Erectile dysfunction linked to opioid use in men

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Erectile dysfunction linked to opioid use in men

Erectile dysfunction linked to opioid use in men

(Author – Cheryl Mussatto MS, RD, LD for use by Dr. David Samadi)

 

Men with chronic pain using opioids to deal with the discomfort should reconsider that decision. Pain-killing medications known as opioids may relieve the pain, but they also can shut down your sex life.  This fact is not necessarily well-known among the medical community but should be discussed with men before automatically prescribing these drugs.

A study back in 2013 which was published in the journal Spine found that men who were prescribed medications for erectile dysfunction (ED) or low testosterone levels were more likely to be taking an opioid medication for chronic back pain. Men with persistent pain should be informed of this potential side effect of long-term opioid use. Since the study was an observational study, it limits the ability to make a cause-and-effect inference.  While opioid use and ED seem to go together, it can’t be said that one causes the other.

Around 11,000 men were included in this study that all had back pain. Out of this group, more than 900 men received medications for ED (Viagra, Cialis, or Levitra), or testosterone replacement. Generally, those men were older than those who did not have a prescription for ED. These same men were also more likely to have depression and other health conditions.  

Commonly used prescribed opioids include hydrocodone, oxycodone, and morphine. For this study, men who used an opioid for more than 120 days, or more than 90 days if more than 10 prescriptions were filled for the drug, as long-term use.

The most significant factor for the men in getting a prescription for ED was their age. Men between ages of 60 and 69 were 14 times more likely to receive a prescription for ED than men who were between 18 and 29.

When the data was adjusted for other possible factors, including age, the researchers found that men who took opioid pain medications for long periods, were about 50 percent more likely to have ED medications or testosterone replacement therapy. Again limitations with the study do not prove that opioid use causes ED as ED could be related to the pain the men were experiencing. However, there is evidence that men who stop taking opioids after using them for a short time will see an improvement in erectile dysfunction but it’s not clear if the same is true after long-term use.

In recent years, there has been growing evidence and much concern on long-term use of opioids on overall health of anyone taking them for pain. The body compensates for taking long-term pain medications, due to changes in the brain and spinal cord making people more sensitive to them.

There can be other contributing factors to ED besides possibly opioid medication use such as diabetes, heart disease, peripheral vascular disease, and alcohol use. In the meantime, all doctors treating any man for chronic pain should discuss with them if they are also experiencing ED.

 

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Priapism – when an erection won’t go away

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Some men may read the title and think, “Wouldn’t a long-lasting erection be a good thing?” Be careful what you wish for.  Men who have an erection that won’t give up most likely have a condition called priapism.

Priapism is probably not a commonly known male condition but any man who has ever experienced it will tell you he never wants to have it again.  Excruciatingly painful, priapism is when a man has an abnormal erection in which blood that engorges the penis fails to drain out. Every year emergency rooms see thousands of men with this distressing condition that if an erection lasts too long – more than 4 hours - can do permanent damage to the penis.  In fact, priapism is considered a medical emergency as it could result in a man’s ability to ever have an erection again. 

Two types of priapism                

There are two types of priapism – ischemic priapism and nonischemic priapism. 

1.     Ischemic priapism is the most common form and occurs when blood is not able to flow back out of the penis.  The symptoms of this type include:

·      An erection lasting more than four hours that is not due to sexual stimulation

·      The penile shaft is very rigid but the glans or tip of the penis is soft.

·      The pain becomes progressively worse with time

One main cause of this type of priapism is sickle cell anemia.  This is an inherited disorder known for its abnormally shaped red blood cells or sickle cells.  These cells block the blood vessels in the penis refraining blood to flow back out of an erect penis.  Another possible cause is due to taking medication for achieving an erection such as Viagra but this is considered rare. Leukemia, Multiple Myeloma, and Non-Hodgkin Lymphoma have also been known to cause this type of priaspism.

Prescription medications are also associated with ischemic priapism which include:

·      Antidepressants

·      Medication injected directly into the penis to treat erectile dysfunction

·      Blood thinners such as warfarin

·      Hormones such as testosterone

·      Medications to treat attention-deficit disorder (ADHD)

2.     Nonischemic priapism is when penile blood flow isn’t regulated normally.  This type is usually painless with symptoms that include:

·      Erection lasting more than 4 hours that is not due to sexual stimulation

·      The penis is erect but not as rigid as in ischemic priapism.

Harmful effects of priapism

Ischemic priapism can lead to possible complications.  An erection lasting more than 4 hours means blood trapped in the penis will be deprived of oxygen.  When blood can’t circulate and carry oxygen to the cells that make up the structures of a man’s penis, those cells start to die which can result in tissue damage, scar tissue and in extreme cases if not treated, can lead to permanent erectile dysfunction.

When to see a doctor

Anytime an erection has lasted more than 4 hours and or a man is in excruciating pain, it is time to seek emergency care. At the ER, a doctor will determine if the prolonged erection is due to ischemic or nonischemic priapism.  The reason for this is each type has a different treatment - ischemic priapism needs to be treated right away.

Treatment for priapism

If priapism is considered ischemic, there are several ways it can be treated:

·      The excess blood can be drained from the penis using a small needle and syringe helping relive pain removing oxygen-poor blood. 

·      A sympathomimetic drug may be injected into the penis constricting blood vessels carrying blood into the penis. 

·      Surgery may be performed if other treatments do not help.  This would involve rerouting blood flow so the blood flows into the penis normally.

Nonischemic priapism usually goes away on its own without treatment.  This type of priapism does not cause any risk to the penis as ischemic priapism can.  One treatment possibly used could be putting ice packs and pressure on the perineum which is found between the base of the penis and the anus to stop the erection.