Sexual Adverse Effects Research Articles

Understanding and Managing Erectile Dysfunction in Patients Treated for Cancer.

Cancer can cause sexual adverse effects by direct and indirect pathways. It can involve sexual organs, indirectly affect body image, or cause fatigue or depression with subsequent effects on libido. Erectile dysfunction (ED), the inability to obtain or maintain an erection firm enough for sexual intercourse, can also result from adverse effects of cancer treatment, such as fatigue, pain, or anxiety about therapy. In addition, depressed feelings about having cancer can affect sexuality, causing a range of signs and symptoms that can lead to ED. Chemotherapy, hormone therapy, surgery, and radiation can all cause sexual adverse effects. Additional factors that play a role include patient age and degree of ED before starting cancer treatment. In this article, we discuss how chemotherapy, hormone therapy, surgery, and radiation affect erectile function as well as possible treatment options for ED.

A qualitative investigation comparing sexual effects of alcohol and marijuana among adults

Aims: Alcohol andmarijuana (cannabis) are the twomost commonly used psychoactive drugs and each appears to have its own unique sexual effects on users. With marijuana use increasing in the United States, along with more liberal state-level policies, it is important to examine and compare sexual effects and sexual risk behavior associated with these drugs in order to inform prevention of HIV, other sexually transmitted infections and unplanned pregnancy. Methods: We conducted semi-structured interviews with 24 racially and ethnically diverse adults in New York City (mean age=27.4, SD=5.8). To be eligible, subjects must have (1) been between ages 18–35, (2) had sex while high on marijuana in the last 12 months, (3) had sex while not high on marijuana in the last 12 months; and (4) must not have used any other illicit drug in the last 12 months. All subjects self-identified as heterosexual and HIV-negative, and 50% were female. Results: Thematic analysis yielded various themes. Many subjects described differences between the two drugs with regard to interactions and contexts in use before sex, partner choice, perceived attractiveness of self and others, disinhibition, adverse sexual effects and sexual dysfunction, and dose effects. Differences were also commonly described regarding libido, length and intensity of sex and orgasm, specific sexual behaviors (including risk behavior), and feelings such as regret after sex. Compared to marijuana, alcohol was more likely to be associated with atypical partner choice and lead to regret. Illegality ofmarijuana sometimes facilitated intimate encounters. Conclusions: Results can inform prevention efforts regarding specific sexual risks and allow us to design more realistic prevention programs and interventions to guide potential users to make safer choices. Financial support: This pilot study was funded by the Center for Drug Use and HIV Research (P30DA011041).

Moderators of electronic screening and brief intervention for marijuana among students in a health center: eCHECKUP TO GO bolsters efforts of those who are already trying to change

Aims: Alcohol andmarijuana (cannabis) are the twomost commonly used psychoactive drugs and each appears to have its own unique sexual effects on users. With marijuana use increasing in the United States, along with more liberal state-level policies, it is important to examine and compare sexual effects and sexual risk behavior associated with these drugs in order to inform prevention of HIV, other sexually transmitted infections and unplanned pregnancy. Methods: We conducted semi-structured interviews with 24 racially and ethnically diverse adults in New York City (mean age=27.4, SD=5.8). To be eligible, subjects must have (1) been between ages 18–35, (2) had sex while high on marijuana in the last 12 months, (3) had sex while not high on marijuana in the last 12 months; and (4) must not have used any other illicit drug in the last 12 months. All subjects self-identified as heterosexual and HIV-negative, and 50% were female. Results: Thematic analysis yielded various themes. Many subjects described differences between the two drugs with regard to interactions and contexts in use before sex, partner choice, perceived attractiveness of self and others, disinhibition, adverse sexual effects and sexual dysfunction, and dose effects. Differences were also commonly described regarding libido, length and intensity of sex and orgasm, specific sexual behaviors (including risk behavior), and feelings such as regret after sex. Compared to marijuana, alcohol was more likely to be associated with atypical partner choice and lead to regret. Illegality ofmarijuana sometimes facilitated intimate encounters. Conclusions: Results can inform prevention efforts regarding specific sexual risks and allow us to design more realistic prevention programs and interventions to guide potential users to make safer choices. Financial support: This pilot study was funded by the Center for Drug Use and HIV Research (P30DA011041).

