How Hepatitis C Can Affect a Patient's Sex Life
Hepatitis C is commonly accompanied by fatigue and depression, followed by a decreased interest in sex. Additionally, antiviral medications typically used to battle Hepatitis C may cause sexual dysfunction and decreased libido. Sexual dysfunction is the most frequently encountered side effect of many antidepressant medications used to treat the depression and anxiety associated with Hepatitis C combination treatment. When discontinued, the medication-induced sexual dysfunction typically vanishes. Due to its prevalence in chronic Hepatitis C patients, openly discussing sexual problems with a physician can help identify if the source is the disease, prescribed medications or some other condition.
Although no large-scale clinical trials have been conducted proving that the Hepatitis C virus (HCV) directly causes sexual dysfunction, many patients report an association between the two. The following two studies demonstrate a relationship between sexual dysfunction and Hepatitis C:
- A study published in the June 2006 issue of American Journal of Gastroenterology investigated the prevalence of sexual dysfunction among men with chronic HCV infection and evaluated its impact on health-related quality of life. After evaluating 350 participants, researchers concluded “…Our study demonstrates a strong association between chronic HCV infection and sexual dysfunction among men in the United States. Men with chronic HCV infection had markedly reduced sexual function in all the five domains evaluated (sex drive, erectile function, ejaculation, sexual problem assessment and overall sexual satisfaction) compared to HCV-uninfected controls…”
- A study published in the February 2005 edition of Journal of Endocrinology evaluated sexual dysfunction in men with chronic HCV on antiviral therapy. Researchers found that testosterone levels decreased significantly during antiviral therapy, closely correlating with decreased libido and sexual function. Additionally, depression increased during interferon therapy, a condition also associated with sexual dysfunction.
Hepatitis C infection also contributes to advanced liver disease which can alter levels of hormones. Approximately two percent of middle-aged men experience decreased sexual interest and erectile dysfunction. This percentage remains consistent both in men without liver disease and those in the early stages of liver disease. However, men with advanced liver disease are more likely to experience the following conditions related to changes in hormone levels:
- Testicular dysfunction
- Loss of body hair
- Gynecomastia (enlarged breasts)
- Redistribution of body fat
- A female configuration of pubic hair
- Decreased muscle mass
- Decreased sexual desire
- Erectile dysfunction
The male sex hormone (testosterone) is typically lowered with advanced liver disease, while the female sex hormone (estrogen) typically increases. Because alcohol abuse further lowers testosterone levels, alcoholic men with Hepatitis C who have progressed to advanced liver disease are particularly vulnerable to sexual dysfunction issues.
Women with chronic Hepatitis C commonly complain of vaginal dryness, which typically results in decreased sexual interest. The majority of women with Hepatitis C who experience pain during intercourse, vaginal irritation, vaginal burning and itching are on interferon and ribavirin therapy. Discomfort may be severe when combined with atrophic vaginitis, a condition common when estrogen levels decline, such as in postmenopausal women. While a topical estrogen and progesterone cream can improve or alleviate the dryness, oral estrogen supplements should only be taken under a physician’s close supervision. Whether in the form of natural soy estrogen or oral estrogen supplements, estrogen supplementation carries the following risks to women with liver disease:
- Worsening jaundice
Regardless of your gender or whether or not you are undergoing combination therapy, living with Hepatitis C can spawn sexual dysfunction. Even though it is a subject that most of us prefer to avoid, speaking up on impaired sexual function or interest can prompt your physician to re-evaluate your liver management plan. Since a healthy sex life is one expression of physical, spiritual and emotional health, supporting this component can dramatically increase someone’s quality of life. By discussing this sensitive topic, people with Hepatitis C can get the help needed to reclaim this most basic part of being human.
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M R Krauss, et al., Sexual dysfunction in males with chronic hepatitis C and antiviral
therapy: interferon-induced functional androgen deficiency or depression?, Journal of Endocrinology, February 2005.
www.liverdisease.com, Sex and Liver Disease, Melissa Palmer, MD, 2007.
www.natap.org, Sexual Dysfunction is Highly Prevalent Among Men with Chronic Hepatitis C Virus Infection and Negatively Impacts Health-Related Quality of Life, The American Journal of Gastroenterology, Ann Danoff, MD, et al, June 2006.