P089 Counselling and monitoring for sexual dysfunction during treatment with isotretinoin: experience of Irish dermatologists
Authors: Herlihy Maeve , Beatty Paula , Field Sinead 
Published: June 2024

Abstract
Isotretinoin is the most effective treatment for severe acne. There are rare reports of sexual dysfunction associated with isotretinoin; however, a causal association has not been shown. In October 2023, the Medicines and Healthcare products Regulatory Agency published updated guidelines with new warnings and monitoring requirements for sexual dysfunction with isotretinoin. The aim of this study was to assess the experience of Irish dermatologists regarding sexual dysfunction with isotretinoin and practices around counselling and monitoring. An online survey was distributed to members of the Irish Association of Dermatologists by email and included questions on experience of sexual dysfunction and counselling practices. Of 135 members surveyed, 48 (35.6%) responded. Of these, 65% were consultants and 35% were specialist registrars or registrars. Over half (52%) treat more than 50 patients annually. The majority (92%) were aware of the updated guidelines. Half of the respondents (n = 24, 50%) do not counsel patients on sexual dysfunction, while one-quarter counsel all patients (n = 12, 25%). For 19% (n = 9), counselling is patient dependent and three (7%) counsel only male patients. Of those who counsel patients, 42% (10 of 24) did so prior to the updated guidelines. Factors that influence counselling include age, whether they are sexually active and gender (male). Most (83%, n = 40) had not experienced patients reporting sexual dysfunction. Vaginal dryness was the most frequently encountered issue (n = 8). Three respondents had patients report erectile dysfunction. None had patients reporting reduced libido or genital hypoaesthesia. Persistence of symptoms after stopping isotretinoin had been encountered by two physicians and two were unsure. Only 6% (n = 3) routinely ask about sexual dysfunction during follow-up and 10% (n = 2) sometimes ask. The potential need for lubrication was regularly advised by four respondents (8%). Themes identified from open-ended questions included a lack of evidence to support causality, overloading patients with information, and potential harm to those who may be deterred from taking isotretinoin. Many expressed that it was difficult to strike a balance between presenting all possible side-effects and overburdening patients with information. This study demonstrates variation in the practices of Irish dermatologists around counselling for possible sexual dysfunction with isotretinoin. Many of those who regularly counsel patients have only started doing so since the guidelines were updated. In this cohort, vaginal dryness was the most common encountered side-effect; however, the possible need for lubrication was not frequently advised. We suggest that this could be incorporated into the discussion on strategies to manage mucosal dryness. Further information on sexual dysfunction, if not discussed, could be incorporated into written information provided to patients. There is a need for further research into this potential side-effect.