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Pharmacologic Management of Sexual Dysfunction: Benefits and Limitations

Published online by Cambridge University Press:  07 November 2014

Abstract

What is the current knowledge concerning the pharmacologic treatment of human sexual dysfunction? A number of interventions, including oral phophodiesterase inhibitors and intracorporeal agents with vasodilatory effects, are available to treat male erectile disorder. Serotonergic drugs have been shown to be effective in the treatment of rapid ejaculation. Various lines of research suggest that high dosages of androgenic agents may eventually have a role in the treatment of decreased libido in females. There may be a role for phophodiesterase inhibitors in the treatment of a subgroup of women with arousal disorders. Normal sexual function involves successful integration of biological, psychological, and interpersonal influences. Clinical psychiatry with its biopsychosocial model should incorporate the treatment of human sexual dysfunction within its purview.

Type
Review
Copyright
Copyright © Cambridge University Press 2003

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References

REFERENCES

1.Laumann, EO, Gagnon, JH, Michael, RT, Michaels, S, eds. The Social Organization of Sexuality: Sexual Practices in the United States. Chicago. Ill: University of Chicago Press; 1994.Google Scholar
2.Fugl-Meyer, KS. Epidemiology of female sexual function. Paper presented at: the Female Sexual Function Forum, Boston Mass: October, 2001.Google Scholar
3.Dunn, KM. Association of sexual problems with social, psychological, and physical problems in men and women: a cross sectional survey. J Epidemiol Community Health. 1999;53:144148.CrossRefGoogle Scholar
4.Lindal, E, Stefansson, JG. The lifetime prevalence of psychosocial dysfunction among 55- to 57-year olds in Iceland. Soc Psychiatry Psychiatr Epidemiol. 1993;28:9195.CrossRefGoogle Scholar
5.Kennedy, SH, Dickens, SE, Eisfeld, BS, Bagby, RM. Sexual dysfunction before antidepressant therapy in major depression. J Aff Disord. 1999;56:210–208.CrossRefGoogle ScholarPubMed
6.Kockott, G, Pfeiffer, W. Sexual disorders in nonacute psychiatric outpatients. Comprehensive Psychiatry 1996;37:5661.CrossRefGoogle ScholarPubMed
7.Wiederman, MW, Pryor, T, Morgan, CD. The sexual experience of women diagnosed with anorexia nervosa and bulimia nervosa. Int J Eat Disorder. 1996;19:109118.3.0.CO;2-R>CrossRefGoogle Scholar
8.Minnen, AV, Kampman, M. The interaction between anxiety and sexual functioning: a controlled study of sexual functioning in women with anxiety disorders. Sexual Relationship Therapy. 2000;15:4757.CrossRefGoogle Scholar
9.Zemishlany, Z. Pharmacotherapy of sexual dysfunction in special populations. European Psychiatry. 2002;7(suppl 1):15s.CrossRefGoogle Scholar
10.Nkanginieme, I, Segraves, RT. Neuropsychiatric aspects of sexual dysfunction. In: Fogel, B, Schiffer, R, Rao, S, eds. Neuropsychiatry. Baltimore, Md; Williams & Wilkins: In press.Google Scholar
11.Edwards, E, Muirhead, GJ. Introduction. Bri J Clin Pharmacol. 2002;53:1S3S.Google Scholar
12.Levine, LA. Diagnosis and treatment of erectile dysfunction. Am J Med. 2000;109(suppl 9a):3s12s.CrossRefGoogle ScholarPubMed
13.Padma-Nathan, H, McMurray, JG, Pullman, WE. On demand IC351 (Claims) enhances erectile function in patients with erectile dysfunction. Int J Impot Res. 2001;13:29.CrossRefGoogle Scholar
14.Klotz, T, Sachse, R, Heidrich, A. Vardenafil increases penile rigidity and tumescence in erectile dysfunction patients: a Rigiscan and pharmacodynamic study. Word J Urol. 2001;19:3239.CrossRefGoogle Scholar
15.Andersson, KE, Wylie, MG. Receptor pharmacology related to erectile dysfunction. In: Carson, CC, Kirby, RS, Goldstein, I, eds. Textbook of Erectile Dysfunction. Oxford, England: Oxford University Press; 1999;123132.Google Scholar
