Sexual dysfunction associated with oral antihypertensive medication: a critical survey of the literature

It is commonly held clinical belief that antihypertensive agents affect sexual performance. The authors survey the English language literature concerning oral antihypertensive agents and critically review studies examining sexual side effects. Surprisingly, few studies support much of the conventional clinical wisdom. Evidence is strong for the pathogenicity of guanethidine upon ejaculatory mechanisms. Contrary to expectation, strong evidence also exists for the ability of propranolol, especially in high doses, to inhibit erectile functioning. Only equivocal support was found for the pathogenicity of methyldopa, reserpine, and clonidine upon sexual functioning. The authors suggest that this may be in part due to underdeveloped methodology for assessing the sexual side effects of hypertensive medications. Suggestions are offered for future studies as well as for the clinical evaluation of sexual dysfunction in the hypertensive patient.