In this age of the little blue (and now pink) pill, it seems like there is a medication to treat almost anything. Unfortunately, many people are too quick to jump to the fast and seemingly easy fix. Every medication that is put into the body can have a potential side effect or unwanted result. For example, a rare side effect of erectile dysfunction medication is blindness or permanent erectile dysfunction. That is why it is always best to try to treat the cause of the problem (if possible) instead of just the symptoms. Your sex life is no different.
There are many things than can cause issues with sexual performance and enjoyment. Some of it is out of your control, such as an age related decline in hormones. Other things are. Managing high blood pressure and diabetes can significantly decrease your risk of developing vascular disease. Peripheral vascular disease is highly associated with erectile dysfunction. In addition, certain medications are notorious for sexual dysfunction, such as multiple (but not all) antidepressants. This is ironic, because depression itself can also cause sexual dysfunction. It seems like it is a lose-lose situation. Performance anxiety is a real issue and can result in an excessive amount of stress. Increased stress may lead to performance issues, thereby again creating a negative feedback loop. In cases such as this, counseling is a preferred method of treatment rather than medication, since the medications typically used for anxiety and depression can lead to further sexual dysfunction as noted above.
What I commonly see is back pain related issues. Pain can result in a multitude of problems, ranging from physical to psychological. There is a strong link between chronic pain and depression. There is also a link between chronic pain and fear avoidance behavior. This simply means that people with pain will tend to avoid activities which may aggravate or worsen their pain. Sex is one of those behaviors. Having an open discussion with your partner and trying various positions is the best way to manage this. Some positions will likely aggravate low back pain, while you may find others that won’t.
Outside of fear avoidance, another big factor contributing to sexual dysfunction in people with pain is the pain medication itself. Numerous studies have demonstrated that opioid medications can cause decreased testosterone levels in males and may also effect female sex hormones as well. Up until recently, it was common to use hormone replacement to compensate for this. Unfortunately, testosterone supplementation has been linked to an increased risk of heart attack, stroke, and cardiovascular disease. Estrogen replacement has been linked to an increased risk of blood clots and certain types of cancer. While hormone replacement can still be used in appropriate situations and under appropriate supervision, it is not appropriate for everyone. The best solution is to taper off the opioid medications as tolerated. This is one of the reasons why I do not advocate the use of long term, high dose opioid medications for what is called non-malignant pain.
There is no easy solution to this problem because, as noted above, many times the side effects of treatment may be just as bad as the primary issue. Sometimes the best treatment is not the easiest one. That is why it is important to speak with your physician to try and identify (and fix) the underlying cause before reaching for yet another pill.
- Nikoobakht M, Fraidouni N, Yaghoubidoust M, Burri A, Pakpour AH. Sexual function and associated factors in Iranian patients with chronic low back pain. Spinal Cord. 2014 Apr;52(4):307-12. PubMed PMID: 24322217