16.Virag, R, Becher, E, Carrier, S, et al.Local pharmacological treatment modalities. In: Jardin, A, Wagner, G, Khoury, S, eds. Erectile Dysfunction. Plymouth, United Kingdom: Health Publication Ltd.; 2000;241304.Google Scholar
17.Segraves, RT, Althof, A. Psychotherapy and pharmacotherapy for sexual disorders. In: Nathan, P, Gorman, JS, eds. A Guide to Treatments That Work. 2nd ed. New York, NY: Oxford University Press; 2002:497524.Google Scholar
18.Mulhall, JP, Goldstein, I. Oral agents in the management of erectile dysfunction. In: Carson, CC, Kirby, RS, Goldstein, I, eds. Textbook of Erectile Dysfunction. Oxford, England: Oxford University Press; 1999:309315.Google Scholar
19.Lal, S, Ackman, D, Thavundayil, J, Kieley, M, Etienne, P. Effect of apomorphine, a dopamine receptor agonist on penile tumescence in normal subjects. Progress in Neuropharmacology. 1984;8:695699.Google ScholarPubMed
20.Lal, S, Laryea, E, Thavundayil, J, et al.Apomorphine-induced penile tumescence in impotent patients. Preliminary findings. Prog Neuropharmacol Biol Psychiatry. 1987;143:819820.Google Scholar
21.Danjou, P, Alexander, L, Warat, D, Combiez, L, Perch, A. Assessment of erectogenic properties of apomorphine and yohimbine in man. J Clin Pharmacol. 1988;26:733739.CrossRefGoogle ScholarPubMed
22.Segraves, RT, Bari, M, Segraves, KB, Spirnak, P. Effect of apomorphine on penile tumescence in men with psychogenic impotence. J Urol. 1991;145:11741175.CrossRefGoogle ScholarPubMed
23.Morales, A. Apomorphine to uprima: the development of a practical erectogenic drug: a personal perspective. Int J Impot Res. 2001;13(suppl 3):S29S34.CrossRefGoogle ScholarPubMed
24.Heaton, J. Characterizing the benefit of apomorphine SL (uprima as an optimized treatment for the representative populations with erectile dysfunction. Int J Impo Res. 2001;13(suppl 3)S35S39.CrossRefGoogle Scholar
25. Von Kietz, AT, Stroberg, P, Bukofzer, S, Mallard, N, Hibberd, M. A European multicenter study to evaluate the tolerability of apomorphine sublingual administered in a forced dose-escalation regimen in patients with erectile dysfunction. BJU International. 2002;89:409415.Google Scholar
26.Bukofzer, S, Livesay, N. Safety and tolerability of apomorphine SL (Uprima). Int J Impot Res. 2001;13(suppl 3):S40S44.CrossRefGoogle ScholarPubMed
27.Giulano, F, Allard, J. Dopamine and sexual function. Int J Impot Res. 2001;13(suppl 3):S18S28.CrossRefGoogle Scholar
28.Andersson, KE. Neurophysiology/pharmacology of erection. Int J Impot Res. 2001;13(suppl 3):S8S17.CrossRefGoogle ScholarPubMed
29.Rosen, RC, Padma-Nathan, H, Goldstein, I. Process of care model for the management of erectile dysfunction in the primary care setting. In Carson, CC, Kirby, RS, Goldstein, I, eds. Textbook of Erectile Dysfunction. Oxford, England: Oxford University Press; 1999;497503.Google Scholar
30.Segraves, RT. New treatment for erectile dysfunction. Curr Psychiatry Reports. 2002;2:206210.CrossRefGoogle Scholar
31.Olsson, AM, Speakman, MJ, Dinsmore, WW, et al.Sildenafil citrate (Viagra) is effective and well tolerated for treating erectile dysfunction of psychogenic or mixed etiology. Int J Clin Practice. 2000;54:561566.CrossRefGoogle ScholarPubMed
32.McCarthy, B. Relapse prevention strategies and techniques with erectile dysfunction. J Sex Marital Ther. 2001;27:18.CrossRefGoogle ScholarPubMed
33.Pallas, J, Levine, SB, Althof, SE, Risen, CB. A study using Viagra in a mental health practice. J Sex Marital Ther. 2000;26:4150.Google Scholar
34.Wise, TN. Psychosocial side effects of sildenafil therapy for erectile dysfunction. J Sex Marital Ther. 1999;25:145150.CrossRefGoogle ScholarPubMed
35.Mintz, D. Unusual care report: nonpharmacological effects of sildenafil. Psychiatric Services. 2000;51:674675.CrossRefGoogle Scholar
36.Mendels, J, Cameran, A, Sikes, C. Sertraline treatment for premature ejaculation. J Clin Psychopharmacol. 1995;15:341346.CrossRefGoogle ScholarPubMed
37.Haensel, S, Klem, T, Hop, W, Slo, A. Fluoxetine and premature ejaculation. J Clin Psychopharmacol. 1998;18:7277.CrossRefGoogle ScholarPubMed
