Article

Sexual Dysfunction in Men Who Abuse Illicit Drugs: A Preliminary Report

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Abstract

Despite being seen as aphrodisiacs, illicit drugs are reported to have detrimental effects on male sexual function but most studies have been based on small case numbers with ambiguous results. To assess the impact of illicit drugs abuse on male sexual function. International Index of Erectile Function (IIEF) and global assessment questions. Illicit drug abusers in a Drug Abstention and Treatment Center were recruited to complete the questionnaires and their data were compared with an age-matched control. The abusers (N = 701, mean age 33.8 years) had a lower mean IIEF score in each domain than that of the controls (N = 196, mean age 35.4 years). Heroin, amphetamine, and MDMA ("Ecstasy") were the leading drugs used. Erectile dysfunction (ED) was reported in 36.4% of the abusers and the odds ratio of having ED (compared with the controls) in mono-users of heroin, amphetamine, and MDMA was 4.8 (P < 0.05), 3.2 (P < 0.05), and 1.4 (P > 0.05), respectively. Of the abusers, 38.6% reported to have decreased sexual desire with illicit drug use, more often seen in the heroin mono-users (46.7%), and 18.4% reported to have enhanced sexual desire, more often seen in the amphetamine mono-users (22.6%). Mean IIEF sexual desire domain score of the abusers was lower than that of the control, even for those who reported to have enhanced sexual desire. Increased and decreased ejaculation latency affected by illicit drugs was reported in 49.9 and 14.3%, respectively, of the abusers, showing no significant difference among the mono-users of three different drugs. Illicit drug male abusers were prone to have ED, decreased sexual desire, and increased ejaculation latency. ED and decreased sexual desire were most commonly seen in heroin, followed by amphetamine and MDMA mono-users, while increased ejaculation latency occurred commonly in all of the abusers.

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... Opioids may increase sexual desire in the short term [6], but their long term use is known to negatively impact on sexual function and to lead to erectile dysfunction (ED) [7,8]. Various studies explored ED in men on opioid replacement therapy (ORT) and reported a 21-52% prevalence [7,[9][10][11], with a peak of approximately 80% in a longitudinal study on a small group of patients in China [12]. Most studies were on small samples of men on ORT, but a meta-analysis suggested that factors associated with sexual dysfunction include age, familial status, medical comorbidity, psychiatric illness, testosterone levels, opioid dosage, duration of treatment, and other current substance use disorders [13]. ...
... Each IIEF-5 item is rated on a 5-point Likert scale, ranging from 1 to 5, with higher scores indicating better erectile function and satisfaction. The severity of ED (range: 5-25) was graded as none (IIEF-5 score: [22][23][24][25], mild (17)(18)(19)(20)(21), mild to moderate (12)(13)(14)(15)(16), moderate (8)(9)(10)(11), and severe (5)(6)(7), and the absence of sexual intercourses was also recorded [26]. ...
... Age was significantly higher in patients with ED and significantly correlated with ED severity (i.e., the higher the age, the more severe the ED) in multivariate analysis. This finding is in keeping with those in opioid users [9,10,13,30], and in the general population [2,4]. ...
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Background Erectile dysfunction (ED) is common among men on opioid replacement therapy (ORT), but most previous studies exploring its prevalence and determinants yielded contrasting findings. Moreover, the impact of ED on patients’ quality of life (QoL) has been seldom explored. Objective To explore the prevalence and determinants of ED in men on ORT, and the impact on QoL. Methods In a multicentre cross-sectional study, we recruited 797 consecutive male patients on methadone and buprenorphine treatment, collected data on demographic, clinical, and psychopathological factors, and explored their role as predictors of ED and QoL through univariate and multivariate analysis. ED severity was assessed with a self-assessment questionnaire. Results Nearly half of patients in our sample were sexually inactive or reported some degree of ED. Some demographic, clinical and psychopathological variables significantly differed according to the presence or absence of ED. Multivariate regression analysis indicated that age, employment, smoke, psychoactive drugs, opioid maintenance dosage, and severity of psychopathological factors significantly influenced the risk and severity of ED. QoL was worse in patients with ED and significantly correlated with ED severity. Age, education, employment, opioid maintenance dosage, ED score, and severity of psychopathology significantly influenced QoL in the multivariate analysis. Conclusions ED complaints can be explored in male opioid users on ORT through a simple and quick self-assessment tool. ED may have important effects on emotional and social well-being, and may affect outcome.
... [8] The illicit drugs are often seen as aphrodisiacs although the available research suggest that most psychoactive drugs have deleterious acute and chronic effects on male sexual functioning. [8][9][10] Of the so-called "club drugs" or "party drugs," METH is the most strongly associated with sexuality and sexual behavior. [11] Diverse effects of amphetamine on sexual function were reported, including positive effects (spontaneous erection and enhanced sexual desire) and negative effects (reduced libido and arousal, impaired erection, and difficulty in achieving orgasm). ...
... [13] These findings were compatible with clinical observations that METH abuse increases the risk of erectile dysfunction (ED). [9,10] Cross-sectional studies in 1159 METH monodrug users showed that the odds ratio of ED for METH use was 2.1 (95% confidence interval = 1.2-3.6) compared with normal controls. ...
Article
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Background: There is a paucity of animal study investigating the effect of methamphetamine (METH) on penile erection in spite of its worldwide population. Aim: We investigated the changes of intracavernous pressure (ICP) elicited by cavernous nerve stimulation after a single and repeated dosing of METH in male rats. Methods: Rats were randomly assigned to five treated groups and one control group with each group having 3 rats. Rats in treated group 1, 2, and 3 received a single dose intravenous injection with 0.1, 1.0, and 10.0 μg/kg METH, respectively. Rats in treated group 4 and 5 received an intraperitoneal injection with 1.0 and 5.0 mg/kg METH four times daily for two weeks, respectively. ICP was measured during penile erection elicited by cavernous nerve stimulation. Expression of neural nitric oxide synthase (nNOS) was measured in the cavernous nerve and muscle after single and repeated dosing. Main Outcome Measures: The primary outcome measure was the ΔICP/mean arterial pressure (MAP) and the secondary was the expression of nNOS in the tissue. Results: The ΔICP/MAP increased slightly in group 1 rats and decreased substantially in group 2 and 3 rats compared with the baseline. A single dose of METH within the range of 0.1 to 10.0 μg/kg exhibited an inhibitory effect of ICP (%). The ΔICP/MAP significantly decreased in group 4 and 5 rats after repeated dosing of METH, compared with that in group 3. The expression of nNOS significantly increased in the cavernous muscle after single and repeated dosing of METH compared with the control. Conclusions: The preliminary results suggested that a single dose of METH exhibits an inhibitory effect on ICP and repeated dosing of METH exerted a greater inhibition than a single dosing. However, these results need further study.
... Cocaine is a stimulant and is often used to increase sexual desire and energy; however it can inhibit sexual arousal and subsequently lead to painful sex, particularly for women (Johnson, et al., 2004). Heroin use is associated with decreased sexual desire in men (Bang-Ping, 2009); notably, however, the rates of sexual dysfunction in methadone and buprenorphine users is no different from the general population (Bliesener, et al., 2005; Brown, Balousek, Mundt, & Fleming, 2005). Across most non-prescription drugs (e.g., cocaine, alcohol, marijuana), a common theme is the stimulation of sexual desire or initial arousal but impairment of late-stage arousal and orgasm (Bang-Ping, 2009) – likely indicating the predominant positive effects of these drugs is related to reduction of sexual inhibition rather than a direct pharmacologic effect on sexual function per se. ...
... Heroin use is associated with decreased sexual desire in men (Bang-Ping, 2009); notably, however, the rates of sexual dysfunction in methadone and buprenorphine users is no different from the general population (Bliesener, et al., 2005; Brown, Balousek, Mundt, & Fleming, 2005). Across most non-prescription drugs (e.g., cocaine, alcohol, marijuana), a common theme is the stimulation of sexual desire or initial arousal but impairment of late-stage arousal and orgasm (Bang-Ping, 2009) – likely indicating the predominant positive effects of these drugs is related to reduction of sexual inhibition rather than a direct pharmacologic effect on sexual function per se. ...
Research
Full-text available
Review of research on substance induced sexual dysfunction, including illicit and prescription drugs use in adults and adolescents. Complete chapter to be included in The SAGE Encyclopedia of Abnormal and Clinical Psychology (2016).
... As stated in the present finding research, like body image, the average of sexual satisfaction in non-substance abuser group is higher than methamphetamine and opium abuser group. This result is in line with previous research (43,47,51,52,53). According to Rawsen et al,. ...
... Additionally, fewer opiate users, compared to cocaine users, reported their drug use had made them obsessed with sex and/or made their sex drive abnormally high (43) . Bang-Ping (52) showed that in three groups of the substance user (heroin, methamphetamine, and ecstasy) amphetamine abuser group has reported more have enhanced sexual desire. Stand on the present findings and previous researches suggest that the therapist recognize the importance of sexual satisfaction in addiction treatment, as it is one of the obstacles in improvement in the addiction treatment. ...
Article
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Background: Sexual satisfaction is a vital component in marital satisfaction and quality of life. The appraisal of body image has influence on the sexual satisfaction. The previous study showed that people use methamphetamine and opium to enhance the sexual functioning. Objectives: The current study is designed to examine the impact of methamphetamine and opium use in sexual satisfaction and body image. Patients and Methods: The sample includes 100 non-substance user men and 53 methamphetamine users and 47 opium users that were selected with available method and convenience sampling, respectively (age ranged below 50 years, mean=34.71±6.35) in Tehran, in 2012. The research instruments were Index of Sexual Satisfaction (Frazoni 1984) and Body Esteem Scale (Hudson 1981). Data was analyzed between three groups by utilizing the Pearson correlation and MANOVA. Result: Body image is associated with sexual satisfaction in non-substance user (p<0.01) and opium user (p<0.01), but this relationship was not observed in the methamphetamine group (p<0.05). In addition, the significant difference was found between three groups in sexual satisfaction and body image (p<0.005). Besides, the results revealed that the average of body image and sexual satisfaction in non-substance abuser is higher than the substance user (p<0.05), and sexual satisfaction in methamphetamine group is higher than opium group (p<0.05). Conclusion: These findings support the idea that body image is a critical factor in sexual satisfaction. Consequently, treatment must consider the psychological and physical impact of methamphetamine and opium use in sexual function.
... Les personnes recevant des services de réadaptation en dépendance rapportent en forte proportion des difficultés sexuelles pouvant s'apparenter à un trouble (Bang-Ping, 2009 ;Carroll, McGinley et Mack, 2001 ;Vallejo-Medina et Sierra, 2013). Chez les hommes de cette population, une baisse du désir et des difficultés érectiles sont associées à la consommation de certaines substances, dont l'héroïne, l'amphétamine et le MDMA (Bang-Ping, 2009). ...
... Les personnes recevant des services de réadaptation en dépendance rapportent en forte proportion des difficultés sexuelles pouvant s'apparenter à un trouble (Bang-Ping, 2009 ;Carroll, McGinley et Mack, 2001 ;Vallejo-Medina et Sierra, 2013). Chez les hommes de cette population, une baisse du désir et des difficultés érectiles sont associées à la consommation de certaines substances, dont l'héroïne, l'amphétamine et le MDMA (Bang-Ping, 2009). En outre, la majorité des hommes recevant un traitement de maintien à la méthadone rapportent des troubles sexuels, particulièrement par rapport au désir sexuel (Yee, Loh, Hisham Hashim et Ng, 2014). ...
Article
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Si l’importance de considérer l’ensemble des sphères de vie des jeunes aux prises avec un problème de consommation fait consensus, la sexualité demeure encore aujourd’hui en retrait. Cet article dresse un portrait d’ensemble des connaissances entourant la sexualité chez les jeunes adultes aux prises avec un problème de consommation de substances psychoactives en vue d’effectuer des recommandations entourant l’offre de service, la prise en charge et la recherche. Une revue narrative de la documentation est réalisée entourant la consommation relativement aux thèmes des comportements sexuels à risque et des infections transmissibles sexuellement et par le sang, des troubles sexuels, de l’orientation sexuelle ainsi que des activités et de la satisfaction sexuelles. Les constats issus de la démarche proposée soulèvent la nécessité de considérer un ensemble de facteurs qui dépasse les activités sexuelles en soi afin de circonscrire la présence de comportements sexuels à risque associés à la consommation. Alors qu’il est probable que la consommation amène ces jeunes à éprouver des problèmes quant à leur fonctionnement sexuel, cette dimension fait rarement l’objet d’une évaluation ou d’interventions. Pour plusieurs, la consommation semble également être utilisée afin d’améliorer la satisfaction sexuelle et peut être fortement associée à la sexualité au point de représenter en soi un facteur de risque de rechute. Parmi les pratiques recommandées auprès des jeunes adultes issus de minorités sexuelles ayant un problème de consommation, il est suggéré d’adopter une vision multidimensionnelle de l’orientation sexuelle ainsi qu’un ensemble précis d’attitudes en lien à la sexualité. Différentes suggestions sont émises quant au déploiement d’une offre de service intégrant la sexualité à la réadaptation en dépendance, l’utilisation de balises à l’évaluation et à l’orientation ainsi que l’adoption d’une vision globale et positive de la sexualité. Les recherches se doivent dès lors d’intégrer les multiples dimensions de la sexualité et de considérer la relation complexe qu’elle peut avoir avec la consommation.
