Sexual Pharmacology: Drugs That Affect Sexual Function.

Sexual Pharmacology: Drugs That Affect Sexual Function, by Theresa L. Crenshaw, M.D., and James P. Goldberg, Ph.D. New York: W. W. Norton, 1996, 596 pages. Hardcover, $75.00.

Reviewed by Michael Young, Ph.D., Program in Health Sciences, Health Education Projects Office, University of Arkansas, Fayetteville, AR 72701.

Physicians prescribe drugs to treat various types of diseases. Such drugs are prescribed, of course, for their therapeutic effects, the benefits that the patient will derive from them. In addition to therapeutic effects, the "miracle" drugs that have been developed by pharmaceutical companies have enabled physicians to save lives and improve quality of life. Most drugs, however, also have some side effects, other than the intended therapeutic effects. Generally, when prescribing a drug, a physician knows from the literature the potential side effects and depends on the patient to report side effects that are experienced. If a patient experiences and reports undesirable side effects, the physician (preferably in partnership with the patient) can decide to continue the drug, because its benefits outweigh the undesirable effects; switch to another drug that could be expected to produce beneficial effects, but have fewer side effects; or discontinue drug treatment.

We now know that many commonly prescribed drugs may cause sexual problems. The problem, as identified by Crenshaw and Goldberg, authors of Sexual Pharmacology, is that physicians most often prescribe drugs without considering the sexual implications, and they do not ask patients about sexual side effects they may be experiencing. This is the case, in part, because the literature readily available to physicians concerning the sexual side effects of drugs has often been "spotty and incomplete." This is a problem because although patients may be willing to report other types of side effects to their physicians, they are often embarrassed and uncomfortable talking with their physician (or anyone for that matter) about sexual side effects, unless they are specifically asked. Many times patients may attribute symptoms (such as decreased desire) to other causes and may not associate them with the medication they are taking. Patients who do recognize that their medication is responsible for the change in sexual functioning may risk serious health problems by discontinuing the drug without consulting their physician.

Sexual Pharmacology: Drugs That Affect Sexual Function, by Theresa Crenshaw, M.D., and James Goldberg, Ph.D., provides the information, relevant to sexual functioning, that physicians need when prescribing drugs. Having access to the appropriate information, sharing it with patients, monitoring sexual side effects, and discussing alternative courses of treatment will help physicians enhance the sex lives and relationships of their patients. Improving patient compliance will also save lives.

Although the authors have developed a rather comprehensive reference work, they have not attempted to describe the sexual properties Of every known drug. They have tried to "teach the reader a system for understanding the sexual properties of drugs; learning how to analyze any existing drug for its sexual properties by applying existing knowledge with common sense in a logical sequence of steps that leads to appropriate conclusions" (p. 11). They have done this well.

The text includes 31 chapters organized into 5 major parts: basic principles of sexual pharmacology, sex differences and hormonal therapies, substance use and abuse, antihypertensives, and sexually effective drugs. Separate chapters are devoted to the sexual effects of commonly used and abused drugs such as alcohol, nicotine and caffeine, opioids, and marijuana and other illegal drugs. In addition to reviewing thoroughly the scientific literature, the authors report the results of relevant research conducted by other scientists and share findings from their extensive clinical work. They document everything and include 94 pages of references!

In Chapter One, "Understanding Sexual Properties of Drugs," the authors point out that drugs can have direct sexual side effects (as erectile difficulties, orgasmic function, and -decreased sexual desire) and also indirect effects (as body image, halitosis and altered taste, physical comfort, and neurological side effects). They make it clear that "indirect side effects can be as sexually disabling as direct ones" (p. 9). For example, many medications can cause bad breath by drying out the mouth. "Although understandably overlooked as a sexual side effect, drug induced halitosis can have an impact on sexual behavior... Kissing and hugging are often the first overture of sexual intimacy. If that simple bridge is broken, sexual opportunity may vanish altogether" (p. 9).

For many readers the section of the text of most interest will be Part Five--sexually effective drugs. This section includes chapters on dopaminergic drugs (it appears that phenylethylamine "somehow mediates the feelings of romance and love," p. 376), Bupropion (which "has a side-effect profile and sexual benefits particularly attractive to women," p. 396), serotonin antagonists ("which have some of the most prominent sexual side effects of all drug categories," p. 409), peptides (analysis of their sexual effects is one of "the most fascinating areas of sexual pharmacology," p. 415), vohimbine (inhibited sexual desire improved, erection enhanced), and vasodialators ("have added a fascinating new dimension to sexual pharmacology," p. 457).

I was impressed by Crenshaw and Goldberg's work. The authors have provided a valuable reference. Physicians, sex therapists, and sexuality educators (and theft patients, clients, and students) will benefit from theft work.