New member with a delicate question my huband is too shy to ask

[Guest guest]

Hi, My name is and my husband Steve was diagnosed with PSC

only in 1999 and has mostly been symptom free except for one

cholangitis episode in 2004 where he was in the hospital.

They said there was mild (grade 1?) virices due to portal hypertension

but nothing has progressed since then. So on to my delicate topic:

E.D. Is there any correlation between PSC or Liver Disease

hypertention and ED? Is there safe treatment? I have heard of Cialis

and Viagra of course, but also Testosterone? Are any of these safe

options? I did do some searching online and found Cialis is NOT safe

for Liver disease, but only this article (more advice it seems) about

Viagra:

http://www.liverdisease.com/sex.html

He's of course totally embarrased about it and won't even talk to the

doctor... I was just hoping for advice even though probably not a easy

thing to discuss. I wonder if insurance pays for prescriptions like

that or are they considered " elective " if they were safe.

Certainly there are worse things that can happen to worry about and

it's not all the time... but it does get him depressed.

thanks,

MR

[Guest guest]

,

PSC affects everyone differently, so for some there is no effect on

the libido, in others the effect is extreme. I think you will find a

very helpful discussion of this subject in the archives started by

Ellen's question on March 14, 2001, message #21434, (is there

something about March that brings this subject forth?) with Maureen's

reply at #21442. Further threads on the same or related topic were

spun off starting at 21520, 21561, 21565 and 21601. The archives may

not answer all your questions, but they will at least give you food

for thought.

Tim R

>

> Hi, My name is and my husband Steve was diagnosed with PSC

> only in 1999 and has mostly been symptom free ... my delicate topic:

> [Erectile Disfunction] Is there any correlation between PSC or Liver

Disease [and E.D.?]

[Guest guest]

Hi ;

I'd be very concerned about the potential risk of variceal bleeding

when taking Viagra with a background of varices and portal

hypertension:

Am J Gastroenterol. 2002 Jul;97(7):1856. Sildenafil (viagra) is a

risk factor for acute variceal bleeding. Tzathas C, Christidou A,

Ladas SD. PMID: 12135063.

Curr Surg. 2005 Jan-Feb;62(1):55-6. Fatal variceal rupture after

sildenafil use: report of a case. Finley DS, Lugo B, Ridgway J, Teng

W, Imagawa DK. PMID: 15708146.

This would be something to discuss with his doctor before taking any

medication of this kind.

Best regards,

Dave

(father of (21); PSC 07/03; UC 08/03)

>

> Is there safe treatment? I have heard of Cialis and Viagra of

course, but also Testosterone? Are any of these safe options? I did

do some searching online and found Cialis is NOT safe for Liver

disease, but only this article (more advice it seems) about Viagra:

[Guest guest]

>Hi ;

> I'd be very concerned about the potential risk of variceal bleeding

> when taking Viagra with a background of varices and portal

> hypertension:

>

- Would you believe the same for Cialis, as they are in same

class of medications?

Joanne

(, Ca; mom of , 16, UC/PSC 2-06)

[Guest guest]

> - Would you believe the same for Cialis, as they are in same

> class of medications?

Hi Joanne;

Yes, I would suspect that Cialis might have the same problems as

Viagra in potentially causing bleeding because they have the same

mode of action. The following two studies indicate that Cialis can

cause nose bleeding, much like Viagra:

______________________________________________________

Acta Otolaryngol. 2005 Mar;125(3):334-5.

Recurrent epistaxis after treatment with tadalafil (Cialis).

Ismail H, Harries PG

Department of Otolaryngology, Southampton University Hospitals,

Southampton, UK. hasnaa@...

A 66-year-old male presented to our department with recurrent

epistaxis. On examination it was not possible to identify the source

of the bleeding, despite various measures. The bleeding stopped

spontaneously each time and advice on nose bleeds was given to the

patient. During a consultation the patient volunteered that the

trigger for the epistaxis appeared to have been energetic sexual

activity. To enhance his sexual performance he had taken Viagra;

however, on stopping the Viagra and changing to the newer drug

Cialis, the episodes of epistaxis continued. We document what we

believe to be the first case of epistaxis caused by Cialis. PMID:

15966709.

