Yes, something can be done. Your partner should visit his physician to determine whether another antihypertension medication would treat his high blood pressure without causing sexual dysfunction. There very well may be other choices that will work.

If your physician is not an expert on the sexual side effects of many blood pressure medications on the market, you may want to point him or her to Sexual Pharmacology: Drugs That Affect Sexual Function, by Dr. Theresa Crenshaw and James Goldberg, PhD. It's a thoroughly referenced textbook that analyzes most medications available at the time of its publication in 1996. It also can assist in assessing the sexual side effects of drugs developed since then.

If your partner wants to have an informed discussion with his physician, he should know how the different classes of antihypertension drugs attack the problem. Here are the principal drug groups and a basic explanation of how they work:

• Diuretics: These decrease blood pressure by eliminating extra fluid from your body. Less fluid in the bloodstream leads to lowered blood pressure.
• Beta-blockers: Your body naturally releases adrenaline when you're excited or active, and the adrenaline binds to beta receptors on muscle cells. This causes arteries to constrict, which in turn leads to higher blood pressure. Beta-blockers block these receptors from binding with adrenaline, which allows blood vessels to open wider.
• Calcium channel blockers: When muscles contract, calcium moves into cells. When this movement is blocked, muscles surrounding the artery walls relax, causing them to remain open. When your arteries are dilated, your blood pressure goes down.
• Angiotensin converting enzyme inhibitors: ACE is a protein that activates a hormone called angiotensin. This hormone makes your blood vessels constrict, resulting in increased blood pressure. By inhibiting this enzyme with medication, you can drop your blood pressure.
• Angiotensin blockers: These drugs lower blood pressure by blocking the angiotensin hormone directly, rather than working indirectly through the enzyme.

Antihypertensive medications were the first medications recognized as having sexual-dysfunction side effects. So doctors have known about the problems associated with some of these drugs for a long time. Before you run off to your doctor with a list of alternate drugs in hand, however, you should know that the research done on these side effects has some problems. If you're aware of the following limitations that make our knowledge about this topic less than perfect, your doctor likely will take your suggestions more seriously:

• Studies that last less than six months may not uncover sexual side effects that only set in after half a year on medication. Some researchers may have incorrectly concluded that there was no problem with various drugs because they used a shorter trial period.
• Sexual partners are not routinely included in research, though they should probably be questioned to corroborate the statements of the patient taking the medication. Some patients underestimate their actual difficulties and others overestimate.
• Sexual dysfunction related to the disease itself may not have been distinguished from the sexual side effects of the medication.
• Masturbation is seldom studied, though it would be a very reliable source of sexual side effect information.
• Imprecise terminology and euphemistic language may have obscured the sexual side effects or may have blurred several sexual problems into one.
• The use and abuse of alcohol and other recreational drugs can affect sexual functioning, too (see Alcohol Abuse and Drug Abuse). Some studies don't assess those factors.

Nevertheless, sexual scientists are reaching accurate conclusions about which medications probably cause sexual problems and which probably do not. Combining data from two sources -- the Crenshaw and Goldberg book mentioned above and Prescription Drugs With Adverse Effects on Male Sexual Functioning, John Buffum's appendix to Bernie Zilbergeld's book, The New Male Sexuality, -- allows us to make our best assessment of the current crop of antihypertensive medications.

Erection difficulties are a definite possibility when taking these:

• Diuretics: bendroflumethiazide (Naturetin), chlorothiazide (Diuril), chlorthalidone (Hygroton), furosemide (Lasix), hydrochlorothiazide (Hydro Diuril) and spironolactone (Aldactone).
  Diuretics that have not yet been found to cause problems with erections: benzthiazide (Exna), bumetanide (Bumex), cyclothiazide (Anhydron), hydroflumethiazide (Diucardin, Saluron), indapamide (Lozol), methyclothiazide (Enduron), metolazone (Diulo, Zaroxolyn), polythiazide (Renese), quinethazone (Hydromox), torsemide (Demadex) and trichlormethiazide (Metahydrin, Naqua).

• Beta-blockers: acebutolol (Sectral), atenolol (Tenormin), bisoprolol (Zebeta), carteolol (Cartrol), carvedilol (Coreg), labetalol hydrochloride (Normodyne, Trandate), metoprolol tartrate (Lopressor, Toprol XL), nadolol (Corgard), penbutolol (Levatol), pindolol (Visken), propranolol (Inderal), sotalol (Betapace) and timolol (Blocadren). The beta-blocker that does not cause erection problems is betaxolol (Kerlone, Betoptic).

• Calcium channel blockers: amlodipine (Norvasc), bepridil (Vascor), diltiazem (Cardizem), felodipine (Plendil), nifedipine (Procardia) and verapamil (Calan, Isoptin).
  Those that have not been found to cause erection problems: isradipine (Dynacirc), nicardipine (Cardene), nimodipine (Nimotop) and nisoldipine (Sular).

• ACE inhibitors: captopril (Capoten), enalapril maleate (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), quinapril (Accupril) and ramipril (Altace). So far, all ACE inhibitors have been found to cause erection difficulties.

• Angiotensin blockers: Losartan (Cozaar) causes erection difficulties. Valsartan (Diovan) does not, but it does cause decreased sexual desire.

Since all but one of the major groups contain at least one medication that hasn't caused erection problems in research studies, there are probably many possible choices for your partner.

Of course, it also would be wise (for both sexual reasons and general good health) for him to make whatever lifestyle changes possible to reach his desired blood pressure outcome with the lowest level of medication possible. Share this information about medications with him and see what he is willing to do to enhance his experiences during sex.

Louanne Cole Weston, PhD, author of Sex Matters®, is a licensed marriage, family, and child counselor and a board-certified sex therapist in practice since 1983. Her work in the field of human sexuality includes extensive experience as a therapist, educator, and researcher.

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