Whether prescribed by a doctor or bought over-the-counter, it’s a given that certain medications will cause side-effects like dizziness, drowsiness or constipation. But some drugs can affect you in other, more complex ways – including in the bedroom.
There are a myriad of ways meds can cause sexual dysfunction. Some might sap your libido, while others can interfere with your ability to orgasm or cause pain during sex. What’s more, the more medications you take, the greater risk of sexual side-effects.
We spoke to Dr Daniel Cichi, Senior GP at Doctors-4-U, Reece Samani, pharmacist at Signature Pharmacy, and Dr Deborah Lee, sexual and reproductive healthcare specialist at Dr Fox Online Pharmacy, about the key pillars of sexual dysfunction, the main medicinal culprits to watch out for and the next steps if you’re concerned about the side-effects of your medicines:
What is sexual dysfunction?
Sexual dysfunction is the term used to describe a range of conditions that prevents a person gaining pleasure from sexual activity, Samani advises. This may mean you’ve lost interest in sex or no longer enjoy it. You may be physically unable to have sex, or struggle to experience physical pleasure.
For men and people with penises, sexual dysfunction conditions can include:
Erectile dysfunction: having difficulty getting or maintaining an erection over a period of weeks or months.
Premature ejaculation: ejaculating within a minute or less of vaginal penetration, or being unable to control the timing.
Loss of libido: where a person has a lack of sexual drive, thoughts or fantasies, and sometimes a complete aversion to sex.
Retrograde ejaculation: when semen enters the bladder instead of emerging through the penis during orgasm – sometimes called a ‘dry’ orgasm, because little or no semen is ejaculated.
For women and people with vulvas, sexual dysfunction conditions can include:
Loss of libido: a lack of sexual drive, thoughts or fantasies, and sometimes a complete aversion to sex.
Anorgasmia: the inability to have an orgasm despite adequate clitoral stimulation.
Painful sex: experiencing pain at the time of initial vaginal penetration or at some point afterwards.
Arousal disorder: where a person does not respond to stimuli involved in sexual arousal, including adequate lubrication and genital swelling.
‘It’s important to note that sexual problems can be a one-off occasion,’ says Dr Cichi. ‘It becomes a disorder when this is a regular occurrence. Some people may also be sexually satisfied without reaching orgasm – it isn’t sexual dysfunction if you’re satisfied with sex.’
However, if sexual dysfunction becomes ‘frequent, persistent and is causing distress, and stress on a relationship,’ Dr Lee advises, that’s when you ought to seek medical advice.
If your sexual desire is persistently low and it is causing significant problems for you or your relationship, a doctor may diagnose hypoactive sexual desire disorder (HSDD). ‘HSDD has a major effect on your quality of life,’ Dr Lee adds. ‘It is associated with unhappiness, lower levels of satisfaction with your partner, and negative emotions. Many people are embarrassed and feel they have nowhere to turn, such that HSDD is often undiagnosed and untreated.’
How do medicines affect sexual function?
Difference medications can affect your sex life in several ways. They may act directly on hormones involved in sexual function, or indirectly – by causing fatigue, weight gain or confusion, for example. Some of the direct mechanisms include:
Acting centrally on your brain function, affecting your overall desire and energy levels.
Acting on your autonomic nervous system (ANS), which controls bodily functions like heart rate, digestion, and temperature.
Altering levels of neurotransmitters like adrenaline, noradrenaline, dopamine and serotonin, which act as chemical messengers for the ANS.
Lowering levels of reproductive hormones, such as oestrogen, progesterone, and testosterone.
However, these causes are as varied as the drugs themselves. ‘Antihistamines and decongestants have been known to cause impotence in men,’ says Dr Cichi, because they block the release of histamine, which is essential for healthy erections. Medicines that treat high blood pressure can also interfere with erections, ‘because of their actions on the blood vessels and nervous system,’ he continues.
It can be tricky to determine whether a particular medicine is to blame, because many diseases also affect sexual function – as can external factors, like stress. Establishing whether sexual dysfunction is due to the condition, the medicine used to treat it, or something else entirely, is easier said than done.
Additionally, sexual side-effects aren’t typically reported to doctors – either because the patient is embarrassed, or because they haven’t made the link between the two. This means the true rate of sexual dysfunction caused by medicines may be far higher than reported.