Buspirone: Back to the Future

Buspirone, first synthesized in 1968 and marketed in 1986, is a pharmacologically unique azapirone drug. It is effective for treating generalized anxiety, but not other anxiety disorders. Buspirone also is efficacious for depression, either alone or together with an antidepressant drug, and for treating adverse sexual effects. Studies of buspirone for substance use disorders have had disappointing outcomes, although it may be useful for treating coexisting anxiety and one controlled study suggested efficacy for heroin detoxification. Buspirone may be considered a treatment option for managing irritability, agitation, and aggression in older adult patients with dementia as well as in pediatric patients, although additional effectiveness studies are warranted. Buspirone and melatonin may synergistically promote neurogenesis, supporting the potential use of this combination for treating depression and cognitive impairment.

Summary of Findings From the FDA Regulatory Science Forum on Measuring Sexual Dysfunction in Depression Trials

Sexual dysfunction is a significant treatment-emergent adverse reaction to the serotonergic antidepressants (selective serotonin reuptake inhibitors [SSRIs] and serotonin-norepinephrine reuptake inhibitors [SNRIs]). However, the rate of sexual dysfunction is often underestimated in registration trials, which have relied on unsolicited reports. We conducted a literature search to examine the rates of sexual dysfunction with SSRIs/SNRIs when these rates were ascertained by structured questionnaires or standardized instruments. Additionally, we conducted exploratory analyses of major depressive disorder (MDD) registration trial data. For the literature search, we used the PubMed and EMBASE databases, with a cutoff date of April 1, 2011. We included all the SSRIs and SNRIs that at the time had been approved for the treatment of MDD. For each of these drugs, a search was conducted with the following terms: sexual dysfunction, SD, sexual adverse effects, desire, arousal, excitement, and orgasm. For the exploratory analyses of US Food and Drug Administration in-house trial data, we searched our database for short-term (6-8 weeks), randomized, placebo-controlled MDD monotherapy trials of approved drugs included in New Drug Application submissions that used a standardized instrument to assess sexual function. For the literature search, we initially found a total of 123 nonduplicate articles, some of which included multiple studies. After screening based on our inclusion/exclusion criteria (and to remove duplicate trial-level data), we were left with 7 articles representing 11 unique studies in which sexual dysfunction was assessed with direct questioning or standardized instruments. The Changes in Sexual Functioning Questionnaire-Short-Form (CSFQ-14) and Arizona Sexual Experiences Scale (ASEX) were the only instruments represented. For the exploratory analyses of in-house MDD trial data, we found controlled studies using either the CSFQ-14 (6 trials) or ASEX (5 trials). For the literature search, we were able to pool the results for the studies that included direct questioning. For the studies that used standardized instruments to assess sexual function, we simply describe our findings. For the exploratory analyses of in-house MDD trial data, we constructed a dataset containing all subject-level CSFQ-14 or ASEX item scores for each of the trials as well as demographic and other relevant variables. For each treatment or placebo group, analyses were performed on pooled data, including multiple studies, and on individual studies. For our literature search, regardless of which method was used to assess sexual function, the data from these articles were informative and showed the expected effects on sexual function with SSRIs/SNRIs. However, for our exploratory analyses, no trend was observed in CSFQ-14 or ASEX results for individual drugs or drug classes. These results raise the question as to why the CSFQ-14 and ASEX appeared to perform well in the published studies but not in our exploratory analyses of in-house MDD trial data. We discuss possible reasons and solutions.

Adverse effects of 5α-reductase inhibitors: What do we know, don't know, and need to know?

