Skip to main content

Iatrogénie Sexuelle des Médicaments: conduite à tenir

Management of drug-induced sexual dysfunctions

Résumé

Une des étapes primordiale de la prise en charge des troubles sexuelles est l’identification d’une éventuelle cause médicamenteuse. De nombreux médicaments sont en fait probablement moins impliqués eux-mêmes dans la survenue de troubles sexuels que la maladie pour laquelle ils ont été prescrits. Ainsi, l’analyse critique de la littérature, la standardisation des paramètres mesurables de la sexualité utilisés en études cliniques et la mise au point de molécules plus spécifiques ont permis de réduire considérablement le nombre de médicaments impliqués dans la survenue de troubles sexuels iatrogènes.

Les psychotropes et les antiandrogènes sont les deux grandes classes thérapeutiques qui génèrent de façon indéniable des troubles du désir, de l’orgasme, de l’éjaculation et de l’érection. L’information des patients lords de la prescription de ces traitements est un élément important de la prise en charge, permettant notamment d’identifier le désir de procréation et mettre en place les moyens nécessaires à la préservation de gamètes.

Les modifications du traitement doivent être réalisées en collaboration avec le prescripteur et le rôle de l’andrologue ne se limite pas à l’indtification du problème mais à faire une ou des propositions d’adaptation thérapeutique a spécialiste.

Abstract

Sexual dysfunction due to prescription medications is sometimes difficult to prove and is probably underreported. One of the major steps of the medical history of patients presenting with sexual dysfunction is to assess the use of concomitant medications, as some drugs can either cause or contribute to the patient’s sexual difficulties and a change in medication may result in improvement of sexual dysfunction. In fact, most medications are probably less directly involved in sexual dysfunction than the patient’s disease and associated comorbidities. The recent critical analysis of the literature, standardization of the assessment of human sexual parameters in clinical studies and the development of new drugs have dramatically reduced the number of drugs implicated in iatrogenic sexual dysfunction.

Psychotropic and anti-androgenic medications are the two main classes of drugs undeniably involved in sexual adverse events such as decreased sexual desire and arousal, dysorgasmia, ejaculation disorders and erectile dysfunction. Patient information is one of the major concerns allowing a discussion of the desire for a child and gamete preservation when needed. Treatment modifications must be discussed with the physician responsible for the initial prescription and the role of the andrologist is not limited to the diagnosis of the sexual disorder, but must also propose alternative treatment options.

References

  1. 1.

    CARBONE D.J. Jr, HODGES S.: Medical therapy for benign prostatic hyperplasia: sexual dysfunction and impact on quality of life. Int. J. Impot. Res., 2003, 15: 299–306.

    PubMed  Article  Google Scholar 

  2. 2.

    CHOBANIAN A.V., BAKRIS G.L., BLACK H.R. et al.: Joint National Committe on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National of Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension, 2003, 42: 1206–1252.

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    COLSON A.E., KELLER M.J., SAX P.E., PETTUS P.T., PLATT R., CHOO P.W.: Male sexual dysfunction associated with antiretroviral therapy. J. Acquir. Immune Defic. Syndr., 2002, 1 30: 27–32.

    Google Scholar 

  4. 4.

    DELLA CHIESA A., PFIFFNER D., MEIER B., HESS O.M.: Sexual activity in hypertensive men. J. Hum. Hypertens., 2003, 17: 515–521.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    EKSELIUS L., VON KNORRING L.: Effect on sexual function of long-term treatment with selective serotonin reuptake inhibitors in depressed patients treated in primary care. J. Clin. Psychopharmacol., 2001, 21: 154–160.

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    FLACK J.M.: The effect of doxazosin on sexual function in patients with benign prostatic hyperplasia, hypertension, or both. Int. J. Clin. Pract., 2002, 56: 527–530.

    PubMed  CAS  Google Scholar 

  7. 7.

    FORESTA C., CARETTA N., ROSSATO M., GAROLLA A., FERLIN A.: Role of androgen in erectile function. J. Urol., 2004, 17: 2358–2362.

    Article  Google Scholar 

  8. 8.

