Medications and Sex

Derek C. Polnsky MD

There is a constant dilemma for me when considering giving patients of mine medications.  There are many instances where medications are in fact helpful and a careful evaluation is always important in weighing the pros and cons.  When it comes to psychotropic meds, i.e. drugs that are used in the context of psychological issues the potential side effects need to be explained carefully.

First, let me mention the ‘usual suspects’ of drugs and then talk about what they do and what problems might result.


These medications are known as the ‘benzos’  (which is short for benzodiazepene)  The brand names include Ativan, Xanax, Klonopin, Valium and Librium.  These medications act within 20 minutes and are helpful for people who have moderate anxiety.   They usually do not have sexual side effects.


These are ‘antidepressants’.  There are several different types.  The older drugs were amitryptaline, imipramine, nortryptaline.  They were effective, but the side effects were a problem, Dryness of the mouth, blurred vision, low blood pressure and sexual side effects.  They are not used much today.

“SSRIs”:  Drugs such as: Prozac, Zoloft, Paxil, Celexa and Lexapro.  They have been around for 40 years and are very effective in helping people with depression and with generalized chronic anxiety.  Just giving out pills, though, is not what I do.  I use these medications as a ‘helper’ to the talking therapy.  When combined, they can be very useful.  Patients talk about how they have made a huge difference to how they feel; less anxiety, less obsessive thinking, improved mood and sense of well being.

Effexor, Cymbalta and Pristiq are similar medications, but their chemical structure is slightly different.

Wellbutrin is a totally different antidepressant.   I don’t find it as effective as the others, but use it occasionally when the others have not been helpful, as a means of ‘boosting’ the SSRIs and sometimes to reverse the sexual side effects caused by some antidepressants.


With the SSRIs and the Effexor group the following side effects MAY occur:

1               Lowered sexual interest and desire.

2               Difficulty with orgasm (both for women and men) It may take a longer time to have an orgasm, the orgasm may not feel as good or it may interfere with having any orgasm.  By the way, this side effect is sometimes helpful for guys who come very quickly.

3               Decreased arousal.  For women, they may not get as wet, and for guys, it may take longer to get an erection. There may also be decreased physical sensation.

I always have to balance the side effects with the intensity of the psychological symptoms an individual has.  If the depression or anxiety is severe and interferes with work, relationships, sleep, a combination of medication and talking therapy is what I do.  There are instances where there is a long family history of depression, and here, talking is not that helpful alone.  Exercise, relaxation can be useful, but by and large can not overcome what is a ‘biological’ depression.  In some of these instances the depression is immobilizing and worse than having sexual side effects from meds.

There are many instances where medications are overused, but at the same time it’s unfortunate that people refuse to take meds that could be very helpful with symptoms that have a very negative effect on their lives.

I use the example of insulin dependent diabetes.  Here, one has to take insulin all the time to control the level of the blood sugar.  There is a biological problem with the pancreas, and no amount of good food, exercise, yoga and good thoughts will get it to produce insulin.  In this extreme situation, refusing to take insulin will usually result in coma and death.


It’s always important to describe for my patients what they might be and then see if the individual notices any changes.  There is no way of predicting who will have the sexual side effects.  Some people have none; others have side effects that can be quite intense with effects on sexual functioning.   Sometimes the side effects will lessen over time; and for some, adding wellbutrin may alleviate the difficulties with arousal and orgasm.   For a significant number of women, Viagra (or Levitra or Cialis) may help.  There is increased blood flow in the clitoris and vagina, and arousal and orgasm might improve.

I encourage eople who have been in touch with their sexual feelings, know what feels good and know how to masturbate in ways that are exciting, to make sure they masturbate frequently.  It may initially feel a bit like work, but it can help get over the sexual inhibition.  I have had some women who would almost meditate into sexual arousal, and who described their orgasms as being longer, deeper and more intense.  (Same with some men)

So if you have symptoms that include depression, anxiety, preoccupying thoughts and dread that are having a major impact on your life, medications in combination with talking therapy can be extremely helpful.  It is important in this regard that you find a therapist with whom you feel comfortable, and whom you feel understands and listens.  If you take medications and there are effects on sexuality, discuss this with your doctor and either a dose change or a medication change might make a difference.

Derek Polonsky is a psychiatrist in Boston who does individual, couples and sex therapy.

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