What Is Substance/Medication-Induced Sexual Dysfunction?

When Alcohol, Drugs or Medications Impair Your Sexual Performance

Man is upset while partner sleeps
Sexual dysfunction can be the result of alcohol, drugs, or medications. skynesher / Getty Images

Substance/medication-induced sexual dysfunction is the medical diagnostic name for alcohol- or drug-induced sexual problems.

There are many different types of sexual problems. These problems can include losing interest or the desire to have sex, sometimes to the point where even thinking about sex can be unpleasant. They can also involve difficulty with becoming sexually aroused, which can affect men or women.

Men can develop problems with getting an erection, even if they feel sexually aroused, or they can lose their erection before or during sex. Women can develop problems with vaginal lubrication, even if they feel sexually aroused, although these problems are more easily resolved than erectile problems, simply by using a vaginal lubricant before having sex. People can also have difficulty experiencing sexual pleasure, or difficulty reaching orgasm or ejaculating.

The consequences of sexual problems for individuals and couples can be significant. All of these sexual problems can cause feelings of confusion, unattractiveness, and inadequacy in both partners. Sometimes, changes in sexual interest or sexual expression can even cause suspicion in the other partner, who may feel it is evidence that their partner no longer finds them attractive, or that he or she is having an affair. For this reason, it is important to communicate openly with your partner about your feelings, or, it your partner is the one affected, to listen without judgement.

Unlike the normal fluctuations in sexual interest and sexual performance that everyone experiences from time to time, substance or medication-induced sexual dysfunction is considerably more pronounced, and long-lasting. It is also more problematic than the temporary difficulties with getting or keeping an erection, which can happen as a normal result of drinking alcohol—so-called "brewer's droop," or using certain recreational drugs which can stimulate the sympathetic nervous system, such as amphetamines or LSD.

Although this problem affects many men, not all experience difficulty getting an erection after using these substances, which can lead to feelings of inadequacy in men who do. If you find this is a problem, try avoiding intoxication prior to sexual contact, and see if it is easier to get and keep an erection. If you continue to have difficulties, or if you are finding it difficult to have sex without drinking or using drugs beforehand, consider discussing this with your doctor.

For some people, substance or medication-induced sexual dysfunction can significantly impact their sex life, causing distress, frustration, and relationship difficulties. Partners of men who are unable to get or keep an erection may feel this is because their partner no longer loves them, or finds them attractive, when in fact, this may not be the case. Therefore, it is important to get help, before problems develop between you and your partner that could be prevented.

When doctors or psychologists give a diagnosis of substance/medication-induced sexual dysfunction, they check to make sure that the sexual problem wasn't there before the use of alcohol, drugs, or medications thought to be responsible. This is because there are different types of sexual problem, and if the symptoms were there before the substance use, it isn't the substance/medication-induced type of sexual dysfunction.

How Soon After Taking the Drug Can Sexual Problems Be Induced?

In some cases, almost immediately. There is even a category "with onset during intoxication," which means that the sexual problem actually began when the individual was under the influence. It can also occur during withdrawal, during which sexual difficulties are common. However, when sexual problems are simply a symptom of withdrawal, the person's sexual functioning will usually improve within a few days of ceasing to take the drug or medication, while with substance-induced sexual dysfunction, it can start during withdrawal, and continue or get worse as the person moves through the detox process.

Generally, the diagnosis isn't given if the person has a history of sexual problems without substance use, or if the symptoms continue for more than a month after the person becomes abstinent from the alcohol, drugs, or medication.

Finally, for the diagnosis of substance/medication-induced sexual dysfunction disorder to be given, the sexual problem must be causing them (and often, their partner) significant distress.

Which Drugs Cause Substance/Medication-Induced Sexual Dysfunction?

A wide variety of psychoactive substances can cause substance-induced dysfunction, including:

  • Alcohol-induced depressive disorder
  • Opioid-induced depressive disorder
  • Sedative-induced depressive disorder
  • Hypnotic-induced depressive disorder
  • Anxiolytic-induced depressive disorder
  • Amphetamine-induced depressive disorder
  • Other stimulant-induced depressive disorder
  • Cocaine-induced depressive disorder
  • Other substance-induced depressive disorder
  • Unknown substance-induced depressive disorder

Although not listed in the DSM-5, there is also evidence that cannabis can also impair sexual functioning, and, in some cases, there is evidence that marijuana can cause infertility. However, although it can affect male and female fertility in various ways, unfortunately, marijuana and other non-contraceptive drugs are not reliable forms of birth control.

