My husband is 25 and has Tourette's Syndrome. He is unable to maintain
an erection. I am wondering if this is a side-effect of his disorder.
We have tried Viagra and don't like it because the increased blood
flow makes his face very red and hot. Should we see a neurologist?
What might be causing this problem? Our marriage is suffering. Thank
you very much for any answers.

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Request for Question Clarification by librariankt-ga on 10 May 2004 08:37 PDT

Hi Sewing101 -

Is your husband on any medications for the Tourette's?  This may have
an effect - if you let us know if/what he's taking that would help us
answer your question.

- Librariankt

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Clarification of Question by sewing101-ga on 11 May 2004 13:34 PDT

He is on no medication. The side effects from medication do not
outweight the benefits. He has not taken medication since he was a
child. I do agree that he has anxiety about sex. Would anti-anxiety
medicine be beneficial? A friend of mine takes Paxil and I know that
it has an adverse sexual effect. We would prefer to take a more natual
approach.
What I really wanted to know was if this is a normal side effect for
Tourette's. Is it treatable? Thank you again.

Hi Sewing101,

As Northtrade2003 noted below, selective serotonin reuptake inhibitors
(SSRIs), which are standard drug treatments for Tourette's, are known
to have impotence  as a side effect.  Since your husband isn't taking
any drugs, we can rule that out as a cause.

I have not been able to find materials that list erectile dysfunction
as a major link with Tourette's Syndrome.  However, since both ED and
Tourette's are neurological disorders I have to say I'm not all that
surprised.  What's more, his stress over the TS may be contributing to
his problem.  Here's a quotation from the very informative Tourette
Syndrome Fact Sheet from the National Institute of Neurological
Disorders and Stroke:

"Although the basic cause of TS is unknown, current research suggests
that there is an abnormality in the gene(s) affecting the brain's
metabolism of neurotransmitters such as dopamine, serotonin, and
norepinephrine. Neurotransmitters are chemicals in the brain that
carry signals from one nerve cell to another."
(http://www.ninds.nih.gov/health_and_medical/pubs/tourette_syndrome.htm)

What's more psychological tension is a known "side effect" (for lack
of a better term) of TS, and tension is a known cause of ED.  A lot of
people with TS have other disorders including obsessive compulsive
disorder and ADHD.  All this is to say that the evidence points to TS
as often ocurring in tandem with other neurological problems and
psychological problems.

As for your question about anti-anxiety medication, I'd strongly urge
you to discuss it with his doctor.  Paxil and many of the other drugs
used for anti-anxiety and "social anxiety" are SSRIs, which I
mentioned above.  MedMaster (a drug guide available for free online)
mentions that "changes is sex drive or ability" is a known side
effect: http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a698032.html

The Tourette Syndrome Assocation suggests psychotherapy and
biofeedback as ways to address the stress and anxiety that TS may
engender (http://www.tsa-usa.org/ - click on "What is TS?").  Another
resource for you is the information on Tourette's from We Move:
http://www.wemove.org/ts/

So, to sum up: I did not find that impotence is a major side effect of
Tourette's Syndrome.  I did find that TS is often associated with
behavioral and neurological problems.  I found that psychotherapy can
be helpful for dealing with these problems.  My strong recommendation
to you is that you talk to your husband's doctor about this issue. 
This is a serious issue (as you well know) and something the doctor
should know about - not just because it can wreck your marriage if
left unfixed but also because it could indicate some other medical
problem for your husband.

I found the above information by going to the MedlinePlus consumer
health index from the National Library of Medicine
(www.medlineplus.gov) and looking at the resources they list for
Tourette Syndrome (http://www.nlm.nih.gov/medlineplus/tourettesyndrome.html).
 You might find some of those pages helpful as well.  The information
on Paxil comes from MedlinePlus' drug information pages.

I wish you the best of luck.  Please feel free to ask for a
clarification if anything here is unclear or if you'd like more
information.

- Librariankt

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Request for Answer Clarification by sewing101-ga on 12 May 2004 10:16 PDT

Thank you for your answer. We have no medical insurance at the moment,
but are working on getting some. Your answer was very good. My only
other question is where can I find a list of anti-anxiety drugs that
are not SSRIs? Thank you.

