Drug Safety

, Volume 8, Issue 6, pp 414–426 | Cite as

Drug-Induced Male Sexual Dysfunction

An Update
  • Gerald B. Brock
  • Tom F. Lue
Review Article Drug Experience


Impotence, defined as the consistent inability to maintain an erect penis of sufficient rigidity for sexual intercourse, has been estimated to affect 10 million American men. An age dependence has been shown to exist, with 25% of men over age 65 affected. A large body of clinical experience and published reports in the literature link many commonly prescribed drugs with sexual dys-function.

Drugs can affect sexual function at a variety of points such as inhibition of ejaculation or sedation/depression leading to reduced libido. Antihypertensive drugs have been most commonly associated with impotence. There have been reports of sexual dysfunction with almost all classes of antipsychotics, but little clinical investigation has been performed. Other drugs associated with sexual dysfunction include digoxin, clofibrate, cimetidine and various hormonal agents and antineoplastics.

An important first step in approaching all impotent patients is the taking of a detailed medical, surgical, sexual and drug/substance abuse history. The least invasive form of therapy should be employed. Recent studies have shown intracavernous injections of alprostadil (prostaglandin E1) to be safe and effective for long term use. Vacuum constriction devices may also be of help. Better and more durable prostheses are now available should other treatment be unsuccessful.


