medications such as cardiovascular, cytotoxic, gastrointestinal, and hormonal agents are
unknown. Elevated rates of sexual dysfunction have been reported with methadone or
high-dose opioid drugs for pain. There are incr eased rates of decrease d sexual desire, erec-
tile dysfunction, and difficulty reaching org asm associated with illicit substance use. The
prevalence of sexual problems appears related to chronic drug abuse and appears higher
in individuals who abuse heroin (approximately 60%–70%) than in individuals who abuse
amphetamines or 3,4-methylenedioxymethamphe tamine (i.e., MDMA, ecstasy). Elevated
rates of sexual dysfunction are also seen in  individuals receiving methadone but are sel-
dom reported by patients receiving bupren orphine. Chronic alcohol abuse and chronic
nicotine abuse are related to higher rates of erectile problems.
Development and Course
The onset of antidepressant-induced sexual dy sfunction may be as early as 8 days after the
agent is first taken. Approximately 30% of indi viduals with mild to moderate orgasm de-
lay will experience spontaneous remission of the dysfunction within 6 months. In some
cases, serotonin reuptake inhibitor–induce d sexual dysfunction may persist after the
agent is discontinued. The time to onset of sexual dysfunctio n after initiation of antipsy-
chotic drugs or drugs of abuse is unknown. It  is probable that the adverse effects of nico-
tine and alcohol may not appear until after ye ars of use. Premature (early) ejaculation can
sometimes occur after cessation of opioid use. There is some evidence that disturbances in
sexual function related to substance/medication use increase with age. 
Culture-Related Diagnostic Issues
There may be an interaction among cultural fa ctors, the influence of medications on sexual