ERECTILE DYSFUNCTION IN SUBSTANCE ABUSERS TREATED WITH SILDENAFIL, 2008 update

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Slide 1 :

ERECTILE DYSFUNCTION IN SUBSTANCE ABUSERS TREATED WITH SILDENAFIL 2008 UPDATE

Slide 2 :

DARWIN TELIAS Director, “Matara” Center for Addictions, Mental Health Center Beer Sheva, MOH, ISRAEL ANA KADMON-TELIAS Director, “Beer-Sheva Half-Way House”, Prisoners Rehabilitation Authority, ISRAEL

Slide 3 :

SEXUAL PROBLEMS ARE COMMONLY REPORTED BY SUBSTANCE ABUSERS APPLYING FOR TREATMENT THE MOST COMMONLY REPORTED PROBLEMS ARE: EJACULATIA PRECOX AND ERECTILE DYSFUNCTION

Slide 4 :

ACCORDING TO PATIENTS’ REPORTS,THOSE PROBLEMS ARE SELDOM CAUSED BY THE SUBSTANCE ABUSE, BUT MOST FREQUENTLY THEY ARE THE RESULT OF DEFICIENT SEX EDUCATION, EXCESSIVE ANXIETY AND SOCIAL AND PSYCHOLOGICAL PROBLEMS

Slide 5 :

A NUMBER OF THOSE PATIENTS REPORTED THAT ABUSING SUBSTANCES HELPED THEM PERFORM BETTER SEXUALLY, BEFORE THE PROLONGED ABUSE REDUCED THEIR SEXUAL DRIVE AND ABILITY TO PERFORM

Slide 6 :

IT IS OUR OPINION THAT OPIATES, BY CALMING DOWN THEIR ANXIETY AND FEARS, PERMITED THEM TO PERFORM “NORMALLY”, AND THAT, FOR THE GREAT MAJORITY OF THOSE PATIENTS, THERE WAS NO REAL PHYSICAL IMPEDIMENT TO SEXUAL PERFORMANCE

Slide 7 :

MEDICAL LITERATURE REPORTS THE REDUCTION IN LIBIDO AND IMPOTENCE CAUSED BY CHRONIC USE AND ABUSE OF SUBSTANCES (Fasolis et al, 1991; Donatucci & Lue, 1993; Carroll et al, 2001) AT THE TIME OF OUR ORIGINAL PUBLICATION (2002) WE WERE UNABLE TO FIND REPORTS OF SEXUAL DYSFUNCTION PRIOR TO THE BEGINNING OF THE ABUSE

Slide 8 :

AFTER THAT, A CERTAIN NUMBER OF PAPERS REPORTED RESULTS SIMILAR TO OURS (LaPera et al, 2003, 2006, 2007), BUT OTHER PAPERS CONTINUED TO REPORT NO SPECIAL SEXUAL DIFFICULTIES IN ADDICTS (Brown R, Balousek S, Mundt M, Fleming M., 2005)

Slide 9 :

OTHER REPORTS INDICATE THAT METHADONE MAINTENANCE, BUT NOT BUPRENORPHINE MAINTENANCE, SEEM TO CAUSE ERECTILE DYSFUNCTION IN PATIENTS (Hallinan R, Byrne A, Agho K, McMahon C, Tynan P, Attia J, 2008 ), ALTHOUGH THE CAUSES, HYPOGONADISM AND DEPRESSION, ARE VERY DIFFERENT FROM THE CAUSES WE HYPOTESIZED ABOUT

Slide 10 :

IT WAS OBSERVED THAT PATIENTS WHO PRESENTED THEMSELVES FOR TREATMENT HAD BEEN PERFORMING SEXUALLY UNDER THE INFLUENCE OF OPIATES UNTIL THEY CAME TO US

Slide 11 :

SOME OF THEM EVEN REPORTED THAT THE CAUSE WHY THEY STARTED ABUSING SUBSTANCES WAS THE SEXUAL DYSFUNCTION:

Slide 12 :

THEY FOUND BY TRIAL AND ERROR THAT WHEN UNDER INFLUENCE THEY WERE ABLE TO PERFORM BETTER, SO THEY BECAME FREQUENT USERS AND THEN DEVELOPED THEIR DEPENDENCE

Slide 13 :

THEIR PROBLEM STARTED WHEN THEY CAME FOR TREATMENT, AND THEN, SUDDENLY, THEY WERE EXPECTED TO PERFORM SEXUALLY WITHOUT OPIATES

Slide 14 :

MANY OF THEM FOUND IT IMPOSSIBLE, AND SOME OF THEM EVEN RESORTED TO USING OPIATES AGAIN JUST TO BE ABLE TO FUNCTION SEXUALLY

Slide 15 :

IN 2002 WE PUBLISHED A CASE REPORT (Telias, Kadmon-Telias, 2002) WITH OUR FIRST OBSERVATIONS

Slide 16 :

IN THE PAPER, WE DESCRIBED THE FIRST TREATMENT ATTEMPTED. WE OFFERED LECTURES ON SEXUAL FUNCTION AND ON THE MOST COMMON DYSFUNCTIONS.

