It is important, however, for the clinician to carefully review the reported effects on sexual function of a substance used by a patient, as available at MEDLINEplus, and to have a clear view of what the substance purports to do in the area of sexual functioning. The distinction between an aphrodisiac and a drug to enhance physiological response is key in this regard.
For example, Viagra and Cialis are not aphrodisiacs. They do not increase one’s desire for sex; they augment erectile activity and usually require stimulation—physical and psychic—to be effective. Testosterone, on the other hand, acts on the libido without significantly increasing erectile response. Thus, if a healthy man has erectile dysfunction and a normal testosterone level, there is no reason to give him exogenous testosterone for the erectile dysfunction. In a double-blind, placebocontrolled crossover study, Raul Schiavi and colleagues reported that there was no effect on erectile functioning when testosterone was administered to men with erectile dysfunction.
Only a slight increase in ejaculatory frequency was noted, and this was not connected with the participants’ self-reports of any increased sense of sexual desire. The question of medication use by the healthy to enhance sexual function most often arises in connection with the process of healthy aging. The normal aging decrements in function versus the limitations caused by a disease process are a complicated and controversial subject. For an approach to this question, I look at the question of the aging body and sex.
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