Influence of substance use on the erectile response in a sample of drug users

Interrogating erectile dysfunction and evaluating novel therapeutic frontiers, with emphasis on stem cell strategies

Male infertility arises from a complex interplay of factors affecting reproductive organs and various physiological pathways. Among these, erectile dysfunction (ED), a widespread global issue, plays a key role. While existing ED treatments address some aspects, achieving complete reversibility and avoiding side effects remains a challenge. In this context, stem cell therapy emerges as a promising, potentially transformative approach. Preliminary evidence from preclinical animal models and clinical trials highlights stem cell therapy's remarkable efficacy and effectiveness for ED. This novel strategy offers several advantages, including enhanced effectiveness and a reported absence of adverse side effects. This review delves into the causes of male infertility, with a particular focus on ED and its pathophysiology. We explore the current treatment landscape, highlighting therapy's existing strategies' limitations and stem cell therapy's unique potential. By examining relevant preclinical and clinical studies, we provide a comprehensive picture of this innovative approach and its promising future in restoring men's fertility and quality of life.

Substance abuse and male sexual dysfunction: what lies beneath?

INTRODUCTION

Substance abuse has become a worldwide health problem, leading to numerous consequences such as social problems among family members, abnormal behavior, adverse health effects, and psychological problems as well as economic consequences.

OBJECTIVES

We sought to assess the relationship between substance abuse and male sexual health.

METHODS

A search was carried out in the following databases: PubMed, MeSH (Medical Subject Headings), Science Direct, Scopus, Cochrane Library, EMBASE, CINAHL, Academic Search Complete, and the Egyptian Knowledge Bank. The following keywords were used to assess the outcomes for relevant associations: illicit drugs, addiction, substance abuse, sexual health, erectile dysfunction, ejaculatory disorders, impotence, orgasm disorders, and sexual performance.

RESULTS

The initial literature search identified a total of 148 articles in all searched databases. After removal of duplicate studies and application of inclusion/exclusion criteria, 75 reported studies were retained for review, including 38 case-control studies and 37 cross-sectional studies. These articles were classified into the following categories according to the type of abused substance addressed: cannabis/marihuana, 16 articles; opioids, 13 articles; heroin, 11 articles; cocaine, 5 articles; tramadol, 6 articles; ketamine, 2 articles; ecstasy, 4 articles; amphetamine, 2 articles; khat, 7 articles; androgen anabolic steroids, 2 articles; and polydrugs, 7 articles. Most of these recruited articles demonstrated a negative impact of the addressed substance on male sexual health, with variable levels.

CONCLUSION

Substance abuse has negative impacts on male sexual health that should be addressed. More studies conducted with proper methodological and statistical approaches, including logistic regression analysis, are needed to predict the effects of specific substances, considering the rapidly growing effects of non-substance-use disorders on male sexual health.

Proposing a “Brain Health Checkup (BHC)” as a Global Potential “Standard of Care” to Overcome Reward Dysregulation in Primary Care Medicine: Coupling Genetic Risk Testing and Induction of “Dopamine Homeostasis”

In 2021, over 100,000 people died prematurely from opioid overdoses. Neuropsychiatric and cognitive impairments are underreported comorbidities of reward dysregulation due to genetic antecedents and epigenetic insults. Recent genome-wide association studies involving millions of subjects revealed frequent comorbidity with substance use disorder (SUD) in a sizeable meta-analysis of depression. It found significant associations with the expression of NEGR1 in the hypothalamus and DRD2 in the nucleus accumbens, among others. However, despite the rise in SUD and neuropsychiatric illness, there are currently no standard objective brain assessments being performed on a routine basis. The rationale for encouraging a standard objective Brain Health Check (BHC) is to have extensive data available to treat clinical syndromes in psychiatric patients. The BHC would consist of a group of reliable, accurate, cost-effective, objective assessments involving the following domains: Memory, Attention, Neuropsychiatry, and Neurological Imaging. Utilizing primarily PUBMED, over 36 years of virtually all the computerized and written-based assessments of Memory, Attention, Psychiatric, and Neurological imaging were reviewed, and the following assessments are recommended for use in the BHC: Central Nervous System Vital Signs (Memory), Test of Variables of Attention (Attention), Millon Clinical Multiaxial Inventory III (Neuropsychiatric), and Quantitative Electroencephalogram/P300/Evoked Potential (Neurological Imaging). Finally, we suggest continuing research into incorporating a new standard BHC coupled with qEEG/P300/Evoked Potentials and genetically guided precision induction of “dopamine homeostasis” to diagnose and treat reward dysregulation to prevent the consequences of dopamine dysregulation from being epigenetically passed on to generations of our children.

