EXPLAINS HOW ALCOHOL AFFECTS PERSONAL LIFE ..

1. SEXUAL DYSFUNCTION
IN
ALCOHOLICS
- DR.VYSHNAV SRINIVASAN
31st Jan 2018

2. OVERVIEW
• INTRODUCTION
• NORMAL SEXUAL HORMONAL FUNCTION
• HORMONAL CHANGES DUE TO HPG AXIS CHANGES
• NORMAL SEXUAL RESPONSE
• NEUROTRANSMITTERS OF SEX
• EFFECT OF ALCOHOL ON SEXUALTY
• TYPES OF SEXUAL DYSFUNCTION IN ALCOHOLICS
• ALCOHOL DURING PREGNENCY
• MANAGEMENT OF ALCOHOL-INDUCED SEXUAL DYSFUNCTION
• REFERENCE

3. INTRODUCTION
• Alcohol use and abuse are widespread problems across the
country
• Alcohol-induced sexual dysfunction is a common problem, but it is
rarely addressed
• Prevalence of Alcohol- induced sexual dysfunction - 48% in males
and 32% in females in a study conducted in an OPD in rural
Karnataka ( Tirthahalli et.al, 2011)

4. NORMAL SEXUAL HORMONAL FUNCTION.
Normal sexual hormonal function is maintained by
HYPOTHALAMO-PITUITARY-GONADAL AXIS.

5. IN MALES..
• FUNCTION OF FSH.
• Stimulates sertoli cells to produce
androgen binding protein, thereby
stimulating spermatogenesis.
• FSH also stimulate sertoli cells to produce
inhibin,which provides negative feedback
to the anterior pituitary to decrease FSH
secretion.
• FUNCTION OF LH.
• Stimulate leydig cells to produce
testosterone.
testosterone provides negative
feedback to anterior pituitary and
hypothalamus.

7. IN FEMALES
GNRH frm hypothalamus stimulate anterior pituitary
to release FSH and LH.
• FUNCTION OF FSH.
• Stimulates ovary to produce steroids..
ovaries will produce estradiol during follicular
phase and progesteron during luteal phase.
• Surge at midcycle,with LH, triggers ovulation.
• FUNCTION OF LH.
• Stimulates ovaries to produce steroids.
• Surge at midcycle triggers ovulation.
leutinising hormones turns the
follicles into the corpeus leuteum by triggering
ovulation.

9. HORMONAL CHANGES IN FEMALE REPRODUCTIVE
SYSTEM DUE TO HPG AXIS CHANGES
• Amenorrhea
• Anovulation
• Luteal phase dysfunction
• Infertility
• Reccurent spontaneous
abortions

10. HORMONAL CHANGES IN MALE REPRODUCTIVE SYSTEM DUE TO
HPG AXIS CHANGES
• Testicular atrophy
• Oligospermia
• Erectile Dysfunction-
partial flaccidity, inability
to sustain erections
• Infertility

11. NORMAL SEXUAL RESPONSE CYCLE
• Male sexual responce their is brief period
of Excitement and Plateau phase followed
by narrow phase or orgasm and Quick
resolution.
• In Female sexual responce,Excitment and
plateau phase last longer than males, it
will be followed by one or multiple
orgasm, and resolution may occur even
without orgasm.

12. NEUROTRANSMITTERS OF SEX
• Dopamine- orgasm
• Serotonin- decreases intensity and frequency of
orgasm
• Norepinephrine- sex drive
• Estrogen- libido
• Progesterone- desire,arousal
• Prolactin- inhibits desire, arousal
• Testosterone- arousal,libido

13. HOW MUCH ALCOHOL CAUSES SEXUAL PROBLEMS?
• maximum daily limit of
alcohol in males is 3-4
units a day .
• maximum daily limit of
alcohol in femals is 2-3
units a day.
• maximum limit a week is
14units.

