According to television commercials, you would think that sexual dysfunction is a national epidemic.
There are ads for erectile difficulties, low desire, vaginal dryness, testosterone, menopause-related discomfort, and products promising to improve sexual functioning. Watching them, I began thinking about something we hear much less about: the medications and drugs people already take may themselves be affecting sexual response.
We often talk about sex as though the body simply “works” or “doesn’t work.” But sexual response has different parts, and a medication or drug may affect one without affecting the others.
There is desire: Do I want sex? Am I interested? Do I think about it?
There is arousal: Is my body responding? Can I become erect? Is there vaginal lubrication? Is genital sensation present?
And there is orgasm: Can I get there? Does it take longer? Does it feel different? Can I get there at all?
Once you begin separating those three, some otherwise puzzling experiences start to make sense:
A person can want sex and still have difficulty becoming physically aroused. A person can become physically aroused but have little desire. And someone can have both desire and arousal and still be unable to reach orgasm. Medications and recreational drugs can affect each of these differently.
Alcohol is an easy example. A drink may lower inhibition and make someone feel more interested in sex. Desire may increase. But as the amount of alcohol increases, erection, vaginal lubrication, genital responsiveness, and orgasm may become more difficult.
So, is alcohol helping or hurting the sexual response? A more insightful question is: What is it doing to my desire? Am I able to become aroused? Am I able to have an orgasm?
MDMA, or Ecstasy, may heighten feelings of closeness, sensuality, touch, and sexual interest while at the same time making erection or orgasm more difficult. Research on MDMA and sexual response has found increases in desire and sensual experience alongside possible impairment of erection, ejaculation, or orgasm.
Viagra and Cialis improve the physiological ability to have an erection. They do not necessarily increase desire, and they do not guarantee orgasm. MedlinePlus specifically notes that Cialis (tadalafil) does not increase sexual desire.
SSRIs — selective serotonin reuptake inhibitors — include familiar medications such as Prozac, Zoloft, Lexapro, and Paxil. They have helped enormous numbers of people with depression and anxiety. They can also affect sexual functioning.
Possible sexual side effects include decreased desire, reduced genital sensation, difficulty with erection, delayed ejaculation, and delayed or absent orgasm. MedlinePlus lists decreased sexual desire, erection difficulties, delayed or absent ejaculation, and delayed or absent orgasm among sexual effects reported with serotonergic antidepressants.
There is also growing concern about reports of sexual problems that continue after an SSRI has been discontinued. Researchers are still trying to determine how often this occurs and why. The point is not that everyone who takes an SSRI will experience lasting problems. The point is that sexual side effects are real and deserve to be taken seriously. FDA labeling for fluoxetine states that symptoms of sexual dysfunction have occasionally persisted after treatment was discontinued.
Some blood-pressure medications can contribute to erectile difficulties. Long-term opioid use can alter reproductive hormones and affect desire and orgasm. Finasteride, prescribed for hair loss and enlarged prostate, can affect desire, erection, and ejaculation. Even familiar over-the-counter medications such as antihistamines may, particularly when they are sedating or drying, interfere with arousal.
Cannabis is another example. Some people report increased desire, touch sensitivity, pleasure, or more intense orgasm. Others experience anxiety, distraction, or poorer sexual response. Research suggests that effects vary considerably among individuals, and the evidence is still accumulating.
Sexual side effects are not trivial. They affect quality of life, relationships, intimacy, and sometimes whether people are willing to continue taking medication they need.
If sexual functioning changes after starting a medication, increasing the dose, or adding another drug, talk with a physician or pharmacist. Do not stop or change a prescription medication on your own. Sometimes the condition being treated can affect sexual functioning, and a healthcare professional can help sort out what is contributing.
Adapted from my forthcoming book, Eros, Essence and Sexual Well-Being.
I’m also preparing a free downloadable guide to common medications and recreational substances that may affect desire, arousal, and orgasm, along with reliable sources for learning more.
References and Further Reading
MedlinePlus — Drugs That May Cause Erection Problems
Overview of prescription medications and recreational drugs that can affect sexual functioning.
https://medlineplus.gov/ency/article/004024.htm
U.S. Food and Drug Administration — Fluoxetine Prescribing Information
Includes information about SSRI-related sexual dysfunction and reports that symptoms may occasionally persist after treatment is discontinued.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/202133s012lbl.pdf
MedlinePlus — Tadalafil (Cialis)
Explains how tadalafil treats erectile dysfunction and notes that it does not increase sexual desire.
https://medlineplus.gov/druginfo/meds/a604008.html
MedlinePlus — Antihistamines for Allergies
Consumer information about antihistamines, including sedation and drying effects.
https://medlineplus.gov/ency/patientinstructions/000549.htm
UK Medicines and Healthcare products Regulatory Agency — Finasteride and Dutasteride Safety Information Safety information about sexual side effects, including reports of symptoms persisting after treatment is stopped.
PubMed — Cannabis and Human Sexuality
Review of research on cannabis and sexual functioning.
https://pubmed.ncbi.nlm.nih.gov/38977465/
PubMed — MDMA and Sexual Function
Research examining MDMA’s effects on sexual desire, erection, ejaculation, and orgasm.
https://pubmed.ncbi.nlm.nih.gov/37888490/
National Institute on Drug Abuse — Drugs A–Z
Evidence-based information about cannabis, cocaine, methamphetamine, MDMA, opioids, psychedelics, and other recreational drugs.
https://nida.nih.gov/research-topics/drugs-a-to-z
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Disclaimer: This article is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. Do not start, stop, or change a prescription medication without consulting a qualified healthcare professional.
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If this piece resonated with you, you might also enjoy:
Intimacy: The Sacred Space Between Us is available on Amazon in three formats: Hard cover, soft cover, and ebook. Find it here.
Let’s Talk Sex: Birds, Bees & Beyond my podcast with Carolina Freire. Subscribe, share, comment.
Work With Me individual coaching and workshops about intimacy and relationships including transcendent sexuality.
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