Causative Relationship Between Drug Abuse And Sexual Dysfunction in Males

Objectives: Most studies investigate sexual dysfunction in drug abusers. However, no data is available about drug abuse in patients with sexual dysfunction especially in Upper Egypt. Therefore, this study aims to assess the pattern of drug abuse in patients with sexual dysfunction, and its potential impact on hormonal profile. Material and Methods: The study included 100 male patients with history of sexual dysfunction for at least 6 months. Initial evaluation with history, general & local examinations were done. Sexual dysfunction was evaluated with the Arabic version of Sexual health inventory for men (SHIM), Erection hardness score (EHS), and the Arabic Index of Premature Ejaculation (AIPE). Morning blood sample was used for assessment of Total Testosterone (TT), Luteinizing Hormone (LH), and Follicle Stimulating Hormone (FSH). Urine sample was screened by (ABON™ Multi-Drug) dipstick kits for the following drug abuse tramadol, opiate, THC (Cannabis), amphetamine, barbiturate, cocaine and benzodiazepines. Positive results were confirmed by the Immunoassay drug analyzer through the use of specific antibodies. Results: Patients' characteristics showed age 39 (31-45) years with 52% were smoker. Sexual dysfunction complaints included PE (76%), ED (57%), and combined (43%), with average duration of 11 (8-18) months. Patients' hormonal profile showed TT 6.3 (2.67-7.55) ng/ml, FSH 3.5(1.86-5.01) mIU/ml, and LH 3.1(2.1-5) mIU/ml. SHIM, EHS, and AIPE were 15 (12-19), 3 (2-3), and 19(16-24) respectively. Urine screening was positive in 39 % (39/100). Confirmation by drug analyzer revealed 4 patients were false positive. Therefore, the final result for drug abuse was 35% (35/100); with the most common drug was tramadol 19% (19/100) followed by THC (Cannabis) 12% (12/100). Patients with positive drug abuse had significantly higher smoking percent (p=<0.0001), higher driver occupation (p=0.018), and higher positive drug abuse history (p=<0.0001). There were no significant changes in both the sexual dysfunction severity and hormonal profile between positive and negative drug abuse groups. Through binary logistic regression, both smoking (OR=22.39, 95% CI: 4.20- 119.19, p=<0.0001), and history of drug abuse (OR=20.26, 95% CI: 5.21- 78.76, p=<0.0001) are significantly independent predictors for positive drug abuse test. Conclusions: Drug abuse is prevalent among Egyptian male patients with sexual dysfunction, especially tramadol. The drug abuse is common among smoker, and driver occupation. However, no hormonal disturbance could be shown in drug abuse patients. More patient awareness and legal regulations should be considered to reduce drug abuse in Egypt.