Loss of sexual drive or desire (libido) is a common problem of chronic ill health. It can contribute to emotional problems (e.g. depression) and have a significant impact on quality of life and feelings of self worth.

Causes

Impotence and the loss of libido are commonly the result of emotional distress, depression or the physical symptoms of a chronic illness. In HIV the fear of transmission of the virus to your partner and the fear of rejection are major contributing factors. Fear of disclosing their HIV status also leads some people to prevent sex from happening.

Rarely, loss of libido can be caused by a specific and treatable disease unrelated to HIV. Lower than normal levels of sex hormones such as testosterone have often been found in some people with advanced HIV infection and are probably the result of either the direct effect of HIV or of chronic ill health. Impotence may also be caused by HIV damaging the nerves which control penile erection (autonomic neuropathy) or by a problem in the spine such as myelopathy.

Several drugs used to treat HIV, AIDS and depression can affect sexual function. Megestrol acetate (Megace), an appetite stimulant, can cause loss of libido, and the anti-depressant fluoxetine (Prozac) can make it harder for men to ejaculate. Drugs that cause neuropathy, such as ddI, d4T and ddC, can sometimes cause numbness in the genital area that can affect sexual function.

Several studies have found an association between combination antiretroviral therapy, particularly protease inhibitors, and sexual dysfunction, but no mechanism to explain this phenomenon has been suggested yet. Spanish researchers found that 14 out of 260 men who had started protease inhibitor treatment reported erectile dysfunction within the first 14 months of treatment. Another study found that, even when controlling for depression and age, men were over three times more likely to experience impotence after starting protease inhibitors. Despite reporting a link between sexual problems and combination antiretroviral therapy, another study of HIV-infected men found that treatment did not affect sex hormone levels. This suggests that psychosocial factors may contribute to the association between combination therapy and sexual problems. Alternatively, sexual dysfunction may another manifestation of the metabolic disorders caused by antiretroviral treatments.

What to do

The importance of a good sex life in any relationship varies from person to person but may clearly affect quality of life. Discussing these problems, fears and anxieties openly with your partner or talking to a counsellor to try and overcome the difficulties can be of help. In some clinics and hospitals specific psychosexual counsellors and psychologists may be available.

If appropriate, medical treatments that can boost libido, such as testosterone replacement or patches, may be offered.

Medication for impotence (inability to get and maintain an erection) may also be prescribed to men with HIV. The anti-impotence drugs Viagra and Cialis can interact with protease inhibitors and with NNRTIs. See Impotence drugs: Viagra in Drugs used by people with HIV for further information.