38.Althof, A, Levine, S, Corry, P, Risen, C, Stern, E, Kurit, D. Clomipramine as a treatment for rapid ejaculation: a double-blind crossover study of 15 couples. J Clin Psych. 1995;56:402407.Google ScholarPubMed
39.Waldinger, M, Hengeveld, M, Zwindman, A. Ejaculation retarding properties of paroxetine in patients with primary premature ejaculation: a double blind randomized study. Br J Urol. 1997;156:16311632.Google Scholar
40.Waldinger, M, Hengeveld, M, Zwindman, A, Olivier, A. Effect of SSRI antidepressant on ejaculation. A randomized placebo controlled study with fluoxetine, fluvoxamine, paroxetine and citalopram. J Clin Psych. 1998;18:274281.Google Scholar
41.Waldinger, M. SSRIs and ejaculation: a double-blind randomized fixed dose study with paroxetine and citalopram. J Clin Psychopharmacol. 2001;21:556560.CrossRefGoogle ScholarPubMed
42.Segraves, RT, Saran, A, Segraves, K, Maguire, E. Clomipramine versus placebo in the treatment of premature ejaculation: a pilot study. J Sex Marital Ther. 1993;19:198200.CrossRefGoogle ScholarPubMed
43.McMahon, C, Touma, K. Treatment of premature ejaculation with paroxetine hydrochloride. Int J Imp Res. 1999;11:241245.CrossRefGoogle ScholarPubMed
44.Morales, A. Hormonal erectile dysfunction. Evaluation and management. Urol Clin N America. 2001;28:279288.CrossRefGoogle ScholarPubMed
45.Tenover, JL. Male hormonal replacement therapy including andropause. Endocrinol Metab Clin North Am. 1998;27:969987.CrossRefGoogle ScholarPubMed
46.Wang, C. Transdermal testosterone gel improves sexual function, mood, Muscle strength, and body composition parameters in hypogonadal men. Testosterone Gel Study Group. J Clin Endocrinol Metab. 2000;85:28392853.Google Scholar
47.Waxenberg, SE, Drellich, MG, Sutherlamd, AM. Changes in female sexuality after adrenalectomy. J Clin Endocrinol Metab. 1959;19:197202.CrossRefGoogle ScholarPubMed
48.Greenblatt, RB. Hormone factors in libido. J Clin Endocrinol. 1942;3:305308.Google Scholar
49.Segraves, RT. Female sexual disorders:psychiatric aspects. Canadian J Psychiatry. 2002;47:419425.CrossRefGoogle ScholarPubMed
50.Sherwin, BB, Gelfand, MM. The role of androgen in the maintenance of sexual functioning in oophorectomized women. Psychosomatic Medicine. 1987;49:397409.CrossRefGoogle ScholarPubMed
51.Basson, R. Androgen replacement for women. Canadian Family Physician. 1999;45:21002107.Google ScholarPubMed
52.Shifren, JL, Braunstein, GD, Simon, JA, et al.Transdermal testosterone treatment in women with impaired sexual function after oophorectomy. N Eng J Med. 2000;343:682688.CrossRefGoogle ScholarPubMed
53.Tuiten, A, van Honk, J, Koppeschaar, H, Bernaards, C, Thijssen, J, Verbaten, R. Time course of effects of testosterone administration on sexual arousal in women. Arch Gen Psychiatry. 2000;57:149153.CrossRefGoogle ScholarPubMed
54.Segraves, RT, Croft, H, Kavoussi, R, et al.Bupropion sustained release (SR) for the treatment of hypoactive sexual desire disorder (HSDD) in nondepressed women. J Sex Marital Ther. 2001;27:303316.Google Scholar
55.Arlt, W, Callies, F, van Vlijmen, J, et al.Dehydroepiandrosterone replacement in women with adrenal insufficiency. N Eng J Med. 1999;341:10131020.CrossRefGoogle ScholarPubMed
56.Guay, AT, Jacobsen, J. decreased free testosterone and dehydroepiandrosterone–sulfate (DHEA-S) levels in women with decreased libido. J Sex Marital Ther. 2002;28(suppl 1):129142.CrossRefGoogle ScholarPubMed
57.Munarriz, R, Talakoub, L, Flaherty, E, et al.Androgen replacement therapy with dehydroepiandsrostrerone for androgen insufficiency and female sexual dysfunction: androgen and questionnaire results. J Sex Marital Ther. 2002;28(suppl 1):165174.CrossRefGoogle ScholarPubMed
58.Meston, CM, Heiman, J. Acute dehydroepiandrosterone effects on sexual arousal in pre-menopausal women. J Sex Marital Ther. 2002;28:5360.CrossRefGoogle Scholar
59.Meston, CM & Frohlich, PF. The neurobiology of sexual function. Arch Gen Psychiatry. 2000;57:10121030.CrossRefGoogle ScholarPubMed