Preliminary Evidence on How the Dual Control Model Predicts Female Sexual Response to a Bogus Negative Feedback

The Dual Control Model of sexual response has been mostly tested with men. As such, there is a lack of evidence on how such model applies to women's experience of sexual arousal, particularly when they face a threatening situation such as the threat of sexual performance failure. The aim of the current study was to test whether the Dual Control Model dimensions predict women's sexual responses to a bogus negative feedback about their sexual performance. In addition, 22 women were exposed to a sexually explicit film clip, while their genital arousal was being measured. During this presentation, a bogus negative feedback, aimed at increasing women's anxiety about their sexual performance, was provided. Vaginal photopletismography and self-report questions were used as means to evaluate women's genital and subjective sexual arousal, respectively. The Sexual Excitation/Sexual Inhibition Inventory for Women was further used to capture women's sexual dynamics. Regression analysis on the high-order factors revealed that sexual excitation proneness was the only predictor of the subjective sexual responses, while none of the factors has predicted genital arousal. "Arousability" and "Concerns about sexual function" dimensions predicted subjective sexual arousal. Sexual arousability may prevent women of lowering their subjective sexual responses in a sexually demanding situation, while "Concerns about sexual function" may have the opposite role, thus being a target of clinical interest. This work provides new data on the Dual Control Model of sexual response, and particularly on its role in women's sexual functioning.

Psychometric Properties of the Spanish Version of the Sexual Inhibition/Sexual Excitation Scales for Men

The dual control model (DCM) postulates the involvement of relatively independent inhibitory and excitatory systems, which together provide a "double control" over sexual response and associated behavior (Janssen & Bancroft, 2007). Based on this model, the Sexual Inhibition and Sexual Excitation Scales assess the propensity for sexual excitation and sexual inhibition. This research focused on analyzing some psychometric properties of this questionnaire and developing a Spanish version in men. The sample consisted of 823 heterosexual men of ages ranging from 18 to 74 years. Confirmatory factor analysis generated a version of the scale that consisted of 34 items (11 items with the worst factor loadings were eliminated) distributed in four factors (one sexual excitation factor and three sexual inhibition factors). This is consistent with the DCM of sexual response. The four factors demonstrated good reliability coefficients except for sexual inhibition due to the threat of performance consequences, which was found to have a low internal consistency. Consequently, this is something that will be addressed in future studies. The four factors were found to have good test-retest reliability. The measures of the Sexual Inhibition and Sexual Excitation Scales had good validity properties and a coherent relationship with sexual sensation seeking and erotophilia.

Sexual Pain Disorders in Spanish Women Drug Users

BACKGROUND

The impact of pain in sexuality, couple relationships and the quality of life is very well known.

OBJECTIVES

The relationship between substance abuse and the presence of sexual pain disorder is assessed, together with anxiety and sexual attitudes .

METHOD

Two samples were selected. One sample for women with a history of substance abuse (n = 129), and another one of women nonconsumers (n = 129). The Golombok Rust Inventory of Sexual Satisfaction (GRISS), the Sexual Opinion Survey (SOS) and the State Trait Anxiety Inventory (STAI) questionnaires were used.

RESULTS

The results indicate that women consumers obtained a higher mean scores in sexual pain disorder (4.88 > 2.89, that is 65.12%), plus higher mean scores on state anxiety (23.82 > 14.56) and trait anxiety (30.93 > 16.95), and lower average figure in erotophilia (84.93 < 95.81). It was also verified that the period of abstinence does not improve sexual response.