______________________________________________________

Int J Impot Res. 2006 Mar-Apr;18(2):213-4.

Epistaxis after PDE-5 inhibitors misuse.

Pomara G, Morelli G, Menchini-Fabris F, Dinelli N, Campo G, LiGuori

G, Selli C

Urology Unit - University of Pisa, S Chiara Hospital, Via Roma, Pisa,

Italy. g.pomara@...

A 32-year-old male presented to our department for recurrent

epistaxis during sexual intercourses. The patient controlled the

bleeding each time with sponge packs and gauzes. During the

consultation, he volunteered that the trigger for the epistaxis

appeared to have been misuse of phosphodiesterase (PDE)-5 inhibitors,

Viagra and Cialis. This first report of epistaxis after PDE-5

inhibitors in a young patient underline the possibility that in the

next years the number of similar cases might increase due to the

diffusion of PDE-5 inhibitor misuse in recreational settings. PMID:

16107867.

______________________________________________________

So I would also be concerned that Cialis might also cause episodes of

esophageal bleeding in persons with varices and/or impaired blood

clotting activity as a result of liver dysfunction.

Best regards,

Dave R.

[Guest guest]

Thanks for the responses. Not sure if he is ready to talk to the docs

about this topic yet. I will do some reading in the messages archive

for the posts Tim mentioned.

On another related subject, the features of Yahoo groups are a bit

outdated compared with today's internet.I am surprised a group like

this is still on Yahoo groups with all the other message board options

out there. Just the ability to have separate sections would be great.

I imagine the transplanted folks have different things to discuss than

the new people, etc, but yet a message board would still be a way to

still be all together, it's the best of both. One cool thing I like

about message boards is the ability to edit your posts. That way if I

say something dumb and want to change it, I can, where here there's no

retraction feature. Anyway, not trying to rock the boat on my first

day here - Thanks again for the advise. What a great resource.

>

> > - Would you believe the same for Cialis, as they are in same

> > class of medications?

>

> Hi Joanne;

>

> Yes, I would suspect that Cialis might have the same problems as

> Viagra in potentially causing bleeding because they have the same

> mode of action. The following two studies indicate that Cialis can

> cause nose bleeding, much like Viagra:

> _________________________________________________

[Guest guest]

,

The forum renewal topic comes up once in a

while. I agree that this forum has not evolved with the new, exciting internet

options. It appears that we got used to this format and are stuck with it.

I have nothing to add about the ED, but I

am glad you are trying to help your husband out with this. In my humble opinion

it is nothing to be ashamed of, just another medical condition or mind set. Sometimes

worrying about something like ED will make it worse. It is harder to " perform "

when you are worried about not being able to. The importance of mindset is

illustrated by women who get pregnant after they decide to adopt a child because

they seem to be unable to get pregnant.

Regards,

Chaim Boermeester, Israel

[Guest guest]

ED is probably more common than is known for men with PSC. I doubt most

doctors, GI and Hepatologists, ask about it. But the liver is involved

in metabolism of hormones and chronic liver disease is known to affect

testosterone metabolism. In addition, chronic liver disease is males

affects testicular function, again leading to decreased testosterone

levels. Combined with the fatigue of chronic liver disease sexual

performance can tank. As mentioned, none of the erectile dysfunction

drugs are safe for anyone with varices. And since testosterone may

increase liver damage it's probably not safe either.

As a side note, your husband should be having regular once at least and

perhaps more often, upper endoscopies to look at his varices. At that

time any larger ones can be banded to prevent bleeding. If he's taking

a beta-blocker for prevention of variceal enlargement, these kinds of

drugs are known to cause ED and sexual performance issues.

The best news is that all of this will resolve after transplant.

Aubrey, MD

PSC '81, UC '90, LTX '98, Recurrence '05