Various medications are known to cause substance-induced sexual dysfunction, resulting in the following conditions:

  • Antidepressant-induced sexual dysfunction
  • Antipsychotic-induced sexual dysfunction
  • Hormonal agent-induced sexual dysfunction
  • Cardiovascular agent-induced sexual dysfunction
  • Cytotoxic agent-induced sexual dysfunction
  • Gastrointesinal agent-induced sexual dysfunction
  • Benzodiazepine-induced sexual dysfunction

Some conditions for which medications that affect sexual functioning are prescribed can also have an impact on the quality of people's sex lives. Breast cancer, for example, can greatly affect women's self image, feelings of interest in sex, and the physical aspects of sexual arousal, such as vaginal lubrication. They may feel less attractive, due to having breast tissue removed, or their breasts being affected by the disease. Developing medication-induced sexual dysfunction can cause further difficulties with intimacy and sexual expression, resulting in greater feelings of depression.

Clinical depression can also affect sexual interest and arousal, and there has been considerable research conducted, which has identified how common it is for people with depression to have sexual problems, Added to that, antidepressant medications can also cause sexual dysfunction. Several treatments for people taking antidepressants who have developed sexual dysfunction have been trialed in research studies with encouraging results, but more research is needed before specific treatments can be widely recommended.

As it is so common for people to experience variations in sexual interest and sexual functioning, many people do not realize that the substance or medication is responsible. Sexual feelings can often become less important as we age, so sometimes people simply assume that their sex life is over when they reach middle age. They needlessly suffer, and their sexual relationships are often affected, by a problem that can usually be reversed by having the medication you are taking adjusted or changed.

However, the opposite is also true—people who realize that the medication they have been taking is responsible for changes in their sexual functioning may discontinue a medication that was necessary for managing another medical or psychological problem without discussing it with their doctor. Research shows that about a third of people taking psychotropic medications to treat mental health conditions have negative sexual effects, with most believing they are a result of taking from these medications. This results in a negative attitude towards taking their medications, which can be very important for maintaining a good quality of life and managing the symptoms of their mental illness.

Their other symptoms may worsen as a result. Therefore, although you may feel embarrassed, you should always discuss any sexual side effects of medication with your doctor before discontinuing your medication. They may be able to prescribe another medication that does not affect your sexual functioning.

What If My Partner Has Substance/Medication-Induced Sexual Dysfunction?

It can be frustrating and hurtful if your partner seems uninterested in having sex, or unable to enjoy it. Although you might be having a lot of negative feelings about your partner, it is important to remember that they are not able to control the way their body responds to drugs or medication.

Whether your partner is drinking or taking drugs for recreational reasons or for medical reasons, it is important to talk about the difficulties you are experiencing with your sexual relationship in a sensitive and kind way. People experiencing this condition may feel ashamed, or be easily angered by insensitive or blaming comments.

Intimacy is the most important part of your sexual relationship, and there are many ways to get close without needing penetrative sex. Putting aside the need for penetration and orgasm can take the pressure off a sexual relationship, and can even help couples to feel closer.

If you drink or use drugs with your partner, you may have to decide what is more important to you as a couple—using these substances or having a satisfying sex life. Even if you are unaffected sexually by  your substance use, and your partner is the one affected, he or she might feel rejected or unimportant to you if you choose to continue to drink or use drugs alone or with other people. Couples therapy can help you to decide how to move forward in your relationship in a way that meets the needs of both partners.

Sources:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, fifth edition, DSM-5. American Psychiatric Association, 2013.

Apantaku-Olajide T, Gibbons P, Higgins A. Drug-induced sexual dysfunction and mental health patients' attitude to psychotropic medications. Sexual & Relationship Therapy. May 2011;26(2):145-155.

Bari M, Battista N, Pirazzi V, Maccarrone M. "The manifold actions of endocannabinoids on female and male reproductive events." Front Biosci. 16:498-516. 2011.

Segraves R, Balon R. Antidepressant-induced sexual dysfunction in men. Pharmacology, Biochemistry and Behavior June 2014;121:132-137

Taylor S, Harley C, Absolom K, Brown J, Velikova G. Breast Cancer, Sexuality, and Intimacy: Addressing the Unmet Need. Breast Journal [serial online]. July 2016;22(4):478-479.

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