While Viagra may have let the
cat out of the bag, a lack luster libido is not a new thing amongst positive guys.
Erectile Dysfunction, impotence, sexual dysfunction, call it what you want, but the fact
remains that as many as 7 out of 10 people with HIV share this complaint. Viagra is only
one solution to the less than perky penis, and not always the right one. Before jumping on
that Viagra bandwagon, read on; it may not be for you.
Libido lows and erection woes can result from many of the physical
ills of HIV. Culprits are testosterone deficiency (the hormone behind your sex drive),
damage to the part of your nervous system that controls your bodily functions (autonomic
neuropathy), anti-depressants and AIDS meds like protease inhibitors. But depression, drug
and/or alcohol abuse, grief, stress, unemployment, financial problems, fatigue,
association between sex and death, low self esteem etc can have a similar effect.
When erections fade or disappear entirely, more than sex is at risk.
If even morning erections are a thing of the past, it may be a warning that the loss of
body-cell mass is underway as a result of testosterone deficiency. While hormone boosts
treat wasting by building lean body mass, higher levels are needed for a return to the
land of libido. The "normal" testosterone range is 250-1100 ng/dL, but testing
on the low side of "normal" doesn't mean your sexual functioning will be normal.
Some doctors, seeing this "normal" reading, tell their patients that they don't
need hormone treatment. Not true. For the erection correction, men need levels from 500 to
1,000. You can choose a shot every two weeks, a patch or creams. The down side may be the
annoying recurrence of puberty, shrinking balls (treatable) and balding, but for many, a
few zits and some hair loss are a small price to pay for the ability to hits the sheets
with zest.
If your problems turn out to be due to nerve damage, more common
among people with HIV than generally known, you may want to opt for the instant-erection
injection called Caverject (or Muse, little pellets you insert). Synthetic boners
unfortunately need to be kept to three a week max, especially since the long term effects
are unknown and you can end up with a curved penis from overuse. Surgical implants and
mechanical aids like pumps are also considerations, but are expensive and surgery can do
irreversible nerve damage.
Anti-depressants are another possibility. Half the people taking
Paxil, Prozac, Zoloft and Luvox experience a loss of sexual response. Serzone and Remeron
are said to be more sex friendly, and there are always alternatives like St. John's Wort
to try out. If you do so, check into possible drug interactions first.
While new drug therapies have improved many PWA's health with
renewed desire for an active sex live, protease inhibitors can have the nasty effect of
erectile dysfunction (ED). This problem sets in between 2 and 20 months after beginning a
PI regime. Viagra has gotten much press for being a wonder drug for ED, but there are some
important considerations.
The research isn't in yet on how exactly Viagra interacts with HIV
medications like antivirals and macrolides (i.e. clarithromycin) which reduce the liver's
ability to metabolize drugs. In this case, the normal dosage of Viagra leads to blood
levels that are too high. Blood pressure can drop suddenly and your heart rate speed up,
both potentially fatal. Too avoid this, take no more than 25mg in 48 hours. Viagra works
by increasing the blood to the penis and sensitivity, taking about 1/2 -4 hours to kick
in.
Secondly, PI's and Viagra both effect the enzyme required for an
erection to gracefully disappear, leaving the possibility that you'll get more boner than
you bargained for. Should this happen, make sure you go to emergency if four hours come
and go and you're still hard. You want permanent damage. Equally important, the effect of
poppers (those popular sexual stimulants) taken alongside Viagra (tempting though this
double whammy may seem) can lead to a fatal heart attack. Extreme caution is urged before
mixing any drug with Viagra. Remember, Viagra leads to erections only upon sexual
stimulation, it won't help if you don't have the desire.
For those who prefer to opt for an alternative approach, keep in
mind that homeopathic and herbal alternatives are never quick fixes. Some options include
the Ho Shou Wu (said to revive and build blood and sperm), Yohimbine (an African bark that
increases blood flow to the penis but should be used with caution) Ginseng and Ginkgo
(both increase blood flow to the penis and are said to revive sagging libido's). If you
are interested in the philosophy as well as the herbs, you may want to think about your
sex life from a different perspective. Chinese medicine views sex as an important part of
the life force, an element to be conserved when one is seriously and/or chronically ill.
Now, this doesn't mean no sex, but it does mean a very different approach to sex, one that
is not orgasm driven. Less goal oriented sex, like erotic massage and a focus on sensual
touch are suggested.
When deciding what approach you want to take to a better sex life,
keep in mind that not all doctors are on your side. There are some inhibitions in the
medical community about returning HIV positive people to active sex lives. Make sure you
find a doctor who understands that sex is a health issue and supports your choices.
Biomedicine tends to view sex as an element of one's quality of life, but not an aspect of
health because it isn't life or death. But that depends on how you define health. If you
consider health to include the vital aspects of people's sense of self and desire to live,
then sexual dysfunction is most certainly a health issue. The loss of libido and/or
erectile dysfunction have caused a great deal of suffering for many and are certainly
aspects of health to be proactive about.
