Medicines and Sex: Drugs That May Cause Sexual Side Effects

When a doctor tells you that you need a certain medication, you should take it.

But you should also be prepared for the possibility that some medicines and sex don't always mix well together.

This article will explore the types of drugs that could potentially lead to sexual side effects. You'll discover what these medications are prescribed for, how they might influence your sex life, and which specific drugs belong to each category.

We'll also discuss potential solutions to mitigate the sexual side effects, providing you with valuable insights to maintain a satisfying and healthy sex life.

What drugs may affect sexual function?

If your sex life isn't meeting your expectations or has changed significantly, it's crucial to have an open conversation with your physician or health care provider, even if discussing it feels uncomfortable. Several medications can impact sexual function in both males and females.

Dr. Ryan Smith, a University of Virginia School of Medicine urologist specializing in male sexual dysfunction, highlights some standard medication classes linked to or associated with sexual issues. According to Smith, "Some of the more common medication classes which have been linked to or associated with erectile dysfunction can include but are not limited to antidepressants, anti-anxiety medications, opioids, blood pressure medications, 5-alpha reductase inhibitors [used to treat baldness or prostate enlargement], and anti-androgens."

In addition, Smith said, “Others that have been implicated include antihistamines and some anti-reflux medications. While this list is not exhaustive, it's important to ask your provider about risks of sexual dysfunction related to certain medications and treatments."

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are a class of medications primarily prescribed to manage mood disorders like depression and anxiety. They work by increasing serotonin levels in the brain, which can help ease symptoms associated with these conditions, the Mayo Clinic says. However, SSRIs may also have an impact on sex drive and sexual function.

Harvard Health explains that SSRIs can be a ray of hope for many. However, these antidepressants have potential side effects, including those that cast a shadow over your sexual well-being.

Apart from diminishing sexual desire, SSRIs can hinder the ability to become sexually aroused, maintain arousal and achieve orgasm. Some individuals on SSRIs may even experience an inability to reach orgasm. Notably, these symptoms tend to become more prevalent as one ages.

Common SSRIs that can cause sexual side effects include:

• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Fluvoxamine (Luvox)
• Paroxetine (Paxil, Pexeva)
• Sertraline (Zoloft)
• Vortioxetine (Trintellix)

Blood pressure medications

Blood pressure medications are prescribed to manage high blood pressure. Per the U.S. Centers for Disease Control and Prevention, these drugs are crucial for reducing the risk of heart disease, stroke and other cardiovascular issues. However, some of them can impact sex drive and sexual function. Here's what you should know:

These medications are primarily used to treat hypertension, which can lead to serious health problems if left uncontrolled. However, some blood pressure medications may affect sexual function. "Blood pressure and erectile dysfunction are often associated because men with high blood pressure are at higher risk for erectile dysfunction. Erectile dysfunction can also serve as a warning sign for cardiovascular disease," Smith noted.

“It’s important for men to control their blood pressure to help preserve erectile function in the long term," he added. "While some blood pressure medications are more commonly associated with erectile dysfunction, such as diuretics and beta blockers, other classes – including ACE inhibitors and angiotensin-receptor blockers – appear to have less impact.”

The Mayo Clinic indicates that some high blood pressure medicines can affect sex drive or the quality of sex.

• Water pills (diuretics): Diuretics can reduce blood flow to the penis and lower zinc levels, which are important for testosterone production.
• Beta blockers: Older beta blockers have been linked to sexual problems.

Additionally, Medline Plus shares the following list of blood pressure medications that may impact sexual function.

• Atenolol (Tenormin)
• Bethanidine
• Bumetanide (Bumex)
• Captopril (Capoten)
• Chlorothiazide (Diuril)
• Chlorthalidone (Hygroton)
• Clonidine (Catapres)
• Enalapril (Vasotec)
• Furosemide (Lasix)
• Guanabenz (Wytensin)
• Guanethidine (Ismelin)
• Guanfacine (Tenex)
• Haloperidol (Haldol)
• Hydralazine (Apresoline)
• Hydrochlorothiazide (Esidrix)
• Labetalol (Normodyne)
• Methyldopa (Aldomet)
• Metoprolol (Lopressor)
• Nifedipine (Adalat, Procardia)
• Phenoxybenzamine (Dibenzyline)
• Phentolamine (Regitine)
• Prazosin (Minipress)
• Propranolol (Inderal)
• Reserpine (Serpasil)
• Spironolactone (Aldactone)
• Triamterene (Maxzide)
• Verapamil (Calan)

Antihistamines

Antihistamines are a versatile group of medications renowned for their effectiveness in managing various health issues. According to the Cleveland Clinic, antihistamines counteract the effects of histamine, a chemical produced by the body's immune system, thereby relieving allergies.

