Medications and sexual function

The goal of this chapter is to provide an overview of sexual function and dysfunction, with an emphasis on the sexual challenges faced by people with disabilities. Normal sexual response and behavior is discussed along with definitions of various categories of sexual dysfunction in men and women. The sexual dysfunctions commonly seen in patients seen in a physiatry practice are reviewed. Conditions discussed include spinal cord injury, stroke, traumatic brain injury, multiple sclerosis, Parkinson’s disease, cancer, chronic pain, rheumatologic disease, amputation, diabetes, cardiac disease, and depression. Treatments for sexual dysfunctions are discussed in depth.

The aim of the chapter is to provide the reader with an understanding on sexual functioning and how disability, aging, and medication affect this. The specific sexual dysfunction with disability and chronic disorder is discussed. The chapter also looks into the method of sexual evaluation, which includes sexual history, physical examination, and diagnosis. Finally, treatment of sexual dysfunction is addressed.

Opioid analgesics have been widely used to relieve chronic pain conditions; however, a connection between opioid analgesic administration and increased susceptibility to erectile dysfunction (ED) has been hypothesized.

To evaluate whether opioid use was a risk factor for ED in a systematic review and meta-analysis.

The PubMed, Cochrane Library, and Embase databases were searched to identify eligible studies concerning opioid use and risk of ED from inception to April 2017. The association between opioid use and risk of ED was summarized using the relative risk with 95% CI. Sensitivity analyses were conducted to assess potential bias. The Begg and Egger tests were used for publication bias analysis. The GRADE evidence profile tool was used to assess the quality of the evidence.

The overall combined risk estimates for the effect of opioid use on ED were calculated using a random-effects model.

This meta-analysis included 8,829 men (mean age = 41.6 years) from 10 studies, 2,456 of whom received opioid management (duration of intervention = 4 months to 9.5 years). Pooled results demonstrated that the use of opioids was significantly associated with an increased risk of ED (relative risk = 1.96, 95% CI = 1.66–2.32, P < .001). Estimates of the total effects were generally consistent in the sensitivity analysis. No evidence of publication bias was observed. The overall quality of evidence was rated as low.

We found that men with opioid use had a significantly increased prevalence of ED, which suggests that patients and clinicians should be aware of the potential role played by opioid administration in the development of ED.

This is the first meta-analysis performed to describe the relation between opioid use and ED risk based on all available epidemiologic studies. However, the direction of causality between opioid use and risk of ED should be interpreted with caution because most included studies used a cross-sectional design.

Evidence from the included observational studies indicated that men with opioid use had a significantly increased risk of ED. Further randomized controlled trials are still needed to confirm this relation.

Zhao S, Deng T, Luo L, et al. Association Between Opioid Use and Risk of Erectile Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med 2017;14:1209–1219.

Sexuality is a dimension that concerns human health with profound implications not only in the biological and psychological aspects, but also in the social and cultural dimensions, affecting all ages of life. Sexuality in old age is still conditioned by biases, prejudices and from a stereotyped vision, which considered older people as “asexual”, in spite of several studies and surveys showing that older persons have sexual potential to express. In population surveys, a fair number of men and women aged over 60 years reported having sex at least once a month. The most influential predictor of sexual activity seems to be the physical health in older men, and the quality of the relationship in older women. The most common sexual disorders are erectile dysfunction and delayed ejaculation in older men, and reduced sexual interest, arousal disorder, female orgasmic disorder, genitopelvic pain and ailments of penetration in older women. A careful evaluation can identify the presence and severity of disorders in different phases of the sexual response cycle. The management of sexual dysfunction in older people may include reassurance, education, sex therapy and/or the use of drugs in specific cases. Sexuality in patients with dementia may arise as inappropriate sexual behaviour (ISB) due to behavioural disinhibition. Manifestations of ISB can be very distressing for family members and other caregivers and can present substantial challenges for staff and health care providers in long term care. Although there is no established treatment algorithm for dementia-related ISB, there are various non-pharmacological and pharmacological treatments, which can help in the management of these patients.

Sexual dysfunction is an under-recognized problem in men and women with obstructive sleep apnea (OSA). Epidemiologic findings were inconclusive regarding the risk for sexual dysfunction associated with OSA.

The aim of this study was to examine the association between OSA and sexual dysfunction.

The PubMed, Cochrane Library, and Embase databases were searched for observational studies on the OSA and the risk of sexual dysfunction. The methodologic quality of the case–control and cohort studies was assessed with Newcastle–Ottawa Scale (NOS). The cross-sectional study quality methodology checklist was used for cross-sectional study. Data were pooled for the random-effects model. Sensitivity analyses were conducted to assess potential bias.

The association between OSA and sexual dysfunction was summarized using relative risk (RR) with a 95% confidence interval (CI).

This meta-analysis included 1,275 participants from nine studies. Five studies reported the incidence of erectile dysfunction (ED); the remaining four studies reported the incidence of female sexual dysfunction (FSD). Pooled results demonstrated that OSA was associated with increased risk of ED (pooled RR = 1.82, 95% CI: 1.12–2.97) as well as FSD (pooled RR = 2.00, 95% CI: 1.29–3.08). Estimates of the total effects were generally consistent in the sensitivity analysis. No evidence of publication bias was observed.

Evidence from the observational studies suggested that OSA individuals might have an increased incidence of sexual dysfunction despite significant heterogeneity. More researches are warranted to clarify the relationship between OSA and the increased risk of sexual dysfunction. Liu L, Kang R, Zhao S, Zhang T, Zhu W, Li E, Li F, Wan S, and Zhao Z. Sexual dysfunction in patients with obstructive sleep apnea: A systematic review and meta-analysis.