DRUG-INDUCED MALE SEXUAL DYSFUNCTION - AN UPDATE

Impotence, defined as the consistent inability to maintain an erect pe nis of sufficient rigidity for sexual intercourse, has been estimated to affect 10 million American men. An age dependence has been shown to exist, with 255 of men over age 65 affected. A large body of clinical experience and published reports in the literature link many commonly prescribed drugs with sexual dysfunction. Drugs can affect sexual fun ction at a variety of points such as inhibition of ejaculation or seda tion/depression leading to reduced libido. Antihypertensive drugs have been most commonly associated with impotence. There have been reports of sexual dysfunction with almost all classes of antipsychotics, but little clinical investigation has been performed. Other drugs associat ed with sexual dysfunction include digoxin, clofibrate, cimetidine and various hormonal agents and antineoplastics. An important first step in approaching all impotent patients is the taking of a detailed medic al, surgical, sexual and drug/substance abuse history. The least invas ive form of therapy should be employed. Recent studies have shown intr acavernous injections of alprostadil (prostaglandin E1) to be safe and effective for long term use. Vacuum constriction devices may also be of help. Better and more durable prostheses are now available should o ther treatment be unsuccessful.