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Sexual Dysfunction

What sexual problems are common in people with HIV?

While sexual problems can affect everyone, people with HIV may be particularly affected. Common sexual problems affecting PHAs include loss of sex drive or desire (libido), as well as issues with arousal, satisfaction and orgasm.

What causes sexual dysfunction in people with HIV?

For PHAs, sexual difficulties may be related to the impact of HIV on the different aspects of the person’s physical and emotional health.
Specific emotional causes of sexual dysfunction may include:

• the stigma and discrimination associated with the HIV diagnosis
• depression, anxiety and coping with high levels of stress
• the stress of disclosure, condom use and safer sex
• self image issues due to body shape changes from HIV itself or its treatment

Specific physical causes of sexual dysfunction may include:

• Chronic ill health and reduced physical stamina
• Decreased testosterone levels in men and women
• Direct side effects of certain anti-HIV medications
• Nerve damage due to HIV, other viruses (such as CMV) or medications
• Side effects of certain medications (e.g. anti-depressants, medications for treating high blood pressure and high cholesterol)

Issues and treatments for men

For many HIV positive men, the most common sexual problem is impotence, difficulty or inability to get or maintain an erection.
For men with low testosterone levels, testosterone replacement therapy may help with symptoms of sexual dysfunction. Testosterone replacement therapy may come in the form of oral tablets, injections or a gel or patch for applying onto the skin. Testosterone replacement therapy may have other side effects and health risks, so please discuss with your health service provider if you are interested in considering its use.
Sidenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) can be used to treat impotence by increasing blood flow to the penis. However, because of drug interactions, the dosage of these medications should be reduced in people taking Protease Inhibitors, NNRTIs, ketoconazole, itraconazole and erythromycin. In addition, due to potential fatal complications, they should not be taken with Ritonavir, other heart medications such as nitrates, and the recreational drug Poppers.
Other intervention include injection into the penis with a prostate hormone called alprostadil (Muse) that increases blood flow in the penis, or a combination of alprostadil, papavarine and phentolamine (Triple Mix). Side effects can include painful prolonged erection (priapism).
Penile implants and pumps to help erection can also be surgically installed.
Sexual dysfunction may be related to psychological factors such as stress, anxiety and depression, addressing these factors may help to reduce problems with sexual dysfunction.

Issues and treatments for women

Sexual problems affecting women include early menopause, decreased libido, vaginal dryness, increased pain during intercourse, and increased pain or worsened symptoms of premenstral syndrome (PMS).
Treatments for vaginal dryness and discomfort may include water based lubricants (Astroglide, K-Y) that lubricate the vagina for several hours, or vaginal moisturizers (Replens, Lubrin) that may decrease dryness for up to three days with a single application.
For vaginal symptoms associated with early menopause, vaginal hormonal therapy may be helpful. This can come in several forms: vaginal estrogen cream (Estrace, Premarin), vaginal estrogen ring (Estring) or vaginal estrogen tablet (Vagifem). They are all inserted vaginally and work for varying periods of time. However, hormonal therapies may have other side effects or health risks. Talk to your health service providers about the risks and benefits of hormonal therapy.
PMS symptoms may be treated with nutritional supplements such as Vitamin B6, calcium and magnesium; a balanced diet with increased whole grains, vegetables, fruits and decreased salt, caffeine, sugar and alcohol; adequate sleep and regular exercises. Pain can be treated with ibuprofen (Advil) or aspirin (Novasen).
The use of Viagra, Cialis and Levitra have not been sufficiently studied in women for treating sexual difficulties.

What can I do about sexual dysfunction?

Sexual dysfunction/problems are very common and there are many potential treatments available. It is important to talk to your doctor, your counselor and/or your therapist about these problems. They can work with you to investigate and find out the physical or emotional factors that cause these problems, help you get the emotional and psychological help you need, or refer you to the appropriate specialists.