Sexual Difficulties

Many people experience some form of sexual difficulty (the inability to experience sexual arousal or to achieve sexual satisfaction or fulfilment) at some time in their lives. This may be experienced as problems with loss of sex drive, libido or desire, problems with orgasm (anorgasmia) or symptoms of pain (dyspareunia) associated with sexual activity in both men and women. In men there may also be loss of erections and premature (rapid) or delayed ejaculation. In women there may also be reduced lubrication during sexual arousal or tightening of the muscles around the entrance to the vagina (vaginismus).

Any of these problems can cause distress and anxiety and thus impact on self-esteem, relationships and overall quality of life.

In relation to HIV, there is evidence to suggest that an HIV positive diagnosis can also specifically contribute to sexual difficulties – both physically and/or psychologically.

Psychological factors such as fear of passing on the virus to sexual partners, anxiety, depression and post-traumatic stress disorder are common in people living with HIV can lead to sexual difficulties. Medication used to treat mental health problems such as depression can also affect the ability to have sex.

People living with HIV may also experience forms of sexual difficulties as a direct result of their HIV infection e.g. through the physical effects of advanced HIV disease or a reduction in testosterone levels in men.

There is also some evidence to suggest that sexual difficulties are common in people living with HIV following the start of certain anti-HIV drug treatments, particularly protease inhibitors.  If sexual difficulties arise as a result of your anti-HIV drug treatment your consultant may also be able to modify your drug regime.

Specific issues for men

Advanced HIV infection or chronic ill health in general can lead to a reduction in testosterone levels. This can lead to sexual difficulties but there are treatments available to help increase testosterone levels.

Some men may experience erection problems as a result of HIV related nerve damage or as a result of taking certain anti-HIV drug treatments such as ddI (Videx) and d4T (stavudine, Zerit).

Ageing or other underlying health problems (e.g. diabetes or high blood pressure) can also contribute to the experience of problems with getting and keeping an erection or loss of sex drive.

There are various drug treatments available to help with erection problems e.g. Viagra. These can help increase blood flow to the penis and help men get and keep an erection.

However these drugs may interact with certain anti-HIV drugs such as protease inhibitors, NNRTIs, ketoconazole, itraconazole or erythromycin, and may pose a significant health risk.

Alternative drugs to treat erection problems are increasingly available online or through other non-clinical sources but using these without seeking medical advice can be damaging to your health and wellbeing.

Click here to download ‘The Hard Facts’,
a leaflet about erection difficulties and counterfeit drugs.


If you are experiencing problems with erections or loss of sex drive and it is impacting on your quality of life then speak to your HIV consultant or to your GP who will be able to refer you to a specialist who will be able to identify the most appropriate treatment and support for you. Specialists can advise on the safe use of drug therapy as well as other treatments available to help with any erection problems e.g. injections, implants or vacuum pumps.

Specific issues for women

For women living with HIV, there is evidence to suggest that the experience of ageing and a lower CD4 count are associated with poorer sexual functioning and less sexual satisfaction.

Some women living with HIV may experience early menopause as a result of hormonal changes. Menopausal symptoms can result in sexual difficulties such as loss of desire resulting from depression or painful sex as a result of vaginal dryness.

Sexual difficulties in women living with HIV may also be caused by thrush, pain or severe pre-menstrual syndrome (PMS). Thrush is a common condition in people whose immune systems are compromised.

Unfortunately less research has been carried out on the value of drug treatments for sexual difficulties in women but there are some which can be helpful for certain conditions.

If you are experiencing issues relating to a decrease in desire or pain or discomfort during sex then talk to your HIV consultant or your GP for appropriate support and referral. Specialists can advise on suitable therapies including drug treatments and behavioural or psychological interventions.

Getting help and support

Having positive and fulfilling sexual experiences is an important aspect of people’s lives including people living with HIV and can positively contribute to health and wellbeing and quality of life. If you feel that you have a problem it’s important to get help.

There are a range of specialist services available in Sheffield to support people experiencing sexual difficulties. These services will treat sexual difficulties in a number of ways depending on whether the problem is medical or psychological.

Services include:

• Andrology Service at the Royal Hallamshire Hospital – For all aspects of male sexual dysfunction. Referral via your GP or other healthcare professional.
• Porterbrook Clinic – For all sexual relationship problems or difficulties. Referral via your GP or other healthcare professional.
• GU Medicine & HIV Clinical Psychology Services – Psychological support for distress associated with sexual health. Referral via healthcare professionals.
• Psychosexual Clinic, at the Department of Gynaecology, Royal Hallamshire Hospital – For women or couples with sexual or relationship difficulties. Referral via healthcare professionals.

Some of the information on this page has been adapted from www.aidsmap.com  which features a wealth of information about issues for people living with or affected by HIV.

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