Treatment of Sexual Dysfunction: Men

Treatment of Erectile Dysfunction

For men living with HIV, 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
  • Cave: 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

For men living with HIV, consider behavioural interventions and/or psychosexual counselling, SSRIs, tricylclic antidepressants, clomipramine and topical anaesthetics

  • Use lower dose of clomipramine and other tricyclic antidepressants if on PI/r
  • Dapoxetine, a short-acting SSRI, is the only drug approved for on-demand treatment of premature ejaculation in Europe
  • Treatment must be maintained as recurrence is highly likely following withdrawal of medicine