Medicines that can affect sexual function
There are a huge variety of medicines that can cause sexual dysfunction – though as with any drug, side-effects vary from person to person. These include:
Antihistamines work by blocking the production of histamine, the chemical produced during allergic reactions. ‘Antihistamines prevent the production of histamine by blocking the action of acetylcholine; a natural chemical that controls the parasympathetic nervous system,’ says Samani. ‘This anticholinergic action can lead to erectile dysfunction in men.’
Furthermore, he says, certain antihistamines cross the blood-brain-barrier, which means they can cause sedation and in turn a loss of libido.’ And that’s not all. ‘Antihistamines are commonly taken as proprietary remedies for colds and flu, which often also contain decongestants such as pseudoephedrine,’ says Dr Lee. ‘Pseudoephedrine is known to cause blood vessels to constrict and can suppress erections.’
• Non-steroidal anti-inflammatories (NSAIDs)
Non-steroidal anti-inflammatories such as ibuprofen, naproxen, and aspirin prevent the production of prostaglandins, says Dr Lee. ‘Prostaglandins play an important role in producing an erection as they cause powerful vasodilation, she says. ‘Hence, regular use of NSAIDs may interfere with erectile function.’ Studies to prove this have had mixed results.
Selective serotonin re-uptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), and tricyclic antidepressants are commonly associated with sexual dysfunction. ‘It’s unclear exactly why SSRIs can reduce sexual function, however, it may be due to the fact there are interactions between serotonin, dopamine, and testosterone,’ says Dr Lee. ‘Dopamine levels are important for sexual arousal, and testosterone is needed for orgasm.’
While there are eight different types of antihypertensives, all are used to lower the pressure inside your blood vessels. ‘This can be achieved by widening the arteries, reducing blood volume by excreting salt and water, and direct action on reducing the heart rate,’ says Samani. ‘ Sometimes drugs will target a combination of these.’
Sexual dysfunction can develop as a direct result of reduced blood flow. This might present as erectile dysfunction in men. ‘For women, the reduced blood flow could reduce the amount of natural lubrication produced – or reduce pleasure, which can lead to difficulty achieving an orgasm,’ he says. Additionally, beta-blockers can also lower testosterone levels, as well as affecting nitric oxide production, says Dr Lee.
• Antipsychotic drugs
Antipsychotic drugs, such as risperidone, thioridazine and haloperidol, are well known to reduce sexual function, says Dr Lee. ‘This is because they block dopamine and histamine receptors, raise prolactin levels, and increase levels of sedation,’ she says.
Other common culprits include, but are not limited to:
Anti-epileptics: the main type of treatment for most people with epilepsy.
Anxiolytics: a category of drugs used to treat anxiety.
H2 blockers: reduces the amount of acid produced in the stomach to treat acid reflux and ulcers.
Antiandrogens: also known as androgen antagonists or testosterone blockers.
Antiarrhythmics: prevent and treat abnormal heartbeats (arrhythmias).
Benzodiazepines: a class of sedative used for both sleeping problems and anxiety.
5-alpha-reductase inhibitors: a group of drugs used in the treatment of an enlarged prostate gland and male pattern hair loss.
Statins and fibrates: reduces the body’s cholesterol production.
Anabolic steroids: mimics the effects of testosterone.
Alpha-1 adrenoceptor receptor antagonists: which treats enlargement of the prostate.
Hormonal contraception: contains man-made oestrogen and progestin to prevent pregnancy.
Certain medications for Parkinson’s disease.
What to do about sexual dysfunction
If you suspect that your pills may be causing sexual problems, do not stop taking your medication until your doctor has said it is fine to do so, says Dr Cichi. ‘The first thing you should do is see your GP who may be able to reduce your dose or change your medication if this is what is causing your sexual dysfunction,’ he says.
Do not delay seeking help. Your quality of life is important, particularly if you are being treated for something like high blood pressure, which often has no symptoms and can require lifelong treatment. Your doctor may switch you to another medicine in the same class or try a different type of medicine altogether.
‘Try not to be embarrassed,’ says Dr Lee. ‘Sexual function is a vital part of human health and wellbeing. Your doctor is trained to help you and will be more sympathetic than you think. Very often there will be alternative medications you can use instead.’
Additionally, considering enlisting the help of a sex therapist, Dr Lee continues. ‘Many people are surprised by how much they feel after they start sex therapy, and how quickly this has very positive effects on their self-confidence and their relationships,’ she says.
Sexual health resources
For further advice about sexual function and medication or any other relationship or sexual concerns you might have, try one of the following resources:
NHS.UK to check for any medical issues or be referred to a therapist
Brook for under 25
Last updated: 25-11-2020
You Might Also Like