Substance/Medication-Induced Sexual Dysfunction

Symptoms of substance and medication-induced sexual dysfunction can vary between individuals based on factors like age, gender, and type. Symptoms of sexual dysfunction may be lifelong, situational, or acquired over time. Sexual dysfunction is categorized into groups according to symptoms:

Libido and desire disorders

Two libido-related sexual dysfunction disorders include the following: 

• Hypoactive sexual desire disorder (HSDD): Persistent or recurrent lack of desire for sexual fantasies or activity
• Sexual aversion disorder (SAD): Persistent or recurrent aversion or avoidance of genital sexual contact

Arousal disorders

A substance-induced sexual dysfunction can also cause symptoms of orgasm disorders. Orgasm disorders may include the following: 

• Genital arousal disorder: Mental awareness of sexual pleasure without experiencing arousal of the genitals
• Subjective arousal disorder: Genital arousal without mental awareness of sexual pleasure
• Combined sexual arousal disorder: Lack of both genital and mental response to sexual pleasure

Orgasm disorders (anorgasmia)

Orgasm disorders may include the following: 

• Absence of orgasm
• Delay of orgasm
• Fewer orgasms
• Less intense orgasms

Pain disorders

In some cases, individuals experience pain during sex or arousal. Below are substance inducing sexual conditions that may cause pain: 

• Vaginismus: A physiological reaction in which the vaginal muscles tighten uncontrollably and cause pain 
• Dyspareunia: Painful sexual intercourse
• Vulvodynia: Chronic pain or discomfort in the vulva area
• Vaginal dryness: Dryness in the vagina that may occur internally and externally
• Peyronie’s disease: Fibrous scar tissue causing a curve or bend in the penis

These disorders can affect people assigned male at birth (AMAB) and individuals assigned female at birth (AFAB), with the exception of certain pain disorders.

For some who experience symptoms of substance and medication-induced sexual dysfunction, the difficulty can be a source of embarrassment. For example,sexual performance anxiety occurs when there is a problem that leads to frustration with sexual activity or performance. Often, instances of sexual dysfunction go unreported, which can potentially lead to additional challenges, such as the following: 

• Depression
• Anxiety, particularly regarding sexual activity
• Stress
• Relationship troubles
• Lack of sexual fulfillment 

As such, it may be helpful for those experiencing substance and medication-induced sexual dysfunction to seek solutions from a healthcare professional. 

Sexual dysfunction can be caused by physical reasons. But for those who are experiencing sexual dysfunction due to medication or substances, common causes may include: 

• Dosage: Ingesting large quantities of substances such as alcohol, amphetamines, marijuana, and others can sometimes lead to sexual dysfunction. For those taking prescription medication, the required dosage may be inhibiting their sex lives.
• Polysubstance use: Sexual dysfunction can often be caused by polysubstance use, which is the combination of substances or medications.
• Reaction to new medication: In some cases, individuals may report medication-induced sexual dysfunction when starting a new medication. The sexual dysfunction may cease once the individual grows acclimated to the new medication.
• Medication type: SSRIs (selective serotonin reuptake inhibitors) are commonly associated with sexual dysfunctions, including erectile dysfunction, decreased libido, and difficulty achieving orgasm, as side effects of the medication. Selective serotonin reuptake inhibitors (ssris) such as fluoxetine and paroxetine are often to blame. Moreover, antihypertensives such as thiazides are known to cause erectile dysfunction. Methadone has been associated with male sexual dysfunction and hormonal contraceptives are linked to female sexual dysfunction.

If you are experiencing symptoms of sexual dysfunction due to a change in your prescription medication, consult your doctor immediately. Some medications can present serious side effects if the dosage is increased or decreased or if one stops taking them completely without medical supervision. Note that the information in this article is not a replacement for medical advice or diagnosis. Speak to your doctor before starting, changing, or stopping a medication, or if you suspect your medication is impacting your sexual functioning.

For those experiencing symptoms of substance and medication-induced sexual dysfunction, there are various potential treatments³ available that may alleviate this issue. The goal of treatment is often to address the side effects of current medications and the possibility of substance misuse and to bring individuals to a point where they can be sexually fulfilled and satisfied.