15. HOW DOES ALCOHOL CAUSE SEXUAL PROBLEMS?
• GABA is the primary inhibitory neurotransmitter of
the brain
• Alcohol is a GABA- facilitatory substance and
increases the GABA in the brain
• In the long run, GABA causes increase in the
number of receptors
• It acts on Tubero-infundibular Dopamine pathway to
raise Serum Prolactin Levels (decreases sexual
pleasure, causes delayed orgasm)
• It acts on the Meso-limbic Dopamine Pathway (to
Ventral Tegmental Area) and causes decreased
orgasmic pleasure

16. EFFECTS OF ALCOHOL ON SEXUALITY
• Indiscriminate sexual behavior
• Sexual Dysfunction
• Paraphilias/ Disorders of Sexual
Preference
• Effects on pregnancy

17. TYPES OF SEXUAL DYSFUNCTION IN ALCOHOLICS
LACK OF SEXUAL DESIRE : persistent or reccurent deficiency or absence of desire for sexual
activity giving rise to marked distress and interpersonal difficulty.
SEXUAL AVERSION : persistent or reccurent aversion and avoidance of all genital sexual
contact leading to marked distress and interpersonal difficulty.
DIFFICULTY IN ERECTION : reccurent or persistent,partial or complete failure to attain or
maintain an erection until the completion of the sex act.

18. DIFFICULTY IN ACHIEVING ORGASM : persistent or reccurent delay in or absence of orgasm,
following a normal sexual excitement phase.
PREMATURE EJACULATION : Persistent or reccurent ejaculation with minimal sexual
stimulation, before, on or shortly after penetration and
before the person wishes it, which causes marked
distress.
VAGINISMIUS or VAGINISM : it is a conditon that affects a womens ability to engage
in vaginal penetration.
it is the result of an involuntary vaginal muscle spasm
which makes any kind of vaginal penetration painful or
impossible.
DYSPAREUNIA : painful sexual intercourse.

19. ALCOHOL DURING PREGNANCY PERIOD..
• A women who drinks alcohol
while she is pregnant may harm
her developing baby(fetus).
• Alcohol can pass from the
mother's blood into the baby's
blood.
• It can damage and affect the
growth of the baby's cell.
• Brain and spinal cord cells are
most likely to have damage.

20. The term fetal alcohol spectrum disorder (FASD) describe the range of alcohol
effect on a child. The problems range from mild to severe.
Alcohol can cause a child to have physical or mental problems that may last all
of his or her life.
The affect of alcohol can include :
 Distinctive facial features- A child may have small head, flat face, and narrow
eye opening, for instance. This gets more obvious by age 2 or 3.
• parallel folds on ear.
• narrow eye opening.
• thin upper lip.
• smooth philtrum.
• upturned nose.
• flat nasal bridge.
FAS : FETAL ALCOHOL SYNDROME

21. GROWTH PROBLEMS : children who were exposed to alcohol before they
were born may be smaller than other children of the same age.
Learning and behavior problems.
BIRTH DEFECTS : Genetic disorders ; Down syndrome, trisomy18.
Sickle cell anemia, cystic fibrosis,
Structural problems, such as heart defects and
neural tube defect, including spina bifida.

22. MANAGEMENT OF ALCOHOL- INDUCED SEXUAL
DYSFUNCTION
• STOP ALCOHOL CONSUMPTION
• Treat the symptoms
• Premature ejaculation - SSRI(fluoxetine,escitalopra, paroxetine)
• Erectile Dysfunction- Sildenafil Citrate, Tadalafil
• Poor force of orgasm, Delayed orgasm- Low dose of
Sildenafil in women
• Testosterone supplementation in men and women
• Estrogen/Progesterone Supplementation in women

23. TAKE-HOME POINTS
• Prevalence of Alcohol- induced sexual dysfunction - 48%
in males and 32% in females
• excess GABA due to alcohol consumption inhibits
dopamine in Tuberoinfundibular and Mesolimbic
Dopamine Pathway to cause sexual dysfunction
• Treatment includes stopping alcohol consumption and
symptomatic management along with counselling

24. • Kaplan and sadock's comprehenssive textbook of psychiatry.
• Park's textbook of community medicine.
• Harison's textbook of inernal medicine.
• KD Tripathi's textbook of pharmacology.
• Guyton's textbook of physiology.

25. THANK YOU..