Would you rather have an erection when the time is right, or the reassurance that you won’t have a panic attack in the middle of your work presentation? An orgasm, or the ability to get out of bed tomorrow morning?
Image by Sam Woolley
Some of the most important life- and sanity-saving medications can also have a dampening effect on your sex life, so these are the kinds of decisions that millions of Americans are forced to make every day.
Read on for your guide to the effects your medications are having on your sex life and what you can do about it.
An important caveat: I’m not a medical doctor. I’m a sex therapist. Since so many of my clients struggle with sexual side effects, I’ve done a lot of research on this topic, including speaking with Anita Batra, MD, Assistant Clinical Instructor, Internal Medicine, UCLA Health. All of the following information is not to be taken as medical advice; it’s meant to equip you to have a conversation with your doctor.
Anti-Anxiety/Anti-Depressant Medications
These classes of medications are notorious for causing sexual side effects. They’re also some of the most frustrating to deal with, since mental health can obviously be a life or death issue for so many people.
This group includes SSRIs, the most common class of antidepressants. Of SSRIs, Dr Batra says, “These medications are known to cause reduced libido, decreased lubrication and inability to orgasm in women, and erectile dysfunction and delayed ejaculation in men. Complicating matters is that depression itself can cause many of these symptoms.”
Meds: Ativan, Celexa, Cymbalta, Effexor, Rivatori, Lexapro, Pristiq, Prozac, Paxil, Valium, Bupropion, Alprazolam, Zoloft.
Potential side effects:
- Decreased sex drive
- Decreased or dulled sensations
- Decreased vaginal lubrication
- Erectile difficulties
- Difficulty orgasming
- Less pleasurable orgasms
What to talk to your doctor about:
Your body’s reaction to a particular medication can vary greatly, which is why it’s important to be in communication with your doctor. Dr. Batra says, “Your options include waiting to see if side effects improve over the next few weeks as you continue to take the medication, switching to a different SSRI, or trying a non-SSRI medication.”
Bupropion does tend to have the lowest incidence of sexual side effects, and it can be combined with other medications. But it’s certainly not a cure-all.
Medications aside, the single best thing you can do is exercise regularly. Vigorous exercise has been proven to combat the sexual side effects of these medications. It’s also fantastic for your mental health in general. I know it’s always challenging to start an exercise regimen, but this is some pretty damn powerful motivation.
For sensation-related issues, you may want to change the ways you have sex. You may need to go for a longer period of time, to reach orgasm. You can also focus on adding more stimulation with sex toys (try the high-intensity Hitachi Magic Wand), porn, watching yourself/yourselves in the mirror, dirty talk, fantasizing, or masturbation. Adding lube can also increase sensation and decrease discomfort.
There’s a limited amount of research that shows that supplements like Maca and Ginkgo Biloba can combat sexual side effects. Talk to your doctor about the possibility of adding them to your regimen.
Antihistamines
Most people don’t realise that antihistamines can cause sexual side effects. Surprise, they can!
Meds: Allegra, Benadryl, Claritin, Seroquel/Quetiapine, Zyrtec.
Potential side effects:
- Decreased sex drive
- Decreased vaginal lubrication
- Erectile difficulties
- Difficulty orgasming
What to talk to your doctor about:
Many antihistamines clear your body within 4-8 hours, so you may be able to time your dosage to minimise conflicts with your sex life. If you typically get it on at night, try taking your antihistamine in the morning.
Use lube to combat dryness issues.
Blood Pressure Medications
Blood pressure medications are another frustrating category to deal with because blood pressure can be such a serious condition. Dr. Batra notes that many of these medications can also be life-saving when used to treat heart disease and stroke.
Meds: Beta blockers like Betaloc, Cardicor, Emcor, Inderal, Lopresor, Nebilet, and Tenormin. Diuretics like loop diuretics, osmotic diuretics, potassium-sparing diuretics, and Thiazides.
Potential side effects:
- Decreased sex drive
- Erectile difficulties
- Difficulty orgasming
What to talk to your doctor about:
It’s extremely important to work with your doctor to create a game plan. Dr. Batra notes, “… beta blockers play a crucial role in the treatment of cardiovascular disease and sometimes should not be discontinued altogether.” That doesn’t mean you don’t have options. Your particular reaction to a blood pressure medication can vary.
Dr. Batra says, “I recommend discussing with your doctor whether or not the dose can be decreased to improve the side effect profile, or if a different beta blocker could be tried instead.” You can also ask your doctor about different medication classes, like ARBs, ACE inhibitors, or calcium channel blockers.
Hair Loss Medications
This is an interesting category. Propecia, the popular hair loss medication, has been shown to cause a number of sexual side effects. Disturbingly, some studies have shown that the effects can last long after you stop taking Propecia.
