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Medication-Drug Induced Sexual Difficulties

Sexual problems can be caused through the use of prescription medications and legal or illegal recreational drugs.  These problems can include the range of Sexual Dysfunctions listed on this site.  As the diagnosis of ‘Substance Induced Sexual Dysfunction’ or ‘Medication Induced Sexual Dysfunction’ implies, the defining feature includes significantly distressing sexual difficulties that occur during or soon after the substance is used/ingested.  Drug/medication induced sexual difficulties may also occur during the period of withdrawal from a drug or for some months after exposure to a medication.

This diagnosis is considered if the sexual dysfunction has not occurred before the use of the substance/medication.  The diagnosis also only applies if the sexual difficulties persist for approximately a month after intoxication or a drug withdrawal period.  Drug/medication induced sexual dysfunction is defined as Mild if it occurs on 25% to 50% of occasions of sexual activity, Moderate if it occurs on 50% to 75% of occasions and Severe if it occurs on 75% or more occasions of sexual activity.

What types of medication or drugs cause sexual dysfunction?

Sexual problems can be caused by a range of medications and recreational drugs.  Some sexual problems are only mild and the individual can live with these without too much impact on their sex life.  The more serious the sexual problem the more likely it is to cause significant levels of emotional distress.  Most substances can cause sexual dysfunction during intoxication and/or in response to withdrawal from use.

Substances that may cause sexual dysfunction include:

Psychiatric medications.  Antidepressants:  Antidepressants, particularly of the Selective Serotonin Re-Uptake Inhibitors type (SSRI’s) most commonly result in problems achieving orgasm for women or orgasm/ejaculation for men (problems with sexual desire and erection are less frequent).  Some anti-depressant medications including Bupropion (also known as Wellbutrin, Budeprion, Prexaton, Elontril or Aplenzin) and Mirtazapine (Avanza, Axit, Mirtaz, Mirtazon, Remeron, Zispin) have not been associated with side effects that impact on sexual functioning.

Anti-psychotics:  Anti-psychotic medications most commonly result in problems with sexual desire, erection, lubrication, ejaculation and achieving orgasm.  Some common anti-psychotic medications include Seroquel, Zyprexa, Risperidone, Solian and Clozapine.

Mood stabilisers and anti-convulsants; The effects of these medications on sexual functioning is unclear.  However it’s possible Lithium and anti-convulsants (with the possible exception of Lamotrigine) may effect sexual desire.  Difficulties achieving orgasm may occur with Gabapentin.

Tranquillisers (Benzodiazapines):  A higher rate of erectile dysfunction (impotence) and difficulties achieving orgasm may be associated with tranquillisers, although there have been no similar reports with Buspirone.

Methadone:  Methadone may result in various sexual disorders, however these difficulties are less often reported by patients receiving Buprenorphine.

Several non-psychiatric medications are associated with sexual difficulties.  These medications include those for cardiovascular, cytotoxic and gastrointestinal problems and hormonal agents (including hormonal contraceptives).

Legal recreational drugs.  Alcohol:  Alcohol is well known to cause temporary sexual dysfunction during intoxication, particularly if heavily intoxicated.  Long-term heavy alcohol use and alcohol dependency may also result in erectile dysfunction due to the effects of heavy use on physical health (i.e., cardiovascular functioning).

Tobacco:  Tobacco use may also result in erectile dysfunction due to its overall effects on physical health (i.e., cardiovascular functioning).  Constriction of blood vessels in the penis during heavy use of tobacco may lead to temporary impotence or difficulties maintaining an erection.

Illegal substances.  Illegal substances including Amphetamines (e.g., ‘Speed’), Methamphetamines (e.g., ‘Ice’), MDMA (e.g., ‘Extacy’), cocaine and crack cocaine are associated with a range of sexual problems including decreased sexual desire, erectile dysfunction and difficulty reaching orgasm.

How common is sexual dysfunction due to medication or substance use?

It’s difficult to ascertain how common sexual problems are due to patients’ tendency to under-report these types of difficulties when commencing new medication.  There are different classes of anti-depressant medications, these different types are known broadly as monoamine oxidase inhibitors, tricyclic antidepressants, serotonergic anti-depressants and combined serotonergic-adrenergic antidepressants.  Between 25% to 80% of individuals taking any of these types of antidepressants may experience sexual problems.   These difficulties may occur in as little as 8 days after a new medication is commenced.

Approximately 50% of individuals taking anti-psychotic medications will experience sexual side effects including reduced sexual desire, erectile or lubrication problems and difficulties achieving orgasm.

The prevalence of sexual problems for patients prescribed hormonal agents and medications for cardiovascular, cytotoxic or gastrointestinal problems is unknown.

Sexual problems are particularly common for people who abuse heroin (approximately 60%-70%).  Higher rates of sexual dysfunction has also been reported for people prescribed methadone or high-dose opioid drugs for pain.

What can be done about sexual dysfunction due to medication/substances?

If you suspect you’re experiencing sexual difficulties after commencing a new medication it’s extremely important that you don’t just cease taking your recommended daily dose.

Psychiatric and medical concerns may often be treated with different medications.  It’s important to discuss the sexual difficulties you’re experiencing with your prescribing doctor to investigate alternative medications that may address the sexual dysfunction while maintaining treatment for the condition previously diagnosed.

Sometimes, psychiatric medication is prescribed that results in little or no positive effects on the symptoms that need to be managed.  In these instances it’s very important that you discuss with your prescribing doctor the limited outcomes of that medication.  Try not to feel embarrassed asking questions about your sexual functioning if this is part of your concern, after all you’re not the first person to experience these difficulties and you won’t be the last.  Any caring and thorough doctor will be eager to hear feedback from you about the effects, good or bad, of any new medication.  He or she will be open to treating the diagnosed condition with different medication if the costs of what he or she has already prescribed outweigh any positive effects of that medication.

It’s also a good idea to let your partner know that any recent sexual problems you’ve experienced may be due to your medication.  It’s common for people to assume incorrectly that their partner is experiencing trouble in bed because they no longer find them attractive, or that their partner may no longer love them.  Communicating clearly in your relationship regarding your medications and possible side effects can help avoid unnecessary distress or arguments.

If you use any legal or illegal substances in such a way that it is impacting on your sexual functioning then you should seriously consider drug and alcohol counselling.  Christopher has experience in sexual health counselling as well as drug and alcohol counselling, so these issues can be addressed in combination.

Disclaimer:  The information covered on this website is for educational purposes only.  A diagnosis of any psychiatric or medical condition must only be made by a medical or mental health specialist.  Diagnosing a psychiatric concern is a complex process that involves formal training, do not ‘diagnose’ yourself.  If you have concerns that a particular disorder or condition applies to you, please speak with your General Practitioner for further assessment and medical/psychological care.

Individual counselling appointments are 50 minutes long.
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