Substance/Medication-Induced Sexual Dysfunction 449
Many nonpsychiatric medications, such as ca rdiovascular, cytotoxic, gastrointestinal,
and hormonal agents, are associated with distur bances in sexual function. Illicit substance
use is associated with decreased sexual desire, erectile dysfunction, and difficulty reach-
ing orgasm. Sexual dysfunctions are also seen  in individuals receiving methadone but are
seldom reported by patients receiving buprenorphine. Chro nic alcohol abuse and chronic
nicotine abuse are associated  with erectile problems.
Prevalence
The prevalence and the incidence of substa nce/medication-induced sexual dysfunction
are unclear, likely because of  underreporting of treatment-em ergent sexual side effects.
Data on substance/medication-induced sexual  dysfunction typically concern the effects of
antidepressant drugs. The prevalence of an tidepressant-induced sexual dysfunction var-
ies in part depending on the specific agent.  Approximately 25%–80% of individuals taking
monoamine oxidase inhibitors, tricyclic anti depressants, serotone rgic antidepressants,
and combined serotonergic-adrenergic antidepr essants report sexual side effects. There
are differences in the incidence of sexual si de effects between some  serotonergic and com-
bined adrenergic-serotonergic antidepressants, although it is unclear if these differences
are clinically significant.
Approximately 50% of individuals taking antipsychotic medications will experience
adverse sexual side e ffects, including problems with se xual desire, erection, lubrication,
ejaculation, or orgasm. The incidence of thes e side effects among different antipsychotic
agents is unclear.
Exact prevalence and incidence of sexual dysfunctions among users of nonpsychiatric
medications such as cardiovascular, cytotoxic, gastrointestinal, and hormonal agents are