Prevalence of sexual dysfunction in male subjects with alcohol dependence

Chronic and persistent alcohol use is known to induce sexual dysfunction, which leads to marked distress and interpersonal difficulty. This, in turn, is known to worsen the alcohol abuse. Sexual dysfunction in the alcoholic may be due to the depressant effect of alcohol itself, alcoholrelated disease or due to a multitude of psychological forces related to the alcohol use.[1] The spectrum of sexual dysfunction encompasses: Decreased sexual desire—persistent or recurrent complete failure to attain or maintain an erection until the completion of the sex act; Difficulty in achieving orgasm—persistent or recurrent delay in or absence of orgasm, following a normal sexual excitement phase; Premature ejaculation—persistent ejaculation with minimal sexual stimulation, before, on or shortly after penetration and before the person wishes it, which causes marked distress.[2] 4.

Chronic and persistent alcohol use is known to induce sexual dysfunction, which leads to marked distress and interpersonal difficulty.This, in turn, is known to worsen the alcohol abuse.Sexual dysfunction in the alcoholic may be due to the depressant effect of alcohol itself, alcoholrelated disease or due to a multitude of psychological forces related to the alcohol use. [1]The spectrum of sexual dysfunction encompasses: Decreased sexual desire-persistent or recurrent complete failure to attain or maintain an erection until the completion of the sex act; Difficulty in achieving orgasm-persistent or recurrent delay in or absence of orgasm, following a normal sexual excitement phase; Premature ejaculation-persistent ejaculation with minimal sexual stimulation, before, on or shortly after penetration and before the person wishes it, which causes marked distress. [2]lcohol abuse is the leading cause of impotence and other disturbances in sexual dysfunction. [3]Episodic erectile failure in alcoholic men is fairly routine, found to be significantly higher in men consuming more than three standard units of alcohol (12 g ethanol) daily and in subjects smoking more than 10 cigarettes/day. [4]Van Thiel and Lester [5] reported that 61% of patients dependent on alcohol reported sexual dysfunction, the most common being erectile dysfunction followed by reduced sexual desire.[8][9] Vijayasenan, [10] found that of 97 male inpatients admitted for the treatment of alcoholism, 71% suffered from sexual dysfunction for a period of more than 12 months prior to admission to a hospital.The disturbances noted were diminished sexual desire (58%), ) .
Arackal et al.: Sexual dysfunction in male alcoholics ejaculatory incompetence (22%), erectile impotence (16%) and premature ejaculation (4%).Virtually all aspects of the human sexual response are affected by alcohol especially sexual desire and erection. [11]hiavi et al. [12] failed to find any difference in sexual dysfunction in alcoholics abstinent for 2-3 months in comparison with a nonalcoholic control group, speculating that alcohol-induced sexual dysfunction was reversible with abstinence.The aim of the present study was to estimate e. Use of drugs affecting sexual function (antipsychotics, antidepressants, antihypertensives, steroids, disulfiram etc.) All the above subjects were assessed for the prevalence of one or more sexual dysfunction experienced over the past 12 months using a sexual dysfunction checklist (Appendix A) by a trained psychiatrist (BSA).The checklist contains items corresponding to 12 areas of sexual dysfunction described in the Diagnostic Criteria for Research, ICD-10 Classification the prevalence of sexual dysfunction in males with alcohol of Mental and Behavioural Disorders. [15]This was necessary We specifically assessed male subjects as the SCAN does not contain a detailed assessment for the admitted to a treatment center with a diagnosis of alcohol ICD-10 section on Sexual dysfunction not caused by organic dependence syndrome, without obvious hepatic cirrhosis disorder or disease (F52).The disorders specifically tapped or other co-morbidity.Female patients were excluded from by the checklist were aversion towards sex, low sexual the study as the number of women who use alcohol in India desire, difficulty in achieving and in maintaining erection, are few and the number of female alcoholics who avail of premature ejaculation, inhibited or delayed ejaculation treatment centers are too few to contribute to significant orgasm with flaccid penis, anorgasmia, pain at the time of statistical power.Also, the spectrum of sexual dysfunction coitus, dissatisfaction with frequency of intercourse per is different in the female from the male.
week (in the last year and in a representative week 5 years earlier), partner and, own sexual function.

