Sexual Dysfunctions of HIV-Positive Men: Associated Factors, Pathophysiology Issues, and Clinical Management

Abstract

Sexual dysfunctions in HIV-positive men are associated with an increase in risky sexual behavior and decreased adherence to antiretroviral drug regimens. Because of these important public health issues, we reviewed the literature on the pathophysiology, associated factors and clinical management of sexual dysfunction in HIV-positive men. The goal was to investigate the current research on these issues. Literature searches were performed in June 2011 on PubMed, Web of Science, and PsycInfo databases with the keywords “AIDS” and “sexual dysfunction” and “HIV” and “sexual dysfunction”, resulting in 54 papers. Several researchers have investigated the factors associated with sexual dysfunction in HIV-positive men. The association between sexual dysfunction and antiretroviral drugs, particularly protease inhibitors, has been reported in many studies. The lack of standardized measures in many studies and the varying study designs are the main reasons that explain the controversial results. Despite some important findings, the pathophysiology of sexual dysfunction in the HAART era still not completely understood. Clinical trials of testosterone replacement therapy have shown the treatment to be beneficial to the improvement of sexual dysfunctions related to hypogonadism. However, there are not enough psychological intervention studies to make conclusions regarding the therapeutic effects of psychotherapy.

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

“…Distress associated with anodyspareunia (pain with receptive anal penetration) has also been reported as having a negative impact on sexual pleasure and activity (436). Sexual problems are associated with depression, performance anxiety, low self-confidence and poor self-image (429,431,433,437) and there are complex interactions between depression, anxiety, general wellbeing, sexual risk taking and HIV infection (431,432). Recreational drug use and problematic alcohol use have also been identified as risk factors for sexual dysfunction (429,437).…”

“…This has been related to psychological factors (432) and to duration of antiretroviral therapy, but no association has been found with any specific class of antiretrovirals (439). Sexual problems such as erectile dysfunction have also been associated with using sex as an avoidant strategy to cope with daily life stress and sexual risk taking in casual encounters (430).…”

“…Sexual problems such as erectile dysfunction have also been associated with using sex as an avoidant strategy to cope with daily life stress and sexual risk taking in casual encounters (430). Both delayed ejaculation and erectile difficulties have also been associated with antidepressant SSRIs in HIV-positive MSM (432) . MSM Guideline Final Accepted version 021117.…”

“…It has also been argued that they can contribute to sexual risk taking (430)(431)(432). In addition to individual interventions, suggested population interventions have included greater clarity on the criminalisation of HIV transmission and efforts to reduce HIV-related stigma (433).…”

Unprotected Sexual Practices Among Men Who Have Sex with Women and Men Who Have Sex with Men Living with HIV/AIDS in Rio de Janeiro

“…Designing and implementing such programs require that the trends on this population behavior are understood. As there are few Brazilian studies on the risky sexual behavior of men living with HIV/AIDS (Guimarães et al, 2008;Scanavino, 2011), evidence coming from epidemiological studies is warranted in order to plan, implement, and evaluate programs that promote the health of HIV-infected men. Thus the purpose of this study was to describe sexual behavior practices related to HIV/STD and to analyze the factors associated to unprotected sexual practices among MSW and MSM under care at a reference center for HIV in Rio de Janeiro, Brazil.…”