What Medications Impact Sexual Health?
Please note that I am writing this blog from the perspective of a Sex Therapist. If you have any concerns at all with the medication you are taking, please speak to your prescribing doctor. Depending on what the medication is treating, adjustments or alternatives may be proposed. However, it is essential to consult with a doctor in making these changes.
As always, the biological and the medical must be considered in the bigger picture of the psychological and relational. Sexual function does not occur in the isolation of biology, but there is a profound and inseparable interaction with these other factors. To consider biology in isolation is to over-simplify and over-medicalise. At the same time biology is important to consider and does have an effect, but this effect is likely to be minimised or amplified by these other factors.
In this blog post we explore concepts such as specific chemicals in the body that are involved in sexual responsiveness, arousal, and desire.
For a more in depth understanding of these concepts that are only lightly touched on here read the following blogs:
What Are the Key Chemicals in Sexual Health?
Understanding Desire of Libido
Understanding Arousal: The Mind-Body Connection in Sexual Wellbeing
SSRI Antidepressants
Selective Serotonin Reuptake Inhibitors (SSRIs) such as fluoxetine (prozac), sertraline (Zoloft), and paroxetine (paxil) are widely prescribed worldwide as effective medication for anxiety and depression. They are important medications, and yet they are also impactful on sexual functioning.
Serotonin is the brain’s primary brake for sexual responsiveness, as serotonin signals to the brain sexual satisfaction. As SSRIs keep serotonin artificially high, this can signal to the brain to put the brakes on sexual arousal. 30-70% of people report experiencing sexual side effects on SSRIs. The most common complaint is delayed or absent orgasm. Given that serotonin can impact the body’s capacity for arousal, it can significantly impact on the experience of desire.
The effectiveness of SSRIs in delaying orgasm is so reliable, that SSRIs are an off-label prescription to treat premature ejaculation in men. When SSRIs are prescribed for depression and there are negative sexual side effects, an atypical antidepressant such as bupropion (Wellbutrin) may be prescribed instead. This medication boosts dopamine (desire) and norepinephrine (arousal and energy) rather than serotonin, which can reduce sexual side effects.
Blood Pressure Medication
Over time, blood vessels are damaged by high blood pressure (hypertension). This in and of itself is one major cause of erectile dysfunction and vaginal dryness. Arousal to the pelvic region relies on healthy blood flow, therefore any condition that impacts blood flow, impacts arousal. At the same time blood pressure medication can also be a culprit of sexual difficulties.
These blood pressure medications change how blood vessels squeeze and relax to lower blood pressure. They can also alter the balance of fluid in the body. The specific medication that can impact sexual function are older beta-blockers (propranolol and atenolol) and thiazide diuretics (water pills). These can cause erectile difficulties by preventing the smooth muscles in the penis from relaxing and decreasing the blood flow necessary for erections. In female bodies these medications can contribute to a decrease in vaginal lubrication. As some of these drugs cross into the central nervous system, they can also overall decrease the brain’s responsiveness to arousal, causing fatigue and lowered desire.
Alternative blood pressure medication that have lower sexual side effects include ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, and the newer beta-blocker nebivolol.
Hormonal Contraceptives
While revolutionary for reproductive freedom, combined oral contraceptives (COCs) can often lower arousal and desire. COCs contain synthetic estrogen and progesterone (the synthetic version of progesterone is progestin) that stop ovulation. As this estrogen passes through the liver it causes a spike in Sex Hormone Binding Globulin (SHBG), which sweeps through the bloodstream and binds up free testosterone. Testosterone is a fuel for sexual desire and genital sensitivity, therefore a drop in testosterone can decrease spontaneous desire, clitoral sensitivity, and lubrication. Overall testosterone production is also suppressed due to ovulation being stopped. During ovulation there is a natural surge of testosterone produced by the ovaries. Therefore the COC both lowers production and binds up what is left. It is important to note that the impact of COCs is highly variable with 1/3 reporting a decrease in sexual interest, approx. 50% reporting no change, and 1/5 actually experiencing an increase in interest by eliminating the fear of unwanted pregnancy.
