Sexually Transmitted Diseases and Sexual Function Hossein Sadeghi-Nejad, MD,* Marlene Wasserman, BA, MA, DHS, † Wolfgang Weidner, MD, ‡ Daniel Richardson, BSc, MRCP, § and David Goldmeier, MD ¶ *UMD New Jersey Medical School, Newark and Hackensack University Medical Center, Hackensack, NJ, USA; † Sexual Health Center, Cape Town, South Africa; ‡ University of Giessen, Urology, Pediatric Urology and Andrology, Giessen, Germany; § Royal Sussex County Hospital, and Genitourinary Medicine, Brighton, UK; ¶ Imperial College NHS Trust at St Mary’s Hospital, London, UK DOI: 10.1111/j.1743-6109.2009.01622.x ABSTRACT Introduction. There is a need for state-of-the-art information in the area of sexually transmitted infections (STIs) in relation to sexual function. There are an estimated 60 million people living with and 340 million with treatable STIs. Surveys show sexual problems to be as high as 35% for men and 55% for women; however, there is little research directly assessing relationships between infection and sexual function. Aim. To show that STIs are associated with (and may cause) sexual dysfunction. Conversely, sexual dysfunction can increase patients’ risk of STI acquisition. In men, erectile dysfunction (ED) associated with condom use may lead to unsafe sexual practices and, hence, STI acquisition. The role of various therapies including phosphodiesterase type 5 inhibitors in the treatment of ED in positive men taking social drugs will be explored. Methods. To provide state-of-the-art knowledge concerning sexual function and STIs, representing the opinions of five experts from four countries developed in a consensus process and encompassing a detailed literature review over a 2-year period. Main Outcome Measure. Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. Results. This article highlights major factors causing the spread of STIs and suggests management interventions to prevent further spread of HIV/STIs, focusing on the juxtaposition between STIs and sexual functioning. Women’s unique vulnerabilities to HIV/STIs (biological and physiological issues, gender-based violence, gender inequity) and their impact on women’s sexual function are reviewed. Similarly, men’s unique vulnerabilities to HIV/STIs including condom use, disclosure, voluntary counseling and testing, multiple concurrent sexual partners, and recreational drug use—particularly in homosexual men—are explored, as is the association of prostatitis and sexual function. Lastly, the article reviews the relationship between circumcision and sexual dysfunction. Conclusions. A multidimensional approach to achieve optimal treatment outcomes should be embraced. Sadeghi- Nejad H, Wasserman M, Weidner W, Richardson D, and Goldmeier D. Sexually transmitted diseases and sexual function. J Sex Med 2010;7:389–413. Key Words. Sexually Transmitted Disease; Sexual Dysfunction; Treatment Introduction I t is a reasonable assumption that people who contract sexually transmitted infections (STIs) do not have sexual dysfunction and that those who are dysfunctional would not have the capacity to develop STIs. In this review, we have put forward what we believe is a raft of compelling scientific evidence showing that these realms do, in fact, interact, often in causative fashion. Because sexual dysfunction symptoms may be found in up to half of nonbiased population studies and the rates of STIs are measured in tens of millions, these issues potentially affect a sizeable proportion of sexually active men and women in most countries. To date, a systematic and broad review of the interaction of these two major themes has not been under- taken, but with the spread of HIV and other STIs 389 © 2010 International Society for Sexual Medicine J Sex Med 2010;7:389–413