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Some Issues Related to Sexual Dysfunction in Men

March/April 2017

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Medicines

Some classes of medicines may increase the risk of ED and some even cause problems with orgasm and/or ejaculation. The following classes of drugs have been associated with ED in some men. A review with your pharmacist can help you identify if the medicines that you are using are on this list of drug classes. Note that there might be drugs/classes that are not listed that may also be linked to ED and this is yet another reason why conversations with pharmacists (in addition to doctors) are important when investigating drug side effects.

  • anabolic steroids
  • anti-anxiety medicines
  • some antidepressants
  • some antacids called histamine-2 antagonists
  • some antiseizure drugs
  • drugs to reduce high blood pressure
  • calcium channel blockers
  • some diuretics (thiazides and spironolactone)
  • hormones -- estrogens and corticosteroids
  • recreational drugs -- alcohol, cocaine, marijuana, methamphetamine


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ART

There is no firm evidence that ART causes ED. This issue is explored in the following report in this issue of TreatmentUpdate. However, Italian doctors who study HIV and ED have suggested that doctors treating HIV-positive patients consider the possibility of changing a person's HIV treatment if "ED appeared soon after starting [this treatment]."


Screening and Treatment of ED

The Italian doctors also recommended that HIV-positive men receive counselling to help them reduce modifiable risk factors they may have that are contributing to ED. Such factors could include the following:

  • cigarette smoking
  • insufficient exercise
  • obesity
  • alcohol and/or other substance use

A next step is to include assessments to uncover underlying biological and hormonal risk factors (including diabetes, reduced testosterone levels, abnormal lipid levels in the blood, and so on). If such problems are found, treating them can help improve overall health and quality of life and perhaps ED.

The most common drugs to treat ED are inhibitors of an enzyme called PDE-5 and include the following:

  • Cialis
  • Levitra
  • Viagra

One of these will usually work for ED. However, in cases where these drugs do not work, referral to a urologist for further investigation can be a useful next step. Note that these drugs can interact with some medicines and recreational substances, so a discussion with your doctor and pharmacist about possible interactions and side effects of ED treatment is necessary.


A Note About Diet

Observational studies suggest that diet can play a role in reducing the risk of developing ED in HIV-negative men. A longitudinal U.S. study that collected data between the years 2000 and 2008 on more than 25,000 men found that those who ate diets high in certain fruits (including strawberries, blueberries, apples, pears and citrus) had a 14% reduced risk for developing ED compared to men who did not eat such a diet. These fruits contain naturally occurring compounds that act as antioxidants and can help to reduce inflammation. When researchers focused on fruits with the highest amount of these compounds -- citrus and blueberries -- the risk of developing ED was reduced by 19%. These effects were most likely in men who were less than 70 years old. These findings should not be misinterpreted to mean that citrus and blueberries can stop ED or are of equivalent potency to ED treatments. Instead, these colourful fruits seem to help reduce the risk for developing ED. They are not a substitute for engaging in other aspects of healthy living (such as quitting smoking, losing weight, engaging in daily exercise and so on).

A much smaller observational study in 65 men, half of whom ate a Mediterranean-type diet (rich in whole grains, fruit, vegetables, nuts, legumes and olive oil) found that those on the diet were less likely to develop ED. Such diets have been known to reduce the risk of type 2 diabetes and cardiovascular disease; that they might have related benefits (such as on ED) is not surprising.

Since diets high in colourful fruits and vegetables have generally beneficial effects, they should also improve the overall health of HIV-positive people and may have an impact on reducing the risk of ED in some HIV-positive men.


Sexual Dysfunction

In addition to ED there are other forms of sexual dysfunction that can occur in men, such as reduced sexual desire or interest in sex. These problems can occur because of anxiety, depression, relationship difficulties and other issues. Loss of interest in sex can occur because of reduced testosterone levels. Some people, for many reasons, may no longer feel desirable.

