Problems of sexual function in patients with hypertension

Since normal sexual physiology requires adequate function of the autonomic nervous system, sexual dysfunction is common in the hypertensive individual. Potency, i.e., the capacity to achieve and maintain erection, requires centrally mediated sympathetic outflow; ejaculation and orgasm depend on peripheral sympathetic function. Predictably, therefore, sympatholytic drugs cause impairment. Centrally active agents such as methyldopa, clonidine, and reserpine may impair potency in up to 32% of recipients. Failure of ejaculation is reported much less frequently, but delay of orgasm may occur in both men and women. Guanethidine, a peripherally active sympatholytic, produces abnormality of ejaculation in as many as 60% of recipients, depending on the dosage. Impotence may occur as a secondary 'psychogenic' result. The beta blocker propranolol can impair function, perhaps on a central basis, although it does so much less frequently. Diuretics can cause both impotence and failure of ejaculation in as many as 32% of recipients; the mechanisms are unclear. Only the vasodilators, and perhaps prazosin, are free of this complication. Significantly, 17% of 99 men with untreated hypertension reported abnormalities of function, whereas only 7% of age-matched normotensives had similar complaints. To ensure patient compliance, sexual dysfunction must be carefully managed through patient counseling and alteration of the drug regimen.