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Results of logistic regression analyses, persons without sexual dysfunction (reference category) vs. persons with sexual dysfunction, unadjusted and controlling for age (except for the age effect).
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Opioid maintenance treatment (OMT) is the most widespread therapy for both females and males opioid addicts. While many studies have evaluated the OMT impact on men’s sexuality, the data collected about the change in women’s sexual functioning is still limited despite the fact that it is now well-known that opioids - both endogenous and exogenous -...
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Opioid maintenance treatment (OMT) is the most widespread therapy for both females and males opioid addicts. While many studies have evaluated the OMT impact on men's sexuality, the data collected about the change in women's sexual functioning is still limited despite the fact that it is now well-known that opioids-both endogenous and exogenous-aff...
Citations
... The link between substance use and SD is of particular interest, as elevated rates of impaired sexual functioning have been observed in individuals who use opioids. The prevalence of SD in opioid-dependent populations have been reported to be as high as 57 and 93% in women and men, respectively (6,7). Comparable rates have been found in patients suffering from schizophrenia (8), obsessive-compulsive disorder (9), anxiety disorders (4), and depressive disorders (10). ...
Background
Mental disorders pose a high risk for the occurrence of sexual dysfunctions (SD). This study aimed to investigate prevalence of risk factors and help-seeking behavior for sexual dysfunctions in patients with opioid use disorder compared to patients seeking psychotherapeutic help.
Methods
Ninety-seven patients at two opioid agonist treatment (OAT) centers and 65 psychotherapeutic patients from a psychiatric practice (PP) in Switzerland were included in the study. Self-report assessments comprised sexual functioning (IIEF: International Index of Erectile Function; FSFI: Female Sexual Function Index), depressive state, psychological distress, alcohol consumption, nicotine use, and a self-designed questionnaire on help-seeking behavior. We used chi-squared and Mann–Whitney U tests for group comparisons and binary logistic regression models to identify variables predicting the occurrence of sexual dysfunctions.
Results
There was no statistically significant difference (p = 0.140) in the prevalence of SD between OAT (n = 64, 66.0%) and PP sample (n = 35, 53.8%). OAT patients scored significantly higher in scales assessing nicotine use (p < 0.001) and depressive state (p = 0.005). Male OAT patients scored significantly worse on the Erectile Function scale (p = 0.005) and female PP patients scored significantly worse on the FSFI Pain domain (p = 0.022). Opioid use disorder, higher age, and being female predicted the occurrence of SD in the total sample. In the OAT sample, only higher age remained predictive for the occurrence of SD. A lack of help-seeking behavior was observed in both groups, with only 31% of OAT patients and 35% of PP patients ever having talked about their sexual health with their treating physician.
Conclusion
SD are common among psychiatric patients receiving OAT and general psychiatric patients seeking psychotherapy. Professionals providing mental healthcare to patients must emphasize prevention and routine assessments of sexual functioning needs.
... In a study of 258 women, mean age of 38 years, taking methadone (mean 61 mg/day) or buprenorphine (mean 11 mg/day) as opioid maintenance therapy, 56% of patients reported sexual dysfunction [64]. Notably, the patients with sexual dysfunction were characterized, inter alia, by older age, lower levels of education, higher doses of methadone, and worse mental health than patients without sexual dysfunction. ...