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Clarification of Answer by librariankt-ga on 12 May 2004 20:24 PDT

Just wanted to leave a quick note that I've gotten your follow-up
request and am working on it. - Librariankt

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Clarification of Answer by librariankt-ga on 13 May 2004 20:56 PDT

Hi Sewing101 -

I found a chart detailing various medications for anxiety disorders
that separates the medications by type.  There are a lot that aren't
SSRI's - but note that a bunch still have sexual side effects.  Here's
the link:

Anxiety Disorders Assocation of America: Medications
http://www.adaa.org/AnxietyDisorderInfor/Medications.cfm
(click on "Chart")

Also, you may find the other resources on this page helpful, including
the "Self-Help Tools" (they have links to support groups in all 50
states and several non-US countries).

I found this page by going to the MedlinePlus topic area for Anxiety:
http://www.nlm.nih.gov/medlineplus/anxiety.html.  You may also find
the resources on the MedlinePlus topic page for Stress helpful:
http://www.nlm.nih.gov/medlineplus/stress.html

Good luck!

- Librariankt

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Clarification of Answer by librariankt-ga on 13 May 2004 20:57 PDT

I forgot to mention that if you'd like to look up the side effects,
dosage, etc. of any drug on the market a great place to do it is the
Drug Information section of MedlinePlus (honestly, if the National
Library of Medicine were a for-profit entity I'd ask for a fee for
every time I recommend their site!):
http://www.nlm.nih.gov/medlineplus/druginformation.html

- Librariankt

Hi sewing101

Medication if its an SSRI can effect erectile dysfunction, however
anxiety connected to Tourettes can also cause dysfunction and this
needs to be differentiated.
More information at http://www.bigsplace.com/

Your husband might want to ask his physician about BuSpar (buspirone
HCl). This is an anti-anxiety medication that does not usually have
sexual side effects.

As others have noted, each psychiatric medication has different side
effects.  In addition, side effects vary widely from person to person.
 Some may suffer greatly from sexual side effects, while others don't
experience them at all.  As with all psychiatric medications -
particularly those that control or affect Serotonin levels - it is
often necessary to try a number of different ones (or combinations of
different ones) before a good solution is found.

There have been dramatic improvements in SSRIs and related medications
over the past several years, and there are also alternatives to that
class of drugs.  Some medications that aren't on the "officially"
recommended lists for treatment of particular problems are
nevertheless useful - and prescribed - for those problems. 
Experienced psychiatrists who specialize in OCD, Tourette's, clinical
depression, and related disorders have often done a certain amount of
trial-and-error on other patients, and have figured out some good
alternatives.  If your husband has not tried Tourette's medication
since childhood, it probably wouldn't hurt to give it another shot,
since medication changes and improves so rapidly.

As others have said, there is also the possibility that the problem is
psychological in nature (stress, embarrassment, depression), or is due
to some other physiological cause.  One thing that urologists often
ask new ED patients is whether or not they experience spontaneous (or
morning) erections while asleep.  If they do, the problem is often
(though not always) psychological in nature, or related to anxiety,
depression, or stress.  If the patient does not experience nocturnal
(or morning) erections, then a stronger (though not definite) case can
be made for a physiological cause.

There are a number of ways that a urologist can help to treat erectile
dysfunction, including variations on vacuum pumping.  If you don't
have health insurance, check with your local Mental Health county
office (if you're in the U.S.) - they can do intake interviews and get
him set up to talk to someone about the issues at a rate he can afford
(or for free).  It wouldn't hurt to join local Tourette's and ED
support groups, either, or even subscribe to mailing lists that focus
on those issues - invariably you can find someone else who has
experienced similar problems and has worked out a solution (or
workaround) to them.

I have lifelong (since early childhood), clinical-level OCD, and
generally have some erectile dysfunction from the various medications
I have tried.  I eventually found the right medication combination -
the ED comes and goes, but doesn't interfere greatly with my
relationship, and the benefits of the meds outweight the drawbacks. 
It took years to find a combination that worked well with my
particular biochemistry, but it was well worth the effort and time to
do so.

- Jesse