    FOSSA S.D.: Long-term sequelae after cancer therapy—survivorship after treatment for testicular cancer. Acta Oncol., 2004, 43: 134–141.

    PubMed  Article  Google Scholar 

  9. 9.

    GRIGG A.: The impact of conventional and high-dose therapy for lymphoma on fertility. Clin. Lymphoma, 2004, 5: 84–88.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    GRIMM R.H. Jr, GRANDITS G.A., PRINEAS R.J. et al.: Long-term effects on sexual function of five antihypertensive drugs and nutritional hygienic treatment in hypertensive men and women. Treatment of Mild Hypertension Study (TOMHS). Hypertension, 1997, 29: 8–14.

    PubMed  CAS  Google Scholar 

  11. 11.

    HADDAD P.M., WIECK A.: Antipsychotic-induced hyperprolactinaemia: mechanisms, clinical features and management. Drugs, 2004, 64: 2291–2314.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    IVERSEN P., MELEZINEK I., SCHMIDT A.: Nonsteroidal antiandrogens: a therapeutic option for patients with advanced prostate cancer who wish to retain sexual interest and function. Br. J. Urol. Int., 2001, 87: 47–56.

    CAS  Google Scholar 

  13. 13.

    LABBATE L.A, GRIMES J.B., ARANA G.W.: Serotonin reuptake antidepressant effects on sexual function in patients with anxity disorders. Biol. Psychiatry, 1998, 43: 904–907.

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    LABBATE L.A., CROFT H.A., OLESHANSKY M.A.: Antidepressant-related erectile dysfunction: management via avoidance, switching antidepressants, antidotes, and daptation. J. Clin. Psychiatry, 2003, 64 Suppl 10: 11–19.

    PubMed  CAS  Google Scholar 

  15. 15.

    LUE T.F., BASSON R., ROSEN R., GIULIANO F., KHOURY S., MONTORSI F.: Sexual Medicien—Sexual dysfunction in men and women. 2nd International Consultation on Sexual Dysfunction, Paris. Editions 21, 2004.

  16. 16.

    MACDONALD S., HALLIDAY J., MACEWAN T. et al.: Nithsdale Schizophrenia Surveys 24: sexual dysfunction. Case-control study. Br. J. Psychiatry, 2003, 182: 50–56.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    RIZVI K., HAMPSON J.P., HARVEY J.N.: Do lipid-lowering drugs cause erectile dysfunction? A systematic review. Fam. Pract., 2002, 19: 95–98.

    Google Scholar 

  18. 18.

    ROSEN R.C., LANE R.M., MENZA M.: Effects of SSRIs on sexual function: a critical review. J. Clin. Psychopharmacol., 1999, 19: 67–85.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    SALTZMAN E.A., GUAY A.T., JACOBSON J.: Improvement in erectile function in men with organic erectile dysfunction by correction of elevated cholesterole leves: a clinical observation. J. Urol., 2004, 172: 257–258.

    Article  Google Scholar 

  20. 20.

    SCHRODER F.H., COLLETTE L., DE REIJKE T.M., WHELAN P.: Prostate cancer treated by anti-androgens: is sexual function preserved? EORTC Genitourinary Group. European Organization for Research and Treatment of Cancer. Br. J. Cancer, 2000, 82: 283–290.

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    SEFTEL A.D. SUN P., SWINDLE R.: The prevalence of hypertension, hyperlipidemia, diabetes mellitus and depression in men with erectile dysfunction. J. Urol., 2004, 171: 2341–2345.

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Stéphane Droupy.

Additional information

Communication au XXIo Congrès de la Société d’Andrologie de Langue Française, SALF, Clermont-Ferrand, 9–11 décembre 2004.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Droupy, S. Iatrogénie Sexuelle des Médicaments: conduite à tenir. Androl. 15, 378–383 (2005). https://doi.org/10.1007/BF03035297

Download citation

Mots clés

  • troubles sexuels
  • prise en charge
  • médicaments
  • iatrogénie
  • information

Key words

  • sexual disorders
  • management
  • medications
  • iatrogenic effects
  • information