The first step is to recognise and accept that you have a
problem. You don’t need to be ashamed or embarrassed if you’re not happy with
the way you feel about sex, your sexual behaviour or about your sexual
performance.
The next step may be to talk to your partner or a close and
trusted friend about what you are feeling or experiencing. Your HIV doctor may be
able to help or can refer you to a specialist, nurse, health adviser or
counsellor who can.
It is also possible that your doctor might be able to refer
you to a specialist HIV counsellor, so you can talk through with them your concerns
and problems. In other cases, a referral to psychosexual therapy (offered at
your HIV clinic) or to a specialist mental health service might be appropriate.
You may be offered a talking therapy, such as a course of cognitive behavioural
therapy (CBT), to help you recognise and overcome your sexual problems.
Your GP may also be able to help you with these issues, offer
counselling at the surgery or refer you to a local service offering talking
therapies. You can find out more about the options available in NAM’s booklet, HIV, mental health & emotional wellbeing. HIV support agencies are another good place
to seek information and help (visit our online e-atlas to find an organisation near where you
are).
If you’re having problems with arousal or ejaculation, then
it’s important to identify exactly what kind of problems you are experiencing
and what their cause or causes are. This may require an examination and some
tests (such as blood tests to check hormone levels, or to look for other
conditions that may be causing problems).
For men with erectile problems, a number of medicines may be
able to help. If tests show that you have low levels of testosterone, then you
might find that testosterone replacement therapy helps. Your HIV healthcare
team should be able to provide you with advice.
If you have general erectile problems, both with your sexual
partner or partners and by yourself, then the drugs sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra)
are likely to provide an effective treatment. They work by increasing blood
flow to the penis.
However, these drugs should be taken with caution by people
taking protease inhibitors, the anti-fungal drug ketoconazole (Nizoral), itraconazole (Sporanox) or the antibiotic erythromycin,
because of possible interactions between the different drugs. People taking
full-dose ritonavir (Norvir) should
not use Levitra at all, and Viagra only in limited amounts.
It’s important you tell any doctor prescribing one of these
drugs about any other medication you are taking.
Poppers (alkyl
nitrites, also known as amyl nitrites), a recreational drug, cause a drop in
blood pressure, as do the erectile dysfunction drugs Viagra, Cialis and Levitra. Advice is not to take these
drugs at the same time as poppers.
Delayed ejaculation or orgasm can be a side-effect of
medicines, particularly antidepressants. Tell your doctor if you are
experiencing such side-effects, and are concerned about them, as there may be
another drug available that is less likely to cause them. Some people feel that
a reduction in sexual desire is outweighed by the benefits of effective
treatment for depression.
Medical solutions for women with sexual problems are more limited.
There are no Viagra, Cialis or Levitra equivalents: research has
suggested these might have some benefits for women but the evidence is not yet
clear.
If you are experiencing problems, for any reason, it is
always a good idea to discuss these issues with someone in your healthcare
team. It’s possible that a physical condition (for example, the effects of HIV,
diabetes or general ill health) may be contributing to any sexual problem, as
can factors such as medication side-effects, damage to the genital area or
heavy drug or alcohol use.
For women who have been through the menopause (the end of
your menstrual cycle, or periods), hormone replacement therapy may be helpful
in increasing your libido and reducing vaginal dryness. Using a lubricant can also
help with dryness.
Often, the types of sexual problems reported by women with
HIV have underlying psychological or social causes (some of these causes can
cause physical problems too). Talking therapies, which allow you to talk through
issues, such as counselling, cognitive behavioural therapy (CBT) or
psychotherapy, can often help and may be available through your HIV clinic or
GP. Ask about what help is available.