Treatment of Sexual Dysfunction
Men
Treatment of erectile dysfunction
Primarily oral PDE5-inhibitors (sildenafil, tadalafil, vardenafil)
- All at least 30 minutes before initiation of sexual activity
- Use lower dose if on PI/b
- sildenafil 25 mg every 48 hours
- tadalafil 5 mg initial dose with maximum dose 10 mg in 72 hours
- vardenafil 2.5 mg maximum dose in 72 hours
Poppers have a synergistic effect with PD5-blockers which can lead to profound hypotension thus concurrent use is not recommended
- Tadalafil also licensed for use as an everyday ongoing therapy
Treatment of premature ejaculation
- Consider behavioural interventions and/or psychosexual counselling, SSRIs, tricyclic antidepressants, clomipramine and topical anaesthetics
- Use lower dose of clomipramine and other tricyclic antidepressants if on PI/r, see Drug-drug interactions between antidepressants and ARV
- Dapoxetine, a short-acting SSRI, is the only drug approved for on-demand treatment of premature ejaculation in Europe. Dapoxetine is contraindicated with boosted ARVs
- Treatment must be maintained as recurrence is highly likely following withdrawal of medicine
Women
Sexual pain
Counselling
Local hormone therapy
Pelvic physiotherapy
Vaginal/rectal suppositories
Topical lidocaine
Capsaicin
Vestibulectomy
Low desire
Counselling
Hormonal therapy
Bupropion
Flibanserin (contraindicated with boosted ARVs due to risk of hypotension)
Low arousal
Counselling
Hormonal therapy
PDE5 inhibitors (e.g., sildenafil)
Orgasmic dysfunction
Mindfulness, sex therapy
Hormonal therapy
Bupropion
PDE5 inhibitors (e.g., sildenafil)
Yohimbine hydrocholoride (concomitant use of boosted ARVs may increase BP)