Drugs that interfere with sexual function

By Naveed Saleh, MD, MS
Published October 9, 2020

Key Takeaways

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 a side effect of various prescription medications, as well as the conditions that they treat. Some of these treatments, such as antidepressants and antihypertensives, likely come as no surprise to the clinician, and are commonly implicated etiologies. Although sexual dysfunction due to drugs happens in both sexes, the preponderance of extant research has focused on men. 

Here are seven types of drugs that also 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 men and leading to erectile dysfunction. 

Sirolimus and everolimus, which are steroid-sparing agents used in the setting of kidney transplant, can mitigate gonadal function and lead to erectile dysfunction.

HIV meds

Results from a cross-sectional observational study (n=90) published in AIDS indicated that HIV-infected men with stable disease experienced sexual dysfunction while on antiretroviral therapy.

“Older age, depression and lipodystrophy, combined with the duration of exposure to protease inhibitor, determined a lower score on various sexual dysfunction domains,” the researchers wrote. 

“There is a high prevalence of erectile dysfunction in HIV-infected men, with age and the duration of exposure to protease inhibitor being the only identifiable risk factors,” they concluded.

Cancer treatments

Both cancer and cancer treatment can impair sexual relationships. Moreover, cancer treatment itself can further contribute to sexual dysfunction. For instance, long-acting gonadotropin-releasing agonists used to treat prostate and breast cancer can lead to hypogonadism that results in lower sexual desire, orgasmic dysfunction, erectile dysfunction in men, and vaginal atrophy/dyspareunia in women.

Antipsychotics

Per the research, men taking antipsychotic medications report erectile dysfunction, less interest in sex, and lower satisfaction with orgasm with delayed, inhibited, or retrograde ejaculation. Women on 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.” Antipsychotics may also affect other neurotransmitter pathways, including histamine blockade, noradrenergic blockade, and anticholinergic effects, the authors added. 

Antiepileptic 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, antiepileptic 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 antiepileptic 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

Histamine likely plays an important role in penile erection by activity of the H2—and possibly the H3—receptor, per the research. In fact, histamine has been suggested as a diagnostic tool to study erectile dysfunction. Consequently, it should come as no surprise that antihistamines—such as diphenhydramine, dimenhydrinate, and promethazine—may lead to erectile dysfunction. 

Bottom line

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.

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