Sexual Difficulties
Loss of sexual interest, also known as decreased libido, erectile difficulties and difficulties reaching orgasm are frequently ignored problems in people living with HIV. Try not to be embarrassed about sexual difficulties. Discuss any problems you are having with your healthcare provider or other counsellor. A healthy, fulfilling sex life is part of a life well lived and is something that all people living with HIV deserve.
Figuring out the cause
It will be helpful if you can share with your healthcare provider when your sexual difficulties began, what the problems are, and to what extent you are experiencing them. It may be helpful to ask yourself how your current libido and sexual functioning compares to the past. If your sex drive has always been strong and you realize that recently it is not, tell your healthcare provider. If you never had problems having sex and now you do, this is something your healthcare provider needs to know. The more specific you can be in describing your sexual difficulties, the better.
Sexual difficulties can have a number of different causes. Sexual function often changes as people age. Some people consider this a natural part of life, while others seek to address it. Prescription medications can also be a cause. Sexual difficulties have been reported in many people taking protease inhibitors or antidepressants. If your troubles started shortly after the introduction of any new medication, consider that it could be causing or contributing to the problem.
Finally, other factors can contribute to changes in sexual function, including:
- smoking
- alcohol
- hormone problems
- mental and emotional issues, including anxiety, stress and depression
When a physical exam and laboratory analysis appear normal, the search for other possible causes should continue. Autonomic neuropathy, a nerve condition that may occur in people living with HIV and often remains undiagnosed, has been found to cause erectile dysfunction. Nutrient therapies for peripheral neuropathy may help some people.
Not only is it important to find solutions, but some sexual difficulties can indicate health conditions such as diabetes, cardiovascular disease or thyroid gland disease. If your sexual difficulties persist, a consultation with a urologist, gynecologist or sexologist could be in order.
Hormone deficiencies
Testosterone deficiency can contribute to loss of sexual interest. It can also lead to erectile dysfunction, a loss of muscle mass and overall body cell mass, as well as to fatigue, lack of energy and depression. While testosterone levels drop naturally with age, a deficiency can happen at any time for people living with HIV. An evaluation of your testosterone level is important if you are experiencing a decline in sexual interest, erection difficulties, or inability to reach orgasm.
Appropriate hormone replacement can return testosterone levels to normal and reverse sexual problems when testosterone deficiency is the underlying cause. At the same time, restoring normal testosterone levels can help to reverse or prevent other serious problems related to a deficiency. Testosterone gels, creams or patches are preferable to injections. This is because injections can shut down your own testosterone production and can actually cause sexual problems.
Menopause may start earlier, so it may be worth testing levels of estrogen and progesterone in cis women and trans men who are not on gender-affirming hormone therapy. Deficiencies can contribute to sexual arousal disorder, vaginal wall thinning and dryness, the combination of which can cause difficulty with intercourse and reduced pleasure. Based on your test results, you should discuss with your healthcare provider whether hormone replacement therapy to reverse your symptoms is appropriate.
Antidepressant and sleep medications
Stress, anxiety and depression are frequently accompanied by sexual problems. Some people find that the emotional impacts of living with HIV can affect their sexual function. These issues should be treated through effective counselling and medication as needed.
However, if you are taking medications for depression or chronic anxiety and you develop sexual problems, your medication may be the cause. On the other hand, the antidepressant Wellbutrin (bupropion) can increase sexual desire and function, including ability to reach orgasm. The antidepressant Trintellix (vortioxetine) may be less associated with erectile dysfunction than other antidepressants. Discuss these and other options with your healthcare provider and pharmacist.
Sleep medications can also be a problem; they diminish sexual desire significantly in some people. Since many medications and natural alternatives are available to help with sleeping disorders, many people are able to find an effective substitute.
Lifestyle changes
Some recommendations to improve your sexual health include:
- Eat well and avoid heavy meals before sex
- Cut down or quit smoking, which inhibits the sexual reflex
- Cut down how much alcohol you drink; alcohol is a sexual depressant
- Look into ways to reduce your stress; stress lowers libido
- Get enough rest; seven to nine hours is enough for most people
- Avoid using club or party drugs that diminish your sex drive
Drugs to treat impotence
The erectile dysfunction drugs Viagra (sildenafil), Cialis (tadalafil) or Levitra (vardenafil) can be an option for impotence. However, these drugs interact with a number of other drugs, including some antiretroviral medications (particularly protease inhibitors) and heart disease drugs.
These erectile dysfunction drugs should not be used by anyone taking the heart drug nitroglycerin or other nitrate medications. Nor should they be used along with poppers (amyl nitrite and other alkyl nitrites). These combinations can sharply decrease blood pressure and lead to shock or death. Also, lower doses of erectile dysfunction drugs are recommended in anyone on an antiretroviral treatment that includes a protease inhibitor or a non-nucleoside analogue (non-nuke).
People should only use Viagra, Cialis or Levitra after consulting with their healthcare provider, who can identify possible health issues and potential drug interactions. Erectile dysfunction drugs bought without a prescription — often from friends, online or other sources — can be counterfeit and might contain ingredients that are harmful or interact with HIV medications. Always talk to your pharmacist before taking a new medicine.