Slide 17 :

AT THE END OF THE LECTURES PATIENTS COULD RECEIVE INDIVIDUAL CONSULTATION WITH A PSYCHIATRIS, AND COULD RECEIVE MEDICATION FOR THEIR REPORTED SEXUAL PROBLEM

Slide 18 :

THE MOST COMMONLY REPORTED PROBLEMS WERE: EJACULATIA PRECOX AND ERECTILE DYSFUNCTION

Slide 19 :

PATIENTS COMPLAINING OF EJACULTIA PRECOX RECEIVED TREATMENT WITH A LIDOCAINE CREAM

Slide 20 :

PATIENTS COMPLAINING OF ERECTILE DYSFUNCTION WERE OFFERED SILDENAFIL

Slide 21 :

PATIENTS WERE EXPLAINED THAT MEDICATION WOULD MOST PROBABLY BE TEMPORAL, AND THAT NATURAL ERECTIONS AND NORMAL EJACULATIONS COULD EVENTUALLY RETURN AFTER SOME TIME USING THE MEDICATION

Slide 22 :

THE RATIONALE FOR THE USE OF SILDENAFIL WAS THAT WE ESTIMATED THAT THE PATIENTS, ALL OF THEM YOUNG AND OTHERWISE RELATIVELY HEALTHY, WERE BASICALLY ABLE TO PERFORM NORMALLY, WITH OR WITHOUT THE SILDENAFIL

Slide 23 :

WE EXPECTED THE ACTION OF THE MEDICATION WOULD ASSIST THEM TO REDUCE THEIR FEARS AND TO BEGIN TO PERFORM NATURALLY AFTER THE DISCONTINUATION OF THE MEDICATION

Slide 24 :

AT THE TIME OF PUBLICATION OF OUR FIRST REPORT, 3 PATIENTS COMPLAINING OF ERECTILE DYSFUNCTION AND ONE COMPLAINING OF BOTH ERECTILE DYSFUNCTION AND EJACULATIA PRECOX HAD BEEN TREATED. THOSE ARE THE PATIENTS ABOUT WHOM WE HAVE THE LONGEST FOLLOW UP

Slide 25 :

ALL THE PATIENTS RECEIVED A BRIEF COURSE OF SILDENAFIL (ABOUT 1 50mg TABLETS A WEEK), AND THE ONE COMPLAINING OF BOTH AILMENTS ALSO RECEIVED A LIDOCAINE CREAM

Slide 26 :

TWO OF THE PATIENTS WHO COMPLAINED OF ERECTILE DYSFUNCTION, AND THE ONE WITH TWO AILMENTS, REPORTED IMPROVED SEXUAL PERFORMANCE AFTER THE FIRST TREATMENT.

Slide 27 :

THE IMPROVEMENT CONTINUED DURING 2 TO 3 MONTHS OF FOLLOW UP. AT THE END OF FOLLOW UP MEDICATION WAS DISCONTINUED, BUT THE IMPROVED PERFORMANCE CONTINUED.

Slide 28 :

THESE PATIENTS COULD BE FOLLOWED UP FOR OVER A YEAR, AND THEY WERE PERIODICALLY TESTED FOR DRUGS AT THE HALF-WAY HOUSE WHERE THEY HAD BEEN TRANSFERRED.

Slide 29 :

IT IS KNOWN THAT EVEN TODAY THEY ARE DRUG FREE AND HAVE NOT BEEN INVOLVED IN ILLEGAL ACTIVITIES

Slide 30 :

THE FOURTH PATIENT WAS KNOWN TO BE DOING WELL AT 3 MONTHS, BUT HE ABANDONED THE HALF-WAY HOUSE AND CONTACT WAS LOST, SO WE HAVE NO MORE DETAILS

Slide 31 :

IN THE YEARS SINCE OUR FIRST PUBLICATION, SCORES OF PATIENTS WERE TREATED WITH SILDENAFIL, OR WITH A COMBINATION OF SILDENAFIL AND SOME FORMULATION FOR EJACULATIA PRECOX.

