Men living with HIV and experiencing sexual dysfunction: an analysis of treatment options

Men living with HIV (MLWH), especially younger MLWH, may experience sexual dysfunction in greater numbers than men without HIV infection. This manuscript describes the prevalence of two major causative factors of sexual dysfunction in MLWH: hypogonadism and erectile dysfunction. A description of assessment and evaluation is presented. Additionally, the evidence for use of pharmacological and herbal therapies is presented with recommendations for treatment. MLWH who exhibit hypogonadism and/or erectile dysfunction should receive similar care to those without HIV infection. There is evidence to support the use of testosterone replacement therapy and phosphodiesterase 5 inhibitors in this population, and there is limited evidence for the use of certain herbs such as yohimbine. The ethics of treating sexual dysfunction for MLWH are discussed. A case study follows as an example of the application of evidence-based treatments recommended for practice.