Posted on 22-03-2013
Filed Under (ED Treatment) by admin


Although there has been extensive study of antidepressant-associated sexual side effects in patients with depressive disorders, there has been very little investigation into patients treated with lithium for bipolar disorder or unipolar depression.

A small open-label study of bipolar and schizoaffective male patients taking lithium as their only medication, found that 31.4% reported sexual dysfunction on a sexual function questionnaire. Patients were all reportedly euthymic at the time of inquiry. Just over 23% of patients reported reduction in frequency of sexual thoughts and 20% of men reported loss of erection during sex. Maintaining erections were reported by 14% of patients. Despite these problems, almost all patients reported normal pleasure during sexual activity and were satisfied with their sexual performance. Serum lithium concentrations were similar between patients with and without sexual dysfunction. Overall, patients reported that sexual dysfunction was minor, did not lead to noncompliance, and was not a source of distress. Viagra professional Australia

A point prevalence evaluation of patients with bipolar disorder found similar results, suggesting that patients treated with lithium as their only medication infrequently experience sexual dysfunction. In this study, 104 patients with bipolar disorder (nearly all of whom were euthymic) were asked to rate the current effects of lithium on sexual functioning ‘relative to a period of normal mood when the patient was not taking lithium.’ Several parameters of sexual function were rated according to the change affected by lithium, rated as ‘none, mild, moderate or great’. The authors found that among patients taking monotherapy lithium, only 14% of patients reported sexual side effects and these were almost all mild. The type of sexual side effect was not detailed for lithium. On the other hand, when lithium was combined with benzodiazepines, rates jumped to 40% of patients, and many of the complaints were moderate or great. This study has a number of limitations, principally that ratings were made retrospectively, sometimes many years after starting lithium. The study had no control group and medication was not randomly assigned. If the benzodiazepines indeed caused sexual problems, it is not clear if they caused them independently of lithium or if in combination with the lithium.

Finally, one recent study, published in Italian, reported that ‘clinically stable’ patients with bipolar disorder taking lithium were more likely than age-matched healthy controls to report to have ‘never’ or ‘rarely’:

  • sexual intercourses (45% vs. 20%),
  • sexual fantasies (25.4 vs. 13.6%),
  • desire (37.3 vs. 9.5%).

It is unknown from this study how much the patient’s mood disorder or medication treatment contributed to their sexual complaints.

Hence, there has been very limited study into the effects of lithium on sexual functioning, though lithium appears to have limited adverse sexual side effects. Further prospective studies are needed.

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Posted on 14-03-2013
Filed Under (ED Causes) by admin

Anxiety is an important factor in the development of sexual dysfunctions. The phenomenon of performance anxiety is well known, particularly in men who are concerned over their erectile response and durability of the erection. Narcissistic perturbation is yet another psychological consequence of ED that further increases anxiety. The patient’s self-esteem may sink further causing concern for both himself and his partner. This may result in behavioral modifications in the patient, such as avoiding intimacy and temper outbursts. These lead to increasing anxiety and increasing ED resulting in a vicious cycle of failure and escalating anxiety. This specific situation can be treated in most cases with the help of explanations and short-term therapeutic intervention intended to relieve anxiety.

Roughly 15% of the population suffers from various kinds of anxiety disorders. Those include generalized anxiety disorder, panic disorder, obsessive-compulsive disorder (OCD), social phobia (SP) and posttraumatic stress disorder (PTSD).

Research, dating back to the 80s, shows that people with high levels of anxiety have a higher rate of sexual dysfunctions. Although the psychoanalytic literature has directed much attention to the association of anxiety provoked by intrapsychiatric conflicts and sexual dysfunction, there is little information on the comorbidity of sexual dysfunction and anxiety disorders. Kaplan claimed that the role of anxiety is especially clear in the pathogenesis of sexual aversion disorders and phobic avoidance of sex. She found an unexpectedly high incidence of panic disorders in patients who phobically avoid sex or who complain of active sexual aversion. Some of the patients actually experienced panic about their sexual performance or became obsessed with details concerning their sexual performance and loss of control. Monteiro et al. found a high percentage of sexual pathology in untreated patients with OCD of whom up to 24% were virgins and another 9% had not had sex for years.

