Book Review

Drug-Induced Infertility and Sexual Dysfunction

N Engl J Med 1996; 335:1929December 19, 1996

Article

Drug-Induced Infertility and Sexual Dysfunction
By Robert Forman, Susanna Gilmour-White, and Nathalie Forman. 155 pp. New York, Cambridge University Press, 1996. $39.95. ISBN: 0-521-46563-X

When one first picks up this monograph and reads the introductory statement concerning its uniqueness, expectations are raised that this may be a concise compilation of the adverse effects of medications on fertility and sexual function. However, what one learns after reading this book is that much has been written about the effects of various drugs on the male reproductive system, but there is a lack of information pertaining to the female reproductive system.

The effects on male sexual function of antihypertensive, psychotropic, and central nervous system drugs have been well documented, especially as regards anorgasmia and erectile and ejaculatory dysfunction or failure. The authors discuss changes in testosterone levels, libido, and impotence. They emphasize the lack of data, and therefore knowledge, concerning the effects of drugs on hormones and the sexual response in women. The authors note the increase in sex hormone–binding globulin due to the use of antiepileptic drugs in men, with a subsequent decrease in the level of free testosterone, yet they do not discuss the increased pregnancy rate among women who use antiepileptic medications while taking birth-control pills or the need to increase the amount of estrogen taken to relieve menopausal symptoms in postmenopausal women receiving phenytoin or carbamazepine.

When discussing cancer chemotherapy, these authors appropriately emphasize the need for long-term studies to evaluate the teratogenicity of such agents and their genetic effects on subsequent generations. The negative effects of recreational drugs and drugs of abuse on fertility and sexual responsiveness are well described, as are the potential environmental hazards both sexes are exposed to on a daily basis. More studies are needed to sort out the potential adverse sequelae of exposure to phytoestrogens (plant estrogens).

This book can be used as a reference for the potential adverse effects of many commonly used medications on fertility and sexual function and therefore may be helpful to health care providers. But many more studies are needed to evaluate such problems fully in women.

Rudi Ansbacher, M.D.
University of Michigan Medical Center, Ann Arbor, MI 48109