... In addition to heroin users, it was reported that methadone and buprenorphine users also frequently have SD (Palha & Esteves, 2002;Xia et al., 2013). It was reported that ED is most common in those that receive methadone treatment, followed by heroin and buprenorphine users (Hallinan et al., 2008;Quaglio et al., 2008;Bang-Ping et al. 2009). In contrast, Babakhanian et al. (2012) compared IIEF scores in heroin addicts before and after methadone treatment and reported that all IIEF subscale scores improved post-treatment, and, as in the present study, IIEF orgasmic function, sexual desire and general satisfaction subscale scores in the heroin users were low. ...
... Prolonged use of amphetamine-based drugs is associated with ED and delayed ejaculation in men, and delayed orgasm in women (Winslow et al., 2007). Bang-Ping (2009) reported that 36.4% of the MDMA abusers had ED and that in MDMA users the OR of having ED was 1.4 (as compared to controls). In a recent study (Chou et al., 2015), it is reported that the prevalence of erectile dysfunction (ED) was significantly higher in the ampheta-mine mono-illicit drug users than in the controls. ...
Article
Illicit drugs are often used as aphrodisiacs to enhance sexual performance and/or pleasure; however, the available data suggest that most illicit drugs have adverse effects on erection, sexual desire and ejaculation latency in males and that these effects are not fully understood. This study aimed to determine the effect of illicit drug abuse on male sexual function, based on the International Index of Erectile Function (IIEF) score. This descriptive study was conducted at the Alcohol and Substance Research Treatment and Education Center, Ankara, Turkey. Males diagnosed as substance use disorder according to DSM-IV (n = 101) were included as the patient group, and age-matched healthy male volunteers (n = 43) were included as the control group. A 30-item sociodemographic interview form developed by researchers and the 15-item IIEF were administered to all the participants. Data were compared between the patient and control groups. Mean IIEF score was 46.7 ± 3.3 in the patients that used alcohol, 23.7 ± 3.3 in the opioid users, 34.1 ± 5.3 in the ecstasy users, 43.5 ± 4.2 in the cannabis users and 55.3 ± 1.6 in the control group. There was not a significant difference between the alcohol and cannabis users' mean IIEF scores and that in the control group (P > 0.05 and >0.05 respectively), whereas there was a significant difference between the opioid and ecstasy users' mean IIEF scores and that in the control group (P < 0.001 and <0.001 respectively). All IIEF subscale scores in the opioid users were significantly lower than in the control group (P < 0.001). IIEF erectile function, sexual desire and general satisfaction subscale scores were significantly lower in the ecstasy users than in the control group (P < 0.001, <0.005 and <0.001 respectively). In the alcohol users only, the IIEF general satisfaction subscale score was lower than in the control group (P < 0.005).
... The literature on whether or not use of opioids enhances the sexual experience of opioid users is sparse, and much of what has been written focuses on how the drugs affect the sex drive and performance of long-term users. The existing literature also depends heavily on retrospective commentary by heroin users elicited while in treatment for addiction (Bang-Ping 2009;De Leon & Wexler 1973;La Pera et al., 2003;Palha & Esteves, 2002;Palha & Esteves 2008;Rawson et al., 2002). With the exception of their sexual experience during incipient heroin use (Palha & Esteves, 2008), consumers of heroin in most of these studies reported effects on sexual function that were consistently negative. ...
... In the previous literature on sexual activity and heroin use (Bang-Ping 2009;De Leon & Wexler, 1973;La Pera et al., 2003;Palha & Esteves, 2002;Palha & Esteves, 2008), the research depended heavily on retrospective narratives elicited from addicts in treatment. The principal difference between those studies and the data presented here lies in the recruitment of active drug users. ...
Article
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Much of the literature on heroin and opioid addiction holds that regular, long-term users of heroin and other opioids lose interest in sex as their drug using careers lengthen. Analysis of self-reports collected from IDUs in two cross-sectional surveys on patterns of risk behavior in Miami-Dade County, Florida, reveals that large proportions of IDUs report using heroin before or during sex across a wide range of self-injection experience, from as little as twelve months to over 40 years. One half or more of respondents to both surveys reported using heroin in their recent sexual experiences, with similar proportions reported by both males and females. The same IDUs, however, tend not to report using prescription painkillers before or during sex. This finding indicates that co-occurring risk behavior related to both sexual behavior and heroin use may be more prevalent among long-term IDUs than previous literature has suggested. Florida Public Health Review, 2016; 13, 73-81.
... The reported prevalence for ED for all ages in the general population is 18-52%. When looking at men on opioid therapy, ED occurs in 21-67% of men 28-49 years old [12,17,23,[25][26][27][28]. ...
... Several studies have reported high prevalence of ejaculatory dysfunction in men taking opioids. However, most of these studies did not focus solely on ejaculatory dysfunction alone [27,39,54]. One study with an emphasis on PE found that the prevalence is three times higher in opiate-dependent males than in the general population. ...
Article
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Purpose of Review Opioids are the cornerstone for pain treatment with significant recent increases in the number of prescriptions. Sexual dysfunction (SD) is a major side effect of opioid therapy. The goal of this review is to examine the current literature on the effects of opioids on male SD (erectile dysfunction [ED], hypogonadism, ejaculatory dysfunction) and infertility. Recent Findings High prevalence of SD exists in men with opioid use as compared to the general population, with an abundance of evidence suggesting an association between opioid use and ED and hypogonadism. There appears to be a role for testosterone replacement therapy for hypogonadism in men on opioid therapy. Screening for low testosterone levels is recommended in men on opioid therapy with signs and symptoms of androgen deficiency. Data on fertility, ejaculatory, and orgasmic dysfunction are limited. Summary SD is significantly affected by opioid therapy in men. Data demonstrate the benefits of screening for SD and treatment for hypogonadism.
... Comparability between cases and controls based on age was observed in 12 25 (1984), Jensen 83 studies. 30,37,41,47,57,58,61,65,70,71,74,83 In selection, case definition was adequately mentioned in 8 studies. 35,41,47,58,64,65,70,83 Case representativeness was adequate in 9 studies. ...
... 35,41,47,58,64,65,70,83 Case representativeness was adequate in 9 studies. 35,37,47,57,61,64,65,71,83 Adequate definition of controls was given by 6 studies. 35,41,42,47,70,83 None of the studies had adequate selection of controls. ...
Article
Background Substance use may affect sexual functioning in both men and women. Comorbid sexual dysfunction adds to the clinical burden of substance use disorders (SUD). Aims The broad aims were to identify research conduct, types of the available evidence, and research gaps in (i) estimating the incidence, prevalence, type, and severity of sexual dysfunction in adults with SUD; (ii) exploring correlates of sexual dysfunction in SUD. Methods We conducted systematic searches on PubMed, Google Scholar, and Embase for studies published in the English language between August 1954 and November 2020. We included prospective and cross-sectional observational studies that had examined the prevalence or incidence of any sexual dysfunction in adults of either gender with substance use disorders. Review articles and those with an exclusive focus on tobacco use disorders were excluded. The review was registered in PROSPERO. Results Our search identified 65 relevant articles, including five prospective studies. All the prospective studies and most of the cross-sectional studies (n = 40) were done among men and subjects with alcohol (n = 20) and opioid (n = 23) use disorders in clinical populations. Substance use and sexual dysfunction were assessed by a wide range of instruments. Prospective studies reported a prevalence of sexual dysfunction at 75% and 61% for alcohol and opioid use disorders, respectively. The prevalence of any sexual dysfunction in cross-sectional studies ranged between 15 and 100 percent. Erectile dysfunction was the most commonly studied and observed sexual dysfunction. Comorbidity and socioeconomic deprivation were consistently associated with a higher occurrence of sexual dysfunctions. Strengths We did not limit our review by the type of substances and year of publication. We adhered to the standards of conducting and reporting scoping reviews; hence, our review results should be replicable, transparent, and reliable. Limitations The wide clinical and methodological heterogeneity precluded a systematic review. Conclusion Research gaps exist in women, non-clinical population, stimulants, and cannabis use disorders, and effect of treatment of SUD in sexual functioning. The quality of evidence is poor. Ghosh A, Kathiravan S, Sharma K, Mattoo SK. A Scoping Review of the Prevalence and Correlates of Sexual Dysfunction in Adults With Substance use Disorders. J Sex Med 2021;XX:XXX–XXX
... So they often have the opposite effect of what was intended [10]. The use of drugs over a long period of time can lead to sexual dysfunction [11][12][13][14][15][16].Researchers found that psychologically and physiologically, many changes that occur in sexual response are associated with drug use and may cause sexual dysfunction [10].Male sexual dysfunction means an inability to achieve satisfactory sex. sexual dysfunction may be related to orgasm or ejaculation problems, erectile dysfunction or pains in the penis during sexual intercourse .the ...
... Confirmatory factor analysis was used in this study to validate the questionnaire. The results indicated that the questionnaire has three dimensional factor structure including (1) sexual desire [8,[10][11][12][13][14][15][16]19]Most addictive drugs directly or indirectly affect the brain's reward system by overwhelming theneural network with dopamine. Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, motivation, and feelings of pleasure. ...
Article
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Objective: This study aimed to validate the scale of sexual function changes in male addicts. Methods: For this purpose, 101 male addicts who have used one or more types of drugswere selected from drug treatment centers in Semnan.A 14-item questionnaire (Vallejo et al., 2010) was used as a research instrument. Results: The data was analyzed by using exploratory factor analysis on SPSS. Three variables including sexual pleasure (mental factor), sexual desirewere estimated by Cronbach's alpha 0. 90. Sexual arousal and orgasm (physical factor) was estimated by Cronbach's alpha 0.92. The correlation of changes of sexual function questionnaire with Hullbert index of sexual desire (HISD) and sexual desires questionnaire (DSI-2) was respectively significant at the levels of 0.79 and 0.77. This confirms the concurrent validity of our research instrument. Also the retest reliability for mentioned variables was respectively estimated as 0.95, 0.75, and 0.76. In comparison to non-addicted men, the questionnaire clearly showed the sexual dysfunction of addicted men which indicates its validity. Conclusions: So Changes in sexual function questionnaire is a validated tool which is appropriate for measuring changes in sexual function.
... A la vista de los resultados obtenidos, se puede concluir que las personas consumidoras tienen más dificultades en la respuesta eyaculatoria que las personas no consumidoras. Estudios previos señalan que las personas con problemas de adicción tienen más dificultades en la respuesta sexual que las personas no consumidoras 36,37 . En un estudio reciente llevado a cabo con 65 hombres consumidores de opiáceos en tratamiento con metadona se encontró que los consumidores tenían una prevalencia 3 veces mayor de EP que los hombres de la población general 23 . ...
Article
Resumen Introducción La eyaculación precoz puede deberse a múltiples factores y uno de ellos puede ser el consumo de drogas. Objetivos El objetivo principal de este estudio es conocer cómo afecta el consumo de drogas a la respuesta eyaculatoria, teniendo en cuenta las diferentes sustancias de consumo, el nivel de ansiedad y el tiempo de abstinencia. Método Se utilizaron 2 muestras, una correspondiente a hombres que han tenido un historial de consumo de sustancias adictivas (n = 925) y otra de hombres no consumidores (n = 82). Ambas muestras fueron seleccionadas de 28 centros de tratamiento. Se utilizaron los cuestionarios Golombok Rust Inventory of Sexual Satisfaction (GRISS) y el Cuestionario de Ansiedad Estado Rasgo (STAI). Resultados Los resultados muestran que los hombres con historia de consumo obtienen porcentajes mayores en eyaculación precoz frente a los no consumidores (44,3 > 15,9%) y puntuaciones medias también mayores en ansiedad (estado = 19,83 > 11,89; rasgo = 25,66 > 12,39), siendo dichas diferencias estadísticamente significativas (p = 0,000). Los resultados confirman que el período de abstinencia no mejora la respuesta eyaculatoria y tener pareja no funciona como factor de protección en la eyaculación precoz. Conclusiones Los hombres con historia de consumo de drogas tienen más probabilidad de padecer eyaculación precoz y más ansiedad, que no mejora en el período de abstinencia, lo que incita a pensar que los consumidores de drogas tienen rasgos de personalidad que predisponen la eyaculación precoz y/o que los daños neurológicos ocasionados por la drogas contribuyen a disminuir la latencia intravaginal eyaculatoria, cuestiones que deben ser estudiadas en próximas investigaciones.
