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Heroin Addiction and Related Clinical Problems: 2004, 06, 3 (pages: 17 - 26)

Methadone patients' sexual dysfunctions: Clinical and treatment issues

Déglon J. J., Martin J. L., Imer

Summary: Opiates are known to cause loss of libido, erectile and ejaculatory dysfunctions among men, and lack of menstruation and sterility among women. Over the last 30 years, several research studies have shown low testosterone levels causing sexual dysfunction in many heroin addicts or patients treated with opiates (morphine and methadone). Unfortunately, only a few studies on the sexual dysfunctions of patients following a substitution treatment with methadone have become available. We must take these difficulties seriously, as they prevent the development of intimate affective relationships, so inhibiting the social rehabilitation process of these patients. This article provides an overview of recent research studies on the various causes of sexual dysfunctions for patients in substitution treatment, the benefits and risks associated with hormonal replacement therapies, and the value and limitations of bromocryptin prescription, while emphasizing the role of prolactin in sexual dysfunctions. Evaluations of several hundreds of men and women treated at the Phenix Foundation in Switzerland are presented. The sexual dysfunctions that these patients present with are defined by considering the many psychological, psychiatric and neurobiological factors involved. Based on the successful findings of a recent French study comprising the short-term prescription of Viagra, a new hypothesis is put forward on the possible natural increase of testosterone levels after comprehensive treatment involving testosterone level evaluation before and after Viagra prescription, psychosocial counselling and medical supervision. It is hoped that those of our patients who resume sexual activity after months of abstinence will naturally increase their levels of testosterone, thanks to the stimulation of the psyche and of the hypothalamus-hypophyso-testicular axis. The main advantages of this approach seem to lie in enhancing the social rehabilitation of our patients by helping them regain self-confidence and reducing the pressure to perform, along with the fact that patients can gradually quit taking the medication.