SEXUAL dysfunction in chronic hepatitis B is common, multifactorial, and frequently missed in routine clinical care.
A narrative review found prevalence estimates ranging from 8.6% to 63.1% across heterogeneous studies of hepatitis B virus related disease. In one larger chronic hepatitis B cohort, 25.4% of patients experienced sexual dysfunction, with higher rates among those with poorer liver function, greater fibrosis, and more severe depression.
Sexual Dysfunction in Chronic Hepatitis B Has Multiple Drivers
The review presents sexual dysfunction in chronic hepatitis B as the product of interacting biological, psychological, and social factors. Liver dysfunction may disturb sex hormone metabolism, while chronic inflammation, endothelial impairment, neuropathy, and cardiometabolic comorbidities may further affect sexual response.
In men, erectile dysfunction is the most frequently studied manifestation. Women may experience reduced desire, impaired arousal or lubrication, dyspareunia, and orgasmic difficulties, although female specific evidence remains limited.
Anxiety, depression, concerns about viral transmission, stigma, and relationship strain may also reduce desire and intimacy. Among patients receiving oral antiviral therapy, reported prevalence reached 33.0% for depression and 38.3% for anxiety.
Antiviral Effects Require Careful Interpretation
Available evidence does not show a consistent direct association between nucleos(t)ide analogues and sexual dysfunction. When symptoms develop during therapy, clinicians should assess liver disease progression, hypogonadism, psychological distress, diabetes, and other comorbidities before attributing them to treatment.
Interferon based regimens may contribute indirectly through fatigue and neuropsychiatric adverse effects. However, chronic hepatitis B specific evidence remains limited.
Screening Could Close a Clinical Care Gap
The proposed pathway recommends annual or twice yearly screening using validated instruments, including the International Index of Erectile Function and Female Sexual Function Index. Positive results should prompt a nonjudgmental sexual history and assessment of endocrine, psychological, relational, and lifestyle factors.
Management should be individualized and may include optimizing liver disease control, addressing cardiometabolic conditions, treating specific sexual symptoms, providing psychological support, and encouraging appropriate lifestyle changes. The authors emphasized that several interventions are extrapolated from other chronic disease populations because randomized trials in chronic hepatitis B are lacking.
Future studies should use standardized, sex specific measures and include sexual health outcomes in antiviral trials.
Reference
Muzammal S et al. Sexual dysfunction in chronic hepatitis B: a comprehensive review of pathophysiology, clinical burden, and integrated management. Front Public Health. 2026;14. doi:10.3389/fpubh.2026.1865911.
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