It is fair to say that the causes for sexual performance
problems, such as erectile dysfunction, are complex. Equally complex is the
research field regarding individuals who have a history of substance misuse. We
were therefore eager to read a recently published study that considered sexual
performance among men with substance dependence. However, upon noticing the
poor design and inconsistent reporting of the study and its findings, our
enthusiasm was soon dampened. In this brief entry, we outline why.
The study,
which was a collaboration of two teams in Grenada and Columbia, was published
in the Journal of Sexual Medicine. Of
the 906 men that took part, 356 did not meet substance dependence criteria and
were used as controls. All participants were assessed via the Changes in Sexual
Functioning Questionnaire, which was edited to be suitable for individuals who
have a history of misusing drugs. The four areas of concern were sexual desire,
sexual satisfaction, sexual arousal and orgasm. The key findings indicated that
all the participants had moderately impaired sexual performance, but that the
results were different depending on what type of substance the participant had
misused. For instance, alcohol appeared to affect erectile dysfunction the
most. Furthermore, the researchers argued that drug abstinence did not lead to
improvement in sexual functioning. This led the researchers to conclude that
the negative sexual side effects of using drugs would potentially not be
temporary and that ceasing to use drugs may not mean that sexual functioning
would improve.
There are many
aspects of the way this study was reported that can be misleading, and we are
somewhat surprised that it reached the publication stage in a peer-reviewed
journal.
The most
important criticism is that the study did not consider cases and controls, but
compared a clinical sample of which some participants met the criteria for
substance dependence and others did not. This implies that all the men in the
facilities were treated for some kind of dependence, but perhaps not the stated
drugs. It is therefore more likely than not that both groups had co-morbidities
that affected their results, which unfortunately was not considered in depth.
Although using
a questionnaire may have circumvented the issues of having patients who were
embarrassed to discuss their problems, it also completely disregarded the
richness the data could have provided for this population. For instance, it is
not uncommon that individuals with substance problems report poly-use of a wide
range of drugs during different stages of their life. This is why a lot of
research in this field is tricky, as it is nearly impossible to disentangle how
all the drugs would have worked together or against each other to create the
side effects they created. Yet this key aspect was not addressed in the report.
Another aspect
of using a questionnaire was that it relied on self-report. Again the researchers
were not able to corroborate the data and most importantly ignored the clinical
context where the study was conducted. It is worth thinking critically about
how a man in an institution would interpret and rate his sexual satisfaction,
given that the likelihood of him having a partner in a clinical centre may not
be too high.
But what
surprised us the most about this study was the conclusion. Although the
researchers stated that their participants had been abstinent for a year, it is
not clear why this would be the cut-off point to consider something to be
permanent. Similarly, many individuals with substance dependence are likely to
have had a relapse or even been to several unsuccessful treatments in the past.
Yet, this was not included in their one-year calculation.
Overall, this was a poorly conducted and
deplorably reported study, which added little value to research into sexual
performance. We are disappointed that such a study was published and cannot see
the benefit of it to clinicians or researchers.