It’s worth considering the possible side effects before deciding to even start the medication.
Meds: Propecia
Potential side effects:
- Decreased sex drive
- Erectile difficulties
- Difficulty orgasming
What to talk to your doctor about:
Rogaine is available over the counter and hasn’t been linked to any sexual side effects.
High-Cholesterol Medications
Statins are the main class of cholesterol medications. They seem to cause more sexual issues for men than for women, mostly because of their potential interactions with testosterone levels.
Interestingly, statins have been shown to both lead to and alleviate erectile difficulties.
Meds: Crestor, Lescol, Lipitor, Zocor
Potential side effects:
- Decreased sex drive
- Erectile difficulties
- Difficulty orgasming
What to talk to your doctor about:
Talk to your doctor about testing your hormone levels. Your doctor may prescribe testosterone therapy if they believe the statin is affecting your testosterone levels.
Hormonal birth control
The sexual side effects of birth control is a pretty controversial and complex topic. Frustratingly, it’s also not studied nearly as often as it should be, given how many women take hormonal birth control.
Birth control works by changing the hormone levels in your body. These same hormones play a role in your sex drive. A lot of women report that being on birth control decreases their sex drive. On the other hand, knowing you’re taking an effective step towards preventing pregnancy can increase your sex drive.
Meds: there are hundreds of different types of hormonal birth control. Available forms include the patch, the pill, the ring, and the shot.
Potential side effects:
- Decreased sex drive
- Decreased vaginal lubrication
What to talk to your doctor about:
Dr. Batra recommends talking to your doctor about other types of contraception. Options include non-hormonal birth control like condoms or a diaphragm. Or talk to your doctor about Paragard, the non-hormonal IUD.
Use lube for dryness.
Painkillers
Painkillers, especially opioids, can wreak havoc on your sex life (and, well, the rest of your life). The lucky few only need to take painkillers for a short amount of time, for a specific injury. But those with chronic pain conditions may need to grapple with the side effects for much longer.
Dr. Batra says, “Chronic opioid use has been associated with decreased levels of sex hormones, resulting in low libido, erectile dysfunction, infertility and mood problems.”
Meds: OxyContin, Percocet, Vicodin
Potential side effects:
Decreased sex drive
Erectile difficulties
Difficulty orgasming
What to talk to your doctor about:
You and your doctor need a specific game plan for your pain management. Dr. Batra says, “These side effects typically improve with decreasing doses of or weaning off opioid medications. Talk to your doctor about trying adjunctive treatments for pain that may apply to you, including non-opioid medications, physical therapy, low-impact exercise, acupuncture, massage and meditation.”
Men have it better off than women in this regard. If you’re a man, your doctor may prescribe testosterone therapy to combat opioid-induced sexual side effects.
General Tips
Take sexual side effects seriously. I know it can be hard to focus on your sex life when you have more pressing health needs. But you deserve a healthy and fulfilling sex life, if you want one. Allow yourself to take the time and effort to acknowledge and address sexual side effects.
Take care of yourself. We all know the stuff we’re supposed to do to be healthy – exercise, eat right, sleep, de-stress. It’s far too easy to avoid self care, but it’s extremely important. Things like exercise and eating healthily can combat many sexual side effects, plus they’re just plain good for you.
Talk to your doctor. As I keep repeating, it’s extremely important to have a doctor who is on your side when it comes to addressing sexual side effects. Dr. Batra says, “Your doctor definitely wants to hear about any side effects you may be experiencing.” Don’t be afraid to speak up!
Advocate for yourself. Doctors are people too, and not all of them are as open to talking about sex as Dr. Batra. They made not take sexual side effects seriously, or may seem embarrassed or uncomfortable about you talking about your vaginal dryness or sagging erection.
It may feel awkward to talk about your sex life initially, but keep reminding yourself that you value your sex life. Switch doctors if need be. If you’re in a relationship, it may help to have your partner come to appointments with you for support
Don’t mess with your meds on your own. Period.
Give it time. Noticing a sexual side effect can be incredibly distressing, but as Dr. Batra noted, it’s important to give your body some time to adapt to new medications, combinations, or dosages. You may notice that your side effects lessen or even disappear. Keep talking to your doctor throughout this process.
Talk about your expectations. If you’re in a relationship, keep the lines of communication open. Talk about what you want and need from your sex life, and how to work around sexual side effects. You may not be able to eliminate side effects, but feeling like a team can go a long way towards making you feel better about your situation.
Change your definitions of sex. Sex may not look the same way it used to, but that can be OK. The silver lining of sexual side effects is that they can force you to be more creative and open-minded about how you define sex, both in your solo sex life and in your relationship.
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