Steroids are important physiological orchestrators of endocrine as well as peripheral and central nervous system functions. One of the key processes for regulation of these molecules lies in their enzymatic processing by a family of 5α-reductase (5α-Rs) isozymes. By catalyzing a key rate-limiting step in steroidogenesis, this family of enzymes exerts a crucial role not only in the physiological control but also in pathological events. Indeed, both 5α-R inhibition and supplementation of 5α-reduced metabolites are currently used or have been proposed as therapeutic strategies for a wide array of pathological conditions. In particular, the potent 5α-R inhibitors finasteride and dutasteride are used in the treatments of benign prostatic hyperplasia (BPH), as well as in male pattern hair loss (MPHL) known as androgenetic alopecia (AGA). Recent preclinical and clinical findings indicate that 5α-R inhibitors evoke not only beneficial, but also adverse effects. Future studies should investigate the biochemical and physiological mechanisms that underlie the persistence of the adverse sexual side effects to determine why a subset of patients is afflicted with such persistence or irreversible adverse effects. Also a better focus of clinical research is urgently needed to better define those subjects who are likely to be adversely affected by such agents. Furthermore, research on the non-sexual adverse effects such as diabetes, psychosis, depression, and cognitive function are needed to better understand the broad spectrum of the effects these drugs may elicit during their use in treatment of AGA or BPH. In this review, we will summarize the state of art on this topic, overview the key unresolved questions that have emerged on the pharmacological targeting of these enzymes and their products, and highlight the need for further studies to ascertain the severity and duration of the adverse effects of 5α-R inhibitors, as well as their biological underpinnings.

Adverse Event Reporting in Clinical Trials of Finasteride for Androgenic Alopecia: A Meta-analysis.

Two meta-analyses conclude that finasteride treatment of androgenic alopecia (AGA) is safe but do not assess quality of safety reporting. To assess safety reporting for clinical trial reports of finasteride for AGA. MEDLINE, ClinicalTrials.gov, and a clinical data repository for an academic medical center. Published clinical trial reports for finasteride treatment of AGA. For each trial, we assessed quality of adverse event reporting, extracted the number and type of adverse events in treatment and placebo groups, and assessed duration of safety evaluation and adequacy of blinding. Two observers independently extracted the data; differences were resolved by consensus. We assessed generalizability in a large cohort of men prescribed finasteride, 1.25 mg/d or less, by assessing for eligibility in the finasteride-AGA pivotal trials. Quality was assessed as adequate, partially adequate, inadequate, or no events reported. We used funnel plots of the hazard ratio to assess bias. Of 34 clinical trials, none had adequate safety reporting, 19 were partially adequate, 12 were inadequate, and 3 reported no adverse events. Funnel plots were asymmetric with a bias toward lower odds ratio for sexual adverse effects, suggesting systematic underdetection. No reports assessed adequacy of blinding, 18 (53%) disclosed conflicts of interest, and 19 (56%) received funding from the manufacturer. Duration of drug safety evaluation was 1 year or less for 26 of 34 trials (76%). Of 5704 men in the clinical data repository who were treated for AGA with finasteride, 1.25 mg/d or less, for AGA, only 31% met inclusion criteria for the pivotal trials referenced in the manufacturer's full prescribing information and 33% took finasteride for more than 1 year. Available toxicity information from clinical trials of finasteride in men with AGA is very limited, is of poor quality, and seems to be systematically biased. In a cohort of men prescribed finasteride for routine treatment of AGA, most would have been excluded from the pivotal studies that supported US Food and Drug Administration approval for AGA. Published reports of clinical trials provide insufficient information to establish the safety profile for finasteride in the treatment of AGA.

‘Accepting what is’: an approach for managing the long-term sexual side effects of selective serotonin reuptake inhibitors (SSRIs) in women

Sexual difficulties may not be a pressing issue for women on antidepressants during the early phase of selective serotonin reuptake inhibitor (SSRI) treatment; however, this can emerge as a substantial problem once women are stabilised on medication. Little is known about how women cope with the adverse sexual effects of SSRIs. This qualitative study used Interpretative Phenomenological Analysis to explore the experiences of Australian women currently coping with the sexual side effects of this antidepressant. Interviews were conducted with 10 heterosexual women, aged 45 years and younger. Four major coping strategies were identified “searching”, “suffering in silence”, “trying to resolve” and “accepting what is”. This paper explores one particular response “accepting what is”, which includes a number of strategies commonly employed by women on long-term medication. Findings from the study have particular relevance for sex and relationship therapists and may assist women in managing sexual side effects that are perceived to be beyond their control. This paper adds to the current literature by increasing understanding of how “accepting what is” can be a step forward, particularly for women who have chosen to remain on long-term medication. In theoretical terms, a deeper understanding of how women cope could inform debate about the appropriate management of long-term sexual side effects in the absence of effective pharmacological interventions.