Progestin-only methods tend to be less impactful on sexual responsiveness, with many individuals not reporting any sexual side effects in comparison to COCs. This includes the mini-pill, mirena (hormonal intrauterine device), and progestin implant (Implanon). However, the exception to this is the Depo-Provera Shot which injects progestin in a high-dose. This has a high desire suppressing effect as it aggressively suppresses the body’s release of hormones. It is considered a “sledge-hammer” to sexual desire. (read my blog on these hormones here)
Antipsychotics
Antipsychotics are prescribed for mental health conditions such as schizophrenia, bipolar, and acute psychotic episodes. They may be prescribed at lower doses for severe anxiety or uncontrolled anger. These medications primarily work by blocking dopamine. As dopamine is involved in driving the wanting of sex, these medications can suppress sexual desire. These medications also cause a spike in prolactin which is the body’s natural signal of sexual satisfaction. Prolactin is also involved in causing the refractory period for erections, which in the case of antipsychotic medication can therefore lead to erectile dysfunction. In all individuals, there can be the experience of desire and orgasm difficulties due to this spike in prolactin.
Some antipsychotics can also cause dry ejaculation where semen empties into the bladder rather than out through the penis, and in rare cases trigger painful, prolonged erections (priapism) which requires emergency medical treatment.
Sedatives
Benzodiazepines (Valium, Xanax, Ativan) are prescribed for severe anxiety, panic attacks, muscle spasms, and sleep disorders. These act as a central nervous system depressant, slowing down brain activity to produce a calming effect. However, as they sedate the nervous system they also hit the brakes on sexual responsiveness. Sexual arousal requires building physical tension. Therefore, chemically enforced relaxation can lead to difficulties with physical arousal and orgasm, erectile dysfunction, and decreased spontaneous sexual desire. A small dose for a small minority may ease sexual performance anxiety, but for a majority this medication broadly diminishes sexual responsiveness.
ADHD Medication
This includes nervous system stimulants (such as Adderall) and non-stimulants (Strattera) to improve focus, attention, and impulse control in ADHD. Stimulants work by acting directly on the central nervous system to increase dopamine and activate the sympathetic nervous system. Dopamine is crucial for sustained attention without the urgent need to seek out external stimulation impulsively. Non-stimulants increase the availability of noradrenaline (norepinephrine), which acts as an emergency and alertness messenger. Increasing this maintains sustained alertness and cognitive focus.
The impact on sexual responsiveness can be mixed. For some these medications improve sexual responsiveness by improving presence and focus during sexual intimacy, as well as reducing sexual impulsivity. However, the actual medications themselves have physical side effects that can impact on sexual responsiveness. This includes erectile difficulties, reduced vaginal lubrication, and inhibited or delayed orgasm. Both non-stimulant and stimulant medication activate the sympathetic nervous system which also mimics the biological brakes that tighten the smooth muscle of the pelvic region, restricting blood flow in that area and directing blood flow to vital organs, thus reducing arousal in the genitals.
Dopamine Medication
Dopamine medications are primarily prescribed for Parkinson’s and restless leg syndrome. The atypical antidepressant and smoking cessation medication bupropion (Wellbutrin) also boosts dopamine and norepinephrine in the brain. Given that dopamine is the chemical of motivation, boosting dopamine in the brain can enhance sexual responsiveness such as erectile function, orgasmic intensity, and sexual desire. Sometimes these effects go too far and trigger impulsive and excessive sexual behaviour, or even spontaneous and unwanted orgasms.
Nitrates (Heart medication)
Nitrate medication serve the primary function of relaxing smooth muscle and expanding blood vessels. These heart medications are prescribed for heart disease and angina (chest pain). Nitrates dilate the arteries in the heart and increase blood flow back to the heart. These medications dilate blood vessels all through the body causing an overall drop in blood pressure, and in this way, they can cause erectile dysfunction as a side effect (although many may already have an experience of erectile dysfunction given the impacts of heart disease on blood flow in the first place). Arousal requires a high build-up of localised blood pressure to the genitals, and if overall blood pressure drops it can be difficult to achieve the pressure needed for an erection.
It is absolutely critical to NOT use PDE-5 inhibitors (such as Viagra, Cialis) in the case of nitrate medication. Mixing these two medications can lead to a sudden and life-threatening drop in blood pressure that can lead to stroke, kidney failure, heart attack, or even death. While not a medication, it is also critical to note that the use of recreational “poppers” (amyl nitrate) absolutely should not be used with PDE-5 inhibitors, for the same reason that heart disease medication should not be used with PDE-5 inhibitors. Poppers carry the same risk of death when combined with PDE-5 medication.
