close up view of two medicinal tablets

Substance/ Medication Induced Sexual Dysfunction

(I) Substance / Alcohol Induced Sexual Dysfunctions:

  • Initially, many substances enhance sexual performance by decreasing inhibition or anxiety. But with continued use erection, orgasm & ejaculation become impaired.
  • Most of the substance abusers have spent crucial developmental years under the influence of a substance. So, they lack the experience that would have enabled them to learn sexual skills. They usually find themselves helpless during intimate relationship with their partners in the absence of a substance/ alcohol. This is the reason why patients recovering from substance dependency should be treated for sexual dysfunctions simultaneously.

1. Alcohol:

In Men:

  • Decreases testosterone levels
  • Erectile dysfunction
  • Long term use reduces the ability of the liver to metabolize estrogenic compounds which produces signs of feminization (testicular atrophy & gynecomastia).

In Women:

  • Slight rise in testosterone levels. This is the reason why some women report increased libido after drinking small amounts of alcohol.

2. Opioids:

  • Erectile Dysfunction
  • Decreased Libido

3. Cannabis:

  • Prolonged use of cannabis decreases testosterone levels.

4. Sedatives, Anxiolytics, Hypnotics:

  • Depress Sexual Desire.

(II) Medication Induced Sexual Dysfunctions:

1. Antipsychotics:

  • Antipsychotics which are potent anticholinergics (Chlorpromazine & Trifluperazine) impair erection & ejaculation.
  • Antipsychotics may lead to retrograde Ejaculation ( ejaculation occurs but seminal fluid passes back into the bladder. When urinating after orgasm, the urine may be milky white. Patients may feel worried but this condition is harmless)
  • Antipsychotics may rarely lead to Priapism.

2. Antidepressants:

  • Tricyclic Antidepressants have anticholinergic effects which may lead to interference with erection & delayed ejaculation. Sometimes, TCA’s causes painful ejaculation.
  • Clomipramine may increase sexual desire.
  • Bupropion may also increase sexual desire.
  • SSRI’s & Venlafaxine lower sexual desire & difficulty in reaching orgasm.
  • Trazodone can lead to Priapism.
  • MAO inhibitors impair erection, delay ejaculation, retrograde ejaculation, vaginal dryness & inhibited orgasm.

3. Lithium:

Impaired erections are seen some patients.

4. Psychostimulants: (amphatamine, methylphenidate)

Psychostimulants raise plasm levels of norepinephrine & dopamine. This increases libido. However, with prolonged use, loss of desire & erection occurs.

5. Antihypertensives:

Alpha adrenergic & Beta adrenergic receptor antagonists can lead to decreased libido in both sexes & erectile dysfunction, decreased volume of ejaculate and retrograde ejaculation in men.

6. Amantadine:

  • Amantadine can cause dryness of mucous membranes & erectile disorder.
  • However, it reverses SSRI- induced orgasmic dysfunction through its dopaminergic effect.

7. Cyproheptadine:

  • Cyproheptadine has a potent activity as ‘serotonin antagonist’.
  • It can block SSRI- induced sexual dysfunction.

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