Dealing with sexual problems

Whilst sexual dysfunction can be a problem for anyone, people living with HIV may be particularly affected. Loss of sexual drive or desire (libido) can have a significant impact on quality of life and feelings of self-worth, and may contribute to emotional problems such as anxiety and depression.

Sexual problems are common during times of stress, such as when one receives an HIV-positive diagnosis. This can be a time of shock, worry, and disbelief and sexual desire and performance can suffer as a result. Concerns about possibly infecting your sexual partners can also affect sex and intimacy. Negative associations between HIV - a potentially life-threatening infection - and sex could also cause sexual problems.

Other everyday issues can also affect sexual desire and performance, for example work or relationship difficulties. If they do not go away, ask for help.

Excessive intake of alcohol or recreational drugs can also diminish both the desire and ability to have sex.

Many of the drugs commonly used to treat depression, e.g. fluoxetine (Prozac) or paroxetine (Seroxat) can also affect sexual function. Additionally, megestrol acetate (Megace), an appetite stimulant, has been shown to cause loss of libido.

Sexual dysfunction among men can often be a result of decreased testosterone levels (hypogonadism), which can also lead to fatigue. Lower than normal testosterone levels have been found in people with advanced HIV infection, and can be caused both by the direct effects of HIV or chronic ill health itself. Many men receive testosterone treatment to alleviate these problems. Men who use testosterone replacement therapy usually gain muscle mass, experience an emotional 'lift', and an increase in their libido.

Impotence, or the inability to get or maintain an erection, can be caused by HIV damaging the nerves in the penis that control an erection (this is called autonomic neuropathy). Similarly, anti-HIV drugs that cause neuropathy such as ddI (didanosine, Videx) and d4T (stavudine, Zerit) may cause numbness in the genital area, which can make it difficult to sustain an erection. Protease inhibitors have also been reported to cause impotence, with some evidence suggesting that those containing ritonavir (Norvir) are particularly likely to cause sexual dysfunction.

Sexual problems in women with HIV haven't been as extensively studied, but can involve difficulties with arousal and lubrication.

Don’t be ashamed if you’re not happy with the way you feel about sex or about your sexual performance. Try talking to your partner or a close and trusted friend about what you are feeling or experiencing. Your HIV doctor will help or refer you to a specialist, nurse, health adviser or counsellor who can. If it is a medicine which is causing your sexual problems it might be possible to change it to one that does not have these side-effects. It is also possible that your doctor might be able to refer you to a specialist HIV counsellor where you will have an opportunity to talk through your concerns and problems. In other cases a referral to specialist HIV mental health services might be appropriate. Here you may be offered a course of cognitive behavioural therapy (CBT) to help you recognise and overcome your sexual problems.

Medicines may also be able to help. The drugs sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) are tablets used to treat impotence in men which works by increasing blood flow to the penis, making it more sensitive to touch. However, these drugs should be taken with care by people using protease inhibitors, non-nucleoside reverse transcriptase inhibitors (NNRTIs), the anti-fungal drugs ketoconazole (Nizoral) and itraconazole (Sporanox) or the antibiotic erythromycin. For people taking full-dose ritonavir (Norvir), it is recommended that Viagra should not be used at all, given the potential health risks. Similarly, the recreational drug poppers must not be used with Viagra, Cialis, or Levitra under any circumstances as this can result in a dangerous drop in blood pressure.

There's no Viagra-type drug for women, but talking about your feeling about sex and your experiences with a trained counsellor of psychotherapist might be useful.