Sexual dysfunction in male crystalline heroin dependents before and after MMT: a pilot study

Sexual dysfunction (SD) is a common problem among chronic opiate dependents. The purpose of this study is to examine the prevalence of SD and to investigate whether there is a change in SD after six months of methadone maintenance treatment (MMT) compared with baseline.

We recruited 30 patients mean age 34.5 years from an MMT center in Damghan, Iran. Patients underwent structured interviews that consisted of the following: (i) socio-demographic characteristics, drug use, and sexual behavior ; (ii) the International Index of Erectile Function (IIEF-15) test for SD; (iii) the Zung test for depression; and (iv)analysis of serological status.

Overall, 8% of participants reported no SD, 69% reported mild to moderate SD, and 23% reported severe SD upon admission. After completion of the MMT program, these results decreased to 61% and 20%, respectively. In comparison with admission, the mean IIEF-15 score showed moderate improvement from 16.77 ± 7.08 to 21.8 ± 6.40 (P = 0.003). The mean IIEF-15 score for intercourse satisfaction completely improved from12.20 ± 4.55to 15 ± 3.76 (P = 0.001). Slight improvements were noted in the mean IIEF-15 score for sexual desire which increased from 5.10 ± 2.28 to 6.57 ± 2.12 (P = 0.017) and the mean IIEF-15 score for overall satisfaction which increased from 5.10 ± 2.29 to 6.58 ± 2.12 (P = 0.017). However, the mean IIEF-15 score for orgasmic function very slightly decreased from 4.73 ± 4.50 to 4.57 ± 1.92 (P = 0.191), which showed no statistically significant improvement after MMT. There was no relation with depression.

The findings of this study reveal a prevalence of SD and improvements in some aspects of SD in patients after six months of MMT. Patients should be screened for SD at the onset of opioid replacement treatment. Future studies on SD should examine the potential benefits of androgen replacement, hormone assay and the role of psychosocial factors.