Cocaine Erectile Dysfunction Sexual Function Sexual Dysfunction Impotence 
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  1. Abel EL. A review of alcohols’s effects on sex and reproduction. Drug and Alcohol Dependence 5: 321–322, 1980PubMedCrossRefGoogle Scholar
  2. Aboseif SR, Breza J, Bosch R, Steif CG, Lue TF, et al. Local and systemic effects of chronic intravenous injection of papaverine prostaglandins El and saline in primates. Journal of Urology 142: 403–408, 1989PubMedGoogle Scholar
  3. Abramowicz M (Ed.) Drugs that cause sexual dysfunction. Medical Letter on Drugs and Therapeutics 29: 65-70, 1987Google Scholar
  4. Adaikan PG, Kottegoda SR, Ratnam SS. Is vasoactive intestinal polypeptide the principal transmitter involved in human penile erection? Journal of Urology 135: 638–640, 1986PubMedGoogle Scholar
  5. Balducci L, Phillips DM, Gearhart JG, Little DD, Bowie C, et al. Sexual complications of cancer treatment. American Family Physician 37: 159–172, 1988PubMedGoogle Scholar
  6. Bansal S. Sexual dysfunction in hypertensive men: a critical review of the literature. Hypertension 12: 1–10, 1988PubMedCrossRefGoogle Scholar
  7. Benson GS. Penile erection: in a search of neurotransmitter. World Journal of Urology 1: 209–212, 1983CrossRefGoogle Scholar
  8. Breza J, Aboseif SR, Orvis BR, Lue TF, Tanagho EA. Detailed anatomy of penile neurovascular structures: surgical signifi-cance. Journal of Urology 141: 437–443, 1989PubMedGoogle Scholar
  9. Brindley GS. Cavernosal alpha-blockade: a new technique for in-vestigating and treating erectile impotence. British Journal of Psychiatry 143: 332–337, 1983PubMedCrossRefGoogle Scholar
  10. Buffum J. Pharmacosexology: the effects of drugs on sexual function. A review. Journal of Psychoactive Drugs 14: 5–44, 1982PubMedCrossRefGoogle Scholar
  11. Buffum J. Pharmacosexology update: prescription drugs and sexual function. Journal of Psychoactive Drugs 18: 97–106, 1986PubMedCrossRefGoogle Scholar
  12. Buffum J. Prescription drugs and sexual function. Psychiatric Medicine 10: 181–198, 1992PubMedGoogle Scholar
  13. Bulpitt CJ, Beevers DG, Butler A, Coles EC, Hunt D, et al. The effects of antihypertensive drugs on sexual function in men and women: a report from the DHSS hypertension care computing project (DHCCP). Journal of Human Hypertension 3: 53–56, 1989PubMedGoogle Scholar
  14. Carroll PR, Lue TF, Narayan P, Tanagho EA. Impotence and incontinence after radical prostatectomy: pathophysiology and management. In Williams & Carroll (Eds) Advances in urological oncology: treatment and perspectives, Pergamon Press, Elmsford, 1990Google Scholar
  15. Chang SW, Fine R, Siegel D, Chesney M, Black D, et al. The impact of diuretic therapy on reported sexual function. Archives of Internal Medicine 151: 2402–2408, 1991PubMedCrossRefGoogle Scholar
  16. Christ GJ, Maayani F, Ealcic M, Melman A. Pharmacological studies of human erectile tissue: characteristics of spontaneous contractions and alterations in α-adrenoceptor responsiveness with age and disease in isolated tissues. British Journal of Pharmacology 101: 375–381, 1990PubMedCrossRefGoogle Scholar
  17. Cocores JA, Miller NS, Pottash AC. Sexual dysfunction in abusers of cocaine and alcohol. American Journal of Drug and Alcohol Abuse 14: 169–173, 1988PubMedCrossRefGoogle Scholar
  18. Curb JD, Borhani NO, Schnaper H, Kass E, Entwisle G, et al. Detection and treatment of hypertension in older individuals. American Journal of Epidemiology 121: 371–376, 1985PubMedCrossRefGoogle Scholar
  19. Dalterio S, Bartke A, Mayfield D. Δ-9-Tetrahydrocannabinol in-creases plasma testosterone concentrations in mice. Science 213: 581–583, 1981PubMedCrossRefGoogle Scholar
  20. Deamer RL, Thompson JF. The role of medications in geriatric sexual function. Geriatric Sexuality 7: 95–111, 1991Google Scholar
  21. Dollery CT, Harrington M. Methyldopa in hypertension. Lancet 1: 759–763, 1962PubMedCrossRefGoogle Scholar