MATERIALS AND METHODS
Sexual dysfunction was rated for the last one year and One hundred male subjects, consecutively admitted to temporary or situational complaints were ignored.Data the Deaddiction Centre of the National Institute of Mental regarding the quantity of alcohol usually consumed per day Health And NeuroSciences (NIMHANS), Bangalore, India, [in standard drinks; where 1 drink = 30 ml.Spirits = 330 ml. with a diagnosis of Alcohol Dependence Syndrome With Beer = 1/3 sachet of arrack] and duration of dependence, Simple Withdrawal Symptoms (F10.30,ICD-10 criteria) was extracted from the items corresponding to the section were recruited for the study.All subjects gave on Mental and Behavioural disorders due to use of alcohol informed consent for taking part in the study.Subjects were [F10.0] in the SCAN and used in the analyses.However, only initially assessed on the schedules for clinical assessment in the presence or absence of tobacco consumption and not a neuropsychiatry (SCAN) [14] by a trained psychiatrist (VB).All measure of severity was used for analyses.The ratings were patients were subjected to detailed clinical and biochemical sought after two weeks of inpatient stay after the period of examinations including blood glucose and liver enzymes.
detoxification with benzodiazepines.Patients with significantly high levels of liver enzymes or physical findings suggestive of hepatic cirrhosis were RESULTS referred for ultrasound assessment of the abdomen.
The 100 male subjects had a mean age of 37.09 (± 6.74) Subjects were included if they were: years.The quantity of alcohol consumed per day was 20.6 between 20-50 years of age (± 9.07) standard drinks [8-42 drinks per day].The mean married or had a regular sexual partner duration of alcohol dependence was 8.59 (± 6.64) years. dependence.
Patients 87% of the subjects also used tobacco [chewing and / or smoking].Seventy-two of the 100 subjects reported one or more sexual dysfunction.Four (4%) subjects reported aversion to sex to the extent that they had not attempted sexual intercourse in the last one year.Consequently, the prevalence of sexual dysfunction other than aversion to sex and low sexual desire, had to be calculated after excluding these 4 subjects.
Premature ejaculation was reported by 36 out of 96 (37.5%) subjects, out of which, 27 (28.12%)had complaints of ejaculating within the first minute itself and the rest (9.38%) ejaculated within three minutes of intromission.The next most frequent sexual dysfunction reported was low sexual desire, which was reported by 36 out of 100 subjects.Erectile ) .
dysfunction did not depend on the number of years of alcohol dependence or on the age of the subject.One reason for these findings may be the narrow range of ages at presentation and durations of dependence across the

DISCUSSION
Sexual dysfunction appears to be common among male subjects with alcohol dependence.Seventy-two per cent of the subjects with alcohol dependence complained of one or more problems with sexual functioning.This is similar to what has been reported in earlier studies. [10,16]Multiple co-Nine subjects (9.37%) had dissatisfaction with the sexual existing dysfunctions seemed to be the norm in the sample relationship with their partner and eight subjects reported studied.The most common condition reported in our study (8.33%) orgasm with flaccid penis.Coital pain or feeling of was premature ejaculation followed closely by low sexual pain in genitals at the time of sexual intercourse was seen desire and erectile dysfunction.in six subjects (6.1%).
The number of symptoms reported appeared to be a function There was a significant reduction in the frequency of sexual of the amount of alcoholic beverage consumed.The chance intercourse per week over the last five years having decreased of developing sexual dysfunctions appears to increase with from a mean of 4.6 (± 2.6) times per week to 2.2 (± 2.2) increasing quantity of alcohol consumed.Higher levels of times per week currently.Forty-eight per cent of the sample alcohol intake may result in greater neurotoxic effects.It had more than one sexual dysfunction.Of the 24 subjects has been reported that heavy alcohol use may contribute to with only one complaint, the most frequent complaint was a reversible vagal neuropathy, which is perhaps reversible that of premature ejaculation in 18 subjects.on abstinence. [17]However, chronic heavy use of alcohol is also known to significantly alter gonadal hormones. [9]he number of sexual dysfunction complaints was significantly associated with the amount of alcohol There is also a significant population, which has psychogenic consumed per day.On curve-fitting the data, there was a sexual dysfunction, which is likely in a situation of significant positive linear relationship (F = 10.54;dF 87; marital conflict, which commonly exists in the families of P = 0.002) [Figure 1].However, there was no correlation alcoholics.[18] There is some evidence of this with more between the reduction in frequency of sexual intercourse than a third of the subjects reporting dissatisfaction with over the last five years and the amount of alcohol their spouses' responses and / or decreased frequency.This consumed.
cannot be conclusive without data on nocturnal erection or sexual activity in alternate situations.One of the limitations There appeared to be no significant correlations between the of this exploratory study is that marital functioning was not subjects' ages and duration of alcohol dependence with the specifically assessed.

Sexual Dysfunction and Alcohol Use
Counterintuitively, the likelihood of developing sexual Sexual Dysfunction 6 group.

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Tobacco use though, was not found to be a significant determinant of sexual dysfunction.This is contrary to all 2 reported evidence. [19]This finding is most likely to be due to our treatment of tobacco use as a categorical (present indices of severity to avoid this error. -2 Alcohol Intake per day (Standard Drinks) The exclusive focus on male alcoholics was necessitated by low.Having a non-drinking or low-drinking control sample, dysfunction in male subjects with alcohol dependence Bijil Simon Arackal, Vivek Benegal Deaddiction Centre, National Institute of Mental Health and Neurosciences, Bangalore -560 029, India variable in a situation where almost 90% of the Linear sample was using tobacco.Future studies need to use

Figure 1 :
Figure 1: Linear regression illustrates the predictive relationship

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Arackal et al.: Sexual dysfunction in male alcoholics dysfunction was reported by 33.3% of the subjects with difficulty in achieving erection in 19 subjects (19.79%) and difficulty in maintaining erection in 13 subjects (13.54%).