Background

Drug-induced sexual dysfunction is a common side effect of various medications. Also, the effect arising from sexual dysfunction may depend on the type of drug, its dosage, use duration, as well as personal factors of a patient. 

Epidemiology

• Prevalence: Impairment of sexual function is reported to occur in many drugs, and prevalence rates differ. For instance, SSRIs are associated with the development of sexual dysfunction in 30-70% of patients using drugs containing this agent. Some of the other medications that commonly cause sexual dysfunction include antipsychotic medications, antihypertensive medications, and some types of anticancer medications used in chemotherapy. 
• Gender Differences: Erectile dysfunction and reduced sexual desire in males as well as reduced sexual desire, sexual arousal disorders, and vaginal dryness in females are some of them. 
• Age Factors: Older people often report drug-induced sexual dysfunction because they are likely to be polypharmacy and complain of age-related sexual dysfunction. 

Anatomy

Pathophysiology

• Neurotransmitters: Most drugs produce an impact on neurotransmitter pathways like the serotonin, dopamine, and norepinephrine which play crucial role in sexual performance. For instance, the drugs used in the treatment of depression, known as selective serotonin reuptake inhibitors (SSRIs) boost the level of serotonin and thus can suppress the sexual desire or sexual arousal. 
• Hormonal Changes: Various drugs like antihypertensive agents, antipsychotics, antidepressants, some antiretroviral drugs, anabolic steroids, and so on can have an impact on the hormone levels especially testosterone and estrogen which play a role in an individual’s sexual desire. 
• Vascular Effects: This includes medications affecting blood pressure or vasodilators commonly known to affect erectile performance or genital arousal. 
• Psychological Impact: Some of side effects of medications are fatigue, depression, anxiety, these factors can have some influence on sexual desire or sexual experience. 
• Direct Receptor Effects: Certain drugs that affect alpha-adrenergic receptors which are part of the sexual response mechanism are among some medications. 

Etiology

• Hormonal Imbalance: A decreased libido or other sexual problems may result from some medicines that alter hormone levels, such as those of testosterone or estrogen. 
• Neurotransmitter Disruption: Drugs that affect the neurotransmitters such as serotonin, dopamine affects the sexual activity and the response. 
• Vascular Effects: Some of the drugs can impact blood vessels or the circulatory system, which is very much related to erectile dysfunction and sexual performance. 
• Psychological Impact: Medications might result in anxiety, depression, or other related diseases that cause sexual dysfunction indirectly. 
• Direct Physical Effects: There may be medicines that act or directly affect the organs or procedures of sexual activity. 

Genetics

Prognostic Factors

It may be suggested that the prognosis is strongly associated with the type of drug used, frequency of dose, and various reactions. In most cases, sexual dysfunction can be overcome by stopping or changing the medication. Thus, replacing a particular medicine with another one or including another medicine that minimizes adverse effects will work sometimes. 

Clinical History

Age Group: 

Young Adults: Certain medication such as antidepressants (SSRIs), or use of drugs such as alcohol, cocaine, nicotine, marijuana can lead to sexual dysfunction. Men could experience a low sexual drive or poor ejaculations. 

Middle-Aged Adults: Antihypertensive drugs or medications used for diabetes, depression, or any other long-term ailment could lead to sexual dysfunction. These include antihypertensive drugs, antidepressants, and antipsychotics, which are some of the commonly used drugs. 

Older Adults: There are problems with sexual functions for medications, or age, and other health issues. Some drugs that affect sexual function are antihypertensives and some psychiatric drugs. 

Physical Examination

• General Health Assessment 
• Endocrine System 
• Genitourinary Exam 
• Neurological Exam 
• Psychiatric Assessment

Age group

Associated comorbidity

• Mental Health Disorders 
• Chronic Illnesses 
• Hormonal Imbalances 
• Substance Use 
• Psychological Stress 

Associated activity

Acuity of presentation

Drug-induced sexual dysfunction can present with a range of symptoms, including: 

• Decreased Libido: For example, a low sexual desire in either of the partners or any reasons that may cause a lack of desire. 
• Erectile Dysfunction: Trouble getting an erection enough for sexual intercourse (males). 
• Delayed Ejaculation: A problem in having an ejaculation or a prolonged time in making it happen (in males). 
• Anorgasmia: Male erectile dysfunction and female sexual dysfunction, notably the difficulty or inability to achieve sexual climax. 
• Altered Arousal: Lack of erection or potency or sensitivity. 