  22. Doogan DP. Toleration and safety of sertraline: experience world-wide. International Clinical Psychopharmacology 6(Suppl. 2): 47–56, 1991PubMedCrossRefGoogle Scholar
  23. Fahrner EM. Sexual dysfunction in male alcohol addicts: preva-lence and treatment. Archives of Sexual Behaviour 16: 247–257, 1987CrossRefGoogle Scholar
  24. Fournier Jr GR, Jueneman KP, Lue TF. Mechanism of venous occlusion during canine penile erection: an anatomic demon-stration. Journal of Urology 137: 163–167, 1987PubMedGoogle Scholar
  25. Ghadirian AM, Annable L, Belanger MC. Lithium, benzodiaze-pines and sexual function in bipolar patients. American Journal of Psychiatry 149: 801–805, 1992PubMedGoogle Scholar
  26. Gilbert DG, Hagen RL, Ds’Agnostino JA. The effects of cigarette smoking on human sexual potency. Addictive Behaviours 11: 431–434, 1986CrossRefGoogle Scholar
  27. Grimsley SR, Jann MW. Paroxetine, sertraline and fluvoxamine: new selective serotonin reuptake inhibitors. Clinical Pharmacy 11: 930–957, 1992PubMedGoogle Scholar
  28. Halikas J, Weiler R, Morse Effects of marijuana use on sexual performance. Journal of Psychoactive Drugs 14: 1–2, 1982CrossRefGoogle Scholar
  29. Hedlund H, Andersson KE. Contraction and relaxation induced by some prostanoids in isolated human penile erectile tissue and cavernous artery. Journal of Urology 134: 1245–1250, 1985PubMedGoogle Scholar
  30. Herman JB, Brotman AW, Pollack MH, Falk WE, Biederman J, et al. Fluoxetine induced sexual dysfunction. Journal of Clinical Psychiatry 51: 25–27, 1990PubMedGoogle Scholar
  31. Hollifield JW, Sherman K, Zwagg RU, Shand DG. Proposed mechanisms of propranolos’s antihypertensive effect in essential hypertension. New England Journal of Medicine 295: 68–73, 1976PubMedCrossRefGoogle Scholar
  32. Hsieh JT, Muller SC, Lue TF. The influence of blood flow and blood pressure on penile erection. International Journal of Impotence Research 1: 35–42, 1989Google Scholar
  33. Ignarro LJ, Bush PA, Buga GM, Wood KS, Fukuto JM, et al. Nitric oxide and cyclic GMP formation upon electrical stimulation cause relaxation of corpus cavernosum smooth muscle. Biochemical and Biophysical Research Communications 170: 843–850, 1990PubMedCrossRefGoogle Scholar
  34. Ishii N, Watanabe H, Irisawa C, Kikuchi Y, Kawamura S, et al. Studies on male sexual impotence, report 18. Therapeutic trial with prostaglandin E1 for organic impotence. Nippon Hiayokika Gakkai Zashi 77: 954, 1988Google Scholar
  35. Jacobs P, Bobek SC. Sexual needs of the schizophrenic client. Per-spectives in Psychiatric Care 27: 15–20, 1991CrossRefGoogle Scholar
  36. Juenemann K-P, Lue TF, Luo JA, Benowitz NL, Abozeid M, et al. Effect of cigarette smoking on penile erection. Journal of Urology 138: 438–441, 1987PubMedGoogle Scholar
  37. Kim N, Azadzoi KM, Goldstein I, Saenz de Tejada I. A nitric oxide-like factor mediates nonadrenergic-noncholinergic neurogenic relaxation of penile corpus cavernosum smooth muscle. Journal of Clinical Investigation 88: 112–118, 1991PubMedCrossRefGoogle Scholar
  38. Kolodny RC. Effects of alpha-methyldopa on male sexual function. Sexuality and Disability 1: 223–227, 1987CrossRefGoogle Scholar
  39. Krane RJ. Sexual function and dysfunction. In Walsh et al. (Eds) Campbells’s urology, 5th ed., p. 700, WB Saunders, Philadelphia, 1986Google Scholar
  40. Krane RJ, Goldstein I, Saenz de Tejada I. Impotence. New England Journal of Medicine 321: 1648–1659, 1989PubMedCrossRefGoogle Scholar
  41. Learmonth JR. A contribution to the neurophysiology of the urinary bladder in man. Brain 54: 147–176, 1931CrossRefGoogle Scholar
  42. Levine LA, Gerber GS. Acute vasospasm of penile arteries in response to cigarette smoking. Urology 36: 99, 1990PubMedCrossRefGoogle Scholar
  43. Lue TF. Patients’s goal directed impotence management. Urology Grand Rounds 29: 1–5, 1989Google Scholar
  44. Lue TF. Physiology of erection and pathophysiology of impotence. In Walsh et al. (Eds) Campbells’s urology, 6th ed., p. 709, W.B. Saunders, Philadelphia, 1992Google Scholar