Sexual dysfunction is common in patients with advanced cancer, although it is frequently belittled, and thus consistently underdiagnosed and untreated. Opioid analgesics remain fundamen- tal and are widely used in cancer pain treatment. However, they affect sexual functions primarily due to their action on the hypothalamus–pituitary–gonadal axis. Other mechanisms such as the impact on the central and peripheral nervous systems are also possible. The opioid-induced sexual dysfunction includes erectile dysfunction, lack of desire and arousal, orgasmic disorder, and lowered overall sexual satisfaction. Around half of the individuals taking opioids chronically may be affected by sexual dysfunction. The relative risk of sexual dysfunction in patients on chronic opioid therapy and opioid addicts increased two-fold in a large meta-analysis. Opioids differ in their potential to induce sexual dysfunctions. Partial agonists and short-acting opioids may likely cause sexual dysfunction to a lesser extent. Few pharmaceutical therapies proved effective: testosterone replacement therapy, PDE5 inhibitors, bupropion, trazodone, opioid antagonists, and plant-derived medicines such as Rosa damascena and ginseng. Non-pharmacological options, such as psychosexual or physical therapies, should also be considered. However, the evidence is scarce and projected primarily from non-cancer populations, including opioid addicts. Further research is necessary to explore the problem of sexuality in cancer patients and the role of opioids in inducing sexual dysfunction.
... In many countries, methadone maintenance treatment (MMT) is currently the most common form of OAT (21) and only few countries have permitted and introduced heroin-assisted treatment (HAT) (22). As in the general population, reported prevalence rates of SDs in individuals on MMT vary with some scholars reporting rates as low as 14% (23) up to 93% for men (24) and 56.6% for women (25). However, the lack of help-seeking behavior in regard to SDs is present in MMT as well, making precise prevalence estimates difficult: one study reported that in their sample only 8% of men with ED consulted a physician (26). ...
... We found the prevalence of SDs in our sample of GP, MMT and HAT patients to be 25, 70, and 57%, respectively. The prevalence of SDs observed in our sample of MMT patients is in line with previously reported findings (24,25). Importantly, we did not find a significant difference in the respective MMT and HAT prevalence rates and our results therefore indicate that SDs are equally common in HAT patients. ...
Background and Aims
Sexual dysfunctions (SDs) show a marked impact on a person’s general wellbeing. Several risk-factors like physical and mental illnesses as well as alcohol and tobacco use have to date been identified to contribute to the occurrence of SDs. The impact of opioid-agonist treatment (OAT) on SDs remains unclear, with some studies demonstrating an improvement after methadone maintenance treatment (MMT) initiation. However, no studies on the prevalence and predictors of SDs in heroin-assisted treatment (HAT) exist to date.
Methods
A cross-sectional study was conducted with patients from a MMT center (n = 57) and a center specializing in HAT (n = 47). A control group of patients with mild transient illnesses (n = 67) was recruited from a general practitioner (GP). The International Index of Erectile Function, the Female Sexual Function Index, as well as measurements for psychological distress, depressive state, nicotine dependence, and high-risk alcohol use were employed. Patients also completed a self-designed questionnaire on help-seeking behavior regarding sexual health. Mann-Whitney-U tests and chi-square tests were performed for group comparisons and binary logistic regression models were calculated.
Results
Twenty-five percent of the GP sample (n = 17), 70.2% (n = 40) of the MMT sample, and 57.4% (n = 27) of the HAT sample suffered from SDs at the time of study conduction. OAT patients differed significantly from GP patients in depressive state, high-risk alcohol use, nicotine dependence, and psychological distress. Age, depressive state, and opioid dependence predicted the occurrence of SDs in the total sample. No differences between OAT and GP patients were found regarding help-seeking behavior.
Discussion
Age, depressive state, and opioid dependence predicted the occurrence of SDs in the total sample. It remains unclear whether SDs are caused by opioid intake itself or result from other substance-use related lifestyle factors, that were not controlled for in this study. A lack of help-seeking behavior was observed in our sample, underlining the importance of clinicians proactively inquiring about the sexual health of their patients.
Conclusion
The high prevalence of SDs observed in MMT does not differ from the prevalence in HAT. Clinicians should actively inquire about their patients’ sexual health in GP and OAT centers alike.
... Closing this gap in knowledge is an important first step to achieving a better understanding of how to manage patients with co-morbid CPP and OUD. Additionally, OUD and OUD medication treatment have been linked with sexual dysfunction, which may further complicate recovery and other health outcomes for these patients (13)(14)(15). ...
