How Medications can impact sexual abilities

Everyone, at some point in time will become sick, injured, or in dire need of a boost to their immune system. For so many, side effects keep many concerned and up at night. Nobody wants to take prescribed medication, deemed necessary from your primary care physician and experience adverse side effects. This is a safe space, we’ll strictly discuss the avalanche of prescription medications and side-effects not your personal life - someone’s mom is reading!

So what is a person to do!? We end up feeling as if we are trapped in a corner, or worse, frozen in place as we read the medication label. Depending on the severity of the cause of needing the medication we may not even care about side effects as we just want to feel like our best selves, is that too much to ask for 🥺?

Dear Mike, 

My question is simple and to the point, how do medications impact sexual abilities?

Sincerely,

Stuck between medication & sexual stimulation

For this question, we prescribe you to read what Feeling Seen Friend, psychopharmacologist, speaker, and entrepreneur Dr. Bryan K. Sackey has to say about the importance of knowing medications and their side-effects:

Medications! What’s the deal with them?

Ah yes medications, life’s most critical double edge swords. Medications are an inevitable part of our lives and quite frankly, our survival. Many centuries ago, medications were introduced as a pivotal tool in fighting against many of the ailments that would otherwise claim our lives or greatly impact our daily functioning. But as we all know, NOTHING we consume in this world (including our beloved naturally occurring herbal products) comes without some kind of undesired effect. Enter SIDE EFFECTS. Side effects are like that wonderful boyfriend/girlfriend who brings you so much fulfillment in your life but has a bad habit of leaving their clothes everywhere or never cleaning up after themselves (*sigh*).

Now let me be clear, even as a medical provider, I value preventive health the most and doing everything we can to keep our bodies upright (I.e. our exercise and diet habits). Nonetheless, medications are there for moments when we need extra assistance in efforts to keep us alive and thriving. But now you may ask, “Well is it worth it if my sex life is compromised in any way???” The quick answer is YES. The reality is you can never reach the pinnacle of your sex life if you’re not 100% healthy. 

As a clinical psychopharmacologist, I’m going to focus on antidepressants here which is a notorious class of medications when considering sexual side effects. It has a lot of my patients in fear of taking them where they would often try to rationalize the situation by saying things like “Is my mind bad enough to compromise the sex?” Well, I’m here to tell you there are a lot of misconceptions in this area and you can very well protect both.

Our Mental Health and Sex

We can start by referring to a statement I made above: “You can never reach the pinnacle of your sex life if you’re not 100% healthy”. That includes being mentally healthy as well. So that means that before we even jump into the medications, it’s important to know that depression, anxiety, and many other mental health conditions itself can cause sexual dysfunction and low libido (our sex drive). In fact, according to a study published in American Family Physician, 70% of adults facing depression had problems with libido when they avoided treatment. To put it into further context, some of the “sexually activating” chemicals in our body (dopamine and norepinephrine) tend to also be low in the presence of depression and anxiety. So this can explain why when you’re feeling down (say grieving the death of a loved one), you’re probably not looking to get intimate (if so you may need to look into that). Ultimately, our mental health is a critical aspect of our wellbeing which continues to impact over 25% of the US population with suicide being a top 10 leading cause of death. So in other words, the side effect of NOT treating your mental health can not only include sexual dysfunction but also death. Other medical conditions that may lead to sexual dysfunction or libido include diabetes, heart disease, thyroid conditions, substance abuse, emphysema, sleep loss, chronic pain, recent surgery, and cancer.

Mental Health Medications and Sexual Effects

Ok now that we’ve discussed the condition itself, how do we preserve our sexual health while also protecting our mental health when some of the treatment options can potentially worsen libido? Ok so let’s further break that down, but first a couple of disclaimers:

1. Not all antidepressants can cause sexual dysfunction (in fact some can boost it but more on that later)

2. Even though medication has the potential to cause sexual side effects, that does not mean YOU will automatically experience it and that’s because our genetics play a role in how you respond to medication in general

Now when we say “sexual dysfunction” what exactly are we referring to? No, it does not mean your genitals will explode and start malfunctioning. Here are the potential sexual effects we may see with medications in general:

1. Lowered libido (decreased desire to have sex)

2. Anorgasmia (difficulty achieving orgasm)

3. Delayed ejaculation (longer time to finish)

4. Erectile dysfunction (inability to achieve and maintain an erection; reduced arousal & lubrication in women)

Overall about 50% of individuals on antidepressants complain of some form of sexual side effects. Of note, they do NOT affect testosterone levels contrary to random online searches. Now I’m going to get into some pretty geeky stuff here but bear with me (trust me it’s important). So with many antidepressants, the main reason for some of the effects above is their action to increase the levels of the chemical serotonin (Which is their main method of resolving depression hence that double-edged sword thing again). The main group of antidepressants that do this is Selective Serotonin Reuptake Inhibitors or SSRIs. Serotonin mainly delays the time from arousal to orgasm and so delayed ejaculation is often what we see with these medications….which may be desirable for those who deal with premature ejaculation or sexual performance anxiety leading to early ejaculation. However, the other side of this may be relationship issues and potential accusations of infidelity by their partner if an individual has trouble finishing during sex (“Oh so I don’t turn you on anymore huh?!”). Now remember, not all antidepressants work by increasing serotonin, hence why I mentioned earlier that not ALL antidepressants cause sexual issues. 

