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Singaporeans living with HIV might be wondering if their condition is causing their erectile dysfunction. Unfortunately, there is somewhat of a link.

At the heart of it, HIV weakens the body’s natural defences, making it vulnerable to other infections.

HIV attacks the body’s immune system by destroying white blood cells that fight infection by destroying viruses, bacteria and other infectious organisms that may cause sickness and AIDS.

This makes a person vulnerable to opportunistic infections such as pneumonia, typhoid, candidiasis, toxoplasmosis, and tuberculosis (TB).

Do you have erectile dysfunction?

Erectile dysfunction is a common condition in which a man has difficulty achieving and maintaining an erection firm enough for sexual intercourse

A local study in Singapore showed that 51.3% of Singaporeans have some form of erectile dysfunction, classified into mild (23%), moderate (8.8%) and severe (19.3%).

Is there a link between ED and HIV?

There is some evidence indicating erectile dysfunction (ED) may be associated with HIV infection.

A Spanish study reported that men receiving care in a HIV clinic had erectile dysfunction. They quoted past studies that show that the rate of erectile dysfunction is higher than HIV-negative men and concluded that,

“Erectile dysfunction is common in HIV-infected men. The prevalence of erectile dysfunction in our study was 53.4%, similar to that obtained in other HIV-positive cohorts.”

However, the relationship between ED and other aspects of HIV infection has not been examined comprehensively and so the following are only theories.

One overarching theory that explains how HIV causes ED drills down to how HIV affects the general health of the person living with HIV, hence causing erectile dysfunction.

Lower white blood cell (CD4) count

HIV is associated with decreased infection-fighting white blood cells, ultimately leading to a compromised immune system.

HIV affects CD4 cells, a specific type of helper T cells that coordinate the immune response by stimulating CD8 cells, macrophages, and B lymphocytes to combat an infection.

HIV causes a drastic decrease in helper and fighting white blood cells, which invites multiple opportunistic bacteria and viruses to cause disease due to increased susceptibility.

Can a lower white blood cell count cause erectile dysfunction?

A lower white blood cell count is associated with severe HIV infection, which leads to erectile dysfunction.

Lack of an optimal amount of protective white blood cells in the body leads to an altered immune response. Free radicals are produced during an HIV infection which causes oxidative damage to different organs and the cardiovascular system.

Due to oxidative damage, buildup of fatty plaques may develop in the blood vessels connected to the penis, making it difficult to get an erection. This is known as atherosclerosis.

Low testosterone (hypogonadism)

HIV infection is associated with male hypogonadism, an endocrine abnormality in males with impaired testosterone production.

All the major endocrine glands are susceptible to opportunistic microorganisms in the body due to a compromised immune system in HIV infection.

Hence, a faulty endocrine system is unable to produce the required sex hormone levels.

How does low testosterone cause ED?

Hypogonadism alone can cause erectile dysfunction, but it’s generally because the person also has other illness present in addition to low testosterone levels.

People with lowered testosterones levels can often have other medical conditions like diabetes, atherosclerosis, and high blood pressure.

Hypogonadism and all these conditions affect the blood flow toward the penis, leading to erectile dysfunction. For instance, blood flow is hampered in diabetes, which results in decreased blood supply to several organs, including the penis. The penis is unable to erect when there is insufficient blood supply.

Psychologically-related ED resulting from HIV

Psychological reasons are a major reason why Singaporeans have erectile dysfunction, and people living with HIV are especially vulnerable to psychogenic ED.

People living with HIV might suffer much because of stigma against HIV, embarrassment, guilt, stress, anxiety or depression.

HIV medication might cause ED

While there are different classes of antiretrovirals; protease inhibitors are the most commonly used antiretroviral medication for HIV.

In simple terms, protease inhibitors stop the replication of HIV.

The science behind protease inhibitors

Antiretroviral proteases inhibitor binds to the catalytic or active site of the HIV protease. This binding prevents the cleavage of immature polyproteins and prevents their maturation, thereby stopping the replication of HIV.

Similarly, Norvir acts at the enzyme’s active site and inhibits its activity. This leads to the prevention of polyprotein cleavage resulting in immature, ineffective viral protein.

Do antiretrovirals cause erectile dysfunction?

Some studies show antiretroviral medications are linked with erectile dysfunction, but the results are inconsistent and vary from individual to individual.

Erectile dysfunction is not linked with any particular class of antiretrovirals. However, the duration of taking a certain class of antiretrovirals is important.

Some classes of antiretrovirals are associated with erectile dysfunction; especially protease inhibitors (Norvir) are studied to cause ED directly or indirectly.

Apart from the class of antiretroviral medication, the health status and current sexual performance of a person determine the effect of antiretrovirals.

Erectile dysfunction treatment for people living with HIV

Treatment for erectile dysfunction for people living with HIV remains similar for people without HIV.

Doctors generally use a two-pronged approach which involves examining your psychological condition (psychogenic ED) and your physical condition (organic ED).

If you have physical issues that cause erectile dysfunction, there are six solutions to treat ED.

However, if it’s psychological, you might need to talk it out with a sex therapist who can walk you through any guilt, stress, fear and other mental health barriers.

Frequently Asked Questions (FAQs)

Q: Is there a link between HIV and erectile dysfunction (ED)?

Yes, there is a recognized link between HIV and erectile dysfunction. While not everyone with HIV experiences erectile dysfunction, the virus and its associated factors can contribute to sexual health issues.

Q: Can psychological factors related to HIV contribute to erectile dysfunction?

Yes, the psychological impact of living with HIV, including stress, anxiety, depression, and body image concerns, can contribute to erectile dysfunction. Mental health plays a significant role in sexual well-being.

Q: Is there a difference in the prevalence of erectile dysfunction between people with HIV and those without the virus?

Research suggests that erectile dysfunction may be more prevalent among individuals with HIV compared to the general population. However, the severity of the condition and its impact can vary widely.

Q: Can treating HIV help improve erectile dysfunction?

Effectively managing HIV through antiretroviral therapy and maintaining overall health can positively impact sexual health. It’s important to communicate with healthcare providers about any sexual health concerns you may have.

Q: What can individuals with HIV do to address erectile dysfunction?

Individuals with HIV can take steps to address erectile dysfunction, including discussing the issue with their healthcare provider, exploring treatment options, managing stress, adopting a healthy lifestyle, and addressing psychological factors.

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The percentage of men in Singapore aged 30 and above who experience some degree of erectile dysfunction.

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