Effets négatifs sur la sexualité des traitements médicamenteux des symptômes du bas appareil urinaire liés a l’hypertrophie bénigne de la prostate

The aim of this review is to discuss the negative effects on sexual function of medications for lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS-BPH). An international non-systematic literature review was performed. It included randomized trials of seven drugs of interest and the summaries of the characteristics of these products. This work did not aim comparison between the drugs. Only maximal reported frequencies are presented in this abstract. With prolonged-release alfuzosin, they were 2.8% vs. 1.3% for erectile dysfunction, compared to placebo and 1% vs. 0% for ejaculatory dysfunction. With doxazosin, the incidence was 5.8% vs. 3.3% for erectile dysfunction, 3.6% vs. 1.9% for reduced libido and 0.4% vs. 1.4% for ejaculatory disorders. The incidence of ejaculatory disorders with tamsulosin, was 11% vs. <1% with the placebo and with silodosin, it was 28.1% vs. 1.1%. With finasteride, at 12 months, the highest frequency was 9% vs. 5% for erectile dysfunction, 4.4% vs. 1.5% for ejaculatory disorders and 6.4% vs. 3.4% for reduced libido. At 24 months, for dutatsteride, frequencies were 7.3% vs. 4.0% for erectile dysfunction, 2.2% vs. 0.8% for ejaculatory disorders and 4.2% vs. 2.1% for reduced libido. For tadalafil, a phosphodiesterase-5 inhibitor, and tolerodine, an anticholinergic drug, no negative effect on ejaculation or libido has been reported. For plant extracts, no sexual adverse effects (AEs) were reported among the most common AEs. The medications for LUTS-BPH may alter erection, ejaculation or libido. A greater knowledge of the adverse effects of each of these drugs could guide physicians in the clinical management of men with BPH-LUTS.

Androgen levels and semen parameters among former users of finasteride with persistent sexual adverse effects.

Androgen levels and semen parameters among former users of finasteride with persistent sexual adverse effects.

Immunohistochemical evaluation of androgen receptor and nerve structure density in human prepuce from patients with persistent sexual side effects after finasteride use for androgenetic alopecia.

Finasteride is an inhibitor of 5-α-reductase used against male androgenetic alopecia (AGA). Reported side effects of finasteride comprise sexual dysfunction including erectile dysfunction, male infertility, and loss of libido. Recently these effects were described as persistent in some subjects. Molecular events inducing persistent adverse sexual symptoms are unexplored. This study was designed as a retrospective case-control study to assess if androgen receptor (AR) and nerve density in foreskin prepuce specimens were associated with persistent sexual side effects including loss of sensitivity in the genital area due to former finasteride use against AGA. Cases were 8 males (aged 29–43 years) reporting sexual side effects including loss of penis sensitivity over 6 months after discontinuation of finasteride who were interviewed and clinically visited. After informed consent they were invited to undergo a small excision of skin from prepuce. Controls were 11 otherwise healthy matched men (aged 23–49 years) who undergone circumcision for phimosis, and who never took finasteride or analogues. Differences in AR expression and nerve density in different portions of dermal prepuce were evaluated in the 2 groups. Density of nuclear AR in stromal and epithelial cells was higher in cases (mean 40.0%, and 80.6% of positive cells, respectively) than controls (mean 23.4%, and 65.0% of positive cells, respectively), P = 0.023 and P = 0.043, respectively. Conversely, percentage of vessel smooth muscle cells positive for AR and density of nerves were similar in the 2 groups. The ratio of AR positive stromal cells % to serum testosterone concentrations was 2-fold higher in cases than in controls (P = 0.001). Our findings revealed that modulation of local AR levels might be implicated in long-term side effects of finasteride use. This provides the first evidence of a molecular objective difference between patients with long-term adverse sexual effects after finasteride use versus drug untreated healthy controls in certain tissues.