SP and Sexual Behavior

The main component of SP is extreme fear of public behavior that may cause embarrassment or ridicule. This is a combination of performance anxiety and interpersonal anxiety that exists in 7% of the population. It is reasonable to expect that this type of anxiety disorder is accompanied by sexual dysfunction. Heimberg and Barlow hypothesized that sexual dysfunction (especially reduced erectile capability) is a result of performance anxiety or fear of scrutiny by others, similar to SP. Using a laboratory model, they found that healthy men exposed to both erotic stimuli and anxiety-provoking stimuli showed increased arousal compared to healthy men exposed to erotic stimuli alone. However, in sexually dysfunctional males, the opposite occurred: they reacted to the anxiety-provoking stimuli with decreased arousal. The authors concluded that anxiety apparently affects sexually functional and dysfunctional males in opposite ways and that dysfunctional males may employ the same cognitive model as patients with SP. There are several studies suggesting that patients with SP may have sexual problems. In a study of college students, Leary and Dobbins reported that subjects with a high rate of ‘heterosocial anxiety’ showed a higher incidence of sexual dysfunction. Figueira et al. reported a 33.3% rate of sexual difficulties, especially premature ejaculation, in patients with SP. Bodinger et al. evaluated 40 consecutive, drug-free outpatients with SP (24 males, 16 females) attending an anxiety clinic, and 40 healthy, age and gender-matched controls. A detailed rating scale was used to assess quantitatively and qualitatively sexual function and behavior. The findings showed that men suffering from SP reported moderate impairment in sexual enjoyment and subjective sexual satisfaction. In addition, the men reported a later age for first sexual experience and a higher rate (42%) of paid for sex as compared to the healthy men (8%). Women suffering from SP reported severe impairment in desire, arousal, sexual activity and subjective satisfaction. These women had less sexual partners compared to the healthy controls. Seven out of 16 (44%) had only one partner or none throughout their lifetime, compared with 6% in the control group. Both men and women showed avoidance of intergender behavior. Viagra in Canada – ed medications with great discounts.

PTSD and Sexual Disorders Exposure to extreme traumatic events (military, traffic accident, rape) may lead to behavioral and physiological abnormalities which at times persist long after the precipitating event and become permanent, leading to the clinical syndrome known as PTSD. PTSD is known to affect significantly emotional, social, occupational and sexual functioning. Kaplan has shown that sexual problems are prevalent among PTSD patients. Letourneau et al. reported that over 80% of PTSD patients studied, were experiencing clinically relevant difficulties. ED and premature ejaculation were the most frequently reported problems. They suggest that PTSD may be a risk factor for sexual problems. PTSD patients are frequently treated for symptoms of anxiety and depression, mainly with anxiolytics and antidepressants. Fossey and Hamner reported that clonazepam can cause sexual dysfunction in male veterans with PTSD. The role of antidepressants in inducing sexual dysfunction is well known.

A study by Kotler et al. compared the various components of sexual functioning among three groups of males:

  • untreated PTSD patients (n _ 15),
  • PTSD patients being treated with SSRIs (n _ 27)
  • a group of healthy controls (n _ 49).

All participants completed an 18-item questionnaire for assessment of sexual functioning. Those with PTSD also completed the impact of events scale and the symptom checklist-90. Untreated and treated PTSD patients had significantly poorer sexual functioning in all domains (desire, arousal, orgasm, activity and satisfaction). Compared to healthy controls, those treated with SSRIs had greater impairment in desire, arousal and frequency of sexual activity with a partner. There was a high correlation between sexual dysfunction among the PTSD group and the anger-hostility subscale of the symptom checklist-90.
Treating male PTSD sufferers with sildenafil in a dose of 50mg brought about significant improvement (53.5%) in erection functionality and at the same time improved desire, orgasm and sexual satisfaction. This study shows that the phases of the sexual cycle are connected to each other and improving one usually results in improvement of the other phases. In conclusion, anxiety disorders are associated with a significant impairment in all domains of sexual functioning.

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