Sexual Dysfunctions in Patients Receiving Opioid Agonist Treatment and Heroin-Assisted Treatment Compared to Patients in Private Practice—Identifying Group Differences and Predictors

Abstract

Background and AimsSexual dysfunctions (SDs) show a marked impact on a person’s general wellbeing. Several risk-factors like physical and mental illnesses as well as alcohol and tobacco use have to date been identified to contribute to the occurrence of SDs. The impact of opioid-agonist treatment (OAT) on SDs remains unclear, with some studies demonstrating an improvement after methadone maintenance treatment (MMT) initiation. However, no studies on the prevalence and predictors of SDs in heroin-assisted treatment (HAT) exist to date.MethodsA cross-sectional study was conducted with patients from a MMT center (n = 57) and a center specializing in HAT (n = 47). A control group of patients with mild transient illnesses (n = 67) was recruited from a general practitioner (GP). The International Index of Erectile Function, the Female Sexual Function Index, as well as measurements for psychological distress, depressive state, nicotine dependence, and high-risk alcohol use were employed. Patients also completed a self-designed questionnaire on help-seeking behavior regarding sexual health. Mann-Whitney-U tests and chi-square tests were performed for group comparisons and binary logistic regression models were calculated.ResultsTwenty-five percent of the GP sample (n = 17), 70.2% (n = 40) of the MMT sample, and 57.4% (n = 27) of the HAT sample suffered from SDs at the time of study conduction. OAT patients differed significantly from GP patients in depressive state, high-risk alcohol use, nicotine dependence, and psychological distress. Age, depressive state, and opioid dependence predicted the occurrence of SDs in the total sample. No differences between OAT and GP patients were found regarding help-seeking behavior.DiscussionAge, depressive state, and opioid dependence predicted the occurrence of SDs in the total sample. It remains unclear whether SDs are caused by opioid intake itself or result from other substance-use related lifestyle factors, that were not controlled for in this study. A lack of help-seeking behavior was observed in our sample, underlining the importance of clinicians proactively inquiring about the sexual health of their patients.ConclusionThe high prevalence of SDs observed in MMT does not differ from the prevalence in HAT. Clinicians should actively inquire about their patients’ sexual health in GP and OAT centers alike.

Sexual dysfunction prevalence, risk factors, and help-seeking behavior in opioid agonist treatment and general psychiatry: a cross-sectional study

“…Therefore, even though no significant differences in prevalence were found, the regression model demonstrates that OUD poses a risk for developing SD when compared to milder psychiatric disorders. In line with this, patients with mild transient physically-related illnesses have been found to have a significantly lower prevalence of SDs when compared to patients with OUD receiving OAT (13). A study comparing psychiatric patients to physically ill patients found significantly higher rates of SD in the psychiatric sample, adding to the existing evidence for the impact of mental health on sexual functioning (43).…”

“…Patients recruited at the PP who received any kind of psychopharmacological treatment, used substances besides alcohol or nicotine at the time of study conduction, or primarily sought help for the treatment of SD were excluded as well. A separate study on the OAT sample specifically investigating the differences between patients receiving heroin-assisted treatment and patients receiving traditional OAT has been published previously by the research group ( 13 ). All patients seeking care at one of the two outpatient treatment centers or at the psychiatric practice and who met the inclusion criteria were asked to participate in the study.…”

“…There is some evidence for opioid agonist treatment (OAT) improving male sexual functioning with stronger effects being observed in buprenorphine when compared to methadone ( 11 , 12 ). However, no difference in SD prevalence has been observed in heroin-assisted treatment when compared to other forms of OAT ( 13 ).…”

Sexual dysfunctions of rheumatological patients are a neglected issue: Results from a national survey of Italian Society of Rheumatology

“…Sexual dysfunctions (SD) are a broad spectrum of conditions such as decreased sexual desire, ejaculatory disorders, erectile dysfunction, orgasmic changes, painful intercourse, and insufficient vaginal lubrication (1)(2)(3). They are very common worldwide and have a negative impact on male and female quality of life (QoL) (4). The etiopathogenesis of SD is multifactorial and it can be related to age, comorbidities, psychological or emotional state, hormonal imbalance, couple difficulties, and medical therapies (5).…”