... Loss of sexual interest or pleasure is a common symptom for drug abusers. For example, from a sample of 1,076 substance abusers, 45.2% had been suffering from sexual dysfunctions (18); out of 701 drug abusers, 36.4% reported erectile dysfunction (19); additionally, there is a higher prevalence of sexual dysfunction in female ketamine abusers with cystitis when compared with ketamine abusers without cystitis (20). Thus, we also presented non-addictive but salient cues in the form of sexual stimuli, which are known to induce activation in the hypothalamus, thalamus, amygdala, anterior cingulate gyrus (ACC), insula, fusiform gyrus, precentral gyrus, parietal cortex, and occipital cortex in healthy people (21), and reduce brain responses to sexual stimuli in the anterior cingulate and dorsolateral prefrontal cortex in breast cancer survivors with chemotherapy (22). ...
Article
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Background Observations of drug-related cues may induce craving in drug-dependent patients, prompting compulsive drug-seeking behavior. Sexual dysfunction is common in drug users. The aim of the study was to examine regional brain activation to drug (ketamine, cigarette smoking) associated cues and natural (sexual) rewards. Methods A sample of 129 [40 ketamine use smokers (KUS), 45 non-ketamine use smokers (NKUS) and 44 non-ketamine use non-smoking healthy controls (HC)] participants underwent functional magnetic resonance imaging (fMRI) while viewing ketamine use related, smoking and sexual films. Results We found that KUS showed significant increased activation in anterior cingulate cortex and precuneus in response to ketamine cues. Ketamine users (KUS) showed lower activation in cerebellum and middle temporal cortex compared with non-ketamine users (NKUS and HC) in response to sexual cues. Smokers (KUS and NKUS) showed higher activation in the right precentral frontal cortex in response to smoking cues. Non-ketamine users (NKUS and HC) showed significantly increased activation of cerebellum and middle temporal cortex while viewing sexual cues. Conclusion These findings clearly show the engagement of distinct neural circuitry for drug-related stimuli in chronic ketamine users. While smokers (both KUS and NKUS) showed overlapping differences in activation for smoking cues, the former group showed a specific neural response to relevant (i.e., ketamine-related) cues. In particular, the heightened response in anterior cingulate cortex may have important implications for how attentionally salient such cues are in this group. Ketamine users (KUS) showed lower activation in response to sexual cues may partly reflect the neural basis of sexual dysfunction.
... Numerous studies have proven the existence of this relationship in the normal population (Haavio Mannila & Kontula, 1997; MacNeil & Byers, 1997; Ménard & Offman, 2009; Sánchez-Fuentes, Santos-Iglesias, & Sierra, 2014; Santos-Iglesias, Sierra, & Vallejo-Medina, 2013). At least in the long term and/or in high doses, drug use has also been proven to decrease sexual functioning (Bang-Ping, 2009; Johnson, Phelps, & Cottler, 2004; Palha & Esteves, 2002; Vallejo-Medina & Sierra, 2013a, 2013b). To the best of our knowledge no studies have assessed sexual assertiveness from a clinical perspective. ...
Research
Current studies assessing sexual assertiveness in drug users are sparse, despite the fact that it would be logical to expect low sexual assertiveness in such patients. Present study had the objective to compare sexual assertiveness between consumers of alcohol, cocaine, cocaine+alcohol, heroin, cannabis, and speedball and a control group. This was assessed in a sample of 556 male drug users from 8 Spanish provinces and 356 non-user males. Results showed significantly lower Initiation assertiveness in the 35-49 year-old age group (particularly in the case of alcohol, heroin, cannabis, and speedball) and worse Sexually Transmitted Diseases and Pregnancy prevention assertiveness in drug users (in the case of alcohol, cocaine, cocaine+alcohol, cannabis, and speedball). Effect sizes ranged from low to moderate. The implications of these results are discussed.
... Numerous studies have proven the existence of this relationship in the normal population ( HaavioMannila & Kontula, 1997;MacNeil & Byers, 1997;Ménard & Offman, 2009;Sánchez-Fuentes, Santos-Iglesias, & Sierra, 2014;Santos-Iglesias, Sierra, & Vallejo-Medina, 2013). At least in the long term and/or in high doses, drug use has also been proven to decrease sexual functioning ( Bang-Ping, 2009;Johnson, Phelps, & Cottler, 2004;Palha & Esteves, 2002;Vallejo-Medina & Sierra, 2013a, 2013b). To the best of our knowledge no studies have assessed sexual assertiveness from a clinical perspective. ...
... Therefore, they try to experience the benefits again, but there are often opposite effects, and drug tolerance and a decline in physical functioning begin to appear [10]. Finally, the increase in the amount and duration of drug use, leads to sexual dysfunction [8,[11][12][13][14][15][16][17]. Other researchers have also found relationships between changes in sexual functioning and use of medications; these changes occur both in psychological and physiological areas, leading to sexual dysfunction or changes in sexual functioning [10]. ...
Article
The present study aimed to validate the Changes in the Sexual Functioning Questionnaire Short-Form (CSFQ-14) and compare male addict’s sexual functioning to that of normal people. In this study, a causalcomparative design was used. A total of 101 men addicted to one or more substances, from addiction treatment centers in Semnan, and a total of 101 normal men from the staff of Semnan’s Universities were selected using a convenience sampling method. The instrument used in this study was the CSFQ which is a 14-item questionnaire. All the study data were analyzed using SPSS software. An exploratory factor analysis revealed 3 factors: 1) sexual pleasure factor (single-item), 2) mental factor (sexual desire) with a Cronbach’s alpha of 0.90, and 3) physical factor (orgasm and arousal) with a Cronbach’s alpha of 0.92. In addition, the results of a MANOVA analysis comparing the sexual functioning of sex addicts to that of non-addicts indicated significant differences between the two groups in all the three factors. Therefore, the validated instrument can be useful in assessing the changes in sexual functioning. The study results also rejected the claim that drugs can solve sexual problems or lead to a feeling of greater sexual pleasure.
... However, it has been shown that illicit male drug users in particular, were prone to have ED together with decreased sexual desire and increased ejaculation latency. Increased ejaculatory latency was seen in all type of abusers while ED and decreased sexual desire were most commonly seen after heroin exposure followed by amphetamine and ecstacy (20) . ...
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Introduction: The aim of the study was to assess the presence and severity of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in the drug and alcohol addicted population. Materials and methods: Alcohol and drug abuse groups constituted of male abusers who presented to a local Alcohol and Drug Abuse Research Center. Control groups were composed of age-matched healthy men who denied any drug/alcohol abuse. Each group was composed of 30 men. Beck Depression and Anxiety Scales, International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OAB-V8), International Index of Erectile Function (IIEF-5) and sexual satisfaction scale were the tools applied to the subjects and controls. Additionally, maximum (Qmax) and average urinary flow rates (Qave) were recorded for statistical assessment in all groups. Results: The mean age, number of children, number of siblings, were comparable between the subjects and controls (p> 0.05). LUTS and ED were more prevalent in drug and alcohol abusers when compared with their controls. Higher mean depression and anxiety scores of the drug and alcohol abusers highlighted their worse psychological status. The quality of life and sexual satisfaction assessment of the drug abusers yielded significantly lower results when compared with their controls. Regarding the comparison between alcohol addicts and their controls; quality of life scores were significantly higher whereas sexual satisfaction assessment results were comparable. The Qave values were similar between drug abusers and their controls while mean Qave was significantly higher in the alcohol addicts than their controls. Conclusion: ED and LUTS are more prevalent in alcohol and drug abusers when compared to healthy controls. It can be proposed that alcohol and drug addiction should be considered in the etiology of ED and LUTS especially in young adult population.
... In the study of 701 illicit drug users, 92.5% were active smokers, 6.6% had alcoholism and 19.0% used more than one kind of illicit drugs. 69 However, the synergic effect of polydrug use on ED is rarely investigated. ...
Article
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Substance use disorders form a major part of global disease burden. With increasing trend of use of psychoactive substance, the deleterious effects associated with it also increases. These effects may be biological, social or legal. Among the biological consequences of substance use, little is known of its effect on sexual functioning. In common parlance it is said that many substances increase the sexual desire and hence act as an aphrodisiac. To what extent this is true remains a question of debate. The purpose of thi s article is to review and summarize the available literature on the impact of psychoactive substances like alcohol, tobacco, cannabis and others on sexual functioning. Almost all of them are associated with one or other form of sexual dysfunction. The mec hanism by which they exert such deleterious effect also varies. Further, the sexual dysfunction resulting from substance use can itself have bearing on treatment aspects of substance use. The relationship between sexual dysfunction and substance is attribu ted not only to pharmacological effects, but also to psychological and social factors stemming from substance use. This information of sexual consequence of substance will be of interest and may serve as a powerful tool to healthcare providers
... Illicit drug use was studied in a cross-sectional trial of Taiwanese detainees (N=701, mean age 33.8 years) with a history of drug abuse versus controls (N=196) (50). Heroin, amphetamine and MDMA ("ecstasy") were the most commonly reported drugs of abuse in this detainee population. ...
Article
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Erectile dysfunction (ED) is a common condition affecting millions of men worldwide. The pathophysiology and epidemiologic links between ED and risk factors for cardiovascular disease (CVD) are well-established. Lifestyle modifications such as smoking cessation, weight reduction, dietary modification, physical activity, and psychological stress reduction have been increasingly recognized as foundational to the prevention and treatment of ED. The aim of this review is to outline behavioral choices which may increase ones risk of developing ED, to present relevant studies addressing lifestyle factors correlated with ED, and to highlight proposed mechanisms for intervention aimed at improving erectile function in men with ED. These recommendations can provide a framework for counseling patients with ED about lifestyle modification.
... Aside from systemic diseases, a range of prescription drugs have been reported to contributed to ED in males including antihypertensive drugs, antidepressants and antiandrogens [3,4]. In addition, recreational drug users have suffered from ED as a toxicological effect, including alcohol, heroin and ecstasy [5][6][7]. However, the relationship between longterm ketamine administration and ED remains unclear. ...
Article
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We investigated and evaluated the mechanisms of erectile dysfunction (ED) in a rat model of long-term ketamine administration. Adult male Sprague-Dawley rats (n = 32) were divided into four groups: namely the control group receiving intraperitoneal injection of saline, 1-month, 2-month and 3-month groups receiving daily intraperitoneal injection of ketamine (100 mg/kg/day) for 1, 2, and 3 month respectively. After treatment, animals underwent an erectile response protocol to assess intracavernosal pressure (ICP). Smooth muscle content was evaluated. Neuronal nitric oxide synthase (nNOS), inducible nitric oxide synthase (iNOS) and endothelial nitric oxide synthase (eNOS) expression were assessed using immunostaining assay. Ketamine-induced apoptosis was analyzed using TUNEL assay. Long-term ketamine administration caused significantly decreased erectile responses as measured by ICP. Smooth muscle content was significantly decreased in the ketamine-treated rats for 3 months. In the erectile tissue, ketamine administration significantly reduced nNOS expression and increased iNOS content compared with controls, whereas eNOS expression was not altered. Ketamine induced apoptosis in corpus cavernosum. The present study demonstrates that long-term ketamine administration led to erectile dysfunction in rat. The molecular mechanisms of ketamine-induced ED involved the increased apoptosis and up-regulated iNOS expression incorporating with loss of corporal smooth muscle content and reduced nNOS expression in cavernous nerve.
... The chronic use of opioids including methadone in men leads to symptoms such as delayed ejaculation, erectile dysfunction and significant reduction of sexual libido [7]. Accordingly, in men seeking treatment for opioid dependence, the prevalence of sexual dysfunction (SD) was significantly higher in comparison with healthy control subjects [8]. ...
Article
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The controversial data for erectile function and quality of life of patients undergoing methadone maintenance treatment (MMT) and lack of questionnaire-based studies, providing information about these bio-psycho-social issues, in Bulgaria motivated the investigators to examine the frequency of erectile dysfunction among patients on methadone maintenance treatment, and to identify quality of life among these subjects. For these needs cross-sectional, observational with no intervention, case-control, questionnaire-based study was performed which included participants from 18 to 40 years of age undergoing MMT for at least six months and clinically healthy people. A total of 91 patients from 5 clinical programs for MMT in Bulgaria took part in the study and 27 clinically healthy people from the same age and without a history of drug abuse, psychiatric and somatic diseases which served as a control group. All participants signed informed consent. For evaluating erectile function International Index of Erectile Function survey was used. SF 36 v.2 quality of life survey was used for assessing the quality of the participants. When comparing results of the quality of life survey in Patient and Control group significant differences were found in all of the components of the survey (p<0.05) with lower results in the Patient group. When analysing results from the IIEF survey significantly lower total scores were present for all components of the survey in the patient as compared to the group of healthy men (p<0.05). Keywords: Erectile Function, Methadone, IIEF, Erectile Dysfunction, Quality of Life, SF 36
... Maddelerin genellikle cinsel performansı ve zevki artırmak için afrodizyak olarak kullanımı yaygındır. Sıklıkla her iki cinsiyette cinsel performansı ve zevki artırmak için madde kullanımı yaygın olsa da cinsellik madde bağımlılığı nedeniyle olumsuz etkilenmektedir (4). Maddelerin bu akut etkileri cinsel eylemle ilişkili dopamin, norepinefrin, serotonin nörotransmitterlerinin düzeylerini yükseltmektedir. ...