Medication

Medication may reduce some of the physical symptoms of medication-induced sexual dysfunction. Consult your primary care provider about medications that can increase sexual desire and performance. Do not mix medications or start, stop, or change medications without consent from your primary care provider and prescribing physician. Working with your physician to adjust the dosage of certain prescribed medications can often alleviate symptoms of sexual dysfunction.

Surgery

In some cases, a doctor may refer a patient to surgical support options. Below are a few of these options to talk to your doctor about: 

• Penile prosthesis implant: Device placed inside the penis to aid in erection
• Vascular reconstruction: Arterial transfer increases blood flow to the penis to aid in erection
• Vestibulectomy: An outpatient procedure to treat vulvodynia

Other treatment options 

There are other options for individuals experiencing sexual dysfunction beyond therapy, medication, and surgery. While medical supervision may not be necessary for some of the following treatments, getting the advice of a medical doctor before use is recommended. 

Some people may use mechanical aids to treat sexual dysfunction, such as the following: 

• Vacuum pumps, penis sleeves, and penis rings to achieve and maintain an erection
• Ejaculation control stimulators
• Vaginal dilators
• Vibrators
• Clitoral stimulators

In some cases, physiotherapy options might be helpful, as well, such as the following three options: 

• Pelvic floor muscle training
• Trigger point therapy
• Global therapeutic massage

One may also apply topical creams and ointments like vasodilators and prostaglandins to the genitals to stimulate arousal.

Self-care for sexual dysfunction

Self-care may be a way to manage daily life and the feelings that may arise due to your sexual dysfunction. Below are a few forms of self-care to consider: 

• Support systems, such as friends, family, and support groups, may promote mental health and well-being, as they are associated with well-being and a lower risk of physical health conditions. 
• Lifestyle changes, such as exercising more or eating nutritious and vitamin-rich foods, may alleviate symptoms of sexual dysfunction.
• If you are living with a substance use disorder, it may be helpful to avoid situations, people, and items related to substance misuse that often cause you to want to relapse. 

Therapy can be a helpful option for those experiencing substance and medication-induced sexual dysfunction. For those who may experience discomfort when discussing sexual issues, online therapy through a platform like BetterHelp is an option that can provide convenient and flexible treatment with a licensed professional from the comfort of home. 

Additional resources may include: 

• Substance Abuse and Mental Health Services Administration (SAMHSA): Operating within the US Department of Health and Human Services, SAMHSA provides access to services, resources, and education for people experiencing substance use disorders and other mental health disorders. 
• Mental Health America (MHA): MHA is a non-profit organization dedicated to promoting mental health and well-being and focusing significantly on mental illness prevention.
• National Institute of Health (NIMH): Also operating within the US Department of Health and Human Services, NIMH is the lead federal agency for education and research on mental disorders. The organization also has a directory for localized services and advocacy groups nationwide.

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

For those who are required to take a medication that has an adverse effect on their sexual function, various possible treatments, such as “drug holidays” (taking time off from the drug causing sexual dysfunction), counteracting medications, and switching up medications may provide relief. Consult your primary care provider before making any medication changes.

Substance and medication-induced sexual dysfunction often coincides with mental health issues, such as depression and bipolar disorder. While ongoing, research on new and improved psychiatric medications is lagging behind many other fields of medicine. Perhaps with further study, side effects like sexual dysfunction may be eliminated from future generations of psychiatric medications.

In addition to medications, techniques like cognitive-behavioral therapy (CBT) also play a significant role in treating psychological disorders that feature sexual dysfunction as a symptom. With time, regular therapy may reduce one’s need for pharmaceutical intervention. Research suggests that CBT is also effective in treating substance use disorders.

Below are several statistics on substance and medication-induced sexual dysfunction:

• As many as 50% of patients taking antipsychotic medications have adverse sexual side effects.
• Between 25% and 80% of those taking antidepressants have adverse sexual side effects.
• Working with a physician who is aware of your sexual history can reduce the likelihood of substance and medication-induced sexual dysfunction.
• Effective management of substance and medication-induced sexual dysfunction can help individuals establish solutions for improved quality of life.