Differential Diagnoses

• Psychological Factors 
• Hormonal Imbalances 
• Neurological Conditions 
• Cardiovascular Issues 
• Chronic Illnesses 
• Substance Abuse 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

• Identifying the Cause: Check the medications the patient currently taking, to know which, one might be causing the problem. 
• Adjusting Medications: Changes in dosage or the use of a drug that will not include effects on sexual functions are recommended. 
• Adding Medications: In some cases, adding a medication to counteract the sexual dysfunction may be effective. For example, sildenafil or other compounds belonging to a series of PDE5 inhibitors might be taken for erectile dysfunction. 
• Non-Pharmacological Interventions: Counselling, sex therapy, or lifestyle changes could improve the patient’s sexual function. 
• Monitoring and Follow-Up: Evaluate the treatment to check its efficacy while making the required changes. 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

lifestyle-modifications-to-treat-drug-induced-sexual-dysfunction

• Consult a Healthcare Professional: It is advisable to discuss with a healthcare practitioner on possible other medications or treatment that has minimal or no impact on sexual functions. 
• Adjust Medication Dosage: Sometimes, this helps in sexual dysfunction but is not severe enough to stop the effectiveness of the medication for its intended purpose. 
• Create a Comfortable Setting: Make sure that the atmosphere is tolerant, and that the person is patient to reduce stress that may be caused by some sexual dysfunctions. 
• Address Psychological Factors: It is helpful to consult with a therapist or psychologist if there are any psychological complaints concerning sexual life. 
• Lifestyle Changes: Discuss workout routines, proper nutrition, and sleep patterns that should be adopted by a couple to enhance their health status and hence their sexual health. 
• Open Communication: Stay in constant contact with your spouse about any problems you may be having, and together you will come up with solutions or other strategies. 

Impact of certain drugs on sexual dysfunction

Impact of Antidepressants on sexual dysfunction 

SSRIs (Selective Serotonin Reuptake Inhibitors):  

Fluoxetine, Sertraline and paroxetine 

They are possible to result in low sexual desire, extended time to the climax, and erectile dysfunction. 

SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) 

Venlafaxine and duloxetine 

These are the drugs that also produce similar sexual side effects. 

Tricyclic Antidepressants (TCAs) 

Amitriptyline and nortriptyline  

These drugs prevent cofactors crucial for the synthesis of female and male sex hormones from entering the red blood cells, which leads to decreased libido, erectile dysfunction, and problems with sexual climax. 

Impact of Antipsychotics on sexual dysfunction

Typical Antipsychotics 

Haloperidol and Chlorpromazine  

These are well known tranquilizers can impair sexual performance; the individual may at times have reduced sex drive, difficulty getting an erection, or reaching a climax. 

Atypical Antipsychotics 

Risperidone and olanzapine 

Some of the drugs that may cause sexual dysfunction include risperidone, olanzapine due to actions on neurotransmitter systems. 

Impact of Antihypertensives in sexual dysfunction

Beta-Blockers 

Propranolol and metoprolol 

Erectile dysfunction and low sexual desire are some possible side effects of propranolol and metoprolol. 

Thiazide Diuretics:  

Hydrochlorothiazide 

Some of the drugs may cause a reduced libido and erectile dysfunction for instance hydrochlorothiazide. 

Impact of Hormonal Medications in sexual dysfunction

Contraceptives:  

Some of the side effects of hormonal contraceptives include changes in the sexual drive and hence sexual activity. 

Anti-Androgens: 

Finasteride or spironolactone 

Medications used to treat prostate cancer or other conditions, such as finasteride or spironolactone, can lead to reduced libido and erectile dysfunction. 

role-of-management-for-drug-induced-sexual-dysfunction

Assessment: To determine the drug that is causing the dysfunction, look at the patient’s symptoms, their medical history, and the current medications. 

Modification: Suggest changing the management strategy and using a medicine free of sexually related side effects or reducing the dosage of the medicine being administered. 

Treatment: Also, think about other therapies that may help, like drugs for erectile dysfunction or psychological issues. 

Follow-up: Watch the patient’s response to the change in the new regimen or treatments to be given and make changes to attain its effectiveness while reducing side effects. 

Education: Inform patients about drug-induced sexual dysfunction and the possibility of its prevention by talking about possible side effects of medications. 

Medication

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References

Antidepressant-associated sexual dysfunction: impact, effects, and treatment – PMC (nih.gov)