... In a previous study by Ramdurg et al. approximately 83.0% of men receiving buprenorphine reported sexual dysfunction in at least one domain (14). A recent multicenter study reported that 56.6% of women receiving medication for OUD met criteria for sexual dysfunction (15). This common and unfavorable experience of sexual dysfunction during OUD treatment may influence an individual's decision to continue these lifesaving medications for OUD. ...
Introduction: Chronic pain brings complexity to opioid use disorder (OUD). Psychosocial and neurobiological risks for Chronic Pelvic Pain (CPP) and OUD overlap. The primary objective of this exploratory study is to compare sex-specific prevalence of CPP and sexual dysfunction between individuals receiving buprenorphine for OUD and a comparison group receiving treatment for other chronic medical conditions (CMC).
Methods: Participants from an OUD treatment ( n = 154) and primary care clinic ( n = 109) completed a survey between July 2019 and February 2020 assessing reproductive and sexual health. Sex - stratified CPP and pain interference measures were adapted from the Brief Pain Inventory for females, and for males, the Brief Male Sexual Function Inventory and NIH Chronic Prostatitis Symptom Index. The Male and Female Sexual Function Index assessed sexual dysfunction. Prevalence of CPP and sexual dysfunction between groups were compared using Pearson χ2 and Fisher's Exact tests.
Results: Participants were 54.4% female and 75.0% Black with almost half having a psychiatric diagnosis. Among OUD females, the highest pain severity reported was for menstrual-related pain, and for OUD males, testicular pain. CPP most interfered with mood in OUD females vs. sleep and enjoyment of life in OUD males. There were no differences in prevalence for global sexual dysfunction with 91.6% of females and 84.2% of males screening positive across groups.
Discussion/Implications: CPP and sexual dysfunction are important components of wellness and may play a role in OUD recovery trajectories. The value of addressing CPP and sexual dysfunction in tailored comprehensive, sex-informed OUD treatment approaches should be further investigated.
... 131−133 Studies in women undergoing the same treatment have shown similar results, with 56.6% prevalence of female sexual dysfunction. 134 While one may argue that the sexual symptoms are the end of the chronic behaviors affecting sexual performance and the consequences of methadone itself, particular care should be given when establishing the percentage of real reduction of risk when evaluating HR strategies. Sexual health of subjects undergoing opioid maintenance treatment seems, in fact, to be an unmet need and further research is warranted to identify how to treat the sexuality of these patients. ...
Introduction
Strategies of harm reduction (HR) include policies and community-based measures aimed to reduce the risk of self-harm while continuing potentially hazardous behaviors, such as illegal drug, alcohol, and tobacco use.
Objectives
To assess whether and to which extent strategies of HR could have beneficial, or harmful, effects on sexual and reproductive health, for general and at-risk populations.
Methods
A literature research was performed between July 2020 and January 2021, investigating the association between harm reduction strategies and sexual and reproductive health.
Results
HR strategies are mostly aimed at providing support to at-risk population, such as injection drug users or sex workers. Alcohol and drug use, smoking and high-risk sexual behaviors are among the main targets for HR strategies. Barriers to access, such as stigma, marginalization or lacking awareness, are often present as negative risk factors and require attention from professionals. Preventing sexually transmitted infections (STIs), early/unwanted pregnancies and violence are the most important results HR programs could provide for sexual and reproductive health. However, evidence is limited and often qualitative, rather than quantitative.
Conclusion
HR strategies are important measures to improve sexual and reproductive health in at-risk populations. Increasing personal and social awareness is a key factor for the success of HR programs. A Sansone, E. Limoncin, E Colonnello, et al. Harm Reduction in Sexual Medicine. Sex Med Rev 2021;XX:XXX–XXX.
