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Association Between Treatment With Retinoids and Sexual Dysfunction
abstract
This abstract is available on the publisher's site.
Access this abstract nowSystemic retinoids are frequently prescribed for common dermatological conditions including acne and psoriasis. Animal studies have raised concerns about a potential association between systemic retinoids and sexual dysfunction, since neonatal treatment with retinol resulted in reduced sexual activity of adult male rates. Although retinoids are known to affect sexual reproduction, there remains conflicting clinical data on sexual side effects of retinoids, also termed post-retinoid sexual dysfunction (PRSD). However, product monographs for isotretinoin in various countries including Canada and Australia contain PRSD warnings, and a recent report includes recommendations for the United Kingdom to follow suit. To our knowledge, the literature lacks a systematic evaluation of the association of PRSD with retinoids, and herein, we aim to address this knowledge gap.
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Sexual Dysfunction Following Retinoids: A Systematic Review
Br J Dermatol 2024 Sep 16;[EPub Ahead of Print], H Oi-Yee Li, E Pastukhova, O Brandts-Longtin, A Bailey, MG Tan, MG KirchhofFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Studies have indicated that dermatologists shy away from discussing sexual health, even in encounters where the patient's condition, such as vulvovaginal dermatosis, could have known implications on sexual satisfaction.1 Underreporting of sexual health concerns is common, and patients are hesitant to bring up these issues unless specifically asked.2 What if the medications we are prescribing as dermatologists are the cause of their sexual dysfunction?
This systematic review looked at sexual dysfunction following systemic retinoid treatment. The review found that the common symptoms among females treated with systemic retinoids were vulvovaginal dryness, dyspareunia, vaginal bleeding, and diminished libido. Up to 40% of women experienced vulvovaginal symptoms, and these symptoms seem to be dose-dependent. Interestingly, more cases of sexual dysfunction were reported in males; however, the data were conflicting, with some studies indicating a statistically significant association between systemic retinoids and sexual dysfunction, whereas others not finding a meaningful difference. The authors note several limitations of their review and call for more robust research, including prospective studies using validated sexual assessments and accounting for confounding factors.
Some of the potential connection between retinoids and sexual dysfunction may be explained by retinoid-induced xerosis and increased skin fragility — although this may explain some of the reported symptoms by females, this does not explain the whole story. Animal studies suggest a link between retinoids and sexual dysfunction, but translating these findings to humans has proven to be challenging. This is unsurprising, as we continue to recognize the complexity of human sexuality, which includes hormonal, psychological, social, and physical factors, among others.
This review stresses the need for dermatologists to proactively discuss potential sexual side effects with patients starting systemic retinoid therapy. Despite inconclusive data, dermatologists should adopt a holistic approach, consider sexual side effects, and prioritize open communication about sexual health in retinoid treatment plans. I want to commend the authors of this systematic review for delving into an often overlooked, yet important, research topic and look forward to future research in this area.
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