Treatment of Sexual Dysfunction in PLWH

Men

Treatment of erectile dysfunction

Primarily oral PDE5-inhibitors (sildenafil, tadalafil, vardenafil)

  • All at least 30 minutes before initiation of sexual activity
  • Use lower dose if on PI/b
    • sildenafil (25 mg every 48 hours)
    • tadalafil 5 mg initial dose with maximum dose 10 mg in 72 hours
    • vardenafil 2.5 mg maximum dose in 72 hours

Cave: Poppers have a synergistic effect with PD5-blockers which can lead to profound hypotension thus concurrent use is not recommended

  • Tadalafil also licensed for use as an everyday ongoing therapy

Treatment of premature ejaculation

  • Consider behavioural interventions and/or psychosexual counselling, SSRIs, tricyclic antidepressants, clomipramine and topical anaesthetics
  • Use lower dose of clomipramine and other tricyclic antidepressants if on PI/r, see Drug-drug interactions between antidepressants and ARV
  • Dapoxetine, a short-acting SSRI, is the only drug approved for ondemand treatment of premature ejaculation in Europe. Dapoxetine is contraindicated with boosted ARVs
  • Treatment must be maintained as recurrence is highly likely following withdrawal of medicine

Women

Sexual pain

Counselling
Local hormone therapy
Pelvic physiotherapy
Vaginal/rectal suppositories
Topical lidocaine
Capsaicin
Vestibulectomy

Low desire

Counselling
Hormonal therapy
Bupropion
Flibanserin (contraindicated with boosted ARVs due to risk of hypotension)

Low arousal

Counselling
Hormonal therapy
PDE5 inhibitors (e.g., sildenafil)

Orgasmic dysfunction

Mindfulness, sex therapy
Hormonal therapy
Bupriopion
PDE inhibitors (e.g., sildenafil)
Yohimbine hydrocholoride (concomitant use of boosted ARVs may increase BP)