Thus, in some cases, much investigation by family doctors and/or other specialists may be required to unravel and understand possible factors underlying sexual dysfunction and how to deal with them. This requires time and patience.

More research is needed to understand sexual dysfunction in HIV-positive men and ways to remedy this issue.


References

  1. Santi D, Brigante G, Zona S, et al. Male sexual dysfunction and HIV -- a clinical perspective. Nature Reviews Urology. 2014 Feb;11(2):99-109.
  2. McVary KT. Sexual dysfunction. In: Kasper, Fauci, Hauser, Longo, Jameson, Loscalzo, editors. Harrison's Principles of Internal Medicine. 19th Edition. 2015. McGraw-Hill Education. Pages 324-330.
  3. Lachâtre M, Pasquet A, Ajana F, et al. HIV and hypogonadism: a new challenge for young-aged and middle-aged men on effective antiretroviral therapy. AIDS. 2017 Jan 28;31(3):451-453.
  4. Wunder DM, Bersinger NA, Fux CA, et al. Hypogonadism in HIV-1-infected men is common and does not resolve during antiretroviral therapy. Antiviral Therapy. 2007;12(2):261-5.
  5. Collazos J, Esteban M. Has prolactin a role in the hypogonadal status of HIV-infected patients? Journal of the International Association of Physicians in AIDS Care. 2009 Jan-Feb;8(1):43-6.
  6. Lamers SL, Rose R, Maidji E, et al. HIV DNA Is frequently present within pathologic tissues evaluated at autopsy from combined antiretroviral therapy-treated patients with undetectable viral loads. Journal of Virology. 2016 Sep 29;90(20):8968-83.
  7. Jenabian MA, Costiniuk CT, Mehraj V, et al. Immune tolerance properties of the testicular tissue as a viral sanctuary site in ART-treated HIV-infected adults. AIDS. 2016 Nov 28;30(18):2777-2786.
  8. Slama L, Jacobson LP, Li X, et al. Longitudinal changes over 10 years in free testosterone among HIV-infected and HIV-uninfected men. Journal of Acquired Immune Deficiency Syndromes. 2016 Jan 1;71(1):57-64.
  9. De Ryck I, Van Laeken D, et al. Erectile dysfunction, testosterone deficiency, and risk of coronary heart disease in a cohort of men living with HIV in Belgium. Journal of Sexual Medicine. 2013 Jul;10(7):1816-22.
  10. Biebel MG, Burnett AL, Sadeghi-Nejad H. Male sexual function and smoking. Sexual Medicine Reviews. 2016 Oct;4(4):366-375.
  11. Egeberg A, Hansen PR, Gislason GH, et al. Erectile dysfunction in male adults with atopic dermatitis and psoriasis. Journal of Sexual Medicine. 2017; in press.
  12. Omland T, Randby A, Hrubos-Strøm H, et al. Relation of erectile dysfunction to subclinical myocardial injury. American Journal of Cardiology. 2016 Dec 15;118(12):1821-1825.
  13. Cassidy A, Franz M, Rimm EB. Dietary flavonoid intake and incidence of erectile dysfunction. American Journal of Clinical Nutrition. 2016 Feb;103(2):534-41.
  14. Esposito K, Ciotola M, Giugliano F, et al. Mediterranean diet improves erectile function in subjects with the metabolic syndrome. International Journal of Impotence Research. 2006 Jul-Aug;18(4):405-10.
  15. Boddi V, Fanni E, Castellini G, et al. Conflicts within the family and within the couple as contextual factors in the determinism of male sexual dysfunction. Journal of Sexual Medicine. 2015 Dec;12(12):2425-35.
  16. Chou NH, Huang YJ, Jiann BP. The Impact of illicit use of amphetamine on male sexual functions. Journal of Sexual Medicine. 2015 Aug;12(8):1694-702.
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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication TreatmentUpdate. Visit CATIE's Web site to find out more about their activities, publications and services.
 

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