomic dysfunction. It is unclear whether younger men and women are similarly affected and whether nor-motensive men have fewer such problems (124). Most investigations of the effects of diuretics on sexual function have been characterized by poor study design (125) the majority had no placebo control and relied on comparisons with baseline. The best studies have suggested an increase in erectile dysfunction in thiazides users compared with placebo. Bearing in mind all the confounding factors, it can be concluded that diuretics will sometimes cause impotence, but that in the population as a whole the effect is slight compared with other causes (SEDA-11, 197) (SEDA-11,198). 

There is some evidence that male sexual dysfunction occurs less often with alpha-blockers than with other types of anti-hjrpertensive drugs (2). For example, in a comparison of the effects of prazosin and hydrochlorothiazide on sexual function in 12 hjrpertensive men, plethysmographic measurements and subjective assessments showed less dysfunction with prazosin than with hydrochlorothiazide (3). There is no evidence that this effect can be used therapeutically, but cases of priapism have been reported for example, a 55-year-old man presented with priapism having taken prazosin 7.5 mg tds for 4 months. After a further 3 months, prazosin was discontinued and erectile function became normal (4). 

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. ... 

The goal of treatment is an improvement in the quantity and quality of penile erections suitable for intercourse. Simple as this may sound, health care providers need to ensure that patients have reasonable expectations for any therapies that are initiated. Furthermore, only patients with erectile dysfunction should be treated. Patients who have normal sexual function should not seek—or be encouraged to seek—treatment in an effort to enhance sexual function or enable increased activity. 

To assess the severity of the erectile dysfunction, the patient should be asked about onset and frequency. A standardized questionnaire, such as the International Index of Erectile Dysfunction, is often used. It includes 15 questions about the quality of erectile function and sexual intercourse (Fig. 81-3). The physician should carefully assess the patient s expectations and motivations for erectile function to ensure that they are reasonable. 

Sexual problems among diabetic patients are considerably better described for men than women. Over the last 35 years hundreds of publications on male sexual problems have become available, whereas relatively few studies have been published on female sexual dysfunction. Much along the same line most therapeutic possibilities have been directed towards diabetic men with erectile dysfunction, whereas only very few or practically no therapies have been developed for diabetic women with sexual problems. Over the last years more focus has been placed on female sexual problems and research efforts in developing efficient drugs have been intensified, undoubtedly driven by considerable commercial interests, but also as recognition of the importance of a well-functioning sexual life in both men and women with diabetes. 

Everybody has the right to a well-functioning sexual life according to the WHO (World Health Organisation, 1995), but unfortunately treatment options are limited, in spite of the introduction of efficient oral treatment for erectile dysfunction. Efficient treatment for women with diabetes does not exist and only inefficient symptom-relieving treatment can be offered the unfortunate. 

Sexual function An American group has systematically reviewed the use of finasteride for the treatment of androgenic alopecia and found 12 published studies in 3927 patients that they regarded as eligible for inclusion [48 ]. As far as adverse reactions were concerned, moderate-quality evidence suggested an increase in erectile dysfunction (RR = 2.2 95% CI = 1.03, 4.8 NNTh=82 95% Cl = 56, 231) and a possible increase in the risk of any sexual disturbances (RR=1.4 95% Cl = 0.99,2.0). However, the risk of discontinuing treatment because of sexual adverse reactions was similar to that of placebo. The authors found moderate evidence that daily use of oral finasteride... 

These two indices give a global evaluation of erectile function, but do not assess other sexual disorders since they do not provide information regarding the causes of erectile dysfunction, which can be organic or psychological or secondary to other health issues... 

During clinical trials, it was found that it acted as a vasodilator more effectively in the penis than in the heart, resulting in increased erectile function. The drug is now used to treat erectile dysfunction and sexual impotence. 

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 Sexual dysfunction in response to new antiepileptic drugs has rarely been described. Reversible erectile... 

Stimulation or improvement of male sexual function in experimental animals, with cured (fried with 20% w/w lamb fat) but not raw epimedium ( . brevicornum) being the active herb The aqueous extract of E. brevicornum was recently found to relax rabbit corpus cavemosum strips, through an NO-mediated mechanism, and may thus have potential for the management of erectile dysfunction in... 

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