Drugs That Might Cause Sex Problems

After 40, medication use becomes quite common. Three drugs are notorious for causing sex problems: alcohol, antidepressants, and blood pressure medications (antihypertensives). But they are just the tip of the iceberg of drug-induced sexual side effects. Here is a comprehensive guide to drugs that might impair libido or sexual function.

The Key Word is “Might”

Before we delve into the drugs, however, it’s important to understand that the key word here is might. These drugs might have sexual side effects, but if you take any of them, you’re not fated to suffer them. Some people can have great sex after a few drinks, while others have one drink and sex is out of the question. Some people have no sex problems while taking Prozac, or blood pressure medication, or other drugs linked to sexual impairment. Meanwhile, others take these medications and lose their libidos, erections, clitoral sensitivity, vaginal lubrication, or orgasms. Sexual side effects are highly individual. The important point is to understand that these drugs might cause sex problems. That way, if you develop any, you realize that the problem is probably a drug effect and not some collapse of sexual interest or function on your part or on the part of your lover.

If you believe you’re experiencing sexual side effects from any drug, consult your physician and pharmacist. It’s possible that another drug might be substituted, or that some other treatment might minimize the sexual side effects.

Over-The-Counter Drugs

Alcohol

In Macbeth, Shakespeare wrote that the substance used worldwide to coax reluctant lovers into bed “provokes the desire, but takes away the performance” (Act II, Scene 3).  Truer words were never penned.  The first drink reduces inhibitions. People are more likely to accept sexual invitations. However, if people of average weight drink more than two beers, cocktails, or glasses of wine in an hour, alcohol becomes a powerful central nervous system depressant. It interferes with erection in men, and impairs sexual responsiveness in women. Sexual impairment depends on the individual (some people are more sensitive than others), on the dose (the more alcohol, the greater risk of impairment), and on your weight (heavier people can tolerate more than lighter folks). But in large enough doses, alcohol’s impairment of sexual function is undeniable.

Tobacco

Smoking narrows the blood vessels, impairing blood flow into the penis in men, and causing an increased risk of erection impairment. Compared with nonsmokers, men who smoke are much more likely to suffer erectile dysfunction. In women, the same mechanism limits blood flow into the vaginal wall, decreasing vaginal lubrication.

Other Over-the-Counter Drugs

In addition, the following over the counter drugs have caused sex problems for some people:

* Aleve. Erection problems, no ejaculation in men.

* Antihistamines (Benadryl, Dramamine). Erection problems.

* Tagamet. Erection problems, with possible libido loss.

* Zantac. Libido loss, erection problems.

Prescription Drugs

Blood Pressure Medications (Antihypertensives)

An enormous number of drugs are prescribed to lower high blood pressure. The bad news is that most of them have been linked to sexual side effects. The good news is that some are more likely than others to cause sexual impairment. If you experience problems while taking one class of antihypertensive medication, it’s reasonably likely that you can be switched to another class that doesn’t cause so many problems.

Here are the more problematic blood pressure drugs with their most common sexual effects.

* Aldactone. Libido loss, erection problems, decreased vaginal lubrication.

* Aldomet. Libido loss, erection problems, delayed or no ejaculation in men, delayed or no orgasm in women.

* Dibenzyline. Delayed or no ejaculation in men, ejaculation with no release of semen.

* Esidrix. Erection problems.

* Hydro-Diuril. Erection problems.

* Hygroton. Libido loss, erection problems.

* Hylorel. Libido loss, erection problems, delayed or no ejaculation in men.

* Inderal. Erection problems.

* Ismelin. Libido loss, erection problems, delayed or no ejaculation in men.

* Normodyne. Erection problems, delayed or no ejaculation in men, with some reports of libido loss and priapism (painful, persistent erection).

* Oretic. Erection problems.

* Propranolol. Erection problems.

* Tenormin. Erection problems.

* Thalitone.  Libido loss, erection problems.

* Wytensin. Erection problems.

Antidepressants

The most popular antidepressants are the selective seratonin reuptake inhibitors (SSRIs), among them: Prozac, Zoloft, and Paxil. Unfortunately, SSRIs often cause sexual side effects.

The more sexually problematic antidepressants include:

* Prozac. Libido loss, delayed or no ejaculation in men, no orgasm in women, with possible erection problems.

* Zoloft. Libido loss, delayed or no ejaculation in men, no orgasm in women, with possible erection problems.

* Paxil. Libido loss, delayed or no ejaculation in men, no orgasm in women, with possible erection problems.

* Celexa. Libido loss, delayed or no ejaculation in men, no orgasm in women, with possible erection problems.

* Luvox. Libido loss, delayed or no ejaculation in men, no orgasm in women, with possible erection problems.

* Tofranil. Erection problems, delayed or no ejaculation in men, no orgasm in women.