Article
The effect of heroin use disorder on the sexual functions of women Objective: This study was conducted to evaluate the sexual functions of women with heroin use disorder. Method: This comparative-descriptive and cross-sectional study was carried out at the Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM) of Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery. Included in the heroin use disorder group were 57 women aged 18 years or above who presented to AMATEM between June 1, 2014 and December 31, 2014 and received a diagnosis of substance use disorder according to DSM-5. Inclusion criteria were the absence of psychiatric diseases, substance withdrawal symptoms, or mental retardation, being sexually active, not being pregnant or puerperant, and having given consent to participate in the study. Healthy female relatives of 79 female patients who presented to the Gynecology Clinic of the same hospital during the same period were included in the healthy group. The data were collected through an interview form was developed by researchers, Female Sexual Function Index (FSFI), and Beck Depression Inventory (BDI). Results: No difference was determined between the participants in both groups in terms of average age, period of education, body mass index, or employment and economic situation (p>0.05). It was determined that, in contrast with the healthy group, 70.4% of the women with heroin use disorder had sexual problems and 71.9% of them were not satisfied with their sexual life. It was found that women with heroin use disorder scored significantly lower than healthy controls in FSFI sub-dimensions such as desire, arousal, lubrication, orgasm, satisfaction, and pain, as well as for the total scale, while scores were higher on the BDI scale (p<0.05). Conclusion: Among women with heroin use disorder, sexual functions are adversely affected and depressive symptoms appear to be increased. © 2018 Yerkure Tanitim ve Yayincilik Hizmetleri A.S..All right reserved.
... Some panthi participants who have used methamphetamine for a long period struggled to sustain erections, which mirrors findings from gay and bisexual participants in U.S.-based studies (Bang-Ping, 2009;Shoptaw & Reback, 2007). In turn, these panthi changed their role, from insertive to receptive, to satisfy sexual urges and maximize sexual pleasure. ...
Article
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Methamphetamine use has increased among gender and sexually diverse people in several countries, including Bangladesh. This study aimed to explore the effects of methamphetamine on the sexual lives of these people in Dhaka, Bangladesh. An exploratory qualitative study was conducted, comprising 30 in-depth interviews with gender and sexually diverse people including males having sex with males, male sex workers, and transgender women (hijra) under HIV intervention coverage. Ten key informant interviews were also conducted with individuals who have expertise in relevant disciplines such as drug use, harm reduction, and HIV and AIDS. Digitally recorded data were manually analyzed under the thematic analysis framework. Findings indicated that many participants reported that methamphetamine brought changes in their sexual lives such as increased sexual drive, engagement in group sex, the increased ability to perform serial sex, transactional sex, impulsive and coercive sex, initiation and switching of male-to-male sexual practices, and limited condom use. Key informants noted that there is a dearth of methamphetamine-related services in Bangladesh. Methamphetamine use was found to lead to diverse effects on the sexual lives of gender and sexually diverse people, thus making it a driving force for shaping sexual practices and, hence, sexual risks. Therefore, it is essential for policy-level stakeholders and program managers to consider the risks of methamphetamine use due to their negative ramifications on sexual health, including HIV risks.
... Men who chronically use opioids report an unexpectedly high prevalence of erectile dysfunction at younger ages when compared to the general population. Studies have shown that men who chronically abused opioids with mean age of 28-49years have a prevalence [14][15][16][17][18] of erectile dysfunction which ranges from 21-52%. ...
Article
Full-text available
THE SIDE EFFECT OF CHRONIC TRAMADOL ABUSE ON HYPOTHALAMIC GONADAL AXIS AND ON BREAST TISSUE.
... Interestingly, the anxiety disorder predated the onset of ED in two-thirds of cases. Other psychiatric diagnoses, such as PTSD (Cosgrove et al., 2002;Kotler et al., 2000;Letourneau et al., 1997;Tran et al., 2015) and schizophrenia (Dossenbach et al., 2005;Fortier et al., 2003) have also been associated with ED, as has methadone (Hallinan et al., 2008), cigarette (Mannino et al., 1994), alcohol (Nicolosi et al., 2003), and heroin use (Bang-Ping, 2009). ...
Article
The International Index of Erectile Function (IIEF) has been widely used to measure gay men’s erectile functioning. However, the IIEF was initially developed using a sample of men whose sexual orientation was unspecified. Using scales not validated for specific populations can result in inaccurate assessments. The purpose of the current study was to evaluate the dimensionality, reliability, and validity of the IIEF with a large sample of gay men. One thousand and eighteen men self-identifying as “exclusively gay” completed an online survey consisting of demographics, the IIEF, the Hospital Anxiety and Depression Scale (HADS), the Perceived Stress Scale 4 (PSS4), and the Gay Male Sexual Difficulties (GMSD) erectile difficulties sub-scale. The replicability of the IIEF factor structure with a gay male sample was determined using exploratory and confirmatory factor analyses. Additionally, the HADS, PSS4, and GMSD were used to determine the validity of the IIEF. The current study was unable to replicate the IIEF factor structure. Four items required deletion and the factor solution differed from the original. Thus, reinterpretation of the latent variables was deemed necessary. Although the resultant 12-item IIEF evidenced model fit, validity, and reliability, it is not recommended for use with gay men. The revised IIEF is unable to accurately measure gay men’s erectile functioning as the content of the items fail to capture their sexual behaviors (i.e., insertive and receptive anal sex).
Article
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Background: Sexual and marital dissatisfaction seems to be one the most common complications among patients on methadone maintenance therapy (MMT), which may decrease adherence to continue treatment in patients. Efficacy of adding bupropion to MMT protocols has been investigated in previous studies; but evidence for implication of permission, limited information, specific uggestions, intensive therapy (PLISSIT) method for these patients is limited. So, this study was designed to investigate the efficacy of adding PLISSIT as an adjuvant therapy to MMT protocol on sexual dysfunction and marital satisfaction among men patients. Methods: During a clinical trial study conducted in the addiction quitting clinics of Isfahan University of Medical Sciences, Isfahan, Iran, 50 men patients with sexual dysfunction receiving MMT were randomized into two equal treatment group of 6-week PLISSIT program and control. Both groups received slow-release bupropion with a usual dosage (150 to 300 mg/day) for improving sexual function. Sexual function and marital satisfaction for both groups were assessed accordingly using Arizona sexual experience scale (ASEX), and revised dyadic adjustment scale (RDAS). Findings: During the intervention, the mean changes in the overall scores of sexual dysfunction and marital satisfaction were significantly different between the two groups (P < 0.001 for all). Conclusion: Adding PLISSIT to bupropion could improve sexual function and marital satisfaction among men under MMT. Further studies can support these findings for implication of PLISSIT by counselors in addiction treatment clinics. Keywords: Bupropion, Methadone, Sexual dysfunction, Clinical trial
Chapter
To highlight the salient psychological and interpersonal issues contributing to sexual health and dysfunction; to offer a four-tiered paradigm for understanding the evolution and maintenance of sexual symptoms; and to offer recommendations for clinical management and research.<br /
Article
IntroductionData concerning the impact of amphetamine on male sexual functions are limited, although amphetamine has been used as an aphrodisiac. AimsThis cross-sectional study was to assess the impact of illicit use of amphetamine on male sexual functions. Methods Male illicit drug users in a Drug Abstention and Treatment Center were recruited to complete a self-administered questionnaire, and data were compared with age-matched controls. Main Outcome MeasuresThe International Index of Erectile Function (IIEF) and global assessment questions were used to assess sexual functions. ResultsOf 1,159 amphetamine mono-illicit drug users, the mean age was 31.97.5 (18-57) years, and mean duration of drug use was 30.7 +/- 52.2 (median 9, range 0.1-252) months. Half of them reported that drug use had no impact on their sexual functions. The other half reported drug impacts as reduced erectile rigidity and sexual life satisfaction, enhanced orgasmic intensity, and prolonged ejaculation latency time more often than the opposite effects, while they reported enhanced or reduced effect equally on sexual desire. Dosing frequency of amphetamine was associated with its impact on sexual functions, but duration of its use had little association with that. Compared with 211 age-matched controls, the amphetamine mono-illicit drug users had lower IIEF scores in the domains of erectile function, orgasmic function, and overall satisfaction, but there are no significant differences in intercourse satisfaction and sexual desire scores. The prevalence of erectile dysfunction (ED) was significantly higher in the drug users than in the controls (29.3% vs. 11.9%). The odds ratio of ED for amphetamine use was 2.1 (95% confidence interval 1.2-3.6) after adjustment for other risk factors. Conclusions The impact of illicit use of amphetamine on male sexual functions varied among users, and their ED prevalence was higher than the controls. Chou N-H, Huang Y-J, and Jiann B-P. The impact of illicit use of amphetamine on male sexual functions. J Sex Med 2015;12:1694-1702.
Article
Purpose of review: This review provides a summary of recently published research on sexually transmitted infections (STI) and related behaviors among people who inject drugs (PWID), covering three major areas: sexual behavior and its role in STI transmission among PWID, multilevel factors associated with STI risk, and strategies addressing sexual health of PWID. This review is timely given the growing priority of combination prevention approaches and integrated care for PWID. Recent findings: Modern research improves the understanding that PWID have an increased risk of STI, which varies by gender, setting, type of substance used, and presence of mental disorders. Major socioeconomic and structural factors, specific and nonspecific to PWID, facilitate inequality and sexual risk behavior. Sexual transmission continues to contribute substantially to the spread of bloodborne infections among PWID, accounting for at least 10% of new HIV cases according to epidemiological modeling. Despite the substantial evidence that behavioral interventions can improve sexual health and reduce sex-related risks among PWID, there is a research-practice gap, reflected in the scarcity of implementation studies published recently. Summary: Integration of sexual health into prevention programs for PWID is essential to curb transmission of STI, including HIV, among PWID and their sexual partners.
Article
Background: Erectile dysfunction (ED) is a common condition that may affect men of all ages; in 1999, a Process of Care Model was developed to provide clinicians with recommendations regarding the evaluation and management of ED. Aim: To reflect the evolution of the study of ED since 1999, this update to the process of care model presents health care providers with a tool kit to facilitate patient interactions, comprehensive evaluation, and counseling for ED. Methods: A cross-disciplinary panel of international experts met to propose updates to the 1999 process of care model from a global perspective. The updated model was designed to be evidence-based, data-driven, and accessible to a wide range of health care providers. Outcomes: This article summarizes the resulting discussion of the expert meeting and focuses on ED evaluation. The management of ED is discussed in an article by Muhall et al (J Sex Med 2018;15:XXX-XXX). Results: A comprehensive approach to the evaluation of ED is warranted because ED may involve both psychological and organic components. The updated process of care model for evaluation was divided into core and optional components and now focuses on the combination of first-line pharmacotherapy and counseling in consideration of patient sexual dynamics. Clinical implications: Patient evaluation for ED should encompass a variety of aspects, including medical history, sexual history, physical examination, psychological evaluation, laboratory testing, and possibly adjunctive testing. Strengths & limitations: This update draws on author expertise and experience to provide multi-faceted guidance for the evaluation of ED in a modern context. Although a limited number of contributors provided input on the update, these experts represent diverse fields that encounter patients with ED. Additionally, no meta-analyses were performed to further support the ED evaluation guidelines presented. Conclusion: Comprehensive evaluation of ED affords health care providers an opportunity to address medical, psychological/psycho-social, and sexual issues associated with ED, with the ultimate goal being effective management and possibly resolution of ED. While some or all techniques described in the updated model may be needed for each patient, evaluation should in all cases be thorough. Mulhall JP, Giraldi A, Hackett G, et al. The 2018 Revision to the Process of Care Model for Evaluation of Erectile Dysfunction. J Sex Med 2018;XX:XXX-XXX.
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Purpose – The purpose of this paper is: first, to consider the reported problems in sexual function caused by psychotropic medication. Second, the complex undertaking of completing an assessment of sexual functioning. Third, the role of the pharmaceutical industry is explored. Finally, implications for future research and practice are suggested. Design/methodology/approach – As a commentary this paper draws on the available literature to synthesise what is already known about the relationship between psychoactive substances and sexual functioning. Findings – The limited literature and lack of research attention given to psychotropic induced sexual dysfunction limits our collective understanding of how many people are affected and in what way. Research limitations/implications – A greater focus on psychotropic induced sexual dysfunction is needed for people with a dual diagnosis. There has been an over reliance on single case studies and self-reporting. Large scale epidemiological investigation would help understand the extent and nature of the problem more fully. The demographic shift particularly in relation to an ageing population should be considered as psychotropic substances effect individuals in different ways as they grow older. Practical implications – There is scope for workers to engage more fully in a conversation with clients about their experience of using psychotropic substances and how this has impacted their sexual functioning. The literature suggests that clients want to talk about this issue but staff are unwilling or unable to discuss the topic. Originality/value – To the authors’ knowledge this is the first paper that draws on the available literature to explore the known and likely implications of psychotropic induced sexual dysfunction for this client group.
