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Iatrogénie Sexuelle des Médicaments: conduite à tenir

Management of drug-induced sexual dysfunctions

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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.

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Author information

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.

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

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Mots clés

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

Key words

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