Searching for answers and validation: Australian women's experiences of coping with the adverse sexual effects of antidepressants.

Sexual difficulties relating to selective serotonin reuptake inhibitor (SSRI) medication have an impact on quality of life and are a common cause for non-adherence to medication. While most research has focussed on the prevalence and treatment of sexual difficulties, little is known about how patients cope with the adverse sexual effects of SSRIs. This qualitative study, using Interpretive Phenomenological Analysis (IPA), investigated the experiences of 10 Australian women currently coping with the adverse sexual effects ofthis antidepressant by conducting semi-structured interviews. This paper presents one major theme from the study and reports the findings related to women's self-reported experiences of interacting with GPs in their search for answers and validation of their concerns. Findings from the study add to the current literature by providing an insight into how interactions with GPs impact on women's abilities to cope with adverse sexual effects. Empathic discussions and shared decision-making between GPs and women can provide the opportunity to improve the management of the adverse sexual effects of SSRIs and may lead to improved outcomes for women.

Prevalence and correlates of sexual morbidity in long-term breast cancer survivors

Objective: Breast cancer survivors report adverse sexual effects (sexual morbidity) such as disrupted sexual function, sexual distress and body dissatisfaction. However, most studies have failed to evaluate the persistence of these effects in long-term survivors. The present study comprehensively assessed the prevalence and predictors of sexual/body image problems among survivors three or more years post diagnosis.Design/outcome measures: Eighty-three breast cancer survivors completed surveys a median of seven years post diagnosis. Survey items probed demographic, diagnostic and clinical information, in addition to sexual activity, sexual function (Female Sexual Function Index [FSFI]), body image, and distress regarding body changes and sexual problems (Female Sexual Distress Scale-revised; FSDS-R).Results: Seventy-seven percent of all participants and 60% of sexually active participants qualified for sexual dysfunction based on the FSFI. Between 37 and 51% met criteria for female sexual dysfunction, based on two FSDS-R clinical cut-offs. Body satisfaction was worse than normative values, while body change stress was mid-range. Notable sexual morbidity predictors included mastectomy, which was associated with worse sexual/body change distress, and post-treatment weight gain, which predicted greater body dissatisfaction/body change stress.Conclusions: Breast cancer survivors report substantial sexual morbidity years after treatment, especially after mastectomy or post-treatment weight gain. Breast cancer patients and their providers should be aware of these potential sexual effects.

Exercise Reduces Sexual Side Effects of Antidepressants

Adverse sexual effects are common in women taking antidepressants. Exercise can increase sexual arousal in healthy women, improve sexual function in

Psychotropic-associated sexual dysfunctions: a survey of clinical pharmacology and medication-associated practice

Epidemiological and clinical studies show that often persons affected by depression and schizophrenia can suffer of impairment of the sexual function. Most antidepressant and antipsychotic drugs have adverse sexual effects but it is difficult to identify if the impairment of the sexual function can be attributed to clinical picture or to the psychopharmacological treatments. Both antidepressants and novel and conventional antipsychotics are associated with significant sexual side effects and the presence of sexual side effects may affect compliance and adherence to treatment. In some specific clinical populations (e.g. youths), these specific side-effects turn out to be one of the most annoying and promote increased drop-out rates and poor adherence to treatment. Nevertheless, these clinical variables are often underestimated or not investigated in the course of follow-up of persons suffering from psychiatric disorders in treatment with psychotropic medications. Growing awareness of the adverse effects of psychotropic drugs has led to attempts to use adjuvants or substitute treatments to resolve sexual dysfunction. Effects on sexual function should be carefully diagnosed and treated; it should clearly discuss with patients in order to preserve an adequate quality of life, promote greater adherence to treatment and promote a good remission and recovery. The aim of this study is to review the most recent and significant literature data regarding association between sexual dysfunction and psychotropic medications, especially highlighting neurobiological and clinical data in order to improve the clinical pratice.

