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

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?

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

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

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

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)

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

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

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

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

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.

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 ). New Jersey: Pearson Prentice Hall.