Issue: Many drugs can uniquely affect the phases of human sexual response, both positively and negatively, according to their neuropharmacologic mechanisms of action. Various diseases and disorders can also impact the different phases of the human sexual response, according to their pathophysiologies. Understanding these issues will assist clinicians in determining whether sexual dysfunction is due to a disease or to a drug, which will allow rational management of sexual disorders by targeting the specific dysfunctional phase of the sexual response with a drug that has an appropriate and compensatory neuropharmacologic mechanism of action.
month's Brainstorms1 provided a simplified
formulation of the neuropharmacology of normal human
sexual response: the initial phase is libido, or desire,
linked to satisfaction with sex; the second phase is
arousal of genital tissues, resulting in erections in men
and genital lubrication and swelling in women; and the
final phase is orgasm, accompanied by ejaculation in men.
Compare and contrast this normal physiology (Figure 1)
with the disorders (Figure 2) and drugs (Figure 3) that
affect all 3 phases of normal sexual response.
Various diseases, disorders, and conditions can affect any of the stages of human sexual response2,3 (Figure 2). Men may be more likely in general to have a disorder of arousal (erectile dysfunction or impotence), whereas women may be more likely in general to have a disorder of libido (lack of sexual desire or satisfaction). Some of the most common disorders that can affect each of the 3 phases of human sexual response are indicated here.
Numerous drugs affect sexual functioning, sometimes one phase but not another.3 Some of the most commonly used drugs and their effects on specific phases of the sexual response are indicated in Figure 3.
1. Stahl SM. The psychopharmacology of sex, part 1: neurotransmitters and the 3 phases of the human sexual response. J Clin Psychiatry 2001;62:80-81
2. Meston CM, Frohlich PF. The neurobiology of sexual function. Arch Gen Psychiatry 2000;57:1012-1030
3. Crenshaw TL, Goldberg JP. Sexual Pharmacology: Drugs That Affect Sexual Function. New York, NY: WW Norton & Company; 1996