Male sexual performance and satisfaction often take a big hit when interferon enters the picture as a treatment for hepatitis C.
Widely reported issues include lack of erections and ejaculations, lowered libidos and lack of overall sexual satisfaction.
A few researchers are trying to figure out why, although the topic hasn't received much attention.
All four studies found that sexual appetites and performance returned to pretreatment levels when the interferon regimen was discontinued, although there were reports of lingering issues with erectile and ejaculatory function in a few cases.
In general, HCV-positive patients were more than three times likely to report sexual dissatisfaction, regardless of treatment, another study found. Interferon is the main component of all hepatitis C treatments in use today.
Anyone who's been through the interferon/ribavirin treatment -- typically requiring multiple injections over the course of a week -- can attest to the flu-like symptoms, muscle soreness, shortness of breath and lack of energy. Hardly a mix to inspire sexual activity.
"No activity sounded good to me in the first few weeks of treatment," said Parke, a hep C sufferer from Florida who took the interferon treatment. "After a month or so, sex once again was appealing. The only problem that didn't go away (during treatment) was being out of breath. But when I started taking Paxil (an antidepressant), it was nearly impossible to climax."
Depression, one of the major side effects of treatment with interferon, plays a major role in the sexual dysfunction, researchers have found, but there also appears to be a significant decline of testosterone serum counts during the antiviral therapy for hepatitis C.
Interferon/ribaviron-related depression often is treated with psychotropic drugs in the SSRI class, which are notorious for inhibiting orgasms in men and women. In fact, the drugs sometimes are used to help prevent premature ejaculation.
Some doctors will not use the interferon to treat patients with past histories of depression unless they begin antidepressant therapy. This is due to interferon's effects on the brain's serotonin functions.)
More than half of the men in the fall 2008 study (done at eight treatment centers) reported that their sex life had suffered after 49 weeks of treatment. Problems were reported with sexual desire (51 percent), erectile dysfunction (39 percent) and ejaculation (31 percent).
"The onset of dysfunction appears within four weeks with gradual worsening over time," the authors of "Decline in Sexual Desire, Function and Satisfaction in Men During Peginterferon and Ribavirin Therapy for Chronic Hepatitis C" found.
The Italian research team found that the "psychological influence of (interferon) could justify the partial impairment of sensation linked to sexual behavior.
The German interferon-sex researchers, from the University of Wurzburg, noted that depression scores increased during therapy and were significantly associated with sexual dysfunction.
The Germans also cited lower testosterone levels. "We observed a significant decline of free and total testosterone serum concentrations" over the course of treatment. These declines were "in close correlation with libido/sexual function" and may result from interferon's effects on the gonads or hypothalamic regulatory centers.
Another study from New York looked at men who were HCV positive and not depressed. They were "significantly more likely to not be sexually satisfied as compared with control subjects," the 2006 study published in the American Journal of Gastronenterology said.
The June 2009 study, "Decline in Male Sexual Desire, Function, and Satisfaction During and After Antiviral Therapy for Chronic Hepatitis C," found that African American men were less likely than Caucasians to complain of sexual problems during hepatitis C treatment. A few white patients reported persistent erectile impairment after 48 weeks of treatment, while none of the blacks did.
The researchers noted that sexual side effects were rarely mentioned when it came to the hep c combination therapies: "Most review articles, summary publications on the side effects of therapy and the package inserts for peginterferon do not mention sexual dysfunction as a potential complication of therapy."
There also can be issues of shame. Among men with advanced liver disease, sexually inhibiting phenomena such as larger breasts and female configurations of pubic hair can occur.
Men who are using Viagra should check with their physician or specialists concerning the proper dose, with some experts recommending half treatments for those with HCV.
For women, the common complaint during treatment is of vaginal dryness, leading to pain during intercourse, burning and itching. A topical estrogen and progesterone cream could alleviate the dryness, assuming the doctor approves its use.
Related content: Learn about the risks of hepatitis C transmission via sex.