Slide 32 :

TREATMENT WITH SILDENAFIL HAS NOW ALSO BEEN TRIED FOR ALCOHOL-RELATED ERECTILE DYSFUNCTION (Grinshpoon A, Margolis A, Weizman A, Ponizovsky AM., 2007)

Slide 33 :

WE FIRST TREATED EJACULATIA PRECOX WITH SOME LIDOCAINE CREAM. NOWADAYS WE PROVIDE THE PATIENTS WITH EITHER PAROXETINE OR THE NEW ANTI-EJACULATIA PRECOX CONDOMS

Slide 34 :

PAROXETINE GIVES EXCELLENT RESULTS, BUT MANY PATIENTS COMPLAIN OF THE OVERWEIGHT RESULTING FROM ITS USE

Slide 35 :

THE CONDOMS, BATHED IN SOME DESENSITIZINGPREPARATE, PROVIDE AN EXCELLENT SOLUTION IN MOST CASES OF EJACULATIA PRECOX, WHILE AT THE SAME TIME PROVIDING SOME PROTECTION AGAINST PREGNANCY AND SEXUALLY TRANSMITTED DISEASES

Slide 36 :

BOTH THE SILDENAFIL AND THE ANTI-EJACULATIA PRECOX WERE USED MOSTLY AS BEHAVIORAL TOOLS. AN ADEQUATE COADJUVANT TREATMENT USING SOME SORT OF PSYCHOTHERAPY, MOST PROBABLY COGNITIVE-BEHAVIORALLY ORIENTED, WOULD CERTAINLY IMPROVE THE RESULTS GREATLY

Slide 37 :

NEVERTHELESS, EVEN WITHOUT THE PSYCHOTHERAPY, OUR RESULTS, AND THE RESULT OF OTHER RESEARCHERS, SHOW THAT THERE ARE CONNECTIONS BETWEEN SEXUAL DYSFUNCTION AND SUBSTANCE ABUSE.

Slide 38 :

THE RESULTS ALSO SHOW THAT IT IS POSSIBLE, AND VERY DESIRABLE, TO TREAT THE SEXUAL DYSFUNCTIONS, AND THAT THE TREATMENT ENHANCES THE RESULTS OF THE TREATMENT FOR SUBSTANCE ABUSE

Slide 39 :

BIBLIOGRAPHY CARROLL, J.F.; MCKINLEY, J.J.; MACK, S.E. (2001) – Exploring the self-reported sexual problems and concerns of drug dependent males and females in modified therapeutic community treatment – J. of Substance Abuse Treatment 2O. 245-250 DONATUCCI, C.F.; LUE, T.F. (1993) – Erectile dysfunction in men under 40: etiology and treatment choice. International Journal of Impotence Research 5.97-103

Slide 40 :

FASOLLS, J.; COLOMBO, M.; TARABUZZI, R.; FONTANA, D. (1991)– Drugs, impotence and infertility. Archivo Italiano de Urologia, Nefrologia e Andrologia. 63.397-401 GRINSHPOON, A.; MARGOLIS, A.; WEIZMAN, A.; PONIZOWSKY, A.M. (2007) - Sildenafil citrate in the treatment of sexual dysfunction and its effect on quality of life in alcohol dependent men: preliminary findings. Alcohol Alcohol. Jul-Aug;42(4):340-6. HALLINAN, R.; BYRNE, A.; AGHO, K.; MACMAHON; C.; TYNAN. P.; ATTIA, J. (2008) - Erectile dysfunction in men receiving methadone and buprenorphine maintenance treatment. J Sex Med. Mar;5(3):684-92.

Slide 41 :

BROWN, R.; BALOUSEK, S.; MUNDT, M.; FLEMING, M. (2005) - Methadone maintenance and male sexual dysfunction. J Addict Dis.;24(2):91-106. LA PERA, G.; FRANCO GIANNOTTI, C.; TAGGI, F.; MACCHIA, T. (2003) Prevalence of sexual disorders in those young males who later become drug abusers. Mar-Apr;29(2):149-56. LA PERA, G.; CARDERI, A.; MARIANANTONI, Z.; LENTINI, M.; TAGGI, F. (2006) - The role of sexual dysfunctions in inducing the use of drug in young males. Arch Ital Urol Androl. Sep;78(3):101-6. LA PERA, G.; CARDERI, A.; MARIANANTONI, Z. et al. (2008) - Sexual dysfunction prior to first drug use among former drug addicts and its possible causal meaning on drug addiction: preliminary results. J Sex Med. Jan;5(1):164-72.

Slide 42 :

TELIAS D.; KADMON-TELIAS, A. (2002) - Four cases of erectile dysfunction in substance abusers treated with sildenafil. Addiction. Nov;97(11):1473-4.

Slide 43 :

THE AUTHORS CAN BE CONTACTED AT: teliaska@zahav.net.il

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