Drug-Induced Male Sexual Dysfunction

An Update

Summary

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.

This is a preview of subscription content, log in to check access.

References

  1. Abel EL. A review of alcohols’s effects on sex and reproduction. Drug and Alcohol Dependence 5: 321–322, 1980

    PubMed  Article  CAS  Google 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, 1989

    PubMed  CAS  Google Scholar 

  3. Abramowicz M (Ed.) Drugs that cause sexual dysfunction. Medical Letter on Drugs and Therapeutics 29: 65-70, 1987

  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, 1986

    PubMed  CAS  Google 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, 1988

    PubMed  CAS  Google Scholar 

  6. Bansal S. Sexual dysfunction in hypertensive men: a critical review of the literature. Hypertension 12: 1–10, 1988

    PubMed  Article  CAS  Google Scholar 

  7. Benson GS. Penile erection: in a search of neurotransmitter. World Journal of Urology 1: 209–212, 1983

    Article  Google 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, 1989

    PubMed  CAS  Google Scholar 

  9. Brindley GS. Cavernosal alpha-blockade: a new technique for in-vestigating and treating erectile impotence. British Journal of Psychiatry 143: 332–337, 1983

    PubMed  Article  CAS  Google Scholar 

  10. Buffum J. Pharmacosexology: the effects of drugs on sexual function. A review. Journal of Psychoactive Drugs 14: 5–44, 1982

    PubMed  Article  CAS  Google Scholar 

  11. Buffum J. Pharmacosexology update: prescription drugs and sexual function. Journal of Psychoactive Drugs 18: 97–106, 1986

    PubMed  Article  CAS  Google Scholar 

  12. Buffum J. Prescription drugs and sexual function. Psychiatric Medicine 10: 181–198, 1992

    PubMed  CAS  Google 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, 1989

    PubMed  CAS  Google 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, 1990

    Google 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, 1991

    PubMed  Article  CAS  Google 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, 1990

    PubMed  Article  CAS  Google 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, 1988

    PubMed  Article  CAS  Google 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, 1985

    PubMed  Article  CAS  Google Scholar 

  19. Dalterio S, Bartke A, Mayfield D. Δ-9-Tetrahydrocannabinol in-creases plasma testosterone concentrations in mice. Science 213: 581–583, 1981

    PubMed  Article  CAS  Google Scholar 

  20. Deamer RL, Thompson JF. The role of medications in geriatric sexual function. Geriatric Sexuality 7: 95–111, 1991

    CAS  Google Scholar 

  21. Dollery CT, Harrington M. Methyldopa in hypertension. Lancet 1: 759–763, 1962

    PubMed  Article  CAS  Google Scholar 

  22. Doogan DP. Toleration and safety of sertraline: experience world-wide. International Clinical Psychopharmacology 6(Suppl. 2): 47–56, 1991

    PubMed  Article  Google Scholar 

  23. Fahrner EM. Sexual dysfunction in male alcohol addicts: preva-lence and treatment. Archives of Sexual Behaviour 16: 247–257, 1987

    Article  CAS  Google 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, 1987

    PubMed  Google Scholar 

  25. Ghadirian AM, Annable L, Belanger MC. Lithium, benzodiaze-pines and sexual function in bipolar patients. American Journal of Psychiatry 149: 801–805, 1992

    PubMed  CAS  Google Scholar 

  26. Gilbert DG, Hagen RL, Ds’Agnostino JA. The effects of cigarette smoking on human sexual potency. Addictive Behaviours 11: 431–434, 1986

    Article  CAS  Google Scholar 

  27. Grimsley SR, Jann MW. Paroxetine, sertraline and fluvoxamine: new selective serotonin reuptake inhibitors. Clinical Pharmacy 11: 930–957, 1992

    PubMed  CAS  Google Scholar 

  28. Halikas J, Weiler R, Morse Effects of marijuana use on sexual performance. Journal of Psychoactive Drugs 14: 1–2, 1982

    Article  Google 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, 1985

    PubMed  CAS  Google 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, 1990

    PubMed  CAS  Google 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, 1976

    PubMed  Article  CAS  Google 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, 1989

    Google 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, 1990

    PubMed  Article  CAS  Google 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, 1988

    Google Scholar 

  35. Jacobs P, Bobek SC. Sexual needs of the schizophrenic client. Per-spectives in Psychiatric Care 27: 15–20, 1991

    Article  CAS  Google 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, 1987

    PubMed  CAS  Google 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, 1991

    PubMed  Article  CAS  Google Scholar 

  38. Kolodny RC. Effects of alpha-methyldopa on male sexual function. Sexuality and Disability 1: 223–227, 1987

    Article  Google Scholar 

  39. Krane RJ. Sexual function and dysfunction. In Walsh et al. (Eds) Campbells’s urology, 5th ed., p. 700, WB Saunders, Philadelphia, 1986

    Google Scholar 

  40. Krane RJ, Goldstein I, Saenz de Tejada I. Impotence. New England Journal of Medicine 321: 1648–1659, 1989

    PubMed  Article  CAS  Google Scholar 

  41. Learmonth JR. A contribution to the neurophysiology of the urinary bladder in man. Brain 54: 147–176, 1931

    Article  Google Scholar 

  42. Levine LA, Gerber GS. Acute vasospasm of penile arteries in response to cigarette smoking. Urology 36: 99, 1990

    PubMed  Article  CAS  Google Scholar 

  43. Lue TF. Patients’s goal directed impotence management. Urology Grand Rounds 29: 1–5, 1989

    Google 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, 1992

    Google 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, 1985

    PubMed  CAS  Google 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, 1986

    PubMed  CAS  Google Scholar 

  47. Lue TF, Takamura T, Schmidt RA, Palubinskas AJ, Tanagho EA. Hemodynamics of erection in the monkey. Journal of Urology 130: 1237–1241, 1983

