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In the general population, orgasm difficulties affect 8% of men and 24% of women. Androgen supplementation is used to help arousal and desire difficulties. When checking male hormone status, androgen should be checked, while in women both androgen and estrogen should be checked. Testosterone treatment may encourage tumor growth in cancers dependent on androgen, estrogen, or progesterone. The 4th edition of CURRENT Diagnosis & Treatment: Family Medicine states that “medications that lower the threshold for orgasm can be very problematic for men with premature ejaculation but, can be very effective for treating problems with orgasm.” This applies to bupropion, cyproheptadine, and possibly PDE5 inhibitors. SSRIs negatively affect arousal and orgasm within the sexual response cycle. Diuretics, β-blockers, and antiandrogenic agents all negatively affect arousal and desire. PDE5 inhibitors require erotic or physical stimulation in order to generate erection. PDE5 inhibitor use with nitrates can create serious hypotension and a side effect of temporary greenish-blue hues in color vision can appear because of cross-reactivity with PDE5 isoenzyme in the retina.
Use this to test your knowledge about sexual dysfunction with the quiz below!
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1. In the general population, orgasm difficulties affect _____ of men and _____ of women.
A. 3%; 11%
B. 8%; 24%
C. 35%; 19%
2. Which of the following statements is/are TRUE regarding the status/use of hormones for the treatment of sexual dysfunction?
A. When checking hormone status, in men only androgen should be checked while in women only estrogen
B. Androgen supplements help against arousal difficulties in both sexes
C. Testosterone treatment has no affect upon cancer
D. All of the above
3. True or False. Bupropion is effective for treating male patients who have difficulty achieving orgasm, as well as those with premature ejaculation.
4.Which of the following drug classes has a negative effect upon the orgasm component of the sexual response cycle?
B. B-blockersC. SSRIs
D. Antiandrogenic agents
5. Which of the following statements is/are TRUE regarding PDE5 inhibitors?
A.Use will produce erection without any stimulation necessary B. Use in combination with a nitrate can create hypotension or blood pressure drop C. Side effects may include: temporary changes in color vision D. B and CAnswer Key:
1. B. 8%; 24%
2. B. Androgen supplements help against arousal difficulties in both sexes
3. B. False
4. C. SSRIs
5. D. B and C
For complete information, see:
Mackett CW. Chapter 19: Adult sexual dysfunction. In: South-Paul JE, Matheny SC, Lewis EL, eds. CURRENT Diagnosis & Treatment: Family Medicine. 4th ed. New York, NY: McGraw-Hill Education; 2015:187-194.