Sexual risk-taking

The highest mean number of sexual partners while in Spain was shown by females taking oral contraceptives (0.63, N = 8) followed by those not taking contraceptives but in the second half of their menstrual cycle (0.55 N = 11) and finally those in the first half of their menstrual cycle (0.50 N = 12). The differences, however, were not significant (ANOVA F 2 28 = 0.06 P = 0.94). Differences in risk of conception for the three groups were in any case probably minimal, given that the menstrual cycles of well over half of even the women not taking oral contraceptives would be anovulatory (Baker, unpublished data). 

The first and least intrnsive approach is to change the dosing schedule. Sexual side effects of these medications tend to be most problematic when the medication levels are at their peak. Therefore, if the medication is taken at bedtime (i.e., just after most sexual activity), then levels will be at their lowest during the evening hours when patients are most likely to engage in sex. This simple change can adequately alleviate the sexual side effects for some patients and is certainly worth a try. Of course, there is some risk that taking the medication at bedtime will accentuate other problematic side effects such as insomnia. When this measure fails, more extensive steps must be taken. 

Cocaine also has a reputation for being disinhibit-ing. Users may take unusual risks that can lead to longterm consequences. These risks can range from sexual encounters to automobile accidents caused by poor judgment or aggression. 

A similar study from Sweden reported identical findings (8). If we take a baseline annual rate of I % for a 50-year old man, as a result of weekly sexual activity, the risk of an Ml increases to 1.01 % in those without a history of a previous Ml and to I. I % in those with a previous history. 

All prescription drug abuse may lead to harmful consequences such as accidents, injuries, blackouts, legal problems, and unsafe sexual behavior, which can increase the risk of acquiring sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). Specifically, each class of drugs has certain potentially life-threatening consequences of abuse. The abuse of opioids may lead to severe respiratory depression and inability to breathe, which can lead to death. Depressants may also cause respiratory depression and may lead to seizures if an addict suddenly stops taking them. Stimulants speed up the body s activities and raise blood pressure and heart rate, and when abused, may lead to a heart attack, stroke, or a seizure. Combinations... 

The adverse sexual effects of SSRIs have been reviewed (58). The use of SSRIs is most often associated with delayed ejaculation and absent or delayed orgasm, but reduced desire and arousal have also been reported. Estimates of the prevalence of sexual dysfunction with SSRIs vary from a small percentage to over 80%. Prospective studies that enquire specifically about sexual function have reported the highest figures. Similar sexual disturbances are seen in patients taking SSRIs for the treatment of anxiety disorders (59), showing that SSRI-induced sexual dysfunction is not limited to patients with depression. It is not clear whether the relative incidence of sexual dysfunction differs between the SSRIs, but it is possible that paroxetine carries the highest risk (58). 

As we saw with HIV, individual behavior, particularly high-risk behaviors such as unprotected sex and illicit drug use, has the ability to spawn epidemics. According to the World Health Organization, there are approximately 340 million cases of sexually transmitted infections a year worldwide (World Health Organization, 2003 a). These preventable diseases can result in illness, infertility, and disability, as well as death. It is imperative for infectious disease prevention programs and interventions to take these complex social-behavioral components into consideration (Institute of Medicine of the National Academies, 2003). 

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). 

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