Sexual side effects of psychotropic drugs in women and men

Although attention to sexual side effects is new, sexual side effects themselves are not new. Most classes of psychotropic drugs commonly cause sexual side effects. In this chapter we review the types, prevalences, mechanisms, management, and treatment of sexual side effects of psychotropic medications in women and men, with an emphasis on sexual side effects in women. Many of the studies performed with both female and male subjects concentrate on males. The male response is better known, researched, and documented. The fact that mechanisms are more difficult to study in women than in men is not a reason not to study the mechanisms in women, and does not justify simply extrapolating data from men to women. Often, what is known about males is also presumed for females without being properly documented. When sexual side effect information has been collected, it often has been limited to data about impotence or ejaculation difficulties. Sexual side effect questions may be worded in such a manner that women, who do not experience erection or ejaculation, do not identify with the questions or endorse the side effects. Side-effect protocols specific for sexual side effects have been developed. The FDA has not required collection of data on sexual side effects in drug development. However, collection of such information on both women and men should be required, "otherwise the main method of discussing adverse effects will be considerable human suffering". Even so, many premarketing studies last only a few months. Because some sexual side effects emerge after a long period on medication, the percentages of sexual side effects reported from short premarketing studies will be low compared with the percentages that might be found in patients taking the medications longer. Some researchers have claimed that women are less vulnerable to sexual side effects than men, although at least one researcher concluded that women were more vulnerable to such effects. We would discount any blanket assumption that men are more vulnerable to sexual side effects than women because 1) many studies design their symptom categories in a manner that automatically creates a disparity between the percentages of men and women reporting sexual side effects; 2) it is possible that men and women differ in the extent to which they spontaneously report sexual side effects, creating the misimpression that men experience more sexual side effects; and 3) sexual side effects of drugs are easier to measure physically in men than in women, but that does not mean that women do not experience them. Psychotropic drugs often affect sexual functioning, with a "domino effect" on sexual partners. Inattention to sexual side effects may lead to undue distress, misunderstandings, and/or treatment noncompliance. Fortunately, research and clinical attention to sexual side effects and their treatment is growing. (Extract of the publication)