madman
Super Moderator
Abstract
Sexual issues tend to go unaddressed in human immunodeficiency virus (HIV) management, although overt sexual dysfunctions are more prevalent in people living with HIV than uninfected people. Erectile dysfunction is the most frequent sexual problem, with a prevalence of 30–50% even in men <40 years of age, but other issues such as loss of libido and ejaculatory disorders should not be overlooked. Peculiar factors related to HIV infection (e.g., fear of virus transmission, changes in body image, HIV-related comorbidities, HIV distress, and stigma), alongside classical factors non-related to HIV should be considered when approaching sexual problems in HIV patients. For this reason, the diagnostic and therapeutic workout of sexual dysfunction in the context of HIV requires a multidisciplinary approach, involving specialists in both infectious diseases and sexual medicine. This narrative review presents an overview of current knowledge on sexual dysfunction in HIV men, deepening the factors driving and taking part in these issues, providing advice for the clinical approach, and underlining the importance of caring for sexual health to improve the quality of life of HIV patients.
1. Introduction
Healthy and satisfactory sex life is considered an important element for good health status and a gratifying quality of life [1,2]. Even though the relevance of a healthy sex life is a recognized issue also for people living with HIV [3–5], sexual problems tend to be unaddressed in HIV management [6]. Of note, different studies point out the higher sexual problems and overt sexual dysfunctions prevalence in people with HIV than in those who are HIV negative in both sexes [7,8]. Thus, people living with HIV continue to struggle with intimacy and physical pleasure because of several factors strictly linked to HIV infection. Usually, sexual dysfunction and peculiar aspects of sexuality-related to HIV remain in the background in the daily clinical practice with respect to the management of HIV infection itself and of major HIV-related comorbidities [6,9]. Overall, leaving sexual problems overlooked and undermanaged is known to further compromise the quality of life of these patients, which is already impaired by HIV distress, associated morbidities, and stigma [10].
In men, sexual dysfunctions, particularly erectile dysfunction (ED) [11], are more common among HIV-infected than HIV-uninfected men. These dysfunctions, especially if undermanaged, further impair the quality of life and general health, interfering with intimate relationships and lowering the adherence to antiretroviral medications [12–14], probably due to an individual’s belief that HIV medication itself may cause sexual dysfunctions. Thus, health professionals involved in the management of patients with HIV infection should address sexual difficulties not only to promote a healthy and satisfying sexual life but also to enhance survival, improve the general quality of life and relationships, and (through greater medication adherence) potentially nullify the risk of transmission of HIV to another person [6].
2. Male Sexual Behavior in Men Living with Human Immunodeficiency Virus (HIV)
3. HIV-Related Psychological Issues
3.1. Fear of HIV Transmission
3.2. Disclosure of HIV Status to the Partner
3.3. Stigma
3.4. Body Image
4. Psychosexual Factors Related to MSM
4.1. Gay Culture
4.2. Importance of Body Image
4.3. Sexual Performance
4.4. Anal Sex
4.5. Casual Sex and Group Sex
4.6. Recreational Drugs
5. HIV-Related Sexual Behavior Issues
Obligatory Condom Usage
6. Arousal and Sexual Desire Dysfunction
7. Erectile Dysfunction in Men Living with HIV
Prevalence of Erectile Dysfunction in HIV
8. Pathogenesis of Erectile Dysfunction (ED) in Human Immunodeficiency Virus (HIV)
9. Clinical Approach to ED in Men with HIV
9.1. Diagnostic Work-Up
9.2. Erectile Dysfunction (ED) Treatment in HIV
9.3. Pharmacological Treatment
10. Disorders of Ejaculation
11. Impact of Fertility Concern, and Diseases of the Seminal Tract on Sexual Dysfunction in HIV
12. Conclusions
Sexual dysfunctions are common among HIV-infected men. Several HIV-related factors and sexual behavior habits lead to more concerns about sexuality in MSM with HIV in terms of both prevalence of sexual dysfunctions and self-perceived impairment of sexual function. Among all the clinical issues to be investigated and monitored in HIV-infected men (from the infection itself to all the other comorbidities and quality of life) sexual function and dysfunction risk remaining in the background. For this reason, physicians who manage HIV-infected men must be aware of sexual problems in HIV and should include questions useful to know more about the patient’s sexual life and the relative degree of satisfaction. The educational moment devoted to how to practice safe sex may be a good starting point to investigate a patient’s sexuality and sexual behavior during a clinical interview and to point the patient to an adequate workup or to an andrological consultation. Apart from the classical work-up useful for the diagnosis and management of male sexual dysfunction, several peculiar issues related to HIV infection and MSM the psychological and behavioral pattern must be considered since they may influence sexual behavior and sexual performance.
