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Sexualität und Pharmakotherapie

Arzneimittelinduzierte sexuelle Funktionsstörungen und medikamentöse Optionen zur Behandlung sexueller Dysfunktionen

Sexuality and pharmacotherapy. Medication-induced disorders of sexual response and pharmacotherapeutic options for the treatment of sexual dysfunctions

  • Leitthema: Sexualmedizin
  • Published:
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Der vorliegende Beitrag beschäftigt sich mit 2 unterschiedlichen Bereichen der komplexen Zusammenhänge zwischen Pharmakotherapie und sexuellen Funktionen bzw. Dysfunktionen bei Männern und Frauen. Viele Beeinträchtigungen der Sexualität werden auf Medikamentennebenwirkungen zurückgeführt, dabei spielen Psychopharmaka eine wichtige Rolle. Der erste Teil des Beitrages beschreibt daher die Substanzen und pharmakodynamischen Mechanismen, die für Sexualstörungen verantwortlich sein können mit Schwerpunkt auf Antidepressiva und Neuroleptika. Die Abgrenzung medikamentös bedingter Beeinträchtigungen von den unmittelbar der Grunderkrankung zuzuordnenden ist häufig schwierig. Es werden Möglichkeiten des klinischen Umgangs mit den Störungsbildern und deren Abhilfe diskutiert. Im zweiten Teil werden die aktuellen medikamentösen Behandlungsoptionen für sexuelle Dysfunktionen von Männern und Frauen diskutiert. Für Frauen gibt es noch keine zugelassene und bewährte Medikation, abgesehen von transdermalen Testosteronpflastern für ovariektomierte Frauen mit sexueller Appetenzstörung. Für Männer existiert hingegen eine effektive Pharmakotherapie für die Erektionsstörung. Darüber hinaus ist die Testosteronsubstitution die Therapie der Wahl für appetenzgeminderte Männer mit Hypogonadismus. Da sexuelle Funktionsstörungen häufig durch eine Kombination organischer und psychischer Faktoren verursacht sind, wird eine kombinierte pharmakologische und sexualtherapeutische Herangehensweise befürwortet.

Abstract

This contribution addresses two different areas of the complex relationship between pharmacotherapy and sexual function and dysfunction in men and women. As many impairments of sexual function are caused by side effects of medications, particularly psychotropic drugs, the first part of the paper describes substances and mechanisms often related to sexual dysfunction with a special focus on antidepressants and neuroleptics. While serotonine-reuptake inhibitors entail a high risk of sexual dysfunction, it is often difficult to differentiate the nega tive impact of the drug from the impairment caused by the mental disorder itself. Ways to deal with these dysfunctions and remedial measures are discussed. In the second section, current pharmacological treatments for female and male sexual dysfunctions are reviewed. While there is no approved pharmacotherapy with established efficacy for female sexual dysfunction with the possible exception of the transdermal testosterone patch for surgically menopausal women, effective pharmacological therapies are available for male erectile disorders. In addition, testoste- rone substitution is the treatment of choice for hypoactive sexual desire disorders caused by hypogonadism. As sexual dysfunctions are often caused by a mixture of psychological and organic factors, treatment strategies combining pharmacological options and sex therapy are advocated.

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Authors and Affiliations

  1. Medizinische Hochschule, Hannover, BRD

    Uwe Hartmann & C. Rüffer-Hesse

  2. Arbeitsbereich Klinische Psychologie, Abt. Klinische Psychiatrie und Psychotherapie, Medizinische Hochschule Hannover, 30623, Hannover, BRD

    Uwe Hartmann

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  1. Uwe Hartmann
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Correspondence to Uwe Hartmann.

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Hartmann, U., Rüffer-Hesse, C. Sexualität und Pharmakotherapie. Bundesgesundheitsbl. 50, 19–32 (2007). https://doi.org/10.1007/s00103-007-0113-9

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