Sexual Dysfunction Induced By Psychotropic Medication

1. Sexual Dysfunction Induced By Psychotropic Medication Susanne Lampitt Clinical Nurse Educator October, 2008

2. Clinicians tend to………... • Have difficulty broaching the subject • Focus on Extrapyramidal & Anticholinergic side effects • Ignore or minimize effects that impact on sexuality & sexual function • Why?

3. Male and Female prevalence rates of sexual dysfunctional/problems 33% 35% 30% 27% 25% 25% 20% 20% 15% 15% 10% 10% 10% 3% 5% 0% Male dyspareunia Female dyspareunia Premature ejaculation Male erectile problems Male orgasm problems Female arousal problems Female orgasm problems Female hypoactive sexual desire

4. Effects of antidepressants on sexual function • Treatment - emergent sexual dysfunction reported with all • 40% of those taking antidepressants will develop some form of sexual dysfunction (Rothschild, 2000) • Decreased Sexual desire/ excitement • Diminished or delayed orgasm • Loss of sensation in nipples, penis & vagina • Decreased nocturnal erections • Erection & delayed ejaculation • Painful ejaculation • Galactorrhoea • Hard to separate effects of the depression from medication

5. Effects of First Generation (Typical) Neuroleptics • Difficulty in achieving or maintaining erection • Ejaculatory difficulties • Priapism (isolated incidents) • Desire & arousal problems • Poor lubrication • Diminished orgasm • Irregular menstruation/ amenorrhea or menorrhagia • Gynaecomastia, Galactorrhoea & breast discomfort in both men and women

6. Effect of Second Generation (Atypical) Neuroleptics • Significantly lower incidence of EPS and sexual side-effects (Higgins et al, 2005) • Risperidone associated with Galactorrhoea • Olanzapine & Clozapine cause fewer sexual side-effects (negligible effect on prolactin levels)

7. Effect of Anticholinergic Drugs • Can diminish some side effects • Can cause erectile dysfunction • Failure of vaginal lubrication

8. The Clinicians Role • Informed Consent for treatment • Education • Support • Monitoring • Need to be more proactive and feel comfortable introducing the subject • Written information should supplement discussion • Use of standardized side effect assessment tools

9. Side Effect Assessment Scales • Simpson-Angus Scale (Simpson and Angus, 1970) • The Abnormal Involuntary Movement Scale (Guy, 1976) • The Udvalg for Kliniske Undersogelse Scale (Lingjaerde • et al, 1987) • Side Effect Scale/Checklist for Antipsychotic Medication • (Bennett et al, 1995) • Liverpool University Neuroleptic Side Effect Rating Scale • (Day et al, 1995) • The Extrapyramidal Symptom Rating Scale (ESRS) • (Chouinard and Margolese, 2005

11. Treatments • Assess that there is no other physical pathology • Spontaneous remission may occur • Dose reduction • Change medication • ‘Antidote’ medication eg. Viagra

12. KEY POINTS • Psychotropic medication can cause significant side effects that impact on sexuality and sexual function. • Nurses have a key role to play in educating and monitoring these side-effects. • Clients may be reluctant to report these side-effects due to their sensitive nature. • Nurses need to be proactive in informing clients and asking about the impact of drugs on sexual function.

14. References: Agnes Higgins. Impact of psychotropic medication on sexuality: Literature review – Psychotropic Medication. British Journal of Nursing, 2007, Volume 16, No9 Fontaine, K. L. (2009). Gender identity and sexual disorders. In C. R. Kneisl & E. Trigoboff (Eds.), /Contemporary psychiatric-mental health nursing/ (2nd ed., pp. 521-548). New Jersey: Pearson Prentice Hall.