... Sexual quality of life has not been studied systematically in opioid-dependent population yet, however, certain authors have assessed general quality of life and correlated it with sexual dysfunction. [32,33] In addition to an attempt to throw light on a very important and prevalent, yet underestimated phenomenon Total 32.28±17.26 Rated from 1 "completely agree" to 6 "completely disagree." ...
Aims: The primary aim of the current study was to assess the sexual history and behavior among treatment-naïve male patients of heroin dependence presenting to outpatient services; their knowledge and attitude about high-risk sexual behavior; and their sexual quality of life. Methods: A cross-sectional exploratory study was done on treatment-naïve patients of heroin dependence, recruited by purposive sampling method. They were assessed using a semi-structured pro forma that explored sociodemographic and clinical details, including details on injecting behavior, sexual history and behavior, perceived impact of heroin on sexual functioning, and knowledge and attitude toward high-risk sexual behavior; Human Immunodeficiency Virus (HIV) Knowledge Questionnaire-18; and Sexual Quality of Life Questionnaire-Male. Results: Fifty-three married patients with a diagnosis of opioid dependence were included in the study. The mean age of the sample was 31.4 years, with a mean age of heroin initiation being 22.5 years and 39.6% having a history of injecting drug use. About 40% of the sample reported to have engaged in sex with a commercial sex worker or a casual partner, of which many reported that such encounters were unprotected. Almost all of the participants reported sex under intoxication in the last month. Prolonging of the duration of erection and ejaculation was reported by a large majority of participants, while many reported heroin intake to increase libido and sexual pleasure. HIV and sexual quality of life were generally poor. Injecting drug use was associated with significantly greater number of partners, having history of casual partner sex, unprotected sex with casual partner, and poorer sexual quality of life. Conclusion: Risky sexual behaviors are common (including few having coercion/assault) among patients with opioid dependence syndrome. Knowledge regarding high-risk sexual behavior and HIV is poor, which should be a focus of treatment strategies. Injecting drug use is associated with more risky sex and poorer sexual quality of life.
Background: Substance use disorder is a global issue that affects not only the physical and mental health of individuals but also the employment and health of entire countries. Substance addiction is one of the persistent global issues that affects individuals of various ages, socioeconomic backgrounds, areas, levels of education, and countries. Males were believed to be more likely than females to suffer from heroin use disorder. Nonetheless, it was shown that the frequency of heroin use is rising more quickly among women. The goal of this study was assessing several endocrine disorders in female heroin addicts and the socio-demographic characteristics. Methods: The study was a comparative cross-sectional study done in Al-Abbassya Mental Hospital affiliated to General Secretariat of the Mental Health Hospitals, Psychiatry and Neurology Center and Neuropsychiatry Department, Tanta University. The research was conducted from June 2022 through March 2024 over a period of 22 months. Results: All of the study's selected addicts (50) were female smokers between the ages of 20 and 30 (mean = 25.46 ± 2.65). Regarding levels of education, there was not a significant difference between the study groups (P=0.071). In terms of marital status, there was a notable difference between the addicts and the control group (P=0.015). Female addicts had a higher divorce rate. Seventy percent of heroin addicts were from urban areas which means that heroin addiction is more common in urbans in comparison to rurales with no significant difference between the study groups. The control group and the addicts' group differed significantly in terms of smoking index (P=0.001), as the addicts' group had a higher mean than the control group. Total testosterone, estradiol, luteinizing hormone, and follicular stimulating hormone levels were significantly lower in heroin addicts than the control groups (P <0.001). Prolactin levels were significantly higher in heroin users than in the control groups (P <0.001), indicating a substantial difference between the two groups. Conclusions: Heroin use disorder in females caused significant low total testosterone, estradiol, luteinizing hormone and follicular stimulating hormone levels. Heroin use disorder in females led to a significant elevated level of prolactin.
