Erectile and Ejaculatory Dysfunction Associated with Use of Psychotropic Drugs: A Systematic Review

Abstract

Background Sexual dysfunction may be a side effect of treatment with antipsychotics, antidepressants, and other psychotropic drugs. Aim To review the evidence concerning male sexual dysfunctions in patients taking psychotropic drugs to provide specific information to nonpsychiatric physicians for the management of these dysfunctions. Methods A systematic search of Medline and Embase databases was performed up to October 15th, 2020. We included randomized controlled trials comparing the effects of psychotropic drugs versus placebo or versus another drug of the same class, for at least 5 weeks. Outcomes We considered studies whose male population could be evaluated separately from the female population and with a separate analysis of the different phases of the male sex cycle. RESULTS We included 41 studies in the final review. There was a significant association between sexual dysfunction and antidepressant drug therapy, compared to placebo (decreased libido OR 1.89, 95% CI:1.40 to 2.56, 22 series, 11 trials, 7706 participants; erectile dysfunction OR = 2.28, 95% CI: 1.31 to 3.97; 11 trials, 3008 participants; ejaculatory dysfunction OR = 7.31, 95% CI: 4.38 to 12.20,19 trials, 3973 participants). When the effects of selective serotonin reuptake inhibitors (SSRIs) were evaluated separately from those of serotonin/norepinephrine reuptake inhibitors (SNRIs), the use of SNRIs but not that of SSRIs was characterized by significantly higher odds of erectile dysfunction compared to placebo. Only limited data were found regarding the effects of antipsychotics on the phases of the male sexual cycle, as it was shown that aripiprazole and risperidone showed lower and higher odds for erectile or ejaculatory dysfunction, respectively, compared to other atypical antipsychotics. Clinical Implications Treatment of male sexual dysfunction in patients taking psychotropics requires a basic knowledge of the different drugs that affect sexual function with different mechanisms. Strengths & Limitations The effects of psychotropic drugs on erectile function and ejaculation were evaluated separately. The great variability of the mechanisms of action makes it difficult to make comparisons between the effects of the different classes of psychotropic drugs. CONCLUSIONS Administration of antipsychotics affects male sexual function with different mechanisms, although the increase in prolactin values associated with the administration of first-generation antipsychotics and some atypical, such as risperidone, seems to play a primary role in determining male sexual dysfunction. Most antidepressants cause decreased libido, ejaculatory and erectile dysfunction, however the administration of SNRIs appears to be possibly associated with a specific risk of erectile dysfunction.

Sexual Dysfunction in Chronically Medicated Male Inpatients With Schizophrenia: Prevalence, Risk Factors, Clinical Manifestations, and Response to Sexual Arousal

“…In our study, the second-generation antipsychotic drugs were used by all patients, and there were no significant differences in the effects of antipsychotic and antidepressant drugs on sexual dysfunction, which is consistent with a previous study showing that no differences were found in the prevalence of sexual dysfunction between the drug groups (olanzapine, risperidone, aripiprazole, haloperidol) (6,43). However, in other studies, there were significant differences in the incidence of sexual dysfunction between different antipsychotic drugs (7,46,47). Taken together, the diverse rates of sexual dysfunction are likely to be related to the patients' treatment setting (inpatient, community or outpatient), sample size, different sociocultural contexts, clinical symptoms (especially negative symptoms), and possibly antipsychotic treatment.…”

Sperm Retrieval in Non-azoospermic Patients with Persistent Ejaculation Dysfunction

“…These nerves simultaneously contract the bladder neck and close it in order to prevent semen leakage into bladder and its mixing with urine. Therefore, at the end of emission, the semen pools in the posterior urethra between bladder neck (internal urinary sphincter) and membranous urethra (external urinary sphincter) ( 10 ).…”

Drug-Induced Sexual Dysfunction in Individuals with Epilepsy: Beyond Antiepileptic Compounds

“…Antidepressants are most likely to cause SD [ 7 ]. This is possibly due to an imbalance in the dopamine/serotonin ratio, considering that dopamine exerts a positive effect on sexuality, whereas most serotonin receptors negatively affect sexual function [ 8 ].…”

“…There are still limited data on the best treatment for psychotic disorders in epilepsy, although second-generation antipsychotics, especially risperidone, represent a reasonable first-line option due to their low propensity for drug–drug interactions and low risk of seizures [ 16 ]. Antipsychotics may affect sexuality in different ways [ 7 ]. Decreased libido is very common with older antipsychotic drugs, such as chlorpromazine and haloperidol, because they are potent dopamine blockers increasing prolactin levels.…”

“…Decreased libido is very common with older antipsychotic drugs, such as chlorpromazine and haloperidol, because they are potent dopamine blockers increasing prolactin levels. Indeed, it has been reported that up to 60% of patients taking such medications have experienced SD [ 7 , 17 ]. Among the newest atypical antipsychotic drugs, risperidone is most likely to cause elevations in prolactin levels as well as hyperprolactinemia-related symptoms, such as gynecomastia, erectile dysfunction, reduced lubrication and decreased libido.…”