CONCLUSIONS

Substance consumption affects sexual response in women negatively. Sexual response does not improve with abstinence period.

Spanish version of the Sexual Excitation/Sexual Inhibition Inventory for Women: Factorial structure, reliability and validity evidences

Background/Objective: The Dual Control Model suggests that sexual excitation and associated behaviors are the result of the balance between relatively independent excitatory and inhibitory mechanisms. Based on this theoretical model, the Sexual Excitation/Sexual Inhibition Inventory for Women (SESII-W) was developed to evaluate excitation and inhibition dimensions in women. The aim was to adapt and validate the SESII-W in the Spanish population. Method: A sample of 1,380 heterosexual women (aged 18 to 52) completed the Spanish SESII-W, together with other related instruments. After the translation and adaptation of the SESII-W, a Confirmatory Factor Analysis (CFA) was performed. Results: CFA resulted in a version consisting of 33 items divided into eight sub-factors, which were grouped into two higher-order factors (Sexual Excitation and Sexual Inhibition). The sub-factors demonstrated adequate internal consistency values except for Sexual Power Dynamics and Concerns about Sexual Function. Test-retest reliabilities were good. Their scores correlated with erotophilia, sexual sensation seeking, age at first intercourse, and number of sexual partners in the expected direction. Conclusions: The Spanish version of SESII-W has adequate psychometric guarantees for use in clinical practice and research, although it would be necessary to further revise factors that showed a lower level of reliability.

Use of an Ecological Model to Study Sexual Satisfaction in a Heterosexual Spanish Sample

Sexual satisfaction is a key factor in sexual health and has been associated with quality of life. However, few studies have focused on the factors related to sexual satisfaction in the population in Spain. The main goal of this research was to analyze the predictive capacity of an ecological model for the study of sexual satisfaction in a Spanish sample of 723 men and 851 women, with mean age equal to 36.28 (SD = 12.59) and who were in a heterosexual relationship. We analyzed, using structural equation modeling, the degree to which sexual satisfaction was related to different variables. These variables were the following: personal variables (depression and sexual attitudes); interpersonal variables (relationship satisfaction, sexual function, and sexual assertiveness); social variables (social support, parenthood, and annual income); and cultural variables (political ideology, religion, and religious practice). In men, sexual satisfaction was directly predicted by relationship satisfaction and sexual function. Furthermore, political ideology, religious practice, social support, annual income, initiation sexual assertiveness, and sexual attitudes were indirectly associated with sexual satisfaction. In women, sexual satisfaction was directly predicted by relationship satisfaction, sexual function, sexual assertiveness, and sexual attitudes. In addition, political ideology, religious practice, and social support were indirectly associated with sexual satisfaction. Implications for research and therapy are also discussed.

Psychotropic induced sexual dysfunction for people with a dual diagnosis

Purpose

– The purpose of this paper is: first, to consider the reported problems in sexual function caused by psychotropic medication. Second, the complex undertaking of completing an assessment of sexual functioning. Third, the role of the pharmaceutical industry is explored. Finally, implications for future research and practice are suggested.

Design/methodology/approach

– As a commentary this paper draws on the available literature to synthesise what is already known about the relationship between psychoactive substances and sexual functioning.

Findings

– The limited literature and lack of research attention given to psychotropic induced sexual dysfunction limits our collective understanding of how many people are affected and in what way.

Research limitations/implications

– A greater focus on psychotropic induced sexual dysfunction is needed for people with a dual diagnosis. There has been an over reliance on single case studies and self-reporting. Large scale epidemiological investigation would help understand the extent and nature of the problem more fully. The demographic shift particularly in relation to an ageing population should be considered as psychotropic substances effect individuals in different ways as they grow older.

Practical implications

– There is scope for workers to engage more fully in a conversation with clients about their experience of using psychotropic substances and how this has impacted their sexual functioning. The literature suggests that clients want to talk about this issue but staff are unwilling or unable to discuss the topic.

Originality/value

– To the authors’ knowledge this is the first paper that draws on the available literature to explore the known and likely implications of psychotropic induced sexual dysfunction for this client group.