Statins and Fibrates (Cholesterol Medication)
High cholesterol damages the inner lining of blood vessels and creates plaque that clogs the vessels. The pelvic blood vessels are very small and these are often the first to clog. Erectile dysfunction or female arousal difficulties can often be an early warning sign of cardiovascular disease. Cholesterol medication is prescribed to lower the cholesterol that damages and clogs the blood vessels and improves overall blood flow.
While these medications improve blood flow and improve the “plumbing” for arousal, these medications can also sometimes act as a brake. Some taking this medication experience erectile dysfunction, vaginal dryness, lack of clitoral blood flow, difficulty in arousal and experiencing orgasm. However, it is unknown as to how these medications act as a brake for arousal. The good news is that for many people statins improve arousal and sexual function due to the rehabilitation of blood vessels.
How Do These Medications Fit into the Bigger Picture of Sexual Health?
While medications can have a significant impact on sexual function, they are only one part of the picture.
Sexual health is best understood through a biopsychosocial lens, where biology, psychology, relationships, and context are constantly interacting.
For example:
A medication may reduce arousal or delay orgasm, but how an individual interprets and responds to that change (e.g. anxiety, frustration, avoidance) can further amplify the difficulty.
A partner’s response to these changes can either increase pressure and distress, or create safety, understanding, and adaptability.
Emotional wellbeing, stress levels, and relationship dynamics can either buffer or intensify the biological effects of medication.
This means that while medications can influence sexual responsiveness, they do not fully determine the experience of sexuality.
Focusing only on medication effects can sometimes lead to the belief that sexual difficulties are purely biological. In reality, it is often the interaction between the body, mind, and relationship that shapes the experience.
How Sex Therapy Can Help
Sex therapy provides a space to understand your thoughts, emotions, and relationships.
Rather than focusing only on the biological impact, sex therapy supports you to:
reduce performance pressure and anxiety
make sense of changes in desire, arousal, or orgasm
reconnect with sensation and pleasure
communicate openly with a partner about what is happening
adapt sexual intimacy in ways that feel satisfying and sustainable
Where appropriate, sex therapy can work alongside medical care to support a more holistic approach to sexual wellbeing.
I offer online sex therapy across Australia, providing a confidential and supportive space to explore changes in your sexual health, understand the impact of medication, and move toward a more connected and fulfilling experience of sexuality.
Final Thoughts
Medications can have a real and meaningful impact on sexual function. At the same time, they are rarely the full story.
Sexual wellbeing is shaped by the interaction between your body, your mind, your relationships, and your broader life context.
Understanding how medication may be influencing your sexual response can be an important first step to take with your prescribing doctor. From there, it becomes about how you respond to these changes with awareness, flexibility, and support.
Written by Justine
References
Gambescia N, Weeks GR, Hertlein KM. A clinician's guide to systemic sex therapy. 3rd ed. New York, NY: Routledge; 2021.
Tuckman A. ADHD after dark: better sex life, better relationship. New York, NY: Routledge; 2020.
Piché L. ADHD and sex: a workbook for exploring sexuality and increasing intimacy. New York, NY: Routledge; 2025.
Lambert D, Quicke J. Female arousal and orgasm: anatomy, physiology, behaviour and evolution. Singapore: Bentham Science Publishers Pte. Ltd.; 2023.
Longhi EV, editor. Managing psychosexual consequences in chronic diseases. Cham, Switzerland: Springer Nature Switzerland AG; 2023.
Castelo-Branco C, Anglès Acedo S, editors. Medical disorders and sexual health: a guide for healthcare providers. Cham, Switzerland: Springer Nature Switzerland AG; 2024.
Kaplan HS. The new sex therapy: active treatment of sexual dysfunctions. New York, NY: Routledge; 2011.
Crooks R, Baur K, Widman L. Our sexuality. Enhanced 14th ed. Boston, MA: Cengage Learning, Inc.; 2025.
Carson CC 3rd, Kirby RS, Goldstein I, Wyllie MG, editors. Textbook of erectile dysfunction. 2nd ed. New York, NY: Informa Healthcare USA, Inc.; 2009.
