Sexual dysfunction

Graedons’ Guide to
PEOPLE’S
PHARMACY
Treating Sexual Dysfunction
Visit our Web site:www.peoplespharmacy.com S granted. But to enjoy making love, never met and buying Viagra from a
Sexual Desire
reactions to get desire going; then blood financial worries, pressure at work or the fear of being interrupted by children can put a real damper on sexual enjoyment.
arthritis pain or heart disease don't pre- Diabetes, depression, atherosclerosis, al- cohol abuse, urinary tract infection, en- fortable talking about intimate issues.
dometriosis, hypertension, prostatitis, a some of the conditions that can contribute of medications, both prescription and over the counter, can also interfere with sexual fortable with the topic. It's not surpris- s response (please see our Guide to Drugs ing that many physicians are also em-
ogy of sex. To get the help you need, ask people believe that a pill is the solution to virtually everything that might go wrong, FEMALE SEXUAL DISORDERS
Until very recently female sexual difficulties were ignored, except for a tendency to blame any problems on awoman’s “frigidity.” But researchers are now beginning to realize that female sexuality is amenable to study,even though a woman’s sexual response is a lot less obvious than a man’s ability to achieve an erection. It isimportant to get a more scientific understanding of these issues, because as many as three-quarters of womensuffer from one of these problems at some time during their lives.
Clinicians at Boston University (including Irwin Goldstein, M.D., Jennifer Berman, M.D., and Laura Berman) recently proposed four different types of female sexual disorder (Urology 1999; 54:385-391):• Orgasmic Disorder––The woman is unable to reach orgasm, or the orgasms she experiences have a “muffled” • Sexual Arousal Disorder––The woman has sexual fantasies and desires, but the genitals do not respond with appropriate blood flow and lubrication.
• Hypoactive Sexual Desire Disorder––The woman has little or no interest in sexual activity.
• Sexual Pain Disorder––Pain occurs during intercourse, either due to vaginal dryness, spasms of the vaginal wall (vaginismus) or other genital pain.
Hormones
concluded, “Our results corroborate the Testosterone
Side Effects
sexual lust.” The design of this study is every day, with the potential of unpleas- days when they plan sexual activity.
experience increased sexual interest.
Doctors can determine a man’s testoster- one levels and prescribe injections, pills man is deficient. Although low testoster- men, a patch (Testoderm or Andro-
derm) applied daily to the scrotum can
ther in tablets (Estratest, Menogen,
raise blood levels to normal within three General:
(depAndrogyn, Depo-Testadiol,
quickly. Andrew Sullivan, writing in The medically prescribed testosterone: “Be- bloodstream, I can actually feel its power erlands reported in the Archives of Gen- eral Psychiatry (vol. 57, February 2000, and at most a day, I feel a deep surge of AndroGel
cline, the feeling alters a little.The same three to four and a half hours later.
much experience I have with it, this lust like feeling hungry, a feeling you recog- nize and satiate. It creeps up on you.
that lust is a chemical. It comes; it goes.
ize the potential demand could be brisk.
in front of it, but you are certainly not Alprostadil (PGE )
Viagra (sildenafil)
Impotence
1
Treatments
$1 billion on Viagra. Rarely has a
dysfunction (impotence). One of the first erection difficulties was the “Erection Injection,” Caverject. This medication
is alprostadil, a form of prostaglandin E .
It is injected directly into the penis with though urologists were enthusiastic about Drugs that Interact
with Viagra
such as nitroglycerin, Imdur, ISMO,
Crixivan (indinavir)
Isordil, Monoket or Sorbitrate
Invirase (saquinavir)
ment of fibrous tissue in the penis lead- tential for lethal interactions. Over 100 Nizoral (ketoconazole)
ing to Peyronie’s disease (curvature of Norvir (ritonavir)
Sporanox (itraconazole)
Tagamet (cimetidine)
form of MUSE. This is alprostadil in the
rectly into the urethra. Erection usually Other Possible
Interactions
Aldactone (spironolactone)
Biaxin (clarithromycin)
percent), burning or bleeding of the ure- Bumex (bumetanide)
Dyazide (triamterene/HCTZ)
Grapefruit
Inderal (propranolol)
or burning of the vagina after intercourse.