    PubMed  CAS  Google Scholar 

  48. Masters WH, Johnson VE. Human sexual inadequacy, Little Brown, Boston, 1970

    Google Scholar 

  49. McWaine DE, Procci WR. Drug-induced sexual dysfunction. Medical Toxicology 3: 289–306, 1988

    PubMed  CAS  Google Scholar 

  50. Miller NS, Gold MS. The human sexual response and alcohol and drugs. Journal of Substance Abuse Treatment 5: 171–177, 1988

    PubMed  Article  CAS  Google Scholar 

  51. Muller SC, El-Damanhoury H, Ruth J, Lue TF. Hypertension and impotence. European Urology 19: 29–34, 1991

    PubMed  CAS  Google Scholar 

  52. Munjack DJ. The recognition and management of desire phase sexual dysfunction. In Sciarra (Ed.) Gynecological Obstetrics, Harper Row, Philadelphia, 1985

    Google Scholar 

  53. Nadig PW, Ware JC, Blumoff R. Noninvasive device to produce and maintain an erection-like state. Urology 27: 126, 1986

    PubMed  Article  CAS  Google 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, 1990

    PubMed  Article  CAS  Google 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, 1980

    Article  CAS  Google Scholar 

  56. Nielsen BB. Fibroadenomatoid hyperplasia of the male breast. American Journal of Surgical Pathology 14: 774–777, 1990

    PubMed  Article  CAS  Google Scholar 

  57. Oaks WW, Moyer JH. Sex and hypertension. Medical Aspects of Human Sexuality 61: 128, 1972

    Google 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, 1987

    PubMed  Article  CAS  Google Scholar 

  59. Pillay VKG. Some side effects of alpha-methyldopa. South African Medical Journal 50: 625–626, 1976

    PubMed  CAS  Google Scholar 

  60. Remick RA, Froese C, Keller FD. Common side effects associated with monoamine oxidase inhibitors. Progress in Neuro-Psy-chopharmacology 13: 497, 1989

    Article  CAS  Google 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, 1981

    Google 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, 1991

    PubMed  CAS  Google Scholar 

  63. Rosen RC, Kostis JB, Jekelis AW. Beta-blocker effects on sexual function in normal males. Archives of Sexual Behaviour 17: 241–255, 1988

    Article  CAS  Google 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, 1990

    CAS  Google 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, 1990

    PubMed  CAS  Google 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, 1988

    Google Scholar 

  67. Segraves RT. Sexual side effects of psychiatric drugs. International Journal of Psychiatry in Medicine 18: 243–252, 1988

    PubMed  Article  CAS  Google 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, 1985

    Google Scholar 

  69. Shabsigh R, Fishman IJ, Schum C, Dunn JK. Cigarette smoking and other risk factors in vasculogenic impotence. Urology 38: 227–231, 1991

    PubMed  Article  CAS  Google Scholar 

  70. Shabsigh R, Fishman IJ, Scott FB. Evaluation of erectile impotence. Urology 32: 83–90, 1988

    PubMed  Article  CAS  Google 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, 1978

    PubMed  Article  CAS  Google 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, 1986

    PubMed  CAS  Google 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, 1983

    PubMed  Article  CAS  Google 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, 1984

    PubMed  Article  CAS  Google 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, 1990

    Google Scholar 

  76. Soyka LF, Mattison DR. Prescription drugs that affect male sexual function. Drug Therapy 11: 60–76, 1981

    Google Scholar 

  77. Sullivan G, Lukoff D. Sexual side effects of antipyschotic medication: evaluation and interventions. Hospital and Community Psychiatry 41: 1238–1241, 1990

    PubMed  CAS  Google 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, 1988

    Google Scholar 

  79. Van Arsdalen KN, Wein AJ. Male sexual dysfunction. American Urological Association Update Series, Vol. 3, pp. 1–8, AUA, Houston, 1984

    Google Scholar 

  80. Virag R. Intracavernous injection of papaverine for erectile failure. Lancet 2: 938, 1982

    PubMed  Article  CAS  Google 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, 1984

    PubMed  Article  CAS  Google Scholar 

  82. Wagner G. Erection, physiology and endocrinology. In Wagner & Green (Eds) Impotence, pp. 25–36, Plenum Press, New York, 1981

    Google Scholar 

  83. Wein AJ, van Arsdalen KN. Drug-induced male sexual dysfunction. Urologie Clinics of North America 15: 23–31, 1988

    CAS  Google Scholar 

  84. Weiss JN, Mellinger Sexual dysfunction in elderly men. Clinics in Geriatric Medicine 6: 185–196, 1990

    PubMed  CAS  Google Scholar 

  85. Weiss RJ. Effects of antihypertensive agents on sexual function. American Family Physician 44: 2075–2082, 1991

    PubMed  CAS  Google 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, 1987

    PubMed  CAS  Google 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, 1981

    PubMed  Article  CAS  Google Scholar 

  88. Wilson JD, Griffin JE. The use and misuse of androgens. Metabolism 29: 1278–1295, 1980

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Dr Tom F. Lue.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Brock, G.B., Lue, T.F. Drug-Induced Male Sexual Dysfunction. Drug-Safety 8, 414–426 (1993). https://doi.org/10.2165/00002018-199308060-00003

Download citation

Keywords

  • Cocaine
  • Erectile Dysfunction
  • Sexual Function
  • Sexual Dysfunction
  • Impotence