60.Hackbert, L, Heiman, JR. Acute dehydroepiandrosterone DHEA effects on sexual arousal in postmenopausal women. J Women's Gend Based Med. 2002;11:155162.CrossRefGoogle ScholarPubMed
61.Giuliano, F, Rampin, O, Alard, J. Neurophysiology and pharmacology of female genital sexual response. J Sex Marital Ther. 2002;28(suppl 1):101122.CrossRefGoogle ScholarPubMed
62.Bartik, B, Goldberg, J. Female sexual arousal disorder. In: Leiblum, SR, Rosen, RC, eds. Principles and Practice of Sex Therapy. New York, NY; Guilford Press: 2000:85117.Google Scholar
63.Meston, CM, Heiman, JR. Ephedrine-activated physiological sexual arousal in women. Arch Gen Psychiatry. 1998;55:652658.CrossRefGoogle ScholarPubMed
64.Islam, A, Mitchell, J, Rosen, R, et al.Topical alprostadil in the treatment of female sexual arousal disorder.a pilot study. J Sex Marital Ther. 2001;27:531540.CrossRefGoogle ScholarPubMed
65.Rosen, RC, Phillips, NA, Gendrano, N, Ferguson, DM. Oral phentolamine and female sexual arousal disorder: a pilot study. J Sex Marital Ther. 1999;25:137144.CrossRefGoogle ScholarPubMed
66.Rubio-Aurioles, E, Lopez, M, Lipezker, M, et al.Phentolamine mesylate in postmenopausal women with female arousal disorder. J Sex Marital Ther. 2002;28(suppl 1):S205S216.CrossRefGoogle ScholarPubMed
67.Becher, EF, Bechara, A, Casabe, A. Clitoral hemodynamic changes after a topical application of alprostadil. J Sex Marital Ther. 2001;27:405410.CrossRefGoogle ScholarPubMed
68.Basson, R, McInnes, R, Smith, M, Hodgson, G, Spain, T, Koppiker, N. Efficacy and safety of sildenafil in estrogenized women with sexual dysfunction. Obstet Gyn. 2000;96(suppl 1):54.CrossRefGoogle Scholar
69.Basson, R, McInnes, R, Smith, M, Hodgson, G, Koppiker, N. Efficacy and safety of sildenafil citrate in women with sexual dysfunction associated with female sexual arousal disorder. J Women's Health Gender Based Medicine, 2002;11:367377.CrossRefGoogle ScholarPubMed
70.Caruso, S, Intelisano, G, Lupo, L, Agnello, C. Premenopausal women affected by sexual arousal disorder treated with sildenafil:a double-blind crossover study. BJOG. 2001;108:623628.Google Scholar
71.Segraves, KB, Segraves, RT. Hypoactive sexual desire disorder:prevalence and co-morbidity in 906 patients. Sex Marital Therapy. 1991;17:19.Google Scholar
72.Fugl-Meyer, KS. Epidemiology of female sexual function. Paper presented at: Female Sexual Function Forum; Boston, Mass: October, 2001Google Scholar
73.Salerian, AJ, Deibler, WE, Vittone, BJ, et al.Sildenafil for psychotropicinduced sexual dysfunction in 31 women and 61 men. J Sex Marital Ther. 2000;26:133140.Google ScholarPubMed
74.Fava, M, Rankin, M. Sexual functioning and SSRIs. J Clin Psychiatry. 2002;63(suppl 5):1316.Google ScholarPubMed
75.Michelson, D, Bancroft, J, Targum, S, Kim, Y. Trepner R. Female sexual dysfunction associated with antidepressant administration:a randomized, placebo-controlled study of pharmacological intervention. Am J Psychiatry. 2000;157:239243.CrossRefGoogle Scholar
76.Landen, M, Eriksson, E, Agren, H. Fahlen T. Effect of buspirone on sexual dysfunction in depressed patients treated with selective serotonin reuptake inhibitors. J Clin Psychopharmacol. 1999;19:268275.CrossRefGoogle ScholarPubMed
77.Kennedy, SH, McCann, SM, Masellis, M, et al.Combining bupropion SR with venlafaxine, paroxetine or fluoxetine: a preliminary report on pharmacokinetic, therapeutic, and sexual dysfunction effects. J Clin Psychiatry. 2002;63:181186.CrossRefGoogle ScholarPubMed
78.Nurnberg, HG, Gelenberg, AJ, Fava, M, et al.Sildenafil for SRI associated sexual dysfunction: a three-center six weeks double blind placebo controlled study in 90 men. Poster presented at: New Clinical Drug Evaluation Unit. Albuquerque, NM; 1999.Google Scholar
79.Nurnberg, HG, Gelenberg, A, Hargreave, TB, Harrison, WM, Siegel, RL, Smith, MD. Efficacy of sildenafil citrate for the treatment of erectile dysfunction in men taking serotonin reuptake inhibitors. Am J Psychiatry. 2001;158:19261928.CrossRefGoogle ScholarPubMed