  45. Lue TF, Hricak, H, Maricn, KW, Tanagho EA. Vasculogenic impotence evaluated by high resolution ultrasonography and pulsed Doppler spectrum analysis. Radiology 155: 777–781, 1985PubMedGoogle Scholar
  46. Lue TF, Hricak H, Schmidt RA, Tanagho EA. Functional evaluation of penile veins by cavernosography in papaverine-induced erection. Journal of Urology 135: 479–482, 1986PubMedGoogle Scholar
  47. Lue TF, Takamura T, Schmidt RA, Palubinskas AJ, Tanagho EA. Hemodynamics of erection in the monkey. Journal of Urology 130: 1237–1241, 1983PubMedGoogle Scholar
  48. Masters WH, Johnson VE. Human sexual inadequacy, Little Brown, Boston, 1970Google Scholar
  49. McWaine DE, Procci WR. Drug-induced sexual dysfunction. Medical Toxicology 3: 289–306, 1988PubMedGoogle Scholar
  50. Miller NS, Gold MS. The human sexual response and alcohol and drugs. Journal of Substance Abuse Treatment 5: 171–177, 1988PubMedCrossRefGoogle Scholar
  51. Muller SC, El-Damanhoury H, Ruth J, Lue TF. Hypertension and impotence. European Urology 19: 29–34, 1991PubMedGoogle Scholar
  52. Munjack DJ. The recognition and management of desire phase sexual dysfunction. In Sciarra (Ed.) Gynecological Obstetrics, Harper Row, Philadelphia, 1985Google Scholar
  53. Nadig PW, Ware JC, Blumoff R. Noninvasive device to produce and maintain an erection-like state. Urology 27: 126, 1986PubMedCrossRefGoogle Scholar
  54. Nakagawa S, Watanabe HO, Nakao M. Sexual behaviour in Japanese males relating to area occupation, smoking, drinking and eating habits. Andrologia 22: 21–28, 1990PubMedCrossRefGoogle Scholar
  55. Neri A, Aygen M, Zukerman Z, Bahary C. Subjective assessment of sexual dysfunction on long term administration of digoxin. Archives of Sexual Behaviour 9: 343–347, 1980CrossRefGoogle Scholar
  56. Nielsen BB. Fibroadenomatoid hyperplasia of the male breast. American Journal of Surgical Pathology 14: 774–777, 1990PubMedCrossRefGoogle Scholar
  57. Oaks WW, Moyer JH. Sex and hypertension. Medical Aspects of Human Sexuality 61: 128, 1972Google Scholar
  58. Palmer RMJ, Ferrige AG, Moneada S. Nitric oxide release accounts for the biological activity of endothelium-derived relaxing factor. Nature 327: 524–526, 1987PubMedCrossRefGoogle Scholar
  59. Pillay VKG. Some side effects of alpha-methyldopa. South African Medical Journal 50: 625–626, 1976PubMedGoogle Scholar
  60. Remick RA, Froese C, Keller FD. Common side effects associated with monoamine oxidase inhibitors. Progress in Neuro-Psy-chopharmacology 13: 497, 1989CrossRefGoogle Scholar
  61. Report of Medical Research Council Working Party on mild to moderate hypertension. Adverse reaction to bendrofluazide and propranolol for the treatment of mild hypertension. Lancet 2: 539–543, 1981Google Scholar
  62. Rosen MP, Greenfield AJ, Walker TG, Grant P, Dubrow J, et al. Cigarette smoking: an independent risk factor for atherosclerosis in the hypogastric-cavernous arterial bed of men with arteriogenic impotence. Journal of Urology 145: 759–763, 1991PubMedGoogle Scholar
  63. Rosen RC, Kostis JB, Jekelis AW. Beta-blocker effects on sexual function in normal males. Archives of Sexual Behaviour 17: 241–255, 1988CrossRefGoogle Scholar
  64. Rosenthal T, Grossman E, Rathaus M, Bernheim J, Zeuin D, et al. Treatment of hypertension by enalapril and hydrochlorothiazide separately and together: a multicenter study. Israel Journal of Medical Science 26: 63–66, 1990Google Scholar
  65. Roy JB, Petrone R, Said SI, Paul S. Clinical trial of intracavernous vasoactive intestinal peptide to induce penile erection. Journal of Urology 143: 302–304, 1990PubMedGoogle Scholar
  66. Saenz de Tejada I, Blanco R, Goldstein I, Azadzoi K, de las Morenas A, et al. Cholinergic neurotransmission in human corpus cavernosum. Response of isolated tissue. American Journal of Physiology 254: 459–467, 1988Google Scholar
  67. Segraves RT. Sexual side effects of psychiatric drugs. International Journal of Psychiatry in Medicine 18: 243–252, 1988PubMedCrossRefGoogle Scholar
