Psychogenic Factors that Impair Sexual Ability

Through its pervasive influences on a diversity of mind-brain functions, stress can increase or diminish a variety of motivational urges, including sexuality. While mild stress can sometimes increase sexual urges, sustained stress diminishes erotic urges. Indeed, one of the primary stress hormones in the brain, CRH, dramatically reduces all prosocial and sexual activities, as well as all other appetites, when released within the brain (Chapter 21).

None of the major psychiatric drugs, aside from dopamine facilitators (Panksepp,

1998), consistently promote sexual urges, but many reduce them in ways that are often emotionally troublesome to people. The most widespread problems are associated with the anorgasmia and reductions in sexual motivation that result from the use of antide-pressants, most recently the selective serotonin reuptake inhibitors (SSRIs) (Rosen et al., 1999). However, other agents are not without problems (Gitlin, 1994), and there are some drugs that can facilitate sexual abilities (Crenshaw and Goldberg, 1996). Mammalian sexual energy is dependent heavily on brain dopamine release, so it is not surprising that all antipsychotics tend to diminish sexual urges (Van Furth et al., 1995). There is no simple way around these problems except drug discontinuation. Despite the ability of sexual performance enhancers such as sildenafil (Viagra) to promote sexual capacity, they still need to be evaluated in interaction with the major psychiatric drugs as well as in terms of various psychological factors relevant to psychiatric practice.

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