(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.
- 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).
- Slight rise in testosterone levels. This is the reason why some women report increased libido after drinking small amounts of alcohol.
- Erectile Dysfunction
- Decreased Libido
- Prolonged use of cannabis decreases testosterone levels.
4. Sedatives, Anxiolytics, Hypnotics:
- Depress Sexual Desire.
(II) Medication Induced Sexual Dysfunctions:
- 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.
- 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.
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.
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.
- Amantadine can cause dryness of mucous membranes & erectile disorder.
- However, it reverses SSRI- induced orgasmic dysfunction through its dopaminergic effect.
- Cyproheptadine has a potent activity as ‘serotonin antagonist’.
- It can block SSRI- induced sexual dysfunction.