Abstract：
Sexual dysfunction is common in patients with advanced cancer, although it is frequently belittled, and thus consistently underdiagnosed and untreated. Opioid analgesics remain fundamental and are widely used in cancer pain treatment. However, they affect sexual functions primarily due to their action on the hypothalamus-pituitary-gonadal axis. Other mechanisms such as the impact on the central and peripheral nervous systems are also possible. The opioid-induced sexual dysfunction includes erectile dysfunction, lack of desire and arousal, orgasmic disorder, and lowered overall sexual satisfaction. Around half of the individuals taking opioids chronically may be affected by sexual dysfunction. The relative risk of sexual dysfunction in patients on chronic opioid therapy and opioid addicts increased two-fold in a large meta-analysis. Opioids differ in their potential to induce sexual dysfunctions. Partial agonists and short-acting opioids may likely cause sexual dysfunction to a lesser extent. Few pharmaceutical therapies proved effective: testosterone replacement therapy, PDE5 inhibitors, bupropion, trazodone, opioid antagonists, and plant-derived medicines such as Rosa damascena and ginseng. Non-pharmacological options, such as psychosexual or physical therapies, should also be considered. However, the evidence is scarce and projected primarily from non-cancer populations, including opioid addicts. Further research is necessary to explore the problem of sexuality in cancer patients and the role of opioids in inducing sexual dysfunction.
摘要：
性功能障碍在晚期癌症患者中很常见，尽管它经常被轻视，因此始终未被诊断和治疗。阿片类镇痛药仍然是基础，广泛用于癌症疼痛治疗。然而,它们影响性功能主要是由于它们对下丘脑-垂体-性腺轴的作用。其他机制，例如对中枢和周围神经系统的影响也是可能的。阿片类药物引起的性功能障碍包括勃起功能障碍，缺乏欲望和唤醒，性高潮障碍,降低了整体的性满意度。大约一半的长期服用阿片类药物的人可能会受到性功能障碍的影响。在一项大型荟萃分析中，慢性阿片类药物治疗和阿片类药物成瘾者性功能障碍的相对风险增加了两倍。阿片类药物在诱发性功能障碍方面的潜力不同。部分激动剂和短效阿片类药物可能在较小程度上引起性功能障碍。很少有药物疗法被证明是有效的：睾酮替代疗法，PDE5抑制剂，安非他酮,曲唑酮,阿片类拮抗剂，和植物衍生的药物，如罗莎和人参。非药物选择，比如性心理或物理治疗，也应该考虑。然而,证据很少，主要来自非癌症人群，包括阿片类药物成瘾者。需要进一步研究以探讨癌症患者的性行为问题以及阿片类药物在诱发性功能障碍中的作用。
