Prescription drugs and sex—not always a good mix

by Elaine Gottleib

Although prescription drugs are safe and effective, sometimes the cure has different side effects than the illness.

Joe S., a 50 year-old accountant, takes Diuril for his high blood pressure. Jane L., a 35-year-old computer programmer, alleviates her depression with Zoloft. They both feel good all day. However, problems arise at night when they try to make love to their partners. Joe can't maintain an erection and Jane takes forever to have an orgasm. After a few months of these problems, Joe and Jane start to avoid their partners in bed. Sex becomes an ordeal instead of a pleasure.

Joe and Jane's experiences are typical of the millions of Americans who take prescription drugs. "I rarely see couples with sexual dysfunctions where one or the other or both are not on some kind of long-term medication," says Judy Seifer, Ph.D., sex therapist and clinical professor at Wright State University in Dayton, Ohio.

For many people, sexual dysfunctions as side effects of medications come as an unpleasant surprise. "Unfortunately, some doctors just don't tell patients about the most common drug side effects. Other doctors believe that if you tell patients they'll have a sex problem, you may create it or have them looking for it. I haven't found that to be the case in my experience," says Dr. Adam Keller Ashton, clinical assistant professor of Psychiatry at the State University of New York at Buffalo and a member of the Society of Sex Therapy and Research.

Taking a drug that diminishes your sexual functioning doesn't mean the end of your sex life. There are many treatments that can alleviate sexual side effects. If you suspect that a drug you're taking is affecting your sexuality, the first step is to consult your health care provider and your pharmacist.

Most people are greatly relieved when they discover that the drug is the problem and not themselves, reports Dr. Jay Dudley Chapman, a gynecologist in Cleveland, Ohio and Academic Dean of the Institute for Advanced Study of Human Sexuality in San Francisco. If your health care provider isn't open to discussing the problem with you, Chapman advises finding one who will.

The following guide lists some common prescription drugs (brand name followed by generic), their documented sexual side effects, and what can done about them.

High Blood Pressure Medications (antihypertensives)--By reducing the force of blood flow, which helps men to get erections and women to become lubricated, high blood pressure medications can have a negative impact on sexual arousal. (Most high blood pressure medications are used by men).

Diuril, Hydrodiuril (chlorothiazide and hydrochlorothiazide)--can cause men to have difficulty getting erections; have little effect in women.

Aldomet (methyldopa)--decreases sexual desire, arousal, and orgasm; a strong drug that acts on the beta nerves which are involved in sexual arousal.

Catapres (clonidine)--blocks emissions during orgasm.

Indera (propranolol)-- makes it difficult to ejaculate.

The first approach is usually to try switching to a different drug or lowering the dosage. This generally produces some improvement, according to Dr. Chapman. Another possibility is a "drug holiday", during which you stop taking the drug for a specified period, like a weekend, when you plan to have sex. (Note: this should never be tried without consulting your health care provider.)

If none of these approaches help or aren't appropriate for the patient, treatments for impotence are an option. There are pills, injections, or implants which are inserted into the penis to produce erections. A new orally administered pill, Viagra, is currently being tested and should be available within a year.

Dr. Ashton has also had favorable results treating patients with drug antidotes that counter the negative sexual effects of high blood pressure medications. These drugs include Buspar, Ritalin, Urecholine, and Serzone.

Don't be embarrassed to speak with your pharmacist, as well. He or she has much knowledge about the side effects of medication, and can provide valuable information to you and your health care provider.

Tricyclates - include older drugs such as Elavil and Imipramine that have little effect on sexual functioning; in fact, they may cause a slight increase in desire.

MAO Inhibitors - drugs like Parnate or Nardil may make orgasm more difficult for women.

Selective seratonin reuptake inhibitors (SSRIs) - popular new drugs like Prozac, Zoloft and Paxil reduce desire and orgastic response in both men and women.

For some people, feeling better emotionally via pharmacologic means makes up for any sexual problems caused by antidepressants. However, others stop taking these medications because of the sexual effects.

The treatment options are similar to those for high blood pressure medications. You can switch to a different antidepressant like Wellbutrin or Serzone which have few sexual side effects, reduce the dosage, or try drug holidays. Unfortunately a different medication may not alleviate the depression as well.

Dr. Ashton conducted a major study of drug antidotes for antidepressants and found three--Yohimidine, Amantidine, and Cyproheptadine--were quite effective in countering sexual side effects. Another antidote for women is small doses of testosterone, which increases libido and arousal. Unlike antihypertensives, most people don't need to take antidepressants for their entire lives. Once they stop taking the drugs, their sexual functioning returns to normal.

Tranquilizers like Valium and Librium can increase the sexual desires of inibited people, but, like other sedative drugs and alcohol, can delay arousal and orgasm. Judy Seifer finds that many of her patients who take a variety of prescription and over-the-counter medications at the same time experience changes in sexual functioning. She works with their health care providers to pinpoint the \"problem\" drugs.

For most people, a sudden change in sexual responsiveness has at least some emotional impact. "For most people, it only takes a few failed sexual experiences before the sexual difficulty becomes a psychological problem," Seifer explains.

Dr. Ashton has had patients whose prior sexual problems surface during discussions of sexual side effects. Some people on antidepressants become depressed again over their lack of sexual fulfillment. Myles finds that sexual difficulties are a blow to people's self-esteem. It can be a great loss for a man not to be able to have an erection or a woman to become aroused. As a result, sex with their partners can become so uncomfortable that the couples often end up withdrawing from the relationship.

Myles uses a variety of sex therapy techniques to help couples communicate their feelings and reconnect with each other. These include nonsexual touching exercises like massage that help partners to experience physical pleasure together once again.

Many people find new ways to enhance their sexual satisfaction. "You don't have to have a sexless life if you're taking drugs. There are many ways to prime the pump. Which, by the way, people should do whether they're taking medications or not," says Myles.