Academic journal article The Canadian Journal of Human Sexuality

Sexual Effects of Medications and Their Interaction: Implication for Men with Physical Disabilities or Chronic Illness

Academic journal article The Canadian Journal of Human Sexuality

Sexual Effects of Medications and Their Interaction: Implication for Men with Physical Disabilities or Chronic Illness

Article excerpt

ABSTRACT: A significant number of patients who present for treatment of erectile dysfunction also have coexisting medical conditions. This paper summarizes common medical conditions and medications that can contribute to erectile difficulties. The association between chronic illnesses such as cardiovascular disease, diabetes mellitus, renal and liver failure, genital and other cancers, and erectile dysfunction is described. The effect of medications that act as central and peripheral initiation blockers, and central and peripheral conditioner blockers are discussed in relation to their potential effects on erectile function.

Key words: Erectile dysfunction Sexual effects of medication Chronic illness Physical disability

INTRODUCTION

The experience of erectile difficulties can have a significant impact on a man's self-esteem, personal relationships, professional work, and quality of life. The NIH Consensus Conference identified erectile dysfunction (ED) as a major cause of emotional stress and marital discord. A recent telephone survey of 500 Canadian men with ED (Pollara Report, 1998) found that 10% of the men had discussed ending their relationship because of it and 30% of those who were divorced attributed the end of their marriage to ED. Regardless of how one chooses to explain this level of distress in some men with ED, my clinical experience suggests that such reactions are both real and emotionally debilitating. Many of my patients who present for treatment of ED also have coexisting medical conditions that can influence ED and its management. In such cases, it is not always clear whether it is the medical condition itself or the treatment that is responsible for ED. This is because treatments (medications, surgery, radiation) can also contribute either directly or indirectly to ED.

This paper focuses on the more common medical conditions and treatments that can cause or contribute to erectile problems. It is clear that both can influence erectile function either directly, by impairing necessary physiological processes, or indirectly, by altering, mood, desire and/or relationships. A combination of direct and indirect effects is not unusual, and so my goal here is to draw these issues to the attention of physicians, pharmacists, other health care professionals and their patients. Although medical conditions and the medications used to treat them can affect various aspects of sexual functioning and relationshipS, I focus here on ED because it is the most frequently reported sexual problem in the age group of men (40-70 years old) that is also most likely to have the medical conditions I will discuss.

Since I will refer simply to ED throughout this paper without specifying severity, it may helpful to first have comparison points for ED in the general population, and in men 40-70 years old. Erectile dysfunction was defined by the 1993 NIH Consensus Development Conference as the inability to achieve an erection sufficient for satisfactory sexual performance (NIH, 1993). More precise scales to assess various dimensions of erectile dysfunction and its severity have been developed (Rosen et al., 1997), but measures of ED have not been uniform across the studies I will cite. The Massachusetts Male Aging Study (MMAS) (Feldman, Goldstein, Hatzichristou, Krane & McKinlay, 1994) found in a large random sample of men 40-70 years of age that ED was present in 52% (17.2% minimal, 25.2% moderate, and 9.6% complete). In a similarly large sample of men aged 18-59 years, Laumann, Gagnon, Michael and Michaels (1994) found that the predominant sexual problems were rapid ejaculation (39%), performance anxiety (17%) and lack of sexual interest (16%). As would be expected from the findings of the Feldman et al. (1994) study, ED was more prevalent in the older age categories.

PREVALENCE OF CHRONIC ILLNESS & CHRONIC DISABILITY AMONG PATIENTS WITH ERECTILE DYSFUNCTIONS

Most of the patients (75%) seen in our ED clinic are between 40 and 70 years of age (Gajewski et al. …

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