Symptoms of sexondary sexual dysfunction are:
- Fatigue – decreased energy level and interest;
- Spasticity – affects comfort and positioning can be difficult;
- Bladder/bowel; incontinence – causes anxiety and discomfort;
- Cognitive changes;
- Pain/sensory changes.
We know fatigue is a big issue. So fatigue is going to be an implication for sexual dysfunction.
Spasticity. We know that in a specific positions the patient is going to have this extensor fastens and they’re going to lock and those legs are not going to move for a while. So we need to avoid those positions, we need to treat a spasticity before sexual activity.
Bowel and bladder incontinence. We have patients that they can have bladder incontinence or bowel incontinence while they are having sexual intercourse. And that becomes very embarrassing, very stressful; they don’t want to have sex. so we need to talk about all these things and what we can try to do to make it better.
Medications for secondary sexual dysfunction are:
- Antidepressants (SSRI, TCA);
- Anti-spasticity (baclofen);
- Anti-fatigue (amantadine, amphetamines: dose dependent);
- Pain medications.
Patients that have problems with the bladder are probably gonna be on anticholinergics. And this is going to cause a lot of vaginal dryness. So these patients are going to need a lot of lubrication.
Also, antidepressants, SSRI’s (Paxil, Lexil, Lexa Pro); these are going to affect every type of sexual dysfunction. So there is a very nice study in which it shows that if you give Wellbutrin, and this I think is the drug that we use the most in our clinic, Wellbutrin 150 milligrams daily can counteract the effect of SSRI’s in sexual functioning. Most of my patients are going to be in a combination of Wellbutrin and a SSRI.
Tricyclic antidepressants like Amitriptyline, Nortriptyline, those are not used a lot for depression but they are used for pain, and they can also affect sexual functioning. Baclofen is also a medication used for spasticity that can cause erectile dysfunction. So some of the patients that have this problem I recommend to switch them to tizanidine for example or any other anti-spasticity medication.
Then the anti-fatigue medications, amantadine is not used a lot, but those patients that use it can have any type of sexual dysfunction including erectile dysfunction, decreased libido.
Also amphetamines and this is dose-dependent, usually at a high dose patients can have problems with sexual functioning. But at a low intermediate dose, it will be actually beneficial.