Medication and Sexual Wellness: What You Need to Know

Sexual wellness is influenced by a wide range of factors, and medications whether prescribed, over-the-counter, recreational, or herbal, can play a significant role. Both short- and long-term use of certain substances can affect sexual desire, performance, and overall satisfaction. Common side effects may include:

• Reduced sexual desire
• Erectile difficulties in men
• Vaginal dryness in women
• Difficulty reaching orgasm

Being aware of these effects is key to planning and maintaining sexual wellness and intimacy, and understanding potential impacts allows for proactive discussion and management. 

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Antidepressants and Sexual Health

Antidepressants are among the most commonly reported medications affecting sexual function. However, not all antidepressants carry the same risk:

Lower risk of sexual side effects:

• Atypical antidepressants: bupropion (Wellbutrin SR/XL), mirtazapine (Remeron), vilazodone (Viibryd), vortioxetine (Trintellix)
• SNRIs: desvenlafaxine (Pristiq), duloxetine (Cymbalta, Drizalma Sprinkle), levomilnacipran (Fetzima)
• MAOIs: selegiline (Emsam, patch form)

Higher risk of sexual side effects:

• SSRIs: citalopram, escitalopram, fluoxetine, paroxetine, sertraline (paroxetine carries the highest risk)
• SNRIs: venlafaxine (Effexor XR)
• Tricyclic/tetracyclic antidepressants: amitriptyline, nortriptyline, clomipramine
• MAOIs: isocarboxazid, phenelzine, tranylcypromine (phenelzine may have higher risk)

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Other Medications That May Affect Sexual Function

Several other classes of medication may also influence sexual wellness:

Mental health medications: Amoxapine, Buspirone, Diazepam, Lorazepam, Fluphenazine, among others.

Antihistamines and heartburn medications: Cimetidine, Diphenhydramine, Hydroxyzine, Ranitidine.

Blood pressure medications and diuretics: Atenolol, Enalapril, Furosemide, Labetalol, Propranolol, Spironolactone.

Parkinson’s disease treatments: Levodopa, Benztropine, Bromocriptine, Trihexyphenidyl.

Chemotherapy and hormonal therapies: Antiandrogens (Casodex, Flutamide), Cyclophosphamide, LHRH agonists and antagonists.

Opiate analgesics and painkillers: Morphine, Codeine, Oxycodone, Fentanyl, Methadone.

Recreational substances: Alcohol, cannabis, amphetamines, cocaine, nicotine, heroin.

Other medicines and dietary supplements: Estrogen, NSAIDs, St. John’s Wort, Saw Palmetto, Garlic, Flaxseed, and various prescription medications.

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Medications and Contraception

Even reliable methods like oral contraceptives can be affected by other medications or herbal supplements, which may reduce their effectiveness and increase the risk of unplanned pregnancy. These include:

• Enzyme-inducing seizure medications: Carbamazepine, Phenytoin, Topiramate, and others.
• Antiretroviral therapies (HIV): Darunavir, Efavirenz, Lopinavir/ritonavir, Nevirapine.
• Antifungal treatments: Griseofulvin, Ketoconazole.
• Antibiotics: Rifampin.
• Sleep disorder medications: Modafinil.
• Herbal supplements: St. John’s Wort, Saw Palmetto, Alfalfa, Garlic, Flaxseed.

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Key Takeaways

Understanding the impact of medications on sexual wellness is crucial for maintaining healthy intimate relationships and overall wellbeing. Clinicians, caregivers, and individuals should:

• Be aware of potential sexual side effects when starting new medications.
• Discuss concerns openly with healthcare providers to identify alternatives or strategies to mitigate effects.
• Recognise that both prescribed and recreational substances can influence sexual health.
• Monitor for interactions with contraceptives to prevent unintended pregnancies.

By staying informed, planning proactively, and communicating openly, individuals can better navigate sexual wellness while managing medical and mental health needs.