Lasix (furosemide)
Maxzide (triamterene/HCTZ)
tion, increased sensitivity to light, di- Sandimmmune (cyclosporine)
Female Options
are currently under development. Ali-
bra, from the maker of MUSE, contains
tadil creams (Alprox-TD for men and
Femprox for women) and an alpros-
tadil gel, Topiglan. Presumably these
forms of alprostadil will be easier to use.
Uprima (apomorphine)
Lubricants
An advisory committee to the FDA has rec- ommended approval of the first competitor to Viagra. Uprima acts in the brain rather than
on blood vessels as Viagra does. This means that some men who have not benefited from phentolamine (Vasofem) is under
Viagra may be able to achieve erections with this new sublingual tablet. Another advan- tage is that Uprima goes to work within ap- proximately 15 minutes rather than the 30 Future Possibilities
clinical trials, over half the men using Uprima were able to achieve an adequate erection.
Uprima has some serious side effects, how- ever. Men may experience dizziness, nausea, vomiting, drowsiness or even fainting. Low Astroglide, K-Y Jelly,
helpful in treating sexual problems.
blood pressure and slower pulse could be seri- Maxilube or Replens.
ous complications for some men. It is expected to interact with alcohol, which should be that Corn Huskers
• IC351 is one of the most promis-
Most drug interactions have not been stud- to increase blood flow to the penis.
ied yet. We are concerned about the possibility that Uprima may not be compatible with ni- troglycerin or blood pressure medicines. One member of the FDA advisory panel, Dr. Robert Califf of Duke University, voted for approval but cautioned that “This drug is clearly going • PT14 is a peptide molecule that
Vasomax (phentolamine)
estrogen (Estring) are
Phentolamine has a long history of use for treating impotence. Before Caverject was ap- • Dapoxetine is related to Prozac
proved, phentolamine was injected into the penis together with papaverine to produce an Vasomax is available in a quick-release oral form in Mexico, but the FDA is awaiting more research before giving it the green light.
Possible side effects include low blood pres- NATURAL APPROACHES TO SEXUAL DYSFUNCTION
The very first oral medication that was seriously studied for its effect on erection difficulties was yohimbine, derived
from the bark of the yohimbe tree. Healers in West Africa had used the bark to restore “sexual vigor,” but scientificstudies conducted since the 1980s have produced mixed results. An early study was promising, with a responserate of 30 to 60 percent, but a more recent controlled study did not show an advantage over placebo. Side effectsmay be serious for some men. They can include high blood pressure, palpitations, rapid pulse, nausea, headache,nervousness, dizziness, flushing and tremors. Yohimbine is sometimes found masquerading as a “dietarysupplement,” but it should be used only under a doctor’s supervision.
An amino acid, L-arginine, can increase activity of nitric oxide. Since Viagra works on this chemical pathway, a
small study of oral L-arginine (2800 mg daily) was done. In this short-term trial, 40 percent of the men taking L-arginine reported improved erections. No side effects were reported, but further research is needed.
Antidepressants are notorious for interfering with sexuality. Prozac, Paxil and Zoloft can cause lowered libido,
impotence and problems achieving orgasm. Ginkgo biloba (40-120 mg twice a day) has been used to reverse
these problems. In one study over 80 percent of those taking ginkgo reported improvement.
Muira puama (Ptychopetalum olacoides) is a Brazilian herb reputed to have aphrodisiac properties. It is also
known as “potency wood.” Data is scarce, but one study reported benefit in about 50 percent of men with erectiledysfunction. Tieraona Low Dog, M.D., suggests 3 to 5 ml. tincture one half hour before intercourse.

Source: http://www.healthcentral.com/static/pp/pdf_guides/sexualdysfunction.pdf