Sexual Dysfunction in Persons Receiving Opioid Substitution Therapy

Abstract

In the context of a growing opioid epidemic, there is an increased focus on opioid substitution therapy (OST), administered in the forms of methadone maintenance therapy (MMT) and buprenorphine maintenance therapy (BMT). Awareness of the sexual side effects of OST appears to be lacking. Therefore, the goal of this review is to present the pathophysiology of OST and sexual dysfunction, analyze current literature regarding the prevalence of OST and sexual dysfunction, and critically compare MMT and BMT from a sexual medicine perspective. Compared to continued opioid use, OST may improve sexual function. However, there continues to be a high prevalence of sexual dysfunction among those on OST. Specifically, the current literature suggests an association between OST and erectile dysfunction (ED) and hypogonadism for both MMT and BMT. Compared to MMT, BMT appears to have less association with ED and hypogonadism, perhaps due to buprenorphine’s partial opioid receptor agonism mechanism of action. There are no guidelines incorporating sexual side effects as a factor when determining which OST to initiate for patients. Sexual dysfunction is highly prevalent among those on MMT and BMT. BMT is less associated with ED and hypogonadism compared to MMT. Sexual side effects should be discussed during shared decision-making with patients when choosing between MMT or BMT for initiating OST.