SEXUAL DYS­FUNCTION

Sexual dysfunction is a frequent and early symptom of MSA and can include erectile dysfunction, decreased libido, vaginal dryness and difficulties achieving orgasm. Erectile dysfunction (ED) is often the first symptom of MSA and is reported by 100% of patients with MSA.

1. Non-pharmacologic treatment of sexual dysfunction include:

• Cognitive therapy to treat underlying depression and anxiety that is common among MSA patients.
• Moderation of alcohol and tobacco use, as excess use has been tied to ED.
  
• Use of vacuum pumps to increase blood flow to the penis and allow an erection to be attained and maintained.
• Avoidance of medications known to interfere with sexual function, including beta blockers, SSRIs and finasteride.
• Surgical placement of a penile implant can also treat the symptom of ED.
• Vaginal lubricants can be useful to combat the vaginal dryness often seen in women with MSA.

2. Medications used to treat sexual dysfunction include:

• PDE-5 inhibitors, including sildenafil, increase blood flow to the penis and have been proven to treat ED in patients with MSA. Drops in blood pressure are an important side effect of this class of medication and in patients with OH, this may not be recommended.
• Intracavernosal or intraurethral injections of the prostaglandin alprostadil and the vasodilator papaverine are also effective in achieving and maintaining erection.
• Other drugs that have proven effective in the treatment of ED include apomorphine, which can be given either by under the tongue or as an injection into the penis.
• Female sexual dysfunction can be treated with hormonal therapy.

References