SEXUAL DYSFUNCTION
 R.A.S HEMAT, MB;BCh, FRCSI, Dip.Urol.UCL.
The sexual side effects of most antidepressants most likely under some circumstances, but not always jeopardise romantic love and marriage. Serotonin-enhancing antidepressants can cause sexual dysfunction (SD), diminished sexual desire, delayed sexual arousal, and muted or absent orgasm. About 73% of patients on some of these medications can suffer from 1 or more of these side effects. Erectile dysfunction (ED) disturbs not only sexual life but it also impairs quality of life (QoL) for the patient and spouse. Sexual activity can be resumed after myocardial infarction (MI) when the patient can climb 2 flights of stairs without cardiac symptoms.
- Tumescence is initiated by relaxation of vascular tone and a drop in resistance to arterial flow that bathes the cavernous tissues in highly oxygenated arterial blood. Penile erection is a haemodynamic process, involving increased arterial inflow and restricted venous outflow from the penis, co-ordinated with corpus cavernous smooth muscle (CSM) relaxation. The process is generally accepted to be under neuroregulatory control and involves the cholinergic, adrenergic and nonadrenergic noncholinergic (NANC) neuroeffector systems. Nitric oxide (NO) activates Na/K-ATPase in human corporeal smooth musculature (CSM). Diabetes mellitus (DM) has been associated with impaired nitric oxide synthase (NOS) dependent erectile mechanisms. Hypercholesterolaemia impairs endothelial NOS dependent mechanisms. Erectile tissue degenerative changes include decomposition of neural elements, smooth muscle cell cytoplasmic vacuolisation and endothelial disintegration, which are frequently associated with hypoxia or acidosis.
Basic feelings of attachment are associated with elevated activity of oxytocin (OT) and vasopressin. The hypothalamus, amygdala, insula, and other regions of the brain are involved in lust. During intense sexually attraction elevated activity of dopamine and norepinephrine can stimulate testosterone, the hormone of desire. An elevated activity of testosterone stimulates dopamine and norepinephrine, but it suppresses the activity of serotonin (monoamines associated with romantic love). Serotonin-enhancing antidepressants inhibit motivation, discrimination, and self esteem. Women who are on the selective serotonin reuptake inhibitors (SSRIs) would rate the male faces as more unattractive and look at and appraise the faces for a shorter period of time (like being blind). There are 2 aspects to arousal: one is central, going on in the brain; and one is peripheral, going on in the genitalia. Sometimes these are disconnected. Rapid ejaculation (premature ejaculation) is defined on the part of the man feeling that he has ejaculated or come to orgasm sooner than he would like. Sexual pain is pain associated with sexual activity, which tends to occur in women or pain associated with orgasm, which has been mostly reported in men, and associated with certain antidepressant medications.
Testosterone is the hormone driving sexual interest and behaviour in men. It also is important in women, primarily related to cognition, spontaneous thoughts about sex, and sexual fantasies. Prolactin significantly contributes to sexual dysfunction (SD). Some of these hormones affect neurotransmitters, which are very specific in their effects on sexual functioning in the brain. Dopamine appears to drive motivated sexual behaviour. Norepinephrine is very important in both generalised and sexual arousal. Serotonin enhancement can negatively affect nitric oxide (NO) function. Serotonin can have negative effects on sensation, both diminishing sensation and heightening painful sensations in the genitalia. Women with obsessive-compulsive disorder (OCD) are more likely to be both avoidant and anorgasmic than women with generalised anxiety disorder (GAD), even though women with GAD have far more somatic symptoms than women with OCD. Men with posttraumatic stress disorder (PTSD) have very generalised sexual dysfunction and it's made worse by the SSRIs used to treat the disorder. Tamoxifen may increase risk of developing depression in breast cancer patients (27%).
Acute stress enhances intestinal epithelial permeability to macromolecules by mechanisms involving corticotropin-releasing hormone (CRH) and mast cells. Repeated stress induces a colonic barrier defect, and enlarges epithelial cell mitochondria. In chronic stress there may be a habituation of the Hypothalamic-Pituitary-Adrenal (HPA)-axis. Gland cells produce hormones; white blood cells produce antibodies; heart muscle cells generate and conduct biological electricity for the heart beat. Amino acids are the building blocks of proteins. The amino acid proline is a major building block of the stability proteins collagen and elastin. Hyperglycaemia is one of the major causes of vascular dysfunction. Brain chemistry imbalance may be induced by brain damage from an accident, traumatic stress, or some genetic defect. Women's conclusions and emotional reactions are complicated and intensified by the inability to produce enough serotonin. Hurt and resentment increases activity in the limbic system of the brain. When a man remembers being hurt, blood flows to the limbic system of the brain, which governs emotions. When a woman remembers being hurt, 8 times more blood flows to the limbic system. Women are more emotionally vulnerable and sensitive. The major mechanisms involved in smooth muscle contractions, not associated with changes in membrane potential, are the release of inositol triphosphate (IP3) and the regulation of Ca2+ sensitivity. Both mechanisms may be important for the activation of CSM. Soya supplements reduce serum testosterone. Phosphodiesterase (PDE) inhibitors are all analogues of cyclic 3’,5’-guanosine monophosphate (cGMP). Oxytocin (OT) is the key to lasting romance. Autonomy stimulates dopamine and testosterone but lessens OT. This increased testosterone is rewarded by the brain, but it also lowers OT. Increasing testosterone ends to lessen OT, and lower OT decreases a woman's well-being. Testosterone and OT are complementary to each other, when one increase, the other is reduced. Depression is a systemic illness that adversely affects the entire body. Depression is associated with a decreased number of circulating lymphocytes including T cells, B cells, and particularly natural killer cells, which are involved in the detection and removal of tumour cells. Depression is very prevalent in cancer. Depression is common in stroke patients. Depression is an independent risk factor for the development of ischaemic heart disease (IHD). Serotonin reuptake inhibitors (SRIs)-induced sexual dysfunction ranges from 30% to 70%. Medications can cause sexual dysfunction.
October, 2008
The information in this article has been excerpted from the following books:
ANDROPATHY, by R.A.S. HEMAT.
Note: Permission is granted to copy and redistribute this document electronically as long as it is unmodified. This article may not be sold in any medium, including electronic, CD-ROM, or database, or published in print, without the explicit, written permission of Dr. R. A. S. Hemat.
Clinical Orthomolecularism Classroom
Dr. R.A.S HEMAT declares no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, stock holdings, gifts, or honoraria.
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