Erectile and orgasmic dysfunction

Long-standing, untreated hypertension is well known to have a negative impact on sexual function and can lead to complete impotence. Unfortunately, antihypertensive drugs still have a bad reputation with regard to erectile function. Some of the older antihypertensive drugs, such as resurpine and guanethidine, have a well-known negative effect on erectile and orgasmic function. Diuretics, beta-blockers, and antiadrenergic drugs, as well as alpha-blockers, diminish erectile function. Failure to ejaculate, or even retrograde ejaculation into the bladder, may occur with some antiadrenergic drugs. In women, diuretics and certain antiadrenergic drugs may interfere with lubrication. Beta-blockers are known to cause orgasmic dysfunction in women and men alike.

BP lowering (by any drug) may by itself, at least initially, have a slight negative impact on erectile function. However, the body fairly rapidly adjusts to the lower BP level and, with modern antihypertensive therapy (calcium antagonists, ACE inhibitors and ARBs), no lasting sexual dysfunction has been reported. On the contrary, in a recent study, the frequency of sexual intercourse actually increased in patients in whom BP was lowered with an ARB when compared with those whose hypertension was left untreated on placebo [88]. This illustrates that low-grade sexual dysfunction, associated with untreated hypertension, can be unmasked by modern antihypertensive therapy.

Sildenafil and its derivatives seem to be safe in patients with hypertension, even if they are being treated with two or more antihypertensive drugs. It should be remembered that sildenafil is a vasodilator and, in general, causes a mild transient decrease in BP. The patient should be warned that the use of sildenafil, in combination with certain antihypertensive drugs, particularly alpha-blockers, could lead to orthostatic symptoms.

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