Sex and Drug Effect

Sex and effect of drugs is an important topic since many drugs that are prescribed for common conditions such as anxiety and hypertension interfere with sexual functioning. Two cases are illustrated here.

CASE I

30 years old Mr. S K was married for two years. he had no premarital contact. He was childless since he advised his wife to be on oral contraceptive pills to delay conception to have uninhibited sex life. He had healthy sexual life with coital frequency of once in three days. He suffered severe financial loss and became depressed. he withdrew from social and sexual life. He went to a GP who prescribed antidepressants. Two months later he detected to be hypertensive and was started on Aten 50 mg. OD. He abstained from sex for six months until his business normalized. The happy man resumed sexual intercourse but notice impotence. He reconsulted his GP who said problem was psychogenic and send him to a psychotherapist for psychotherapy but there was no improvement. In vain attempt to prove sexual fitness, he visited CSW’s (commercial sex workers) but had poor coital response. He visited another doctor who stopped Aten and added calcium channel blockers for his hypertension and stopped antidepressants as the patients was in normal mood now. Patient started having normal coitus with wife and stopped visits to CSW’s. But by then he had contacted HIV infection and died after three years.

CASE II

Mr. R.K, who was having poor erections due to a vasculogenic cause visited his GP. The GP asked for history of previous ischaemic heart disease which the patient denied. his Echo and ECG was normal. Patient was confidently started on sildnafil (Viagra). Patient died after first dose. Subsequently it was discovered that patient had central chest pain diagnosed as diffuse oesophageal spasm for which he was on nitrates.

Lessons Learned from the Cases

• In case I, the doctor failed to realize that the cause of impotence was not psychogenic but drug related. Removal of antidepressants and switching over to calcium channel blockers from Aten by second intelligent doctor restored potency.
• In case II, the doctor failed to realize that nitrates can be used for other condition other than IHD. Both patients unfortunately died.

Cause of Death – Doctor’s Ignorance?

Both cases teach us that

1. A thorough knowledge of drugs affecting sexual functions is needed by the treating doctor.
2. Drug interactions should be known
3. Discuss with patients freely, making him aware of possible side effects and mask him to report impotence.
4. If impotence occurs, switch over to other drugs with similar effects but not causing impotence.
5. To realize that many diseases by themselves cause sexual dysfunction and hence, to carefully establish if dysfunction is due to disease or medicine used for treating the disease.

How Medicines Affect Sexual Functions

Libido or sex drive depends on testosterone level and emotional and physical health.

Therefore, drugs decreasing testosterone levels or affecting emotional and physical health by causing drowsiness, lethargy, weight gain or confusion reduces libido.

• Arousals and erections depends on the coordinated action between nerves, hormones and blood vessels. Therefore, drugs interfering with nerve impulse transmission or drugs decreasing hormonal levels or acting on blood vessels (such as antihypertensives) affect erection.
• Ejaculation depends on a receptor activity. Alpha blockers impair ejaculation.

Drugs that increase libido and genital response are

Androgens, neurotransmitters, L-dopa, CNS stimulants, amphetamine.

Drugs that decrease libido and genital response are

Barbiturates, codeine, methadone, antiandrogens, estrogens, cyproterone acetate, adrenal steroids, cortisone, ACTH, spironolactone.

Drug that increase sexual functioning by acting on genital organs

Amyl nitrate

Drugs that decrease sexual functioning by acting on genital organs

Atropine, quartinary ammonium compounds, methyl dopa, reserpine, ergot alkaloids, beta blockers.

“Double-Edged” Drugs

(ie: drugs causing different effects in different doses.)

1. AMPHETAMINE

• Acute doses enhances libido by stimulating sex centres in the brain. So taken by teenagers as “Ecstasy” before discotheque.
• Chronic use as anorexiants diminishes sexual libido and sexual functioning.

2. ANTI PSYCHOTIC DRUGS

• In patients with mental illness it can improve sexual response as it causes improvement (or) recovery from mental illness.
• But in the very same patient it can cause “Retrograde ejaculation” (or) “Dry ejaculation” by effect on internal vesicle sphincter causing semen emission into bladder.

3. ANTI ANXIETY DRUGS

e.g. Chlordiazeposixde, diazepam.

These can increase sexual interest in anxiety stricken patients by normalizing anxiety associated with life events or sexual performance, hence can improve sexual response. But in slightly higher doses decreases sexual response by muscle relaxing effects – which impair orgasmic response.

4. ANTI DEPRESSANTS

MAOI antidepressants (e.g. moclobemide, phenelzine).

SSRI antidepressants (e.g. fluoxetine, sertraline, citalopram).

Tricyclic antidepressants (e.g. amitryptaline)

In the severely depressed patients by normalizing depression these can increase sexual desire but by there anticholinergic effects, they can cause impotence. COMMONLY USED DRUGS CAUSING SEXUAL DYSFUNCTION

• Antiepileptic – Carbamazepine
• Antiulcer drugs- Cimetidine, omeprazole
• Antilipid agents – Fibrates (clofibrate/gemlibrozil), statin (Simvastatin)
• Antispasmodic – Propantheline

Some sexual side effects reported with use of antihypertensive therapy

What Can We Do, If When Treating Common Conditions – Impotence Develops?

Treatment of High Blood Pressure

• ACE inhibitors such as enalapril do not seem to cause erectile dysfunction.
• Calcium channel blockers and alpha-blockers cause fewer sexual problems than diuretics or beta blockers.

Treatment of Depression

• SSRI’s cause the highest frequency of sexual dysfunction, followed by MAOI’s (Monoamine oxidase inhibitors) and then trycyclic antidepressants.

Treatment of High Cholesterol Levels

• Statin’s have a lower risk of impotence than fibrates.

Conclusion

• Most commonly used drugs have a potential to cause sexual dysfunction.
• The commonly used drugs are antidepressants, antihypertensives and antipsychotics.
• If impotence occurs, substitute with drugs causing similar action but no sexual dysfunction.
• Only good internal medicine specialist can prescribe drug scientifically.

Dr. Ajay Kumar Gupta
Consultant Sex Therapist and Marriage Counsellor,

E-28, Shastri Nagar,
Jaipur-302016

Tel:2303052, 2305052

E-mail: [email protected]

Consultant Sex Therapist and Marriage Counsellor, E-28, Shastri Nagar, Jaipur-302016 Tel:2303052, 2305052

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