engleski

Pharmacotherapy attempts in a case of combined "sex addiction" and erectile dysfunction

Objective This is a case of a 74-year old man who describes himself as a "sex addict". Since his early twenties he has had a strong sexual desire and needed sex every day, sometimes a few times a day. Even in his 70s he is still in need of sexual activity and needs sex every day. He is married, with two adult children, college educated, retired. Methods He contacts a physician because for the last two years his erections are not as strong and firm as they were earlier and he is not able to penetrate. Even with masturbation, due to a partial erection, he is rarely able to ejaculate. When he decides not to participate in a sexual activity (due to erectile problems) he has stomach-aches. His testosterone level is 7.10 nmol/L, LH 4.8 ; TSH 13.8 ; prolactin 201. He is extremely distressed by his inability to function in accordance with his sexual desire and his general practitioner gave him lorazepam. Results He was first treated with PDE5 inhibitors, but with no effect. Due to his distress and high sexual desire he was given cyproterone. His sexual desire diminished in 12 days and he was very relieved. But, after 40 days of treatment he developed anaemia that called for blood transfusions. Therefore, cyproterone was stopped. Two months later patient insisted that he should be given another trial of pharmacotherapy because his desire was strong and he was not able to participate in sexual activities due to the erectile dysfunction. He was offered ED treatment, which he declined. He wanted his sexual desire to be lower. He was given finasterid, but after seven days he developed generalized rash and itching and the drug needed to be stopped. After that trial, he was again asked to be treated for his ED, which he declined again, but after three more months he decided to try other ED treatment modalities. He was given intracavernosal injections, with partial effect. Also, he was given valproat to help him control his sexual desire. Conclusion This is the case of a man with hypersexuality and erectile dysfunction. Treatment of hypersexuality with hormonal treatments was faced with serious side effects, so combined treatment of erectile dysfunction and control of sexual desire was the most effective in the end as it compiled both medical and psychological aspects of his problem.

sex addiction; erectile dysfunction; cyproterone; valproate

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