  68. Segraves RT, Madsen R, Carter CS, Davis JM. Erectile dysfunction associated with pharmacological agents. In Segraves & Schoenberg (Eds) Diagnosis and treatment of erectile disturbances, pp. 23–63, Plenum, New York, 1985CrossRefGoogle Scholar
  69. Shabsigh R, Fishman IJ, Schum C, Dunn JK. Cigarette smoking and other risk factors in vasculogenic impotence. Urology 38: 227–231, 1991PubMedCrossRefGoogle Scholar
  70. Shabsigh R, Fishman IJ, Scott FB. Evaluation of erectile impotence. Urology 32: 83–90, 1988PubMedCrossRefGoogle Scholar
  71. Shirai M, Ishii N, Mitsukawa S, Matsuda S, Nakamura M. Hemodynamic mechanism of erection in the human penis. Archives of Andrology 1: 345–349, 1978PubMedCrossRefGoogle Scholar
  72. Sidi AA, Cameron JS, Duffy LM, Lange PH. Intracavernous drug-induced erections in the management of male erectile dysfunction: experience with 100 patients. Journal of Urology 135: 704–706, 1986PubMedGoogle Scholar
  73. Slag MF, Morley JE, Elson MK, Trence DL, Nelson CJ, et al. Impotence in medical outpatients. Journal of the American Medical Association 249: 1736–1740, 1983PubMedCrossRefGoogle Scholar
  74. Smith DE, Wesson DR, Apter-Marsh M. Cocaine and alcohol induced sexual dysfunction in patients with addictive disease. Journal of Psychoactive Drugs 16: 359–361, 1984PubMedCrossRefGoogle Scholar
  75. Smith ER, Maurice J, Richardson R, Walter T, Davidson JM. Effects of four beta-adrenergic receptor antagonists on male sexual behaviour. Pharmacology Biochemistry and Behaviour 36: 1713–1717, 1990Google Scholar
  76. Soyka LF, Mattison DR. Prescription drugs that affect male sexual function. Drug Therapy 11: 60–76, 1981Google Scholar
  77. Sullivan G, Lukoff D. Sexual side effects of antipyschotic medication: evaluation and interventions. Hospital and Community Psychiatry 41: 1238–1241, 1990PubMedGoogle Scholar
  78. Troutman WG. Drug-induced sexual dysfunction. In Knoben & Anderson (Eds) Handbook of clinical drug data, 6th ed., pp. 112–119, Drug Intelligence Publications, Hamilton, 1988Google Scholar
  79. Van Arsdalen KN, Wein AJ. Male sexual dysfunction. American Urological Association Update Series, Vol. 3, pp. 1–8, AUA, Houston, 1984Google Scholar
  80. Virag R. Intracavernous injection of papaverine for erectile failure. Lancet 2: 938, 1982PubMedCrossRefGoogle Scholar
  81. Virag R, Frydman D, Legman M, Virag H. Intracavernous injection of papaverine as a diagnostic and therapeutic method in erectile failure. Angiology 35: 79–87, 1984PubMedCrossRefGoogle Scholar
  82. Wagner G. Erection, physiology and endocrinology. In Wagner & Green (Eds) Impotence, pp. 25–36, Plenum Press, New York, 1981CrossRefGoogle Scholar
  83. Wein AJ, van Arsdalen KN. Drug-induced male sexual dysfunction. Urologie Clinics of North America 15: 23–31, 1988Google Scholar
  84. Weiss JN, Mellinger Sexual dysfunction in elderly men. Clinics in Geriatric Medicine 6: 185–196, 1990PubMedGoogle Scholar
  85. Weiss RJ. Effects of antihypertensive agents on sexual function. American Family Physician 44: 2075–2082, 1991PubMedGoogle Scholar
  86. Williams GH, Croog SH, Levine S, Testa MA, Sudilovsky A. Impact of antihypertensive therapy on quality of life: effect of hydrochlorothiazide. Journal of Hypertension 5(Suppl. 1): S29–S35, 1987PubMedGoogle Scholar
  87. Willis E, Ottesen B, Wagner G, Sundler F, Fahrenkrug J. Vasoactive intestinal polypeptide (VIP) as a possible neurotransmitter involved in penile erection. Acta Physiologica Scandinavica 113: 545–547, 1981PubMedCrossRefGoogle Scholar
  88. Wilson JD, Griffin JE. The use and misuse of androgens. Metabolism 29: 1278–1295, 1980PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 1993

Authors and Affiliations

  • Gerald B. Brock
    • 1
  • Tom F. Lue
    • 1
  1. 1.Department of UrologyUniversity of California Medical SchoolSan FranciscoUSA

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