Article
Heroin use disorder is a chronic relapsing brain disease containing multiple phenotypes. These phenotypes vary among heroin users and might be influenced by genetic factors. Single-nucleotide polymorphisms (SNPs) of catechol-O-methyltransferase (COMT) and alpha-1-adrenergic receptor (ADRA1A) genes are associated with heroin use disorder. However, it has not been clarified which phenotypes of heroin use disorder are related to these genes. To address this question, we recruited 801 unrelated heroin users and divided them into different subgroups according to four important phenotypes of heroin use disorder. Then 7 SNPs in the functional regions of these genes were systematically screened and genotyped using a SNaPshot assay. We found that the A allele of ADRA1A rs1048101 was associated with a shorter duration of transition from first use to addiction. Subjects with the C allele of ADRA1A rs3808585 were more susceptible to memory impairment after heroin use disorder. Subjects with the G allele of COMT rs769224 were more likely to take a higher dose of heroin every day. Our study confirmed the association between polymorphisms of COMT and ADRA1A with those specific phenotypes of heroin use disorder, which will be instructive for the precise treatment of the disease.
Article
Introduction: People with any psychiatric disorder tend to have difficulties in responding sexually. However, sexual dysfunction (SD) is usually under-recognized, even the tightly hormonal and neuronal common connexions through the brain-sex axis. Multiple sources of resistance to comprehensive SD assessment and intervention efforts persist to improve this situation. Areas covered: The present review aims to underline the feasibility to introduce SD evaluation in patients with any psychiatric disorders, evaluating the potential mutual benefits of their management. Expert opinion: Women and men living with mental disorders frequently display sexual difficulties; however, some of them consider sexuality as a relevant parameter of their quality of life. In fact, SD as a side effect is a frequent reason for stopping the intake of medication. What’s more, a holistic approach integrating sexual function could foster a better understanding of mental pathologies due to a common origin of pathogenesis. This could improve care quality, in keeping with the global tendency towards the development of personalized medicine. Consistently, the integration of SD assessment is highly recommended in mental health, all the more so when a psychotropic drug is prescribed. An expected consequence would be a reconstruction of the healthcare professional’s consideration for the sexuality of people experiencing mental disorders.
Article
Introduction: Psychological, interpersonal, and sociocultural factors play a significant role in making one vulnerable to developing a sexual concern, in triggering the onset of a sexual difficulty, and in maintaining sexual dysfunction in the long term. Aim: To focus on psychological and interpersonal aspects of sexual functioning in women and men after a critical review of the literature from 2010 to the present. Methods: This report is part 1 of 2 of our collaborative work during the 2015 International Consultation on Sexual Medicine for Committee 2. Main outcome measures: Systematic review of the literature with a focus on publications since 2010. Results: Our work as sexual medicine clinicians is essentially transdisciplinary, which involves not only the collaboration of multidisciplinary professionals but also the integration and application of new knowledge and evaluation and subsequent revision of our practices to ensure the highest level of care provided. There is scant literature on gender non-conforming children and adolescents to clarify specific developmental factors that shape the development of gender identity, orientation, and sexuality. Conversely, studies consistently have demonstrated the interdependence of sexual function between partners, with dysfunction in one partner often contributing to problems in sexual functioning and/or sexual satisfaction for the other. We recommend that clinicians explore attachment styles of patients, childhood experiences (including sexual abuse), onset of sexual activity, personality, cognitive schemas, infertility concerns, and sexual expectations. Assessment of depression, anxiety, stress, substance use and post-traumatic stress (and their medical treatments) should be carried out as part of the initial evaluation. Clinicians should attempt to ascertain whether the anxiety and/or depression is a consequence or a cause of the sexual complaint, and treatment should be administered accordingly. Cognitive distraction is a significant contributor to sexual response problems in men and women and is observed more consistently for genital arousal than for subjective arousal. Assessment of physical and mental illnesses that commonly occur in later life should be included as part of the initial evaluation in middle-aged and older persons presenting with sexual complaints. Menopausal status has an independent effect on reported changes in sex life and difficulties with intercourse. There is strong support for the use of psychological treatment for sexual desire and orgasm difficulties in women (but not in men). Combination therapies should be provided to men, whenever possible. Conclusion: Overall, research strongly supports the routine clinical investigation of psychological factors, partner-related factors, context, and life stressors. A biopsychosocial model to understand how these factors predispose to sexual dysfunction is recommended.
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Background and objectives: Compliance and maintenance of abstinence is a major issue in substance use disorders. Adverse effects of opioid maintenance treatments (OMT) include sexual dysfunctions. There is a vast amount of studies regarding sexual adverse effects of conventional OMTs; however, information regarding buprenorphine/naloxone (Bup/Nal) combination is limited, mostly evaluated in western populations and controversial. In this study, we aimed to assess the sexual adversities of Bup/Nal treatment in a Turkish alcohol and substance use disorder treatment center sample. Materials and methods: We recruited 100 subjects continuing sublingual Bup/Nal combination and 35 control subjects. Subjects were evaluated via the the Golombok-Rust Inventory of Sexual Satisfaction (GRISS) for sexual dysfunction and for erectile dysfunction (ED) with the International Index of Erectile Function-5 (IIEF-5) as a comparison. Results: The mean dose of our treatment was 9.05. Overall sexual dysfunction scores were not significantly different in between groups with GRISS. ED and noncommunication scores were significantly higher in the Bup/Nal treatment group than the control group (p = 0.002, p = 0.02, respectively). Along with the increased ED scores in GRISS, IIEF-5 total scores also revealed more significant severity of the ED in the Bup/Nal group (p = 0.001). Conclusion: Buprenorphine/naloxone combination lead to a higher degree of ED severity than the non-treatment controls. Noncommunication seems to play a role as a risk factor for ED in patients with opioid use disorder. Thus, effective communication can be a key factor for sexual assertivity and disclosing the sexual adverse effects to the clinicians as well as staying in the treatment.
Chapter
Alcohol and other drugs have actions in limbic-hypothalamic hedonic motivational pathways that normally subserve basic biological functions including sexual behaviors. They may also have a range of other physiological and psychological effects on sexual function. Psychoactive drugs are often used to facilitate or enhance sexual behaviors, but they can also cause sexual dysfunction. Their use can be associated with risky or harmful sexual behaviors. Pharmacotherapies commonly used in addiction treatment, including opioid pharmacotherapies, sedative/hypnotics, antidepressants, and antipsychotics, can negatively affect sexual function, with implications for treatment adherence and effectiveness. Further, common psychological and physical comorbidities in people with substance use disorders may cause sexual dysfunction. An understanding of these issues can help clinicians working in the field of addiction better to appreciate motivations for continuing or reducing drug use, can inform motivational and harm reduction interventions, and can improve understanding of issues around treatment adherence. While there are challenges for clinicians in speaking about sexuality with their patients, they are an important part of comprehensive assessment and treatment planning. The clinical benefits of addressing these issues, ranging from reducing sexual risk behavior to improving quality of life of people receiving pharmacotherapies, can be substantial.
Chapter
The effects of chronic abuse of alcohol and/or other substances of abuse vary considerably, depending, for example, on the concentration and dose. Furthermore, other factors also may play a role, such as nutritional status, gender, and ethnicity. This chapter analyzes the main medical consequences related to substance abuse, namely alcohol, nicotine, opioids, cocaine, amphetamine, and benzodiazepines. The effects of these substances on the liver, gut, pancreas, nervous system, cardiovascular system, and endocrine system are analyzed and discussed. The link between substance abuse disorders and tumors is also reported, as well as the relationship between substances of abuse and nutrition and body composition.
Chapter
Alcohol and other drugs have actions in limbic-hypothalamic hedonic motivational pathways that subserve basic biological functions including sexual behaviors. They may also have a range of other physiological and psychological effects on sexual function. Psychoactive drugs are often used to facilitate or enhance sexual behaviors, but they can also cause sexual dysfunction. Their use can be associated with risky or harmful sexual behaviors. Pharmacotherapies commonly used in addiction treatment, including opioid pharmacotherapies, sedative/hypnotics, antidepressants, and antipsychotics, can negatively affect sexual function, with implications for treatment adherence and effectiveness. Further, common psychological and physical comorbidities in people with substance use disorders may cause sexual dysfunction. An understanding of these issues can help clinicians working in the field of addiction better to appreciate motivations for continuing or reducing drug use, can inform motivational and harm reduction interventions, and can improve understanding of issues around treatment adherence. While there are challenges for clinicians in speaking about sexuality with their patients, this may be an important part of comprehensive assessment and treatment planning. The clinical benefits of addressing these issues, ranging from reducing sexual risk behavior to improving the quality of life of people receiving pharmacotherapies, can be substantial.
Article
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Objectives: Drug addiction becomes one of the grave problems worldwide, which has much health adverse effects. There are many reports relating Sexual dysfunction to heroin addiction that also affecting sex hormones. The aim of this study was to investigate the association of sexual dysfunction, expression of sex hormones related genes and sex hormones disturbance with illicit heroin addiction in patients presented to psychiatric outpatient clinic, Zagazig University Hospitals, Egypt. Methods: Semi-structured questionnaire and International index of erectile function scale were used for assessment of erectile and sexual dysfunction of 180 adult males (90 heroin addicts and 90 controls). Then the heroin addiction group was subdivided into (Initiation of heroin withdrawal group and 6-months follow up group, 45 individuals in each subgroup. Blood samples were collected for detection of sex hormones (Testosterone, FSH and LH) by Electrochmeiluminescence analyzer, genes expression of (Cytochrome 19 (CYP19), Follicle Stimulating Hormone related gene (FSH-B), Luteinizing Hormone related gene (LH-B) by Quantitative Real-time polymerase chain reaction(RT-PCR). Results: heroin addicts suffered from a matter of sexual dysfunction as (decrease erectile function, orgasm, sexual desire and intercourse satisfaction), reduction of serum sex hormones and up regulation of CYP19 gene, down regulation of FSH-B and LH-B genes. Conclusion: This study suggested that there is a correlation between heroin addiction and sexual dysfunction with reduction of sex hormones secondary to affection of sex hormone related genes that showed improvement in the group of heroin discontinuation for 6 months. It is recommended to increase the period of follow up of heroin addicts as complete improvement may occur.
Article
The available data suggest that most illicit drugs have adverse effects on erection, sexual desire, and ejaculation latency in male individuals. This study was conducted for the evaluation of the sexual functions of substance abuse men. This descriptive study was conducted at the Alcohol and Substance Research Treatment and Education Center. Male individuals diagnosed as having substance use disorder according to DSM-V (n=106) were included as the patient group. A 30-item sociodemographic and reproductive health interview form developed by researchers and the 15-item International Erectile Function Index were administered to all the participants. It was determined that the most prevalent addiction was cannabis addiction (39.6%) in the substance abuser group, and this was followed by heroin (35.8%) and cocaine addiction (24.6%). It was observed that the substance used by participants at the earliest age (15.81±4.19) was cocaine, and the longest duration in substance use (13.11±9.11) was in the cannabis group. An overall 41.5% of participants stated that they had a sexual problem, and 31.1% of them said they were not satisfied with their sexual life. It was detected that most of the substance abuser men (77.4%) have mild erectile dysfunction (ED) at the rate of 12.3% and moderate ED in 65.1% of them, and the cannabis user group had the most ED (83.3%). Substance abuse affects male sexual functions negatively. There are limited studies about the effects of substance abuse on male sexual functions in our country. For this reason, there is a need for more extensive prospective studies.
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Background & Aims: Today, the role of non-drug treatment is important in the treatment of addiction. Compliance therapy plays effective role in improvement of quality of life, reducing the effects sides of treatment and especially in mental health promotion. The present study has been designed to determine the effect of “compliance therapy “with group therapy on quality of life, general function, acceptance and care after illness in opioid addicted under Methadone Meintanance Therapy (MMT). Material & Method: The clinical trial methodology was done on the addicted persons who are in recovery phase, in 4 addiction treatment centers in Tehran city during 2016 year. Initially, 120 patients were selected randomly, they were devided in four groups (group therapy, group therapy and compliance therapy, compliance therapy and control group). The variables of study were quality of life (QOL), Global Function, treatment acceptance, this variables were assessed by Quality of Life Questionnaire, and Global Assessment Function and compliance therapy scale. To data analysis we used descriptive and inferential statistic (ANOVA) and ANCOVA via SPSS 20 software. Results: Based on ANOVA analysis, there are significant differences in sub scales of quality of life questionnaire (including interpersonal relationship, activities and Common goals), Global Function Assessment in Social, vocational and educational fields and score of compliance between 4 groups. (P-value
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Within the context of inpatient psychiatric settings, the sexuality and sexual health of patients remains a controversial issue in both clinical practice and the research community. Specifically, practitioners’ views on sexuality range from those which regard sexuality as a potential distraction to ongoing psychiatric management, to views that attention to issues of sexuality and its expression is an important element of recovery-based care. To fully address this issue, this chapter will cover the history of sexuality within the context of the psychiatric unit, examine existing tensions between staff attitudes toward inpatient sexuality, discuss current hospital policies, and identify risks associated with sexual autonomy on the inpatient unit. Additionally, several issues relevant to sexual expression, namely, the impact of psychiatric symptoms, substance use, and psychotropic medication on sexuality, will be explored as it relates to the recovery model of mental health. In keeping with the principles of the recovery model, this chapter will also cover other factors that affect patient quality of life and sexuality, such as past and current research on different aspects of sexuality, reproductive health, and family planning in individuals admitted to an inpatient will be explored. The chapter concludes with the call for continued research and discussion upon the sexuality and sexual health of patients within inpatient psychiatric settings.
