Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

90 III. SUBSTANCES OF ABUSEAlcohol consumption has been found to have a negative relationship tophysiological arousal in women. Although women state that they felt morearoused, the physical responses tend to be depressed when alcohol is consumed.Inhibition of ovulation, decrease in gonadal mass, and infertility may followchronic heavy alcohol use.In males, erectile dysfunction may occur transiently with alcohol use, especiallyat blood alcohol levels above 50 mg/100 ml. Decreased libido, erectiledysfunction, and gonadal atrophy are reported in chronic alcoholics (Adler,1992).Chronic male alcoholics, even without liver dysfunction, commonly demonstrateprimary hypogonadism, as evidenced by decreased sperm count andmotility, and altered sperm morphology. Increases in luteinizing hormone and adecrease in the free androgen index were reported in noncirrhotic males andrelated to lifetime quantity of ethanol intake (Villalta et al., 1977).However, a controlled study of abstinent alcohol males selected forabsence of physical illness and use of medications found that sexual dysfunction,level of lutenizing hormone, and level of bioavailable testosterone did notdiffer between the controls and the alcoholics (Schiave, Stimmel, Mandeli, &White, 1995).Normal sexual functioning in abstinent alcoholic men can be expected inthe absence of sexually impairing medications (e.g., disulfiram), liver disease, orgonadal failure.MEDICAL COMPLICATIONS OF ALCOHOLISMGastrointestinal Tract and PancreasSecondary to vitamin deficiencies, alcoholics suffer from inflammation of thetongue (glossitis), inflammation of the mouth (stomatitis), caries, and periodontitis.A low-protein diet, associated with alcoholism, can lead to a zinc deficiency,which impairs the sense of taste and further curbs the appetite of thealcoholic. Parotid gland enlargement may be noted.Alcohol causes decreased peristalsis and decreased esophageal sphinctertone, which leads to reflux esophagitis with pain and stricture formation (Bor etal., 1998). The Mallory–Weiss syndrome refers to a tear at the esophageal–gastric junction caused by intense vomiting. Another source of bleeding fromthe esophagus is esophageal varices secondary to the portal hypertension of cirrhosis.Alcohol decreases gastric emptying and increases gastric secretion. As aresult, the mucosal barrier of the gastrium is disrupted, allowing hydrogen ionsto seep into the mucosa, which release histamine and may cause bleeding.Acute gastritis is characterized by vomiting (with or without hematemesis),anorexia, and epigastric pain. It remains unclear whether chronic alcohol abuseincreases the risk of ulcer disease.