Dr. Anita Clayton, chair of psychiatry and neurobehavioral sciences with the University of Virginia School of Medicine, said that “when used chronically, histamine H2 receptor blockers are more likely to cause sexual dysfunction in women including, low desire, arousal problems [vaginal dryness] and difficulty achieving orgasm.”

The antihistamines that may impact sexual functions include:

• Cimetidine (Tagamet)
• Dimenhydrinate (Dramamine)
• Diphenhydramine (Benadryl)
• Hydroxyzine (Vistaril)
• Loratadine (Claritin, Alavert)
• Meclizine (Antivert)
• Nizatidine (Axid)
• Ranitidine (Zantac, Taladine)
• Promethazine (Phenergan)

Opioids

“Opioids are used for treatment of acute pain associated with injury, surgery, childbirth, etc...," Clayton said. "These medications are usually only prescribed for a few days when acetaminophen [Tylenol] isn’t working, because some individuals will rapidly develop addiction," she noted.

“Chronic use of opioids does not effectively manage pain as tolerance and dependence develop. Opioids cause sexual dysfunction primarily by reducing bioavailable testosterone levels and dopamine levels/function, negatively impacting the brain's reward/pleasure system," Clayton added.

Examples of opioid medications that may impact sexual function include:

• Tramadol (Ultram)
• Hydrocodone/Acetaminophen (Norco)

Individuals dealing with chronic pain often encounter sexual difficulties as a consequence. Pain relievers, particularly opioids, can potentially diminish sexual desire and increase the likelihood of experiencing erectile dysfunction.

Additional medications for treating opioid use disorder can also lead to sexual dysfunction. Those medications include:

• Methadone (Methadose, Dolophine)
• Buprenorphine (Subutex, Sublocade)
• Buprenorphine/naloxone (Suboxone, Zubsolv)

What to do if you have sexual function side effects

Experiencing sexual function side effects can be distressing, but discussing them with your health care provider is crucial. The National Alliance on Mental Illness says sexual dysfunction symptoms can manifest differently in males and females.

In males, changes in sexual function may include a loss of sexual interest or desire, difficulties in obtaining or sustaining an erection and, although rare, the possibility of a painful, prolonged erection. Additionally, some males may face challenges in achieving orgasm.

For females, sexual side effects of drugs may involve a loss of sexual interest or desire, discomfort or pain during sexual intercourse and difficulties in achieving orgasm.

The good news is that medication-induced sexual side effects are not necessarily permanent. There are various options for managing these issues, but it's crucial not to stop your medication without consulting your primary care provider. Potential treatment approaches that your provider may consider include:

• Allowing your body time to adjust to the medication or dose
• Lowering the medication dose
• Switching to a different medication with a lower risk of causing sexual side effects
• Starting a new medication specifically designed to address the sexual side effects

Working closely with your health care provider can help you find the most suitable solution to address your concerns while continuing to manage your underlying medical condition effectively.

Resources

Ryan Smith, MD, urologist, University of Virginia School of Medicine

Anita Clayton, MD, chair, psychiatry and neurobehavioral sciences, University of Virginia School of Medicine

Mayo Clinic: Antidepressants: Which Cause the Fewest Sexual Side Effects?

Mayo Clinic: High Blood Pressure and Sex: Overcome the Challenges

Harvard Medical School: Sexual Side Effects of SSRIs: Why it Happens and What to Do

U.S. Centers for Disease Control and Prevention: Blood Pressure Medicines

Cleveland Clinic: Antihistamines

National Alliance on Mental Illness: Medication-Induced Sexual Dysfunction

Medline Plus: Drugs That May Cause Erection Problems