Article
Correlational evidence has linked methamphetamine use and HIV sexual risk behavior, but the direct effects of methamphetamine on sexual desire and sexual decision making in humans have not been tested. This study was designed to test the effect of methamphetamine administration on sexual desire and hypothetical condom-use decisions as measured by the Sexual Delay Discounting Task. Recreational stimulant users (n = 19) participated in this within-subject, placebo-controlled study comparing the effects of 0 mg, 20 mg, and 40 mg of oral methamphetamine. Compared to placebo, methamphetamine caused dose-related and time-related increases in a single-item sexual desire rating and some standard stimulant abuse liability ratings, as well as dose-related increases in the Sexual Arousal and Desire Inventory (SADI; a multidimensional scale capturing positive and negative aspects of desire/arousal). However, methamphetamine caused no significant mean differences in likelihood of condom use within the Sexual Delay Discounting Task or the Monetary Discounting Task. SADI scores were negatively correlated with change from placebo in condom use likelihood in the Sexual Delay Discounting Task for some partner conditions (i.e., decreased reported likelihood of condom use in participants who experienced increased desire/arousal and vice versa). These mixed results may be consistent with methamphetamine's role as both a treatment for attention-deficit/hyperactivity disorder and as a drug of abuse associated with increased delay discounting, and they suggest that methamphetamine's effects on discounting may be modulated by the reinforcing properties of what is being discounted. Delay discounting may be an understudied element of risky sexual decision making, particularly among individuals who use methamphetamine. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Article
Introduction: Erectile dysfunction (ED) is a common condition the treatment of which over the years has expanded from specialty care settings to various other clinical settings. A Process of Care Model was developed in 1999 to provide primary care physicians with guidance in the diagnosis and management of ED. Aim: This update to the Process of Care Model aims to reflect current ED management practices, because the study of ED has changed since 1999. Methods: Updates to the Process of Care Model were developed during a meeting of international experts from diverse disciplines. The updated model is data-driven, evidence-based, and relevant to a wide range of healthcare providers. Main outcome measures: This article summarizes the results of the expert meeting and focuses on ED management. The evaluation of ED is discussed in a separate article. Results: The updated model presents modification of risk factors and correction of comorbidities frequently associated with ED as critical parts of patient management. Patients should be encouraged to make positive lifestyle changes such as improving diet and increasing physical exercise. Lifestyle changes may be accompanied by the first-line medical therapies of sexual counseling and therapy, which takes into consideration patient sexual dynamics and pharmacotherapy with phosphodiesterase 5 inhibitors (PDE5Is). Clinical implications: The updated model provides guidance regarding risk factors associated with ED, their modification, sexual counseling, and PDE5I selection, dosing, and patient education. Strengths and limitations: This update leverages the extensive clinical expertise and experience of the authors to provide updated, comprehensive guidance for ED management. The model reflects the views and experiences of a limited number of contributors; however, these authors draw upon a diverse array of clinical specialties and are regarded as experts in their fields. Additionally, no meta-analyses were performed to further support the ED evaluation guidelines presented. Conclusion: Effective management of ED may be achieved through a combination of patient risk factor modification and first-line therapy, taking into consideration any patient comorbidities known to be associated with ED. Treatment goals should be individualized to restore sexual satisfaction to the patient and/or couple and improve quality of life based on the patient's expressed needs and desires. Mulhall JP, Giraldi A, Hackett G, et al. The 2018 Revision to the Process of Care Model for Management of Erectile Dysfunction. J Sex Med 2018;XX:XXX-XXX.
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Sexual dysfunction is a very common problem that affects many women in their lifetime. Female sexual dysfunction is a complex multifactor phenomenon that covers a range of sexual problems including sexual desire, sexual arousal, orgasm, or sexual pain disorders. Each one has distinct symptoms that are negatively regulated by drug abuse (i.e., cocaine and heroin, but also antidepressants), tobacco, and alcohol; however, some drugs have been found to make sexual problems worse, others milder. The pharmacological mechanisms associated to female sexual disorders promoted by drugs are unfortunately only partially elucidated. Moreover, the levels of several physiological neurotransmitters, as serotonin or dopamine, or vascular factors, as nitric oxide, seem to contribute to female sexual disorders and are modulated by drugs as antidepressants or by toxic compounds as tobacco. In addition, women have pharmacokinetic and pharmacodynamic characteristics that are different from men and that increase drug side effects respect to men. Further studies are thus necessary to better understanding the impact of alcohol and drug abuse on female sexual dysfunction.
Chapter
Chronic neurological disease can have a tremendous impact on a woman’s health, self-image, and consequently on self-esteem [1]. One of the most important areas that could be impaired after the onset of a neurological disease is sexual function.
Chapter
Erectile Dysfunction (ED) can affect males of all age groups and is often associated with an enormous decrease in quality of life. Furthermore, it is recognized as an early indicator of cardiovascular disease. Standard non-invasive therapy of ED encompasses mechanical options and pharmacological treatment with inhibitors of phosphodiesterase-5 (PDE5-i). More invasive options include local application of vasodilating agents and, in refractory cases, operative implantation of a penile prosthesis. Peyronie’s disease (PD) is caused by an inflammatory process of the penile tunica albuginea, resulting in the formation of fibrotic plaques, which may lead to penile deformity. While medical therapy can help to attain symptom relief and early plaque stabilization, different surgical approaches to correct penile curvature exist. A variety of novel treatment alternatives are available for both diseases. The following chapter sums up current treatment algorithms for ED and PD.
Article
Background: Opioid analgesics have been widely used to relieve chronic pain conditions; however, a connection between opioid analgesic administration and increased susceptibility to erectile dysfunction (ED) has been hypothesized. Aim: To evaluate whether opioid use was a risk factor for ED in a systematic review and meta-analysis. Methods: The PubMed, Cochrane Library, and Embase databases were searched to identify eligible studies concerning opioid use and risk of ED from inception to April 2017. The association between opioid use and risk of ED was summarized using the relative risk with 95% CI. Sensitivity analyses were conducted to assess potential bias. The Begg and Egger tests were used for publication bias analysis. The GRADE evidence profile tool was used to assess the quality of the evidence. Outcomes: The overall combined risk estimates for the effect of opioid use on ED were calculated using a random-effects model. Results: This meta-analysis included 8,829 men (mean age = 41.6 years) from 10 studies, 2,456 of whom received opioid management (duration of intervention = 4 months to 9.5 years). Pooled results demonstrated that the use of opioids was significantly associated with an increased risk of ED (relative risk = 1.96, 95% CI = 1.66-2.32, P < .001). Estimates of the total effects were generally consistent in the sensitivity analysis. No evidence of publication bias was observed. The overall quality of evidence was rated as low. Clinical implications: We found that men with opioid use had a significantly increased prevalence of ED, which suggests that patients and clinicians should be aware of the potential role played by opioid administration in the development of ED. Strengths and limitations: This is the first meta-analysis performed to describe the relation between opioid use and ED risk based on all available epidemiologic studies. However, the direction of causality between opioid use and risk of ED should be interpreted with caution because most included studies used a cross-sectional design. Conclusion: Evidence from the included observational studies indicated that men with opioid use had a significantly increased risk of ED. Further randomized controlled trials are still needed to confirm this relation. Zhao S, Deng T, Luo L, et al. Association Between Opioid Use and Risk of Erectile Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med 2017;XX:XXX-XXX.
Article
Introduction: Heroin addiction is a chronic complex brain disease that contains multiple phenotypes, which vary widely among addicts and may be affected by genetic factors. A total of 801 unrelated heroin addicts were recruited and divided into different subgroups according to eight phenotypes of heroin addiction. Polymorphisms in GAD1 (rs3762555, rs3762556, rs3791878, rs3749034, rs11532313 and rs769395) and GAD2 (rs2839669, rs2839670 and rs2236418) were genotyped using the SNaPshot assay. Associations between genetic variants and the eight phenotypes were mainly assessed by binary logistic regression. Results: We found that the frequencies of G allele of GAD1 rs3749034 and rs3762555 were associated with higher daily dose of methadone use and decreased memory after heroin addiction. The C allele frequency of GAD1 rs3762556 was associated with lower daily dose of methadone use. In GAD1, SNPs rs3762556, rs3762555, rs3792878 and rs3749034 had strong linkage, and the frequency of the C-G-C-A haplotype was higher in the lower dose of methadone group. Patients with the TT genotype of rs11542313 were maintained on lower doses of methadone than patients with the CC genotype. The G alleles of rs3762555 and rs3749034 were lower, while the T allele of rs11542313 was higher, in the memory decreased group. The results of association analyses of GAD2 with phenotypes of heroin addiction showed no significant differences. Conclusion: GAD1 polymorphisms were associated with phenotypes of heroin addiction, especially the daily dose of methadone and memory change in the Han Chinese population. These results may provide individualized guidance for the treatment of heroin addiction.
Article
Recreational use of drugs may be viewed by those who indulge as a relatively victimless pursuit. However, as the author discusses in this article, that is far from the truth and those who engage in such activity should be made aware of the potential harms of their action, not least to the genitourinary system.
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Context While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. Objective To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Design Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. Participants A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Main Outcome Measures Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Results Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall wellbeing. Conclusions The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
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The authors analyzed the incidence of sexual dysfunction (SD) with different selective serotonin reuptake inhibitors (SSRIs; fluoxetine, fluvoxamine, paroxetine, and sertraline) and hence the qualitative and quantitative changes in SD throughout time in a prospective and multicenter study. Outpatients (192 women and 152 men; age = 39.6 +/- 11.4 years) under treatment with SSRIs were interviewed with an SD questionnaire designed for this purpose by the authors and that included questions about the following: decreased libido, delayed orgasm or anorgasmia, delayed ejaculation, inability to ejaculate, impotence, and general sexual satisfaction. Patients with the following criteria were included: normal sexual function before SSRI intake, exclusive treatment with SSRIs or treatment associated with benzodiazepines, previous heterosexual or self-erotic current sexual practices. Excluded were patients with previous sexual dysfunction, association of SSRIs with neuroleptics, recent hormone intake, and significant medical illnesses. There was a significant increase in the incidence of SD when physicians asked the patients direct questions (58%) versus when SD was spontaneously reported (14%). There were some significant differences among different SSRIs: paroxetine provoked more delay of orgasm or ejaculation and more impotence than fluvoxamine, fluoxetine and sertraline (chi 2, p < .05). Only 24.5% of the patients had a good tolerance of their sexual dysfunction. Twelve male patients who suffered from premature ejaculation before the treatment preferred to maintain delayed ejaculation, and their sexual satisfaction, and that of their partners, clearly improved. Sexual dysfunction was positively correlated with dose. Patients experienced substantial improvement in sexual function when the dose was diminished or the drug was withdrawn. Men showed more incidence of sexual dysfunction than women, but women's sexual dysfunction was more intense than men's. In only 5.8% of patients, the dysfunction disappeared completely within 6 months, but 81.4% showed no improvement at all by the end of this period. Twelve of 15 patients experienced total improvement when the treatment was changed to moclobemide (450-600 mg/day), and 3 of 5 patients improved when treatment was changed to amineptine (200 mg/day).
Article
Full-text available
While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall well-being. The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
Article
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The influence of heroin use on sexual behavior was studied in individuals attending a drug abuse program in Porto, Portugal. As we expected, drug abuse was found mainly to adversely affect sexual behavior. A minority of patients reported improvement in sexual behavior with heroin use. Almost all patients remained sexually active and took no special precautions to prevent sexually transmitted diseases. Some patients reported heroin-related sexual effects to be a motivating factor for ceasing drug abuse.
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Methamphetamine use has spread over the past decade from the West to other regions of the nation. Since 2000, Missouri has ranked first in clandestine laboratory incidents. The continuing threat of Mexican-produced methamphetamine tempers recent reduction of clandestine laboratory incidents in Missouri. There are a number of consequences related to the use of the drug and Missouri's healthcare professionals could potentially play key roles in prevention and treatment of the problem.
