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1/4. Improvement in sexual function after reduction of chronic high-dose opioid medication in a cancer survivor.

    OBJECTIVE: To demonstrate improvement in sexual function after reduction of opioids. methods: This was a retrospective examination of a single patient at the cancer pain management clinic at M.D. Anderson Cancer Center in Houston, texas. The patient was a 58-year-old male, free of cancer for 12 years, with chronic low back pain from a prior retroperitoneal mass. Changes in scores from the Brief male Sexual Inventory and visual analog scale pain questionnaires were used to evaluate the patient. RESULTS: In this patient, a decrease in morphine-equivalent daily dose from 690 mg to 20 mg resulted in a significant increase in sexual function. Sexual inventory scores increased from 4 to 43. CONCLUSIONS: Reduction in opioid consumption can dramatically increase libido and sexual function. A possible mechanism involves opioid-related effects on the hypothalamic-pituitary-gonadal axis.
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2/4. risperidone-induced retrograde ejaculation: case report and review of the literature.

    medication adherence with antipsychotics is adversely impacted by the burden of untoward adverse effects. In particular, sexual side-effects may interfere with compliance, but are often underreported by patients. Sexual dysfunction related to hyperprolactinemia is commonly described, but ejaculatory disturbance due to potent alpha1 adrenergic antagonism may also occur, and has been reported frequently with certain typical antipsychotics such as thioridazine, but rarely with atypical antipsychotics. Presented here is the case of a 51 year old male with schizophrenia who developed retrograde ejaculation on high dose risperidone therapy (8 mg/day) with prompt resolution of symptoms upon dose reduction. The absence of decreased libido or erectile dysfunction indicates that alpha1 adrenergic antagonism and not low serum testosterone due to hyperprolactinemia is the etiology for this side-effect. This case illustrates another mechanism for sexual adverse effects, and the need for routine inquiry into sexual dysfunction during atypical antipsychotic therapy.
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3/4. bupropion--an antidepressant without sexual pathophysiological action.

    bupropion, a new nontricyclic antidepressant, was administered clinically on an open basis to 40 male outpatients at doses of 300 to 600 mg/day for 4 to 26 months. Of these, 12 patients had no history of sexual dysfunction, whereas 28 patients reported a history of significant sexual dysfunction (impaired libido, partial erection) while receiving tricyclic, monoamine oxidase inhibitor, maprotiline, and trazodone antidepressants. The adverse sexual effects resolved in 24 of the 28 patients (p less than 0.001) when they were transferred to bupropion. Of the four patients who failed to improve sexually on bupropion, two were diabetic and the other two had lifelong impairments in sexual functioning that were probably unrelated to drugs or depression. The 12 patients who had a negative history of sexual dysfunction continued to have normal sexual functioning during bupropion treatment. Based upon bupropion's lack of anticholinergic and antiadrenergic effects and the clinical observations in this study, this antidepressant appears to have a very low propensity for inducing adverse sexual side effects.
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4/4. Prolactin-secreting tumors in men: surgical cure.

    Two men presented with decreasing libido and impotence. Endocrine evaluation showed that they both had low levels of serum testosterone and a prolactin-secreting adenoma. Transsphenoidal removal of their tumors resulted in normalization of serum prolactin and testosterone concentrations and normalization of sexual function. These patients represent the first two nonacromegalic men with prolactin-secreting tumors and hypogonadism in whom surgical resection of their tumors resulted in a complete clinical and biochemical remission. We discuss the effects of elevated prolactin on male sexual function.
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