Background: Methadone-induced sexual dysfunction in men can significantly impair their quality of life and reduce methadone adherence, thereby interfering with its therapeutic benefits. Objectives: This study aimed to compare the effects of bupropion and amantadine on reducing sexual dysfunction in methadone-dependent males. Methods: This clinical trial included 47 methadone-dependent males attending the Addiction Treatment Center in Babol, Iran. Participants were randomly assigned to either the amantadine group (n = 23) or the bupropion group (n = 24). Demographic data and addiction history were collected using a checklist, and sexual dysfunction was assessed with the International Index of Erectile Function (IIEF) Questionnaire before and after the intervention. Paired t-tests, independent t-tests, and chi-squared tests were used to compare the two groups. Results: Both groups had similar demographic variables and sexual function scores before the intervention (P > 0.05). However, there was a significant difference between the two groups in terms of total sexual dysfunction scores (52.13 ± 13.07 for bupropion vs. 60.79 ± 4.47 for amantadine; P = 0.006). Additionally, significant differences were observed in sexual desire (P = 0.003), satisfaction with intercourse (P = 0.001), and overall satisfaction (P = 0.034), with higher scores in the bupropion group. Adverse medication-related effects were less prevalent in the bupropion group (54.2%) compared to the amantadine group (60.9%). Conclusions: Bupropion appears to be more effective in improving sexual function in methadone-dependent males undergoing methadone treatment, with patients in the bupropion group achieving better scores than those in the amantadine group. Additionally, the occurrence of adverse effects was lower in the bupropion group compared to the amantadine group.
The association between drugs of abuse and sexual function is thought to be prehistoric. In our era, science has shed some light on the roles of different neurotransmitters on sexual function.
Objective
This systematic review aims to summarize the role of drugs of abuse on human sexuality.
Methods
A systematic review was undertaken, according to PRISMA guidelines, for PubMed indexed English articles between 2008 and 2020.
Results
The use of addictive substances is associated with poorer relationship functioning. Additionally, they can be both a trigger and a maintaining factor for sexual dysfunction by affecting any or all phases of sexual response models. These substances include alcohol, tobacco, cannabis, opioids, cocaine, amphetamines, and party drugs. Failure to address drug-induced sexual problems and dysfunctions or their treatment may induce relapses or represent the loss of a precious therapeutic opportunity.
Conclusion
Health care providers should be aware of the relationship between drugs of abuse and sexual function, and use the permission, limited information, specific suggestions, intensive therapy model. We believe addiction professionals should have skills on clinical sexology, and conversely, clinical sexologists should have training in addictions.
L’association faite entre les drogues illicites et le fonctionnement sexuel est perçu comme étant archaïque. De nos jours, la science a apportée une certaine lumière sur les rôles des différents neurotransmetteurs dans le fonctionnement sexuel.
Objectifs
Cette revue systématique vise à résumer le rôle des drogues illicites sur la sexualité humaine.
Méthodes
Une revue systématique a été entreprise, conformément aux directives PRISMA, pour les articles en anglais indexés PubMed entre 2008 et 2020.
Résultats
La consommation de substances addictives est associée à un fonctionnement relationnel inférieur. De plus, ils peuvent être à la fois un déclencheur et un facteur de maintien de la dysfonction sexuelle en affectant une ou toutes les phases des modèles de réponse sexuelle. Ces substances comprennent l’alcool, le tabac, le cannabis, les opioïdes, la cocaïne, les amphétamines et les drogues festives (party drugs). Ne pas s’attaquer aux problèmes et dysfonctionnements sexuels induits par ces drogues ou à leur traitement peut provoquer des rechutes ou représenter la perte d’une précieuse opportunité thérapeutique.
Conclusions
Les pourvoyeurs de soins de santé devraient être conscients de la relation entre les drogues et le fonctionnement sexuel, et utiliser le modèle PLISSIT. Nous pensons que les professionnels de l’addiction devraient avoir des compétences en sexologie clinique et, à l’inverse, les sexologues cliniciens devraient avoir une formation en addiction.
