Drugs which affecting sexual health may be a big problem and must keep it in your mind before prescribing a medication Monitoring and treatment of drug induced sexual dysfunction is important step if the physician can not stop the causative agent

1. Drug Induced Sexual dysfunction
Represented by : Ph. Mohammed Ahmed Sadek
Under supervision of
Prof. Dr Ahmed Fahmy
Dr. shaymaa el sayed

2. Introduction
• Definition : Sexual dysfunction is characterized by
disturbance in sexual desire and in the psychophysiological
changes that characterize the sexual response cycle and cause
marked distress and interpersonal difficulty .

3. DSM-TR Diagnoses

4. • Primary
Developmental dysfunctions
• Secondary
Metabolic, Neurological, Endocrine, Genitourinary,
psychiatric
• Situational/Psychosocial
• Substance-induced
Psychotropic, Non-Psychotropics , drugs of abuse
• Genetic basis

5. Secondary causes of Sexual Dysfunction

7. Drugs that cause sexual
dysfunction
• The mechanism of drug-induced sexual dysfunction
Different drugs affect sexual function in different ways depending
on their mechanism of action. Knowledge of the normal biology of
sexual function allows one to predict whether a medication might
cause sexual problems.

8. Medication induced sexual dysfunctions

10. Substance/illict drug induced Sexual dysfunction
1. Alcohol
2. Opioids
3. Cannabis
4. Nicotine
5. Stimulants
6. Cocaine are the common, alcohol being the
highest

11. Drugs that affect sexual function
 Benzodiazepines act as hypnotics and cause drowsiness, thus reducing
desire. In certain doses they can be disinhibiting and may increase libido.
• Numerous case reports of anorgasmia on benzodiazepines
 Antihypertensive
• β-blockers are used to treat hypertension and anxiety. They are commonly
associated with erectile dysfunction in men, owing to their autonomic
effects.
• Many other antihypertensives, including
• ACE inhibitors and calcium channel blockers, can cause erectile disorders.
• Vasodilators and angiotensin-2 receptor antagonists are free of sexual side
effects.
• Thiazide diuretics, such as bendrofluazide, are associated with erectile
dysfunction.

12.  Antidepressants
• Antidepressants are a well-known cause of sexual dysfunction.
This is primarily via activation of 5-HT2 receptors, which inhibit
both noradrenergic and dopaminergic transmission. Generally,
• antidepressants with fewer 5-HT2 effects tend to cause less
sexual dysfunction.
• Depression itself can cause sexual problems, thus it is
sometimes difficult to tease out what is causing any sexual
dysfunction that may be present.
• It is therefore useful to try to get some idea of a person’s sexual
functioning prior to starting antidepressants.

13.  Desire:
• The mesolimbic system has an essential role in sexuality,
mediated by dopaminergic neurotransmission
• Serotonin reuptake blockade reduce dopamine activity in that
area through 5-HT₂ receptors
 Arousal dysfunction could be a result of:
• Low dopamine in the mesolimbic system.
• Inhibition of peripheral spinal reflexes of the sympathetic and
parasympathetic systems which mediate erection and clitoral
engorgement and this is influenced by several
neurotransmitters including serotonin.

14.  Orgasm dysfunction could be related to low dopamine and
noradrenaline levels caused by 5-HT₂ activation.
• Those changes seems to alter the sympathetic and
parasympathetic systems, that are essential for orgasm and
ejaculation.
• Agents that exert antagonism at 5-HT₂ (e.g., mirtazapine and
nefazodone) do not appear to cause sexual dysfunction.

