Sexual dysfunction and sex hormone abnormalities in patients with cirrhosis: Review of pathogenesis and management

Abstract

Healthy sexual function is important to maintain a good quality of life but is frequently impaired in patients with cirrhosis. The degree of sexual dysfunction appears to be linked with the degree of hepatic dysfunction. In men, sexual dysfunction can be related to the hyperestrogenism of portal hypertension and/or to decreased testosterone resulting from testicular dysfunction. In women, suppression of the hypothalamic‐pituitary‐gonadal axis appears to be a principal contributor, with no significant effect of portal hypertension. There is also a huge psychological barrier to breakthrough as there is a component of depression in many patients with cirrhosis. Sexual dysfunction is often underdiagnosed in the cirrhotic cohort. Management of sexual disorders in patients with cirrhosis can be challenging as they are often multifactorial. Multidisciplinary approach is the key in managing these patients. We review the current literature on the pathogenesis of sexual dysfunction in cirrhotic patients and propose a step‐wise algorithm to better manage these patients.

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