Methylphenidate for the Treatment of Erectile Dysfunction Induced By Long Acting Injectable Paliperidone Palmitate: A Case Report

ABSTRACTErectile dysfunction is one of the common sexual adverse effects encountered in male patients treated with antipsychotics. It is associated with prolactin secretion secondary to dopamine antagonism by the antipsychotics. Methylphenidate is a psychostimulant that inhibits the reuptake of dopamine. In this case, we report a 42 year old schizophrenic male, who developed erectile dysfunction after administration of a long acting injectable antipsychotic, namely paliperidone palmitate. The erectile dysfunction did not respond to sildenafil but recovered with the treatment of methylphenidate 10mg. The current finding suggests that clinicians should be aware of the possible emergence of erectile dysfunction among patients on long acting injectable antipsychotics. Methylphenidate may be an alternative treatment option for erectile dysfunction induced by antipsychotics.

Take Two Aspirin and Feel Better in the Morning

Although the adverse sexual effects of antidepressants are well recognized, other medications, such as lithium, also may be associated with sexual

Reports of Sexual Disorders Related to Serotonin Reuptake Inhibitors in the French Pharmacovigilance Database: An Example of Underreporting

Depressive disorders and use of antidepressants are associated with adverse effects on sexual function. In pharmacoepidemiological studies, sexual disorders are reported by more than 50% of patients taking serotonin reuptake inhibitors (SRIs). The aim of this study was to determine the reporting rate of sexual disorders in association with SRIs, and to investigate the association between reported cases and the use of SRIs. All cases of adverse drug reactions (ADRs) involving sexual disorders, spontaneously reported to the French Pharmacovigilance Database from 1 January 1985 to December 2009, were reviewed. Cases of sexual disorders in SRI users were described. We calculated the rate of reported sexual disorders as a percentage of the total ADRs reported for each drug. The association between reported cases and the use of SRIs was assessed using reporting odds ratios (ROR) with 95% confidence intervals (CIs). A total of 11,863 ADRs in association with SRIs were collected, of which 98 (0.83%) were spontaneous reports of sexual disorders. Subjects were, on average, 45.0±10.6 years of age and mainly male. Sexual disorders were associated with the use of SRI antidepressants (ROR 4.47; 95% CI 3.61-5.53), milnacipran (ROR 11.72; 95% CI 5.79-23.72), fluvoxamine (ROR 6.91; 95% CI 3.79-12.58), paroxetine (ROR 5.54; 95% CI 3.92-7.83), venlafaxine (ROR 3.50; 95% CI 1.93-6.36), fluoxetine (ROR 3.46; 95% CI 2.26-5.29), citalopram (ROR 2.69; 95% CI 1.28-5.67) and sertraline (ROR 2.49; 95% CI 1.03-6.01). It is likely that there are instances of underreporting, particularly for ADRs that are embarrassing to talk about spontaneously. Despite the likely underreporting of this well-described adverse effect, this case/non-case study performed in a large national pharmacovigilance database confirms the existence of the risk of sexual disorders associated with SRIs, and is an example of the lack of sensitivity of spontaneous notification to measure ADRs. Minimization of antidepressant-induced sexual dysfunction could be an important factor to avoid unsuccessful treatment. Physicians should advise their patients on the possible sexual adverse effects.

