Are your medicines disrupting your sex life?
Many medicines can have an adverse effect on your sex life.
Many medicines are suspected of interfering with sexual function, although it is unusual for them to be the sole cause of sexual problems.
It is relatively difficult to determine whether a particular medicine is causing erectile dysfunction or disrupting sexual function because:
- many diseases affect sexual function, so it can be difficult to establish if the dysfunction is a result of the disease or the medicine used to treat it.
- side-effects that involve sexual problems are often not reported to doctors because of embarrassment. This means the actual rate of sexual dysfunction caused by medicines may be higher than reported.
How can medicines affect sexual function?
The mechanism of sexual function is not fully understood.
It involves a complex coordination of hormones, chemical messengers in the brain (neurotransmitters such as dopamine and serotonin) and the sexual organs. In general:
- dopamine increases sexual function
- serotonin inhibits sexual function
- the hormone testosterone is important, as are the blood vessels involved in producing an erection.
A medicine can therefore affect sexual function in several ways.
Medicines that reduce the testosterone level or block its effects are likely to reduce sex drive.
Libido is also affected by your general emotional and physical health. Medicines that affect any of these aspects, even indirectly by causing drowsiness, lethargy, weight gain or confusion, have the potential to reduce your sex drive.
Arousal and erection
Medicines that have a physical effect on the blood vessels in the penis, those that act on the brain or interfere with hormone levels (particularly testosterone) or affect the transmission of nerve messages, can all cause impotence.
Ejaculation
Medicines that block alpha receptors can interfere with ejaculation.
During ejaculation, increased alpha receptor activation closes the bladder neck, facilitating the normal flow of semen out of the penis.
If this mechanism is disrupted, it results in retrograde ejaculation, with semen flowing along the path of least resistance from the urethra up into the bladder.
Various chemicals in the brain are also involved in orgasm and ejaculation, and medicines that affect these chemicals can also cause ejaculatory disturbances.
The most widely prescribed centrally-acting agents that affect ejaculation are selective serotonin re-uptake inhibitor (SSRI) antidepressants.
Medicines that can affect sexual function
Blood pressure lowering (antihypertensive) medicines are also implicated, although the mechanism by which they cause sexual problems will vary from medicine to medicine.
The table of medicines below lists the sexual side-effects that some people have reported during their use. This list is not exhaustive.
Remember, not everyone experiences side-effects with medicines and your sexual difficulties may be completely unrelated to your medication, even if it does appear in this list.
Alternatively, your doctor may try a different type (class) of medicine altogether, providing it is suitable for you to take.
Some examples of erection-friendly medicines are listed below, but there may be no alternative for your condition.
An erection is the result of a coordination between nerves, hormones, blood vessels and psychological factors. This means there are many areas where things can go wrong.
Ejaculation is a complex reflex process that involves the activation of alpha receptors in the prostate gland and seminal vesicles.
Antidepressants are the medicines most frequently implicated in causing sexual dysfunction. This is because they work by altering levels of chemicals in the brain.
In particular, SSRIs increase serotonin levels, which inhibits sexual function.
What if I think my medicine is affecting my sex life?
PRESCRIBED MEDICINE
MAIN USE
POSSIBLE EFFECT ON SEXUAL FUNCTION
Antidepressants
MAOI antidepressants (eg moclobemide, phenelzine)
Depression
Decreased sex drive, impotence, delayed orgasm, ejaculatory disturbances
SSRI antidepressants (eg fluoxetine)
Depression
Decreased sex drive, impotence, delayed or absent orgasm, ejaculatory disturbances
Tricyclic antidepressants (eg amitryptiline)
Depression
Decreased sex drive, impotence, delayed or absent orgasm, ejaculatory disturbances
Antiepileptics
Carbamazepine
Epilepsy
Impotence
Antihypertensives
ACE inhibitors (eg enalapril, lisinopril)
High blood pressure, heart failure
Impotence
Alpha blockers (eg prazosin, doxazosin)
High blood pressure, enlarged prostate
Impotence, ejaculatory disturbances
Beta blockers (eg atenolol, propranolol and including timolol eye drops)
High blood pressure, angina, glaucoma
Impotence
Calcium channel blockers (eg verapamil, nifedipine)
High blood pressure, angina
Impotence
Clonidine
High blood pressure
Impotence, decreased sex drive, delayed or failure of ejaculation
Methyldopa
High blood pressure
Impotence, decreased sex drive, ejaculatory failure
Thiazide diuretics (eg bendroflumethiazide)
High blood pressure
Impotence
Antipsychotics
Phenothiazines (eg chlorpromazine, thioridazine)
Psychotic illness
Ejaculatory disturbances, decreased sex drive, impotence
Risperidone
Psychotic illness
Impotence, ejaculatory disturbances
Cholesterol lowering medicines
Fibrates (eg clofibrate, gemfibrozil)
High cholesterol
Impotence
Statins (eg simvastatin)
High cholesterol
Impotence
Other
Benzodiazepines
Anxiety and insomnia
Decreased sex drive
Cimetidine
Peptic ulcers, acid reflux disease
Decreased sex drive, impotence
Cyproterone acetate
Prostate cancer
Decreased libido, impotence, reduced volume of ejaculation
Disulfiram
Alcohol withdrawal
Decreased sex drive
Finasteride
Enlarged prostate
Impotence, decreased sex drive, ejaculation disorders, reduced volume of ejaculation
Metoclopramide
Nausea and vomiting
Decreased sex drive, impotence
Omeprazole
Peptic ulcers, acid reflux disease
Impotence
Opioid painkillers (eg morphine)
Severe pain
Decreased sex drive, impotence
Prochlorperazine
Nausea and vomiting
Impotence
Propantheline
Gut spasm
Impotence
Spironolactone
Heart failure, fluid retention
Impotence, decreased sex drive
What can my doctor do?
Your doctor may switch you to another medicine in the same class, ie that acts in a similar way, in the hope that the new one will not cause the same side-effects.
Treatment of depression
Treatment of high cholesterol levels
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