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Sexual dysfunction and long-term opioid use

By: Medically reviewed by Timothy J. Legg, Ph.D., CRNP — Written by David Railton
Source: Medical News Today
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Some reports suggest that opioid use over long periods may increase the risk of sexual dysfunction in males. However, these studies have limitations and may not take other factors into account.

The role of opioids in sexual dysfunction is unclear, and the issue may result from an interaction of many variables, including chronic pain, depression, and smoking.

In this article, we look at the available evidence from clinical trials.
Do opioids affect sexual function in males?
Using opioids long-term might lead to levels of sex hormones in the body falling.

In 2016, the United States Food and Drug Administration (FDA) issued a warning regarding severe safety issues associated with opioid pain medications.32

Among information about impeded renal gland function and central nervous system reactions, the FDA reported that “long-term use of opioids may be associated with decreased sex hormone levels and symptoms such as reduced interest in sex, impotence, or infertility.”

The FDA based their decision on a review of published studies that assessed levels of sex hormones in people who used opioids on a long-term basis that the authors considered chronic.

They also identified brands of opioids that already carry warnings of this risk.

However, the FDA cautioned that all of the studies that they had reviewed on the topic “had limitations that make it difficult to determine whether the symptoms were caused by the opioids or other factors.”

Sexual dysfunction is a common problem among people who experience chronic pain.

In spite of this, a relatively small body of medical literature covers the subject, possibly because doctors do not usually ask about sexual health when compiling a medical history of chronic pain.

As a result, confirming whether painkillers directly cause sexual dysfunction can be difficult.

For instance, one factor that may be masking a link between sexual dysfunction and opioid use is depression.

Depression is a risk factor for sexual dysfunction. Some people with depression use opioids, and research indicates that opioids may cause or exacerbate the mental health condition.

The medical community is still unsure whether depression, opiate use, or both reduce sexual function, or whether opiate use worsens both depression and sexual function.

Similarly, smoking has strong associations with prescription opioid use and erectile dysfunction, and it can be difficult to determine which factor has the strongest influence over sexual function.


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