Strategies for managing sexual dysfunction induced by antidepressant medication

Sexual dysfunction (including altered sexual desire, orgasmic and ejaculatory dysfunction, erectile and other problems) is a relatively common side effect of antidepressant medication. These sexual side effects may compromise a person's lifestyle and result in a lack of compliance with the prescribed antidepressant to the detriment of the person's mental health. A wide range of management strategies are possible to address this problem, including behavioural, psychological and pharmacological approaches. 1. To determine the effectiveness of management strategies for sexual dysfunction caused by antidepressants.2. To determine the adverse effects and acceptability of the different management strategies. We searched the Cochrane Depression, Anxiety and Neurosis Group's Specialized Register (CCDANCTR, to 1 January 2013), which includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). Additional searches were carried out by the author team on the same biomedical databases (using terms for 'sexual dysfunction' only) together with CINAHL (1982 to Jan 2012). The reference lists of reports of all included studies were screened. We included randomised controlled trials that compared management strategies for antidepressant-induced sexual dysfunction versus placebo or any alternative strategy. Two authors independently extracted data and assessed trial quality. Study authors were contacted for additional information. We included 23 trials involving 1886 people in this updated review. Twenty-two of these trials investigated the addition of medication to treat the identified dysfunction, with most agents studied in only single studies. One study investigated switching to an alternative antidepressant.In men, data for the phosphodiesterase inhibitors sildenafil (three studies, 255 participants) and tadalafil (one study, 54 participants) indicated they led to a greater improvement in erectile function than placebo. Combined data from three sildenafil studies found benefit over placebo on International Index of Erectile Function ratings of ability to achieve (MD 1.04, 95% CI 0.65 to 1.44), and maintain erections (MD 1.18, 95% CI 0.78 to 1.59). A single point improvement on these ratings is equivalent to an improvement in frequency from 'sometimes' to 'most times'. Men receiving tadalafil were more likely to report improved erectile function (RR 11.50, 95% CI 3.03 to 43.67). For women it remains uncertain whether sildenafil is more effective than placebo. Unpublished data could reduce this uncertainty.Data from three studies in men and women of bupropion 150 mg twice daily indicate a benefit over placebo on rating scale scores (SMD 1.60, 95% CI 1.40 to 1.81), but response rates in two studies of bupropion 150 mg once daily demonstrated no statistically significant difference in effect (RR 0.62, 95% CI 0.09 to 4.41).Other augmentation strategies failed to demonstrate significant improvements in sexual dysfunction compared with placebo.One trial involving 75 people with sexual dysfunction due to sertraline assessed the effect of changing antidepressant. Switching to nefazodone was significantly less likely to result in the re-emergence of sexual dysfunction than restarting sertraline (RR 0.34, 95% CI 0.19 to 0.60), however, nefazodone is no longer available for clinical use.There is an absence of randomised trials assessing the effects of switching to currently-available antidepressant agents with lower rates of adverse sexual effects, the role of psychological or mechanical interventions, or of techniques such as drug holidays.We identified no data for any of the strategies included in the trials assessed that indicated that they led to a worsening of psychiatric symptoms. However, the relatively small numbers assessed for many of the interventions studied means that the possibility of such an effect cannot confidently be excluded in all cases.Given the small numbers of studies assessing most of the strategies assessed, the presence of any unpublished trials could have substantial effects on estimates of effect. In some cases, only results from particular items or subscales within ratings scales are available. It is likely that this could act to bias estimates of effect obtained, increasing apparent effectiveness. The evidence currently available is rather limited. For men with antidepressant-induced erectile dysfunction, the addition of sildenafil or tadalafil appears to be an effective strategy. For women with antidepressant-induced sexual dysfunction the addition of bupropion at higher doses appears to be the most promising approach studied so far.

Erectile dysfunction and lower urinary tract symptoms: a consensus on the importance of co‐diagnosis

Despite differences in design, many large epidemiological studies using well-powered multivariate analyses consistently provide overwhelming evidence of a link between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS). Preclinical evidence suggests that several common pathophysiological mechanisms are involved in the development of both ED and LUTS. We recommend that patients seeking consultation for one condition should always be screened for the other condition. We propose that co-diagnosis would ensure that patient management accounts for all possible co-morbid and associated conditions. Medical, socio-demographic and lifestyle risk factors can help to inform diagnoses and should be taken into consideration during the initial consultation. Awareness of risk factors may alert physicians to patients at risk of ED or LUTS and so allow them to manage patients accordingly; early diagnosis of ED in patients with LUTS, for example, could help reduce the risk of subsequent cardiovascular disease. Prescribing physicians should be aware of the sexual adverse effects of many treatments currently recommended for LUTS; sexual function should be evaluated prior to commencement of treatment, and monitored throughout treatment to ensure that the choice of drug is appropriate.