Remember when I mentioned dopamine can enhance sexual functioning and arousal? Well, guess what, certain antidepressants do just that through their activity in the brain (the drug Bupropion aka Wellbutrin®). Some antidepressants/anti-anxiety medications can minimize the sexual effects of serotonin which can include Mirtazapine (Remeron®) and Buspirone (Buspar®).

1. The overall risk of sexual side effects for serotonin-based antidepressants ranges from 15% to 80%

1. The risk of decreased libido occurring is about ~54%

2. The risk of delayed ejaculation or anorgasmia occurrence is about 36%

3. The risk of erectile dysfunction occurrence is about 37%

2. Other psychiatric medications associated with sexual issues include Risperidone (Risperidal®), Quetiapine (Seroquel®), Clozapine (Clozaril®), Olanzapine (Zyprexa®), Diazepam (Valium®), Lorazepam (Ativan®), Clonazepam (Klonopin®)

Other notable nonmental health medications that may cause sexual side effects include certain blood pressure medications (like propranolol), oral contraceptives (estrogens and progestins), certain acid reducers (i.e. Zantac®), and pain meds like Motrin® and Opioids. Overall, their risk of occurrence all differ and it is important to talk to your doctor about them.

Protecting Our Sexual Life While on Medications

Alright now that we are all experts on some of the medications (and conditions) to look out for, how do we best manage it? Here are some tips for reducing sexual issues from medications:

1. Talk to your doctor about the importance of your sexual health when being prescribed medications

2. Be sure to communicate with your partner in regards to medications you’re on that can affect sexual performance in efforts to prevent false accusations (i.e. infidelity or loss of interest in your partner)

3. Ask your doctor to generally start at lower doses and slowly increase to see if effects occur (remember that not everyone will experience sexual side effects)

4. Ask your doctor about medications or herbal products that may minimize sexual side effects:

1. Viagra® or Cialis® helps with erectile dysfunction

2. If appropriate, consider Wellbutrin® or Remeron® as the antidepressant choice as opposed to SSRIs (Wellbutrin may also be added to SSRIs to minimize sexual side effects)

3. Herbal products that may improve sexual health (be sure to talk to your doctor or medical experts before trying): Maca Root, Ashwagandha, Ginseng, DHEA, Yohimbe, Ginkgo Biloba, Epimedium Sagittatum (Horny Goat Weed powder), Tongkat Ali 

5. Focus on treating underlying conditions which can cause sexual issues (i.e. resolving depression can improve libido)

6. Check testosterone levels (males) to rule that out as a cause of sexual issues

7. Take care of your body: 

1. Get regular exercise (at least 3x a week for 60 minutes)

2. Eat a healthy diet rich in vegetables and lean proteins; avoid foods that contain excess sugar and saturated fats

3. Obtain at least 7-8 hrs. of sleep per night

4. Avoid overconsumption of alcohol and other hard drugs (like narcotics and cocaine)

So in summary, medications can be a double edge sword in that they can truly save lives but also cause unwanted side effects including impacting our sexual health. The area of mental health is often one in which this dilemma arises particularly when considering the medications. However, the good news is that there are several ways to minimize medication-related sexual issues which includes treating the underlying condition itself. Cheers to healthy minds, healthy bodies, and healthy sex!

Reference source: 

1. Am Fam Physician. 2000;62(4):782-786

2. Lancet. 2007;369:409-424.

3. Clin Psychiatry 2002; 63:357-366

Note: This content is only for informational and educational purposes and should not be considered therapy or any form of treatment. I cannot respond to personal requests for advice over the Internet. Best on your continued journey.

Copyright Dr. Bryan K. Sackey, PharmD, BCPS, BCPP

Dr. Bryan K. Sackey, PharmD, BCPS, BCPP, is a board-certified clinical psychiatric pharmacologist, Mental Health Coach, speaker, and Adjunct Assistant Professor at the UT College of Pharmacy. He is nationally recognized for his work in mental health and community outreach in underserved populations through his initiative Your Mind is Our Business (YMOB.org | @yourmind.ourbusiness) along with various other national and global organizations including Pharmacy Initiative Leaders (@pilsconnect) and The Distant Relatives Project.