Iatrogenic sexual dysfunction in men - a practical algorithm for outpatient practice and a pharmacological context

Drug-induced sexual dysfunction (iatrogenic sexual dysfunction) ranks among the most common, least reported, and at the same time clinically most significant adverse effects of long-term pharmacotherapy in men. In clinical practice, it typically manifests as reduced libido, erectile dysfunction (ED), ejaculatory disorders, orgasmic dysfunction, or a combination of several phenotypes, while the temporal relationship to treatment initiation or dose titration may be subtle. The aim of this article is to provide a pragmatic, implementable algorithm for the outpatient physician, integrating sexuological assessment with a basic pharmacological analysis (likelihood of a drug-related cause, dose dependence, interactions, substitution options) and recommended interventions, including the safe use of phosphodiesterase type 5 (PDE5) inhibitors in ED.