first step is to recognise and accept that you have a problem. You don’t need
to be ashamed or embarrassed if you’re not happy with the way you feel about
sex, your sexual behaviour or about your sexual performance.
next step may be to talk to your partner or a close and trusted friend about
what you are feeling or experiencing. Your HIV doctor may be able to help or,
if not, can refer you to a specialist, nurse, health adviser or counsellor who
is also possible that your doctor might be able to refer you to a specialist
HIV counsellor, so you can talk through with them your concerns and problems.
In other cases, a referral to psychosexual therapy (offered at your HIV clinic)
or to a specialist mental health service might be appropriate. You may be
offered a ‘talking therapy’, such as a course of cognitive behavioural therapy
(CBT), to help you recognise and overcome your sexual problems.
you have a GP, they may also be able to help you with these issues, offer counselling
at the surgery or refer you to a local service offering talking therapies. You
can find out more about the options available in NAM’s information booklet, HIV, mental health and emotional wellbeing.
HIV support agencies are another good place to seek information and help (visit
our online e-atlas to find an organisation near where you are).
you’re having problems with arousal or ejaculation, then it’s important to
identify exactly what kind of problems you are experiencing and what their
cause or causes are. This may require an examination and some tests (such as
simple blood tests to check hormone levels, or to look for other conditions
that may be causing problems).
men with erectile problems, a number of medicines may be able to help. If tests
show that you have low levels of testosterone, then you might find that
testosterone replacement therapy helps. Your HIV healthcare team should be able
to provide you with advice on this.
you have general erectile problems, both with your sexual partner or partners
and by yourself, then the drugs sildenafil (Viagra),
tadalafil (Cialis) and vardenafil (Levitra) are likely to provide an
effective treatment. They work by increasing blood flow to the penis.
these drugs should be taken with caution by people taking protease inhibitors,
non-nucleoside reverse transcriptase inhibitors (NNRTIs), the anti-fungal drug
ketoconazole (Nizoral), itraconazole
(Sporanox) or the antibiotic
erythromycin, because of possible drug interactions. People taking full-dose
ritonavir (Norvir) should not use Levitra at all, and Viagra only in limited amounts.
important you tell any doctor prescribing one of these drugs about any other
medication you are taking.
Poppers (alkyl nitrites, also known as amyl nitrites), a
recreational drug, cause a drop in blood pressure, as do the erectile
dysfunction drugs Viagra, Cialis and Levitra. Advice is not to take these drugs at the same time as
ejaculation or orgasm can be a side-effect of medicines, particularly
antidepressants. Tell your doctor if you are experiencing such side-effects,
and are concerned about them, as there may be another drug available that is
less likely to cause them. Some people feel that a reduction in sexual desire
is outweighed by the benefits of effective treatment for depression.
solutions for women with sexual problems are more limited. There are no Viagra, Cialis or Levitra equivalents: research has suggested these might have some
benefits for women but the evidence is not yet clear.
you are experiencing problems, for any reason, it is always a good idea to
discuss these issues with someone in your healthcare team. It’s possible that a
physical condition (for example, the effects of HIV, diabetes or general ill
health) may be contributing to any sexual problem, as can factors such as medication
side-effects, damage to the genital area or heavy drug or alcohol use.
post-menopausal women, hormone replacement therapy may be helpful in increasing
your libido and reducing vaginal dryness. Using a lubricant can also help with
the types of sexual problems reported by women with HIV have underlying
psychological or social causes (some of these causes can cause physical
problems too). Talking through issues, counselling, CBT or psychotherapy can often
help and may be available through your HIV clinic or GP. Ask about what help is