Sexual issues tend to go unaddressed in human immunodeficiency virus (HIV) management, although overt sexual dysfunctions are more prevalent in people living with HIV than uninfected people. Erectile dysfunction is the most frequent sexual problem, with a prevalence of 30–50% even in men <40 years of age, but other issues such as loss of libido and ejaculatory disorders should not be overlooked. Peculiar factors related to HIV infection (e.g., fear of virus transmission, changes in body image, HIV-related comorbidities, HIV distress, and stigma), alongside classical factors non-related to HIV should be considered when approaching sexual problems in HIV patients. For this reason, the diagnostic and therapeutic workout of sexual dysfunction in the context of HIV requires a multidisciplinary approach, involving specialists in both infectious diseases and sexual medicine. This narrative review presents an overview of current knowledge on sexual dysfunction in HIV men, deepening the factors driving and taking part in these issues, providing advice for the clinical approach, and underlining the importance of caring for sexual health to improve the quality of life of HIV patients.
1. Introduction
Healthy and satisfactory sex life is considered an important element for good health status and a gratifying quality of life [1,2]. Even though the relevance of a healthy sex life is a recognized issue also for people living with HIV [3–5], sexual problems tend to be unaddressed in HIV management [6]. Of note, different studies point out the higher sexual problems and overt sexual dysfunctions prevalence in people with HIV than in those who are HIV negative in both sexes [7,8]. Thus, people living with HIV continue to struggle with intimacy and physical pleasure because of several factors strictly linked to HIV infection. Usually, sexual dysfunction and peculiar aspects of sexuality-related to HIV remain in the background in the daily clinical practice with respect to the management of HIV infection itself and of major HIV-related comorbidities [6,9]. Overall, leaving sexual problems overlooked and undermanaged is known to further compromise the quality of life of these patients, which is already impaired by HIV distress, associated morbidities, and stigma [10].
In men, sexual dysfunctions, particularly erectile dysfunction (ED) [11], are more common among HIV-infected than HIV-uninfected men. These dysfunctions, especially if undermanaged, further impair the quality of life and general health, interfering with intimate relationships and lowering the adherence to antiretroviral medications [12–14], probably due to an individual’s belief that HIV medication itself may cause sexual dysfunctions. Thus, health professionals involved in the management of patients with HIV infection should address sexual difficulties not only to promote a healthy and satisfying sexual life but also to enhance survival, improve the general quality of life and relationships, and (through greater medication adherence) potentially nullify the risk of transmission of HIV to another person [6].
2. Male Sexual Behavior in Men Living with Human Immunodeficiency Virus (HIV)
3. HIV-Related Psychological Issues
3.1. Fear of HIV Transmission
3.2. Disclosure of HIV Status to the Partner
3.3. Stigma
3.4. Body Image
4. Psychosexual Factors Related to MSM
4.1. Gay Culture
4.2. Importance of Body Image
4.3. Sexual Performance
4.4. Anal Sex
4.5. Casual Sex and Group Sex
4.6. Recreational Drugs
5. HIV-Related Sexual Behavior Issues
Obligatory Condom Usage
6. Arousal and Sexual Desire Dysfunction
7. Erectile Dysfunction in Men Living with HIV
Prevalence of Erectile Dysfunction in HIV
8. Pathogenesis of Erectile Dysfunction (ED) in Human Immunodeficiency Virus (HIV)
9. Clinical Approach to ED in Men with HIV
9.1. Diagnostic Work-Up
9.2. Erectile Dysfunction (ED) Treatment in HIV
9.3. Pharmacological Treatment
10. Disorders of Ejaculation
11. Impact of Fertility Concern, and Diseases of the Seminal Tract on Sexual Dysfunction in HIV
12. Conclusions
Sexual dysfunctions are common among HIV-infected men. Several HIV-related factors and sexual behavior habits lead to more concerns about sexuality in MSM with HIV in terms of both prevalence of sexual dysfunctions and self-perceived impairment of sexual function. Among all the clinical issues to be investigated and monitored in HIV-infected men (from the infection itself to all the other comorbidities and quality of life) sexual function and dysfunction risk remaining in the background. For this reason, physicians who manage HIV-infected men must be aware of sexual problems in HIV and should include questions useful to know more about the patient’s sexual life and the relative degree of satisfaction. The educational moment devoted to how to practice safe sex may be a good starting point to investigate a patient’s sexuality and sexual behavior during a clinical interview and to point the patient to an adequate workup or to an andrological consultation. Apart from the classical work-up useful for the diagnosis and management of male sexual dysfunction, several peculiar issues related to HIV infection and MSM the psychological and behavioral pattern must be considered since they may influence sexual behavior and sexual performance.
