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

Effects on Reproductive Functioning20. Addictive Disorders in Women 441Whereas single doses of alcohol have little effect on sex hormone levels inwomen, chronic heavy drinking leads to inhibition of ovulation, infertility, anda variety of reproductive and sexual dysfunctions (Blume & Zilberman, 2004).Consumption of alcohol by women suppresses both sexual arousal andorgasmic function in a dose–response fashion. The physiological reality is contraryto the widely held cultural belief that alcohol is an aphrodisiac for women(Blume, 1991). This belief often leads alcoholic women to expect that theyneed alcohol to perform and enjoy the sexual act, in spite of their alcoholrelatedsexual problems. The clinician can help such women by explaining thattheir drinking has depressed rather than enhanced their sexual responsiveness,and that in the presence of a loving relationship, they will find sex more enjoyablein recovery than they did while drinking (Gavaler, Rizzo, & Rossaro,1993).Cocaine and amphetamines are widely believed by their users to be sexualstimulants, whereas chronic use is often associated with loss of sexual desire andinhibited orgasm. In addition, cocaine use has been associated with menstrualalterations, galactorrhea, infertility, hyperprolactinemia, and increased levels ofluteinizing hormones in women (Mendelson, Sholar, Siegel, & Mello, 2001).Heroin use has been reported to suppress both ovulation and sexual desire, ashas abuse of sedative drugs (Zilberman & Blume, 2004).Fetal Alcohol and Drug EffectsFetal alcohol syndrome (FAS), a combination of birth defects producing lifelongdisability, is currently estimated to affect about 1–3 infants for every 1,000live births in the United States. FAS is thus among the three most frequentbirth defects resulting in mental retardation, with a prevalence similar to Downsyndrome and spina bifida. A diagnosis of FAS is based on the co-occurrence ofpre- and postnatal growth deficiency, structural facial abnormalities, and centralnervous system dysfunctions, including poor coordination, mental retardation,and/or behavioral dyscontrol. In addition, a wide variety of other birthdefects affecting vision, hearing, and other body systems are often seen in thesechildren. Although the full FAS syndrome is seen almost exclusively in the offspringof alcoholic women who drink heavily (an average of six or more drinksper day) during pregnancy, women who drink at lower levels are at risk for fetalalcohol effects such as miscarriage, low birthweight, birth defects, and behavioralabnormalities (Warren et al., 2001). The prevalence of fetal alcoholeffects is thought to be many times greater than that of FAS.Fetal damage is also associated with other drug use and abuse (Singer et al.,2002). Cigarette smoking during pregnancy is implicated as an important factor