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Dr.Joe's Data Base

EFFECTS OF DRUGS ON SEXUAL FUNCTION

Common Characteristics

Doctors have become increasingly aware that many common

prescription drugs produce undesirable side effects in male

patients, causing potency problems or affecting other aspects of

sexual functioning. These problems and difficulties are no

longer dismissed with well-meaning words of reassurance, as was

too often the case in the past. Rather, doctors are taking

advantage of the wide variety of drugs now available to work out

solutions that will benefit both their male patients' overall

of the drug, how long the medication is taken, the general

health of the person taking it, and perhaps most important, the

individual's sensitivity to the drug. Not all men taking the

medications that have been reported to cause sexual side effects

will develop problems. If that were the case, few doctors would

prescribe these drugs and even fewer patients would take them.

Sexual side effects have been reported to occur with reserpine

and related drugs prescribed for hypertension (high blood

pressure) and with high doses of tranquilizers (both "minor" and

"major" tranquilizers) prescribed for anxiety and depression.

The side effects of these drugs include impotence, loss of

diminution of sexual desire (libido), breast enlargement, and

an inability to ejaculate. Similar side effects also occur

with drugs commonly prescribed for irritable colon, colitis,

diarrhea, and ulcers; with some drugs given to provide relief

from muscle spasm, nausea, and vomiting; and with drugs taken

to promote weight loss or to lower blood cholesterol levels.

Swelling of the testicles and a reduced sperm count are less

common side effects. It should be reemphasized, however, that

all men taking such medications will not experience these

problems.

Underreporting the Problem

A major obstacle to identifying and solving sexual problems

arising from medicaiton use is lack of awareness. Men may be

more likely to attribute sexual difficulties to marital or

interpersonal problems, stress, or aging than to link these

problems with a drug that they are taking. Too often, failing

to make the connection means that the problem is not brought to

a doctor's attention. This creates a vicious cycle of

underreporting in which doctors, drug companies, and the public

alike remain uninformed about the true frequency of sexual side

effects with various drugs. It is important to remember that

knowledge about drug side effects depends largely on the

willingness of patients to volunteer information about any

problems they may be experiencing.

A second major obstacle is lack of frankness between patients

and doctors. Many people who feel perfectly comfortable telling

a doctor that a particular drug is upsetting their stomach or

making them dizzy shy away from reporting a sexual side effect.

Such uneasiness about sexuality is by no means limited to

patients. Unfortunately, doctors sometimes do not probe as

carefully for side effects on sexual function as they do for the

drug reactions affecting other functions or other parts of the

body. Ideally, doctors should alert their patients to the

possibility of side effects before drug therapy is begun and

should ask about such reactions periodically during the course

of treatment.

Solving the Problem

The first step toward alleviating the sexual difficulty is to

determine whether it is actually related to the medication or

not. If the problem started shortly after the course of

medication was begun, it is probable that the drug is

responsible.

Inability to have an erection at any time suggests that a

medication or a physical illness is responsible for the trouble.

However, if ti is possible to become erect during masturbation

or to achieve an erection with one partner but not with another,

then the cause of impotence is probably psychological--worry,

depression, the wrong partner, the wrong time, or the wrong

place. Awakening with an erection, an event which does not

depend on sexual stimulation, is reassuring evidence that the

sexual function is not physically impaired.

DRUGS THAT AFFECT SEXUAL FUNCTION

Antihypertensives (Decrease Blood Pressure)

Chlorthalidone (Hygroton)

Impotence

Clonidine (Catapres)

Impotence

Hydrochlorothiazide/reserpine (Hydropres)

Loss in Libido

Impotence

Breast swelling in men

Methyldopa (Aldomet)

Loss in libido

Impotence

Breast swelling in men

Reserpine/chlorthalidone (Regroton)

Loss in libido

Impotence

Breast swelling in men

Reserpine/hydralazine/hydrochlorothiazide (Ser-Ap-Es)

Loss in libido

Impotence

Breast swelling in men

Spironolactone (Aldactone)

Impotence

Breast swelling in men

Spironolactone/hydro-chlorothiazide (Aldactazide)

Impotence

Breast swelling in men

Antianxiety/antidepressants

Amitriptyline (Elavil, Endep)

Loss in libido

Breast swelling in men

Testicular swelling

Chlorpromazine (Thorazine)

Breast swelling in men

Diazepam (Valium)

Loss in libido

Doxiepine (Adapin, Sinequan)

Loss in libido

Impotence

Testicular swelling

Imipramine (Tofranil)

Loss in libido

Breast swelling in men

Testicular swelling

Lithium salts

Impotence

Perphenazine/amitriptyline (Etrafon, Triavil)

Loss in libido

Impotence

Breast swelling in men

Testicular swelling

Prochlorperazine (Compazine)

Breast swelling in men

Failure to ejaculate

Thioridazine (Mellaril)

Loss in libido

Breast swelling in men

Failure to ejaculate

Trifluoperazine (Stelazine)

Breast swelling in men

Failure to ejaculate

Gastrointestinal drugs

Chlordiazepoxide/clidinium bromide (librax)

Loss in libido

Cimetidine (Tagamet)

Lower sperm count

Breast swelling in men

Dicyclomine hydrochloride (Bentyl)

Impotence

Prochlorperazine maleate/isopropamide iodide (Combid)

Breast swelling in men

Muscle relaxants

Cyclobenzaprine (Flexeril)

Loss in libido

Breast swelling in men

Testicular swelling

Antinauseants

Prochlorperazine (Compazine)

Breast swelling in men

Failure to ejaculate

Appetite suppressants

Diethylpropion hydrochloride (Tenuate)

Loss in libido

Impotence

Breast swelling in men

Phentermine hydrochloride (Fastin)

Loss in libido

Impotence

Phentermine resin (Ionamin)

Loss in libido

Impotence

Cholesterol-lowering drugs

Clofibrate (Atromid-S)

Loss in libido

Impotence

Antifungal drugs

Metronidazole (Flagyl)

Loss in libido

Hormone agents

Medroxyprogesterone (Provera)

Loss in libido

Other

Alcohol

Loss in libido

Options

If it is determined that a medication is causing the sexual

difficulty, several different options may be considered. If the

problem is only mildly uncomfortable (breast enlargement, for

example), or if the drug must be taken only for a short period

of time (as might be the case with a drug prescribed for an

ulcer), it may be reasonable to continue the medication. On the

other hand, if normal sexual functioning is affected and the

drug has been prescribed for a chronic condition, such as

hypertension, the doctor will probably either reduce the dosage

or change the medication. Once the dosage has been reduced or

another drug has been substituted, the sexual difficulties

should clear up.

Summing up

A number of commonly prescribed drugs may affect normal male

sexual functioning, producing impotence, loss of libido,

inability to ejaculate, and other problems. These are,

naturally, distressing side effects. However, provided the

lines of communication between doctor and patient are kept open,

it is usually possible to change or adjust medication in such a

way that the patient's general health is maintained while his

sexual functioning is not adversely affected.

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