15. Anti depressant drug list induce Sexual
dysfunction

17. Prostate medications: drugs used to treat benign
prostatic hypertrophy (e.g. α-blockers) may cause
ejaculatory problems.
• Finasteride (5-α reductase inhibitor) reduces sexual
desire.
• Tamsulosin (α blocker) associated with approximately
10% increase in ejaculatory dysfunction in treated men
• Drugs used to treat prostatic cancer include anti-
androgens (e.g. cyproterone acetate and flutamide) and
gonadotrophin-releasing hormone analogues (e.g.
goserelin and leuprorelin). These impair the action of
testosterone, thus causing reduced libido and erectile
dysfunction.
Anti-parkinsonian drugs: L-dopa may cause
hypersexuality as a side effect in some cases.

18. Antiepileptics
• Sexual dysfunction is common in patients on
• antiepileptic drugs.Gabapentin and topiramate have
been associated with orgasmic dysfunction in both men
and women, and reduced libido in women
• anorgasmia on gabapentin and carbamazepine
• Case reports of decreased libido, impaired arousal and
anorgasmia on valproate monotherapy
• Carbamazepine (Tegretol) increases serum hormone
binding globulin and thus decreases bioavailabilty of
androgens
• Oxcarbamazpine (Trileptal) does not influence androgen
bioavialabilty

19. • Contraceptives
• Oral contraceptives decrease circulating free
testosterone. It is postulated that this
decreases desire in women, although there is
little evidence tosupport this.
• Depot medroxyprogesterone acetate, used as a
• contraceptive in women, can cause weight gain,
• depression, vaginal atrophy and dyspareunia
with decreased libido in up to 15% of women.

20. Illict drugs
• Psychostimulants tend to increase sexual desire in the
short term, but long-term use may result in reduced
sex drive.
• Amphetamine use is also associated with ejaculatory
disturbance
• in the long term. Long-term cocaine abuse is associated
with reduced sexual sensations in both men and
women and reduced sexual performance in men.
• Ecstasy alters libido and can increase sex drive at the
expense of impaired sexual performance (delayed
orgasm and erectile dysfunction), possibly due to
increased prolactin secretion.

21. • Alcohol is disinhibiting and even in small doses may lead
to increased sexual desire. intoxication can result in
erectile failure and long-term alcohol abuse interferes
with the HPA axis, resulting in reduced testosterone and
feminization in men, and thus reducing sex drive and
performance.
• Anabolic steroids reduce sexual interest, testicular size
and fertility in men. In women they may increase or
reduce sex drive and may be masculinizing.
• Cannabis may cause sexual dysfunction in the long term
in high doses.
• Opiates: heroin reduces sexual feelings and may
decrease desire, and cause erectile and ejaculatory
dysfunction. High-dose methadone is well known to be
associated with sexual dysfunction.

22. Management of drug-induced sexual
dysfunction
• Before starting patients on medications known to cause
sexual dysfunction, it is necessary to obtain a sexual
function history;
• change in sexual function should be monitored on
subsequent visits. Open discussion of the problem may
help to reduce non-adherence later on. This will also help
to distinguish disease- induced sexual dysfunction from
drug-induced sexual dysfunction.
• A number of approaches have been tried to relieve drug-
induced sexual dysfunction, including behavioural
strategies to modify sexual technique, delaying the intake
of the drug until after sexual activity.
• In many cases, drug-induced sexual dysfunction is dose-
related; thus reduction of medication may improve any
dysfunction

23. Management Cont
• However, if this does not help, a ‘drug holiday’ or
changing to a different medication that has fewer sexual
side effects may be necessary. It may take up to 6 weeks
following the switch for improvement to be seen. For
patients who cannot tolerate a reduction of dose or a
switch, it may be necessary to institute a drug to treat
the sexual dysfunction (adjuvant
• therapy), such as sildenafil (Viagra), tadalafil (Cialis),
vardenafil (Levitra) or yohimbine

24. • In women, oestrogen cream can alleviate local symptoms
such as atrophic vaginitis and dyspareunia.
• If a woman complains of sexual dysfunction while on an
injectable progestogen, another form of contraceptive
can be considered
• In appropriate cases, psychosexual therapy should be
offered and, with all patients, attention should be paid to
the effects on the whole person