THE EFFECT OF ALCOHOL ON MALE AND FEMALE SEXUAL FUNCTION

In the chronic male alcoholics several mechanisms are involvedin the pathogenesis of the sexual dysfunction that manifestsitself clinically as testicular atrophy, gynaecomastia, impotenceand sterility. Animal studies have distinctly demonstrated theability of alcohol to impair testosterone production and spermatogenesisboth through its direct toxic effects on the testes and throughinterference in the function of the hypothalamic-pituitary-gonadalaxis. The alcohol-induced enhancement of testosterone catabolismalso contributes to the loss of plasma testosterone. Apart frombeing hypoandrogenized, chronic alcoholic men are also exposedto the excessive oestrogen effect that results from the accumulationof oestrogenic hormones, principally from that of oestrone,and from the changes in oestrogen receptors. The role of hyperprolactinaemiain the alterations of sexual function of chronic male alcoholicsis unknown. The significance of liver damage in the pathogenesisof hormonal disturbances is emphasized by the finding that,apart from impairment of spermatogenesis, the hormonal changesseem to be most marked in alcoholic men with liver cirrhosis. Animal studies have again dearly demonstrated the toxicity ofalcohol to female gonads. Consistent with the animal findings,menstrual abnormalities, decreased female sexual characteristicsand sterility associated with ovarian atrophy have been reportedin chronic alcoholic women. The loss of oestrogens and progesteroneprovides the hormonal basis for these changes. In spite of markedhypo-oestrogenization, plasma gonadotropin levels have not beenelevated in chronic female alcoholics, indicating that disturbedregulation of gonadotropin secretion is an important factorin the genesis of ovarian failure in these patients, even ifovarian function may also be directly impaired. Hyperprolactinaemiais not one of the hormonal hallmarks of sexual dysfunction inchronic alcoholic women.