* Nardil. Libido loss, erection problems, delayed or no ejaculation in men, no orgasm in women.

* Desyrel. Priapism, with possible delayed or no ejaculation in men, no orgasm in women.

* Effexor. Delayed or no ejaculation in men, with possible erection problems.

If you take an antidepressant, what can you do to preserve sexual function? Ask your doctor to reduce your dose. You might find a dose that preserves mood elevation while relieving sexual side effects.

Or ask your physician to switch you to Wellbutrin. This antidepressant has occasionally been associated with sexual side effects (libido loss and erection problems), but in general, it causes far fewer sex problems than other antidepressants.

Or try a “drug holiday.” This advice comes from Anthony Rothschild, M.D., a psychiatrist at McLean Hospital in Belmont, Massachusetts.  He studied 30 couples, each with one member taking an SSRI, and reporting sexual side effects annoying enough to consider going off the medication.  Rothschild advised them to go drug-free on weekends, from Thursday morning to Sunday at noon.  Among the 20 taking Paxil and Zoloft (10 on each drug), half reported better sexual functioning and more desire over the weekend, and only two said they felt more depressed. But of the 10 taking Prozac, only one reported sexual improvement, probably because Prozac takes longer than the other SSRIs to clear from the blood. Note: Do not take a drug holiday without consulting the physician who prescribed your SSRI.

Anti-Anxiety and Psychiatric Medications

When drugs alter mood, they often affect sexuality. Here are the medications most often linked to sex problems:

* Anafranil. Libido loss, erection problems, delayed or no ejaculation in men, no orgasm in women.

* Eskalith. Erection problems.

* Lithonate. Erection problems.

* Mellaril. Erection problems, delayed or no ejaculation in men, no orgasm in women.

* Orap. Erection problems.

* Permitil. Libido loss, erection problems.

* Prolixin. Libido loss, erection problems.

* Sulpitil. Erection problems.

* Supril. Erection problems.

* Thorazine. Erection problems, with possible priapism, libido loss, and delayed or no ejaculation in men and no orgasm in women.

* Trilafon. Delayed or no ejaculation in men.

* Xanax. Delayed or no ejaculation in men, no orgasm in women, with possible libido loss.

Seizure Medications

Many drugs used to treat seizures and convulsions cause sex problems. Here are the ones most frequently cited:

* Diamox. Erection problems, with possible libido loss.

* Atretol. Erection problems, with possible libido loss.

* Carbatrol. Erection problems, with possible libido loss.

* Dilantin. Erection problems, with possible libido loss.

* Epitol. Erection problems, with possible libido loss.

* Mysoline. Erection problems, with possible libido loss.

* Primidone. Erection problems, with possible libido loss.

* Tegretaol. Erection problems, with possible libido loss.

Narcotics, Sedatives, and Tranquilizers

All narcotics, sedatives and tranquilizers can cause sex problems.

* Phenobarbitol (sedative). Erection problems, with possible libido loss.

* Valium and similar drugs (anti-anxiety, anticonvulsant, muscle relaxant). Libido loss, delayed or no ejaculation in men, no orgasm in women.

Miscellaneous Prescription Drugs

Dozens of other medications have been linked to sexual impairment. Here are the ones most frequently cited:

* Atromid (cholesterol-lowering). Erection problems, with possible libido loss.

* Danocrine (endometriosis). Libido loss, sometimes libido boost.

* Digitek. (congestive heart failure). Libido loss, erection problems, with possible breast enlargement in men.

* Digoxin. (congestive heart failure). Libido loss, erection problems, with possible breast enlargement in men.

* Estrogen (hormone replacement therapy). Libido loss.

* Ketoconazole. (antifungal) Libido loss, erection problems.

* Lanoxin. (congestive heart failure). Libido loss, erection problems, with possible breast enlargement in men.

* Methadone (drug addiction). Libido loss, erection problems, delayed or no ejaculation in men, no orgasm in women.

* Mintezol (antiparasitic). Erection problems.

* Niacin (high-dose for cholesterol-lowering). Libido loss.

* Niacor ((antifungal) Libido loss, erection problems.

* Nizoral. (antifungal) Libido loss, erection problems.

Illegal Drugs

Amphetamines, cocaine, crack, and other stimulants boost sexual desire, but impair orgasm, making sex decidedly frustrating. With regular use, desire fades as well.

The most sexually unpredictable illicit drug is marijuana. Some say it enhances lovemaking. But it makes other people withdraw or become anxious or irritable, which can ruin sex.

Help

If you believe that a sex problem is drug-related, but your doctor does not share your opinion, consult a sex therapist. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

References:

Crenshaw, TL and JP Goldberg. Sexual Pharmacology: Drugs That Affect Sexual Function. Norton, NY, 1996.

Finger, W. et al. “Medications That May Contribute to Sexual Disorders,” Journal of Family Practice (1997) 44:33.

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