Sexual dysfunction can affect people living with HIV and may involve changes in sexual desire, arousal, erections, orgasm, ejaculation, or sexual comfort. These problems can have several causes, including physical health conditions, hormone changes, medication effects, psychological factors, relationship concerns, and the effects of living with a chronic condition.
Sexual dysfunction refers to persistent problems involving one or more stages of sexual activity.
It can include:
The type and severity of symptoms can vary considerably.
Some people experience a physical problem, while others experience reduced interest or arousal without a clear physical abnormality. Several factors can also occur simultaneously.
HIV itself is only one possible factor.
Sexual dysfunction among people living with HIV can involve a combination of:
Because these factors overlap, determining the underlying cause generally requires a medical assessment rather than assuming HIV is directly responsible.
Erectile dysfunction is one of the more commonly discussed sexual problems among men living with HIV.
Symptoms can include:
Several possible causes should be considered.
Blood-vessel health plays an important role in erections.
Conditions such as:
can contribute to erectile dysfunction.
People living with HIV may also have additional cardiovascular risk factors, making assessment of general cardiovascular health relevant when erectile problems develop.
Low testosterone can contribute to:
A healthcare professional may consider hormone testing when symptoms suggest testosterone deficiency.
A low testosterone result should not be diagnosed from symptoms alone. Appropriate testing and clinical evaluation are important because testosterone levels vary according to factors such as time of day, illness, medications, and individual circumstances.
Women living with HIV can also experience sexual difficulties.
Possible symptoms include:
Potential contributing factors can include hormonal changes, menopause, medications, mental health concerns, relationship factors, pelvic health conditions, and other medical problems.
Vaginal dryness and pain may have several causes and can require an evaluation that considers reproductive and hormonal health.
Erectile dysfunction does not automatically mean that HIV is worsening.
Erections can be affected by many conditions unrelated directly to HIV.
A healthcare professional may evaluate:
Medication review is particularly important because some medicines can affect sexual function.
HIV medicines can cause side effects, although modern ART generally has fewer and less severe side effects than older HIV treatments. HIV.gov recommends discussing troublesome side effects with a healthcare professional rather than stopping HIV medication independently.
When sexual symptoms appear after starting or changing medication, the timing can provide useful information.
A healthcare professional may review:
A treatment regimen should not be stopped simply because sexual difficulties occur. Interrupting ART can allow the viral load to increase and may contribute to drug resistance.
Psychological factors can play a substantial role in sexual function.
Living with HIV can involve concerns about:
These concerns can affect sexual desire and arousal even when there is no obvious physical cause.
Psychological contributors do not mean that symptoms are imaginary. Sexual response involves the brain, nervous system, hormones, blood vessels, and emotional factors.
Counseling or sex therapy can sometimes be incorporated into treatment when psychological or relationship factors contribute to symptoms.
Concerns about transmitting HIV can influence sexual relationships.
Effective ART changes this aspect of sexual health significantly. People living with HIV who take treatment as prescribed and maintain an undetectable viral load do not transmit HIV through sex. This principle is commonly summarized as U=U, or Undetectable = Untransmittable.
This does not mean that HIV treatment prevents every sexually transmitted infection.
Other STIs, including gonorrhea, chlamydia, and syphilis, can still be acquired or transmitted. HIV.gov recommends STI testing, prevention, and treatment as part of ongoing sexual healthcare.
Sexual dysfunction can sometimes be the first noticeable sign of another health condition.
Possible contributors include:
For this reason, persistent sexual symptoms deserve a broader health assessment rather than being attributed exclusively to HIV.
A healthcare professional may begin with a detailed discussion of symptoms.
Questions can involve:
A physical examination may also be appropriate.
Depending on the symptoms, laboratory testing may include assessments related to:
The exact tests depend on the symptoms and medical history.
Treatment depends on the underlying cause.
There is no single treatment that works for every person.
If symptoms appear after starting a medicine, a healthcare professional may review the treatment regimen and consider whether a medication change could help.
Any ART modification should be medically supervised.
HIV treatment is highly effective when taken as prescribed, and maintaining viral suppression remains an important part of long-term health.
If diabetes, cardiovascular disease, hormonal abnormalities, depression, or another medical condition contributes to sexual dysfunction, treating that condition may improve sexual function.
Prescription medications known as phosphodiesterase type 5 inhibitors are commonly used for erectile dysfunction.
Examples include:
These medicines are not appropriate for everyone.
They can interact dangerously with nitrate medications used for certain heart conditions. HIV medications and other drugs can also create clinically important interactions.
A healthcare professional or pharmacist should review the complete medication list before an erectile-dysfunction medicine is used.
Testosterone replacement may be considered for certain men with confirmed testosterone deficiency and appropriate symptoms.
It is not a general treatment for erectile dysfunction.
Before testosterone treatment is considered, healthcare professionals may evaluate:
Testosterone treatment requires medical supervision.