Medications that may contribute to sexual disorders: a guide to assessment and treatment in family practice

Journal of Family Practice, Jan, 1997 by William W. Finger, Margaret Lund, Mark A. Slagel

(*) Case report(s), package insert, or uncertain frequency; (**) infrequent side effect; (***) frequent side effect; (****) very frequent side effect.

Note: Medications and the accompanying side effects that have been cited frequently as causing sexual disorders are in bold type.

ILLICIT DRUGS, NONPRESCRIPTION MEDICATION, AND OTHER SUBSTANCE EFFECTS

Illicit drugs should not be overlooked in evaluating sexual disorders (Table 5). While physicians know the detrimental effects alcohol can have on sexual function, many patients still believe alcohol will improve sexual function, and they may increase alcohol consumption in response to sexual difficulties. Chronic alcohol abuse may cause hormonal alterations and permanent damage to circulatory and nervous systems,[10,19] so determining whether there is a history of alcohol abuse, as well as current use, is also important. In addition, major and minor tranquilizers, cocaine, and even cigarettes[46,47] have been implicated in sexual disorders. So-called designer drugs (eg, MDMA, "ecstasy") have been less extensively studied, but have been implicated in changes in sexual response and function.[48] Many of these drugs may be overlooked by the patient as a potential cause of his sexual difficulty, as many of these drugs are believed to improve sexual performance by reducing inhibitions, delaying ejaculation, and so on. Any drug that decreases inhibitions and delays ejaculation is likely to have the potential to alter physiological responses necessary for effective sexual function. Although acute effects may enhance sexual function, chronic effects are typically detrimental.[11]

TABLE 5
Illicit and Abused Drugs Associated with Sexual Disorders

Substance            Sexual Disorder

alcohol              acute effect; erectile disorder,(***) desire
                     disorder,(***) delayed orgasm(***); chronic
                     effects: erectile disorder,(***) desire
                     disorder(***)
amphetamines         low doses: may increase desire and delay
                     orgasm(*); high doses and chronic use;
                     delayed or no ejaculation,(***) erectile
                     disorder,(**) inhibition of orgasm (men and
                     women)(*)
amyl nitrite         decreased in arousal and lubrication; erectile
                     disorder; delayed orgasm or ejaculation(*)
barbiturates         decreased desire, erectile disorder, inhibited
                     ejaculation(***)
cocaine              erectile disorder,(***) spontaneous or delayed
                     ejaculation, priapism(*)
diazepam (Valium)    decreased desire, delayed ejaculation, retarded
                     or no orgasm in women(*)
marijuana            decreased desire, hormonal alteration(*)
MDMA                 erectile disorder,(****) inhibited ejaculation
                     (****) and orgasm,(****) decreased desire(**)
methaqualone         erectile disorder, inhibited ejaculation,
                     decreased desire in women(*)
morphine             decreased desire, erectile disorder, hormonal
                     alteration(*)
tobacco              erectile disorder(*)