Top 10 drugs that may contribute to sexual dysfunction
Key Takeaways
A variety of prescription medications, along with the conditions they treat, may contribute to sexual dysfunction.
Some of these drugs are known to interfere with sexual health, such as antidepressants and beta blockers; lesser known culprits include thiazide diuretics or opioids.
Clinicians can help by being aware of medications that may affect sexual function, having open discussions with patients, and adjusting medications where needed.
Sexual function is multiphasic and involves sexual desire, arousal, and orgasm. Men and women can experience issues at any phase, with presentations including decreased desire, premature/retrograde/absent ejaculation, erectile dysfunction, anorgasmia, painful sex, and absence of swelling/lubrication in women.
Sexual dysfunction can be an adverse effect of various prescription medications, as well as the conditions that they treat. Some of these treatments, such as antidepressants and certain antihypertensives, likely come as no surprise to the clinician. Others, however, are not as well-known.
Here are 10 types of prescription medicines that contribute to sexual dysfunction.
Antiandrogens
Antiandrogens are used to treat a gamut of androgen-dependent diseases, including benign prostatic hyperplasia, prostate cancer, paraphilias, hypersexuality, and priapism, as well as precocious puberty in boys.
The androgen-blocking effect of these drugs—including cimetidine, cyproterone, digoxin, and spironolactone—decreases sexual desire in both sexes, as well as impacting arousal and orgasm.
Immunosuppressants
Prednisone and other steroids commonly used to treat chronic inflammatory conditions decrease testosterone levels, thus compromising sexual desire in males and leading to erectile dysfunction (ED).
Sirolimus and everolimus, which are steroid-sparing agents used in the setting of kidney transplant, can mitigate gonadal function and also lead to ED.
HIV meds
The focus of dolutegravir (DTG)-based antiretroviral therapy has been on efficacy, as measured by viral load. Nevertheless, these drugs appear to affect sexual health, which can erode quality of life, according to authors writing in BMC Infectious Diseases.[]
“Sexual dysfunction following transition to DTG-based regimens is common in both sexes of [people living with HIV], who indicated that they had no prior experience of difficulties in sexual health,” the study authors wrote. “Our findings demonstrate that sexual ADRs negatively impact self-esteem, overall quality of life and impair gender relations. DTG-related sexual health problems merit increased attention from HIV clinicians.”
Cancer treatments
Both cancer and cancer treatment can impair sexual relationships. And cancer treatment itself can further contribute to sexual dysfunction.
For example, long-acting gonadotropin-releasing agonists used to treat prostate and breast cancer can lead to hypogonadism, resulting in lower sexual desire, orgasmic dysfunction, erectile dysfunction in men; and vaginal atrophy/dyspareunia in women.[]
Hormonal agents given during the course of endocrine therapy in cancer care lead to a sudden and substantial decrease of estrogens via their effects at different regulatory levels. Selective ER modulators (SERMs) are used to treat ER-positive breast cancers and bind ERs α and β. These receptors are crucial in the functioning of reproductive, cardiovascular, bone, muscular, and central nervous systems. Tamoxifen is the most common SERM used.
In females, reduced estrogen levels due to endocrine therapy can lead to vaginal dryness and discomfort, pain when urinating, dyspareunia, and spotting during intercourse.
Antipsychotics
Per the research, males taking antipsychotic medications report ED, less interest in sex, and lower satisfaction with orgasm, with delayed, inhibited, or retrograde ejaculation. Females taking antipsychotics report lower sexual desire, difficulty achieving orgasm, anorgasmia, and impaired orgasm quality.
“The majority of antipsychotics cause sexual dysfunction by dopamine receptor blockade,” according to the authors of a review article published in the Australian Prescriber.[] “This causes hyperprolactinaemia with subsequent suppression of the hypothalamic–pituitary–gonadal axis and hypogonadism in both sexes. This decreases sexual desire and impairs arousal and orgasm. It also causes secondary amenorrhoea and loss of ovarian function in women and low testosterone in men,” they continued.
Antipsychotics may also affect other neurotransmitter pathways, including histamine blockade, noradrenergic blockade, and anticholinergic effects.
Anti-epileptic drugs
Many men with epilepsy complain of sexual dysfunction, which is likely multifactorial and due to the pathogenesis of the disease and anti-epileptic drugs, per the results of observational and clinical studies.[]
Specifically, anti-epileptic drugs such as carbamazepine, phenytoin, and sodium valproate could dysregulate the hypothalamic–pituitary–adrenal axis, thus resulting in sexual dysfunction. Carbamazepine and other liver-inducing anti-epileptic drugs could also heighten blood levels of sex hormone-binding globulin, thus plummeting testosterone bioactivity.
Both sodium valproate and carbamazepine have been linked to disruption in sex-hormone levels, sexual dysfunction, and changes in semen measures.
Antihistamines
Allergic disease is commonly treated with antihistamines and steroids, with both drugs potentially interfering with sexual function by decreasing testosterone levels. In particular, H2 histamine receptor antagonists can disrupt luteinizing hormone/the human chorionic gonadotropin signaling pathway, thus interfering with the relaxation of smooth muscles at the level of the corpus cavernosum.[]
ß-blockers
ß-blockers contribute to ED likely because they suppress sympathetic outflow.
“Non-cardioselective ß-antagonists like propranolol have a higher incidence of ED than cardioselective ß-antagonists which avoid ß2 inhibition resulting in vasoconstriction of the corpora cavernosa," per investigators writing in Sexual Medicine.[] "Nebivolol has the greatest selectivity for ß1 receptors as well as endothelial nitric oxide vasodilatory effects, and has been shown to have a positive effect on erections."
The authors cite a double-blind randomized comparison in which metoprolol decreased erectile scores after 8 weeks, whereas nebivolol improved them.
As well, he selective β-blocker nebivolol inhibits β1-adrenergic receptors, which may protect against ED vs non-selective β-blockers.[]
Opioids
The µ opioid receptor agonist oxycodone not only inhibits ascending pain pathways, but also disrupts the hypothalamic-pituitary-gonadal axis by binding to µ receptors in the hypothalamus, thereby resulting in negative feedback and resulting in ED, as noted by the Sexual Medicine authors.
Consequently, less gonadotropin-releasing hormone is produced, which results in lower levels of gonadotropins and secondary hypogonadism.
Loop diuretics
Results of a high-powered study demonstrated that men taking thiazides were twice as likely to experience ED compared with those taking propranolol or placebo. It’s unclear whether furosemide also causes ED. It’s also unclear why thiazides cause ED. Nevertheless, the Sexual Medicine authors stress that prescribers should remain cognizant of the potential for thiazide to interfere with sexual function.
What this means for you
It’s important for clinicians to realize the potential for a wide variety of drugs to contribute to problems in the bedroom. If a patient experiences trouble having sex, they may discontinue use of the drug altogether. Consequently, physicians must tailor treatment plans with patients and their partners in mind.
The key to assessing sexuality is to foster an open discussion with the patient concerning sexual function and providing effective strategies to address these concerns.