Medicines and Your Performance In the Bedroom

There are hundreds of medicines, some commonly used drugs, that can affect a man’s sex life and sexual performance.  Many of these drugs are necessary for treatment of depression and hypertension and shouldn’t be stopped.  This blog will discuss the causes of medications and deterioration of sex drive and sexual performance.

How can medicines affect sexual function?

The mechanism of sexual function involves a complex coordination of hormones, chemical messengers in the brain (neurotransmitters such as dopamine and serotonin) and the sexual organs. In general:

  • dopamine increases sexual function
  • serotonin inhibits sexual function
  • the hormone testosterone is important, as are the blood vessels supplying the penis are also involved in producing an erection.

A medicine can therefore affect sexual function in several ways.

Libido or sex drive

Sex drive is influenced by reproductive hormones, particularly testosterone, which is required for sexual arousal.

Medicines that reduce the testosterone level or block its effects are likely to reduce sex drive.

Libido is also affected by your general emotional and physical health. Medicines that affect any of these aspects, even indirectly by causing drowsiness, lethargy, weight gain or confusion, have the potential to reduce your sex drive.

An erection is the result of coordination between nerves, hormones, blood vessels and psychological factors. This means there are many areas where things can go wrong.

Medicines that have a physical effect on the blood vessels in the penis, those drugs that act on the brain or interfere with hormone levels (particularly testosterone) or affect the transmission of nerve messages, can all cause impotence.

Ejaculation is a complex reflex process that involves the activation of alpha receptors in the prostate gland and seminal vesicles.

Medicines that block alpha-receptors can interfere with ejaculation.

During ejaculation, increased alpha-receptor activation closes the bladder neck, facilitating the normal flow of semen out of the penis.

If this mechanism is disrupted, it results in retrograde ejaculation, with semen flowing along the path of least resistance from the urethra up into the bladder.

Various chemicals in the brain are also involved in orgasm and ejaculation, and medicines that affect these chemicals can also cause ejaculatory disturbances.

The most widely prescribed centrally acting agents that affect ejaculation are selective serotonin re-uptake inhibitor (SSRI) antidepressants.

Antidepressants are the medicines most frequently implicated in causing sexual dysfunction. This is because they work by altering levels of chemicals in the brain. In particular, SSRIs increase serotonin levels, which inhibits sexual function.

Blood pressure lowering (antihypertensive) medicines are also implicated, although the mechanism by which they cause sexual problems will vary from medicine to medicine.

The table of medicines below lists the sexual side effects that some people have reported during their use.

.

Antidepressants Main use Possible effect on sexual function
MAOI antidepressants (eg moclobemide, phenelzine) Depression Decreased sex drive, impotence, delayed orgasm, ejaculatory disturbances
SSRI antidepressants (eg fluoxetine) Depression Decreased sex drive, impotence, delayed or absent orgasm, ejaculatory disturbances
Tricyclic antidepressants (eg amitryptiline) Depression Decreased sex drive, impotence, delayed or absent orgasm, ejaculatory disturbances
Antiepileptics Main use Possible effect on sexual function
Carbamazepine Epilepsy Impotence
Antihypertensives Main use Possible effect on sexual function
ACE inhibitors (eg enalapril, lisinopril) High blood pressure, heart failure Impotence
Alpha-blockers (eg prazosin, doxazosin) High blood pressure, enlarged prostate Impotence, ejaculatory disturbances
Beta-blockers (eg atenolol, propranolol and including timolol eye drops) High blood pressure, angina, glaucoma Impotence
Calcium channel blockers (eg verapamil, nifedipine) High blood pressure, angina Impotence
Clonidine High blood pressure Impotence, decreased sex drive, delayed or failure of ejaculation
Methyldopa High blood pressure Impotence, decreased sex drive, ejaculatory failure
Thiazide diuretics (eg bendroflumethiazide) High blood pressure Impotence
Antipsychotics Main use Possible effect on sexual function
Phenothiazines (eg chlorpromazine, thioridazine) Psychotic illness Ejaculatory disturbances, decreased sex drive, impotence
Risperidone Psychotic illness Impotence, ejaculatory disturbances
Cholesterol lowering medicines Main use Possible effect on sexual function
Fibrates (eg clofibrate, gemfibrozil) High cholesterol Impotence
Statins (eg simvastatin) High cholesterol Impotence
Other Main use Possible effect on sexual function
Benzodiazepines Anxiety and insomnia Decreased sex drive
Cimetidine Peptic ulcers, acid reflux disease Decreased sex drive, impotence
Cyproterone acetate Prostate cancer Decreased libido, impotence, reduced volume of ejaculation
Disulfiram Alcohol withdrawal Decreased sex drive
Finasteride Enlarged prostate Impotence, decreased sex drive, ejaculation disorders, reduced volume of ejaculation
Metoclopramide Nausea and vomiting Decreased sex drive, impotence
Omeprazole Peptic ulcers, acid reflux disease Impotence
Opioid painkillers (eg morphine) Severe pain Decreased sex drive, impotence
Prochlorperazine Nausea and vomiting Impotence
Propantheline Gut spasm Impotence
Spironolactone Heart failure, fluid retention Impotence, decreased sex drive

Bottom Line: This blog makes the connection between medications and sexual performance.  The next blog will discuss how to

approach your physician and what options are available for men who have sexual side effects from medications.

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