Article
Among the known results of addiction to amphetamine there is apparently a considerable variation of sexual effects. This is to some degree in contrast with the relative uniformity of other symptoms. However, on closer investigation it may be seen that this variability is more apparent than real, the differences being related to the particular type of sexual organization of the individual addict. A failure to recognize this explains the inconsistent opinions expressed in the literature.One commonly held view is that amphetamine decreases sexual drive. Guttman1 found no evidence of sexual excitation from amphetamine, while Knapp2 recorded that 2 of his cases spoke of a decrease in sexual feeling. In contrast Waud3 observed increased libido during and for a short period after amphetamine inhalation. Similarly Bett,4 Carr,5 and Monroe and Drell6 observed that amphetamine induced erotic sensations and caused
Article
The current mechanism for human ejaculation is a two-part model consisting of a postulated "pressure chamber" created in the prostatic urethra by initial closure of both distal and proximal sphincters with secretions loaded in by adrenergic-mediated smooth muscle contractions of the vas deferens and capsules of the internal genital organs. The pressure build up is claimed then to "trigger" the intermittent relaxation/contraction of the distal sphincter and activate the contractions of the striated pelvic musculature, especially that of the bulbocavernosus, which forcefully expels the semen along the urethra by powerful, rhythmical spurts. A number of difficulties with this model are examined critically against experimental findings which indicate that the so-called pressure chamber is unlikely to be the valid trigger for ejaculation. The most recent finding of a specialised group of lumbar sacral neurons in the spinal cord of rat that function as the spinal ejaculation generator is more likely to be the "trigger" for ejaculation but confirmation that these cells also exist in the human cord is waiting.
Article
The effects of serotonin (5-HT) and thyrotropin-releasing hormone (TRH) on penile reflexes were investigated in intact and spinally transected male rats. Doses of intrathecal 5-HT (0.0, 1.13, 2.26, 11.3, 22.6, and 113.0 nmol), in a range previously shown to inhibit pudendal reflexes in anesthetized spinal preparations, prolonged the latency to the first penile erection in awake intact rats. However, these doses also provoked hyperreactivity and vocalization. Doses of intrathecal TRH (100 and 500 pmol) that effectively inhibited penile erection in intact animals were less effective in spinalized animals. Finally, a combination of subthreshold doses of TRH (100 pmol) and 5-HT (4.0 nmol) at a ratio known to affect other TRH/5-HT-mediated circuits significantly extended erection latency in animals with spinal transections. These data suggest that 5-HT and TRH are both involved in the inhibitory circuits regulating penile erection, either through corelease onto the same population of cells or through independent release onto different populations of neurons.
Article
The primary amines 3,4-methylenedioxyamphetamine (MDA), and 1-(1,3-benzodioxol-5-yl)-2-butanamine (BDB) were measured for efficacy in release of [3H]serotonin (5-HT) from rat hippocampal slices, and release of [3H]dopamine (DA) from rat caudate nucleus slices. The N-methyl derivatives of MDA and BDB, MDMA and MBDB, respectively, and the optical antipodes of these four agents were compared in this paradigm. All of the test compounds demonstrated a similar efficacy of [3H]5-HT release in the micromolar concentration range. No significant stereoselectivity was seen in measurements of 5-HT release. However, striking differences were found between the test compounds when [3H]DA release was studied. N-methylation of racemic MDA resulted in a decreased ability to release DA, while side chain extension from α-ethyl completely abolished this activity. Stereoselectivity for the S-(+)-isomers of MDA and MDMA was also demonstrated in the DA release studies. Correlation of these biochemical findings with human subjective reports indicates that serotonin release may play a more important role in the mechanism of action than does dopamine release.
Article
Silicone pellets containing d-amphetamine base were implanted subcutaneously in rats. These pellets release amphetamine continuously for at least 10 days. Several days after implantation, swollen dopamine axons concomitant with large decreases in tyrosine hydroxylase activity were observed in the caudate nucleus. Decreased tyrosine hydroxylase activity was still present 110 days after pellet removal in the caudate but not in several other brain regions, nor in the caudate of rats injected with an equivalent amount of amphetamine in daily injections. This implies that continuous amphetamine administration has a selective neurotoxic effect on dopamine terminals in the caudate.
Article
3,4-Methylenedioxymethamphetamine (MDMA, "Ecstasy") is a potent neurotoxin which preferentially produces 5-HT nerve terminal degeneration in the CNS in both rodents and primates. Timely research on the behavioral effects of acute and long term treatment of MDMA is critical due to the neuropathological effects of MDMA and its abuse liability. Presently, there are no published reports that have systematically examined the effects of acute or chronic treatment of MDMA on animal sexual behavior. Accordingly, the effects of repeated systemic administration of MDMA on a variety of parameters of male sexual behavior in sexually vigorous male rats were studied. Treatment consisted of subcutaneous injections of MDMA (40 mg/kg) or saline (1 ml/kg) every 12 hours for 4 consecutive days. In addition, neurochemical assessments of brain 5-HT and 5-HIAA depletion following repeated MDMA treatment were also conducted using reverse phase liquid chromatography. The results of this study revealed that repeated systemic administration of MDMA to sexually vigorous male rats produced a transient disruption of the expression of male copulatory behavior. In addition, in MDMA-treated males that did display copulatory behavior, both the ejaculation latency and postejaculatory interval were dramatically lengthened when compared to saline injected controls. Surprisingly, one week after the first behavioral test, copulatory behavior in MDMA treated rats appeared unaffected despite a marked depletion of 5-HT and 5-HIAA content in the striatum, and hippocampus.
Article
Thirteen parkinsonian patients drawn from two large parkinsonism clinics experienced hypersexuality as a consequence of anti-parkinsonian therapy. The cases include only those whose sexual behavior on treatment became a concern to the patient's family or a social agency. The majority of patients were men and had a relatively early onset of parkinsonian symptomatology. There was no relation between functional improvement and increased sexuality. Most patients showed some element of dose dependency between antiparkinsonian drugs and the hypersexual behavior. Prior sexual profile included from no sexual outlet to hypersexuality. Neither the prior history of psychiatric illness nor brain damage predisposed to such response on treatment, and in most patients, it was not a part of hypomania or a more diffuse psychiatric disturbance. We propose that hypersexuality on antiparkinsonian drugs is consequent to inhibition of prolactin secretion.
Article
A single high dose of methylenedioxymethamphetamine, a psychedelic agent, produced a rapid and persistent depletion of striatal indoles similar to that observed following administration of the serotonergic neurotoxin p-chloroamphetamine. The drug had little effect on dopaminergic variables. Like p-chloroamphetamine, methylenedioxymethamphetamine was found to be a relatively selective agent for inducing [3H]serotonin release in vitro. The serotonin uptake inhibitor, citalopram, blocked both [3H]serotonin release in vitro and striatal serotonin depletion in vivo, indicating that both processes were carrier dependent. In vivo comparisons of the stereoisomers of methylenedioxymethamphetamine indicated two phases of serotonin depletion similar to those reported for p-chloroamphetamine. Although both the (+)- and (-)-stereoisomers produced an acute (3 hr) decrease in striatal indoles, the long-term effects of the drug showed stereoselectivity in that the (+)-enantiomer produced the most dramatic serotonin depletion. Comparison of the effects of the stereoisomers of methylenedioxymethamphetamine and its n-desmethyl analog, methylenedioxyamphetamine, on [3H]serotonin and [3H]dopamine release in vitro showed the (+)-enantiomer of both drugs to be the more potent releasing agent. In spite of its reported lack of hallucinogenic activity, (+)methylenedioxyamphetamine was found to be of a potency similar to that of (+)methylenedioxymethamphetamine in inducing [3H]serotonin release in vitro. The results are discussed in terms of the neurochemical similarities between methylenedioxymethamphetamine and p-chloroamphetamine as well as the proposed role of serotonin release in the behavioral effects of methylenedioxymethamphetamine.
Article
In the rat, administration of the psychoactive analog of amphetamine 3,4-methylenedioxymethamphetamine (MDMA), causes selective, pronounced decreases in markers of central serotonergic function. The time course of these neurochemical changes was examined in several serotonergic nerve terminal regions of the brain. Fifteen min after subcutaneous injection of MDMA (10 mg/kg), the enzymatic activity of tryptophan hydroxylase (the rate-limiting enzyme for the biosynthesis of serotonin) was significantly decreased in the frontal cortex; by 1 hr after the injection, the activity of tryptophan hydroxylase had significantly declined in the neostriatum, hippocampus and hypothalamus as well. Although extensive recovery had occurred by 2 weeks, the activity of the enzyme remained significantly depressed in most regions. Decline of the regional content of 5-hydroxytryptamine (5-HT) closely paralleled, but was usually preceded by, that of the enzyme. Concentrations of the primary metabolite of 5-HT, 5-hydroxyindoleacetic acid (5-HIAA), were less responsive: in most regions levels of 5-HIAA had significantly decreased by 3 hr, but not by 1 hr, following treatment. Markers of dopamine function were altered transiently but had returned to control values by 24 hr. Administration of multiple doses of MDMA (5 doses over a 24-hr period) resulted in significant decreases in serotonergic parameters for up to 110 days after treatment. The rate and extent of recovery varied according to both the dose administered and the region examined. The persistence of these serotonergic deficits suggests that MDMA induced the destruction of serotonin-containing axon terminals.
Article
Rats treated with iprindole (IPR) (10 mg/kg, i.p.) were given a single dose (15 mg/kg, i.p.) of amphetamine (AMP). Marked decreases in the activity of tryptophan hydroxylase (TPH) were observed in both the cerebral cortex and neostriatum after 6 hr, with maximum depression observed at 24 hr. Enzyme activity had returned to control levels in neostriatum after 3 days and in cerebral cortex after 7 days. Levels of serotonin (5-HT) in both the cerebral cortex and neostriatum were significantly lowered at 24 hr but had recovered by 72 hr. Levels of tryptophan (TRP) in the cortex were significantly elevated after 6 hr, recovering by 24 hr. In the neostriatum, the activity of tyrosine hydroxylase (TH) was significantly depressed by 24 hr and remained so for 7 days. Concentrations of dopamine (DA) were decreased at all times examined. This study clarifies the differences previously observed in the response of the serotonergic system to amphetamine or methamphetamine (METH) in iprindole-treated rats.
Article
8-Methoxy-2-(di-n-propylamino) tetralin (8-OMe-DPAT) and 8-hydroxy-2-(di-n-propylamino) tetralin (8-OH-DPAT) are two new drugs exerting selective actions on brain 5-HT neurotransmission. In the present experiments we have investigated the effects of these two drugs on male rat sexual behavior. It was found that both drugs reduce the number of intromissions preceding ejaculation and shorten the ejaculation latency. These effects are extremely pronounced and several animals ejaculate at the first intromission. In addition 8-OH-DPAT produced a slight reduction of the post-ejaculatory interval. There were no significant effects on latency to initiate copulation or in the number of mounts preceding ejaculation. Finally, sexual behavior was partly or completely restored in castrated male rats after injection with 8-OMe-DPAT or 8-OH-DPAT.
Article
Following treatment with dopamine (DA) receptor agonists, such as apomorphine, N-n-propyl-norapomorphine, lisuride and 3-(3-hydroxyphenyl)-N-n-propyl-piperidine (3-PPP) (50, 2.5, 400 and 5000 micrograms/kg, respectively), male rats attain ejaculation with receptive females sooner and after fewer penile intromissions than controls. Since doses of DA agonists needed to produce "premature ejaculation" are within the low dose range needed to stimulate DA autoreceptors, it is suggested that "premature ejaculation" in rats results from inhibition of DA neurotransmission. This hypothesis is supported by the finding that 6 hr after haloperidol (1 mg/kg), rats achieve ejaculation after fewer intromissions than normal.
Article
Long-lasting depletion of dopamine and concomitant loss of dopamine uptake sites follow repeated administration of methylamphetamine to rats. We found similar effects after similar treatment with d-amphetamine, but not after treatment with methylphenidate. Methylphenidate also failed to produce long-term depletion of regional catecholamine levels in rhesus monkeys. These long-lasting alterations of the dopaminergic system suggest that amphetamines or their metabolites have toxic interactions with dopaminergic neurons, which do not occur with methylphenidate.
Article
Although opiate addicts often equate the drug experience with sexual orgasm, diminished libido and impaired sexual performance are common sequelae of chronic use. Early clinical studies suggested that opiates may interfere with sex hormone secretion. The authors carried out three sequential studies which demonstrated that heroin use in man results in acute suppression of luteinizing hormone (LH) release from the pituitary followed by a secondary drop in plasma testosterone levels. The time course of these neuroendocrine events correlates well with the tension-reducing effects of heroin and suggests that drive reduction is an important component of opiate reinforcement.
Only in the last few years has the scientific study of hormonal replacement therapy for hyposexuality begun in earnest with the advent of appropriately controlled experiment studies. Dose-response relationships can be demonstrated between testosterone (T) and sexual measures, but these have not yet been investigated in detail. Some aspects of sexual function are maintained in the presence of androgen levels well below the normal range, but preliminary evidence suggests that within a normal population high levels of T are correlated with more vigorous responses to visual erotic stimuli. Though T (and to a greater extent free T) declines with aging in parallel with the decline of sexual function, these hormonal changes contribute only to a minor extent to the behavioural change. Some non-aromatizable androgens may be less effective in stimulating sexual behaviour than T, but initial data on effects of dihydrotestosterone suggests that the capacity of an androgen to be aromatized (converted to oestrogen) is not a requirement for its sexual action. While T apparently increases the incidence of all types of male sexual activity, recent data contradict the belief that it directly facilitates the erectile mechanism in men, even though erection frequency is greatly reduced in untreated hypogonadal men. At the present juncture, it appears that the initial action of T may be on libido factors which lead in turn to the stimulation of other aspects of sexuality. Specifically, we propose that androgen acts through stimulating genital sensations and/or other pleasurable awareness of sexual response rather than directly through cognitive processes such as sexual imagery.
