Drugs and Sexuality

Question 1

Two main ways that drug affects sex

Answer 1

1. altering libido
2. altering performance

Question 2

What 3 things INCREASE libido?

Answer 2

TED

– testosterone (male & female)
– Dopamine
– Estrogen in females?

Question 3

What three things decrease libido?

Answer 3

SEP

– prolactin (male & female)
– estrogen (male)
– serotonin

Question 4

What’s the role CNS neurotransmitters in libido?

Answer 4

DAN increases

• dopamine
• NE
• ACh

Question 5

What’s the role CNS neurotransmitters in libido?

Answer 5

SALLY decreases

• serotonin

Question 6

What are the typical effects of drugs on sex?

Answer 6

DECREASE libido by

Hormonal:
– increasing prolactin secretion
– anti‐androgenic
CNS effects:
– block DAN, increase Sally

Question 7

What would increase sexual response?

Answer 7

androgen receptor agonist (testosterone)

Question 8

How could you interfere with orgasm?

Answer 8

alpha-1 blockade

Question 9

antihypertensive drugs frequently cause sexual problems

Answer 9

α1 blockers: high incidence of ejaculatory failure (but not
of erection)

Question 10

Which anti-HTN have few sexual side effects?

Answer 10

CCB, ACE, ARBs, DRIs

Question 11

Psychiatric drugs:
A common source of sexual problems

Answer 11

But: the disease state itself often affects sexuality,
complicating analysis of drug effects

Question 12

Antipsychotic problems

Answer 12

Decreased libido due to
– DA receptor blockade
– CNS anticholinergic effects
– CNS sedative effects
• Problems w/ erection due to peripheral ACh effects
• Problems w/ orgasm due to peripheral α1 blocka

Question 13

What is the only antipsychotic drug that increases libido??

Answer 13

Levodopa: enhanced libido (increased DA)

Question 14

What effects does acute alcohol ingestion have?

Answer 14

disinhibiting, less intense orgasm

Question 15

What effect does chronic alcohol ingestion have?

Answer 15

Neuropathy

decreased testosterone

Question 16

Acute Cocaine, Amphetamines and Sex

Answer 16

lower doses: enhanced libido (↑DA); delayed orgasm

Question 17

Chronic Cocaine and Amphetamine use

Answer 17

loss of libido; depression
– ejaculatory failure

Question 18

Marijuana and sex

Answer 18

– lower doses: enhancement of sensory effects;
disinhibition; increased empathy
– higher doses: impotence, anxiety

Question 19

Treatment of
Premature Ejaculation

Answer 19

local anesthetic

various agents to delay orgasm have been tried . . . but many of the drugs inhibit libido.

Question 20

Can testosterone be used to enhance libido?

Answer 20

Yes
– Libido response in both males and females
– Can accelerate prostrate cancer, atherosclerosis (?)

Question 21

True/false: Dopamine agonists can be used to enhance libido.

Answer 21

true

Question 22

The three P’s: smooth muscle relaxants to treat ED

Answer 22

1. papverine
2. phentolamine
3. prostaglandin E

Question 23

Papaverine

Answer 23

– for diagnosis and treatment
– quite effective, but limited by multiple adverse effects (bradycardia, hypotension,
priapism)
– chronic use associated w/ hepatotoxicity, penile fibrosis

Question 24

Phentolamine

Answer 24

α1 blocker – blocks sympathetic smooth muscle contraction
– usually used as adjunct with papaverine
• But can interfere w/ orgasm

Question 25

Prostaglandin E

Answer 25

– Most commonly used pre‐Viagra; efficacy up to 65%
– Two forms: injectable & urethal suppository
– side effects: hypotension, mild penile pain, occasional priapism

Question 26

True/false: Sildenafil works on erection; not on libido

Answer 26

True

Question 27

Mechanism of PDE5 inhibitors

Answer 27

Question 28

When do you instruct patients to take sildenafil?

Answer 28

Peak plasma concentrations for sildenafil @ 1 hr; patients instructed to take 1 hr prior
to anticipated intercourse; longer after a heavy meal

Question 29

Newer drugs have longer kinetics

Answer 29

Tadalafil (Cialis): peak conc 1‐6 hrs; half‐life 18 hr – effective duration 36 hr

Question 30

Side effects PDE5 inhibitors

Answer 30

hypotension
– Systolic/diastolic decrease average: 9/6
Common: headache, flushing, indigestion

Less common: visual disturbances (colors & light sensitivity), acute
hearing loss, nasal congestion, diarrhea, rash

Question 31

PDE5 inhibitors can cause sudden hearing and vision loss: TRUE/FALSE.

Answer 31

True

Question 32

Potentially dangerous drug interactions w/ nitrates

Answer 32

– large decrease in BP, syncope, lower cardiac perfusion, MI

Question 33

Mechanisms of anti‐ED drugs

Answer 33

relaxation of smooth muscle in
corpora cavernosa