Article
We undertook a retrospective review of 100 impotent men under age 40 to determine the underlying etiologic factors in the group and to evaluate the role of surgery in their care. Although patients ranged in age from 18 to 40 (mean--32.2 years), the number of patients increased steadily with advancing years. The majority of patients (72) had vasculogenic impotence (arteriogenic--15, venogenic--46, mixed--11), followed by psychogenic (13), neurogenic (12) and other causes (4). The differential diagnosis did not correlate with age. Contributing factors were present in 76%, trauma and substance abuse being most common. Essentially equal numbers of patients were treated surgically (40) and with intracavernous injection of vasoactive agents (39). Considerably fewer had a vacuum constriction device (5), oral medication (5), psychotherapy (4), other therapy (4), and none (3). The majority of patients referred to our tertiary urologic practice for treatment of vasculogenic impotence were sent by other urologists. Although the referral source did not appear to influence the choice of treatment, it probably has accounted for the preponderance of vasculogenic impotence in this series.
Article
To develop a brief, reliable, self-administered measure of erectile function that is cross-culturally valid and psychometrically sound, with the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction. Relevant domains of sexual function across various cultures were identified via a literature search of existing questionnaires and interviews of male patients with erectile dysfunction and of their partners. An initial questionnaire was administered to patients with erectile dysfunction, with results reviewed by an international panel of experts. Following linguistic validation in 10 languages, the final 15-item questionnaire, the international index of Erectile Function (IIEF), was examined for sensitivity, specificity, reliability (internal consistency and test-retest repeatability), and construct (concurrent, convergent, and discriminant) validity. A principal components analysis identified five factors (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction) with eigenvalues greater than 1.0. A high degree of internal consistency was observed for each of the five domains and for the total scale (Cronbach's alpha values of 0.73 and higher and 0.91 and higher, respectively) in the populations studied. Test-retest repeatability correlation coefficients for the five domain scores were highly significant. The IIEF demonstrated adequate construct validity, and all five domains showed a high degree of sensitivity and specificity to the effects of treatment. Significant (P values = 0.0001) changes between baseline and post-treatment scores were observed across all five domains in the treatment responder cohort, but not in the treatment nonresponder cohort. The IIEF addresses the relevant domains of male sexual function (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction), is psychometrically sound, and has been linguistically validated in 10 languages. This questionnaire is readily self-administered in research or clinical settings. The IIEF demonstrates the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction.
Article
The current report examined HIV-related high risk sexual behaviors among a small sample of gay and bisexual male methamphetamine abusers in Los Angeles. Participants were 16 methamphetamine-abusing or -dependent gay or bisexual males who participated in a treatment demonstration project between 1989 and 1993. All participants completed the NIDA/WAVE survey, a detailed inventory of HIV-related risk behaviors. Findings indicate a strong connection between methamphetamine abuse and high-risk sexual behavior. For the 12 months prior to treatment 62.5% of participants reported having anal insertive sex without a condom, and 56.3% reported having sex with someone who had HIV. Drug use before or during sex, measured on a 5-point Likert scale, was frequent (M = 4.27, SD = 0.7). Implications for treatment of gay and bisexual male methamphetamine abusers and prevention of HIV among this population are discussed.
Article
(+/-)3,4-methylenedioxymethamphetamine (MDMA, "Ecstasy") is a popular recreational drug that selectively damages brain serotonin (5-HT) neurons in animals at doses that closely approach those used by humans. We investigated the status of brain 5-HT neurons in MDMA users. We enrolled 14 previous users of MDMA who were currently abstaining from use and 15 controls who had never used MDMA. We used positron emission tomography (PET) with the radioligand carbon-11-labelled McN-5652, which selectively labels the 5-HT transporter. We analysed whether there were differences in 5-HT transporter binding between abstinent MDMA users and participants in the control group. Blood and urine samples were taken and tested to check for abstinence. MDMA users showed decreased global and regional brain 5-HT transporter binding compared with controls. Decreases in 5-HT transporter binding positively correlated with the extent of previous MDMA use. Quantitative PET studies with a ligand selective for 5-HT transporters can be used to assess the status of 5-HT neurons in the living human brain. We show direct evidence of a decrease in a structural component of brain 5-HT neurons in human MDMA users.
Article
The injection of illicit drugs exposes the user to a variety of risks that are not associated with other routes of administration. Information regarding differences between injecting and noninjecting methamphetamine (MA) users is provided. The population studied included MA dependent men and women (n = 427) from the Matrix Institute on Addictions in San Bernardino County, California. The sample was divided into two groups according to their injecting status; 55 individuals (13%) reported injecting, and 372 (87%) reported no history of injecting MA. Differences were found in specific use patterns and in medical, criminal, and psychological histories between the two groups.
Article
The use of psychoactive substances is popularly believed to loosen sexual inhibitions and contribute to increased sexual activity. However, the actual direct and indirect effects of alcohol and drugs on sexual function are still not fully understood. This article provides a new critical review of the research on the impact on male and female sexual function of psychoactive drugs including alcohol, nicotine, and illicit drugs. The authors consider the effects of both acute and chronic use and review findings from controlled laboratory studies as well as survey and interview research. Research on the impact of substance use and abuse on human sexual function has some limitations due to small and nongeneralizable samples, lack of controlled research design or comparison groups, reliance on self-reported data, or failure to specify or control for dosage effects, expectancies, social effects, and multiple substance use. The lack of controls on physiological, psychological, environmental and cultural factors that could alter the relationship between substance use and sexual function also make it difficult to draw conclusions about direct causal mechanisms. Despite these limitations, this review suggests that chronic alcohol and drug abuse have clear deleterious affects on sexual functioning for many individuals.
Article
Apomorphine SL (Ixense, Uprima) is a new oral medication shown to be effective in the treatment of erectile dysfunction. This compound is a dopaminergic agonist with affinity for dopamine receptor sites - mostly D(2) - within the brain known to be involved in sexual function. Apomorphine induces selective activation in the nucleus paraventricularis leading to erectogenic signals. More than 5,000 men with erectile dysfunction participated in phase II/III clinical trials assessing the safety and efficacy of doses ranging from 2 to 6 mg. The most favorable risk/benefit ratio is seen with a dose-optimization regimen of 2-3 mg: the 3-mg dose provides efficacy comparable to that of 4 mg but with fewer side effects. Consequently, review of clinical studies focuses on data with the 2- to 3-mg dose, the registered dose for use in clinical practice. The primary efficacy endpoint in most clinical trials with apomorphine SL was the percentage of attempts resulting in erections firm enough for intercourse - one of the most rigorous endpoints used in ED trials to date. These data were collected from both patients and their partners by reviewing entries in patient diaries and partner BSFI questionnaires. Secondary endpoints included percentage of attempts resulting in intercourse and improvement in ED severity based on the International Index of Erectile Function (IIEF). The proportion of attempts resulting in erections firm enough for intercourse was 49.4% with 3 mg compared with the baseline value of 24.3%. Partner evaluations corresponded with those of the patients. Erections occurred between 18 and 19 min after taking apomorphine SL 2 or 3 mg. The most common side effect was nausea which declined with continued use. Vasovagal syncope was reported in <0.2% of men, and was preceded by clear prodromal symptoms. Thus, apomorphine SL is an effective, well-tolerated drug for erectile dysfunction.
Article
We examined the effects of alterations of the extracellular dopamine level in the medial preoptic area on 2 erectile contexts, namely reflexive and noncontact erections, in male rats. The extracellular dopamine level was measured in the medial preoptic area after administering the dopamine reuptake inhibitor bupropion hydrochloride (Sigma Chemical Co., St. Louis, Missouri) into the same area through a micro-dialysis tube. We measured the frequency and latency of reflexive erections, and the frequency of noncontact erection during infusion of bupropion. Administration of 10 mM. bupropion was associated with significant elevation in the extracellular dopamine level in the medial preoptic area. Bupropion (1 mM.) and Ringer's solution did not induce significant alterations in dopamine in the medial preoptic area. The number of reflexive erections significantly increased and erection latency decreased during infusion of 10 mM. bupropion into the medial preoptic area. The number of noncontact erections was also increased by administering 10 mM. of drug. The altered dopamine level in the medial preoptic area affected 2 distinct penile erectile contexts, suggesting that the dopamine levels in the medial preoptic area may be involved in the regulation of erection. These results may have important implications for the central regulation of penile erection.
Article
Sexual desire is the sum of the forces that lean us toward and away from sexual behavior. The ordinary spectrum of sexual desire's intensity ranges between aversion, disinclination, indifference, interest, need, and passion. Although many individuals have a characteristic pattern of desire throughout their adult lives, this spectrum evolves considerably over the life cycle. It is clinically useful to think of desire as consisting of drive (biological), motive (individual and relationship psychology), and wish (cultural) components. Four master variables--age, gender, social situation, and health--affect sexual desire so basically that many remain blind to their presence. Five dark paradoxes of desire envelop most people at some time in their privacy: (1) Drive and motive are not in sync; (2) Behavioral fidelity is often associated with longing for infidelity; (3) Despite moral proscriptions, lust is possible; (4) Familiarity diminishes sexual interest; and (5) Derogation enhances sexual expression. Clinicians cannot afford to simplify desire's inherent contradictions. Researchers must simplify desire in order to measure it. In both the clinician's and the researcher's hands, sexual desire is a slippery concept.
Article
Amphetamine and substituted amphetamines, including methamphetamine, methylphenidate (Ritalin), methylenedioxymethamphetamine (ecstasy), and the herbs khat and ephedra, encompass the only widely administered class of drugs that predominantly release neurotransmitter, in this case principally catecholamines, by a non-exocytic mechanism. These drugs play important medicinal and social roles in many cultures, exert profound effects on mental function and behavior, and can produce neurodegeneration and addiction. Numerous questions remain regarding the unusual molecular mechanisms by which these compounds induce catecholamine release. We review current issues on the two apparent primary mechanisms--the redistribution of catecholamines from synaptic vesicles to the cytosol, and induction of reverse transport of transmitter through plasma membrane uptake carriers--and on additional drug effects that affect extracellular catecholamine levels, including uptake inhibition, effects on exocytosis, neurotransmitter synthesis, and metabolism.
Article
Ejaculation is constituted by two distinct phases, emission and expulsion. Orgasm, a feature perhaps unique in humans, is a cerebral process that occurs, in normal conditions, concomitantly to expulsion of semen. Normal antegrade ejaculation is a highly coordinated physiological process with emission and expulsion phases being under the control of autonomic and somatic nervous systems respectively. The central command of ejaculation is located at the thoracolumbar and lumbosacral levels of the spinal cord and is activated by stimuli from genital, mainly penile, origin although cerebral descending pathways exert both inhibitory and excitatory regulatory roles. Cerebral structures specifically activated during ejaculation form a tightly interconnected network comprising hypothalamic, diencephalic and pontine areas. A rational neurobiological approach has led to identify several neurotransmitters contributing to the ejaculatory process. Amongst them, serotonin (5-HT) has received strong experimental evidences indicating its inhibitory role in the central control of ejaculation. In particular, 5-HT1A cerebral autoreceptors but also spinal 5-HT1B and, in a lesser extent, 5-HT2C receptors have been shown to mediate the effects of 5-HT on ejaculation. Pharmacological strategies, especially those targeting serotonergic system, for the treatment of ejaculatory disorders in human will undoubtedly benefit from the application of basic and clinical research findings. In this perspective, the use of selective serotonin reuptake inhibitors (SSRIs) which basically increase the amount of central 5-HT and delay ejaculation in humans seems promising.
Article
The evaluation and management of erectile dysfunction (ED) has evolved dramatically following the introduction of oral phosphodiesterase-5 inhibitors. Despite the limited role of directed diagnostic testing in the evaluation of the impotent patient, routine de-termination of a serum testosterone likely is indicated based on evidence that testosterone modulates erectile function, that hypogonadism is prevalent among elderly men and men with ED, and that symptomatology alone rarely detects hypogonadism. Forms of testosterone commonly used include oral, parenteral, transdermal, and implantable preparations, each with significant advantages and disadvantages. The risks and benefits of testosterone supplementation have been characterized incompletely and will require further validation before widespread use of testosterone as hormone replacement therapy in aging men.
Article
As the incidence and prevalence of erectile dysfunction (ED) increase, healthcare providers will require robust, accurate, and efficient tools for appropriately diagnosing and treating patients with ED. Moreover, clinicians will need effective follow-up tools that assess treatment efficacy and satisfaction, to help patients meet their expectations for successful treatment of ED. We provide a summary of some of the most commonly used instruments for the diagnosis and assessment of ED treatment efficacy that will be referred to in this supplement.
Direct evidence of facilitative actions of dopamine in the medial preoptic area on reflexive and noncontact erections in male rats
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