SexRx: benzodiazepines and your sex life

by Karen Schroeder, MS, RD

Type of Medication

Benzodiazepines

Commonly Used Brand Names

Medication	Brand Name
alprazolam	Xanax
chlordiazepoxide	Librium
clonazepam	Klonopin
clorazepate	Tranxene
diazepam	Valium
flurazepam	Dalmane
lorazepam	Ativan
oxazepam	Serax
prazepam	Centrax
temazepam	Restoril

What This Medication Is Most Often Prescribed For

Anxiety
Panic/phobic disorders
Seizure disorders
Acute muscle spasm
Insomnia
Alcohol withdrawal
Jet lag

How This Medication Works

Benzodiazepines cause central nervous system depression and skeletal muscle relaxation. Depending on the medication and dosage, they can lead to any level of central nervous system depression, from mild sedation to hypnosis to coma.

Possible Sexual Side Effects

The effects of benzodiazepines can both help and hinder sexual activity.

Low doses of benzodiazepines may relieve sexual dysfunction that is caused by anxiety, such as:

Lack of desire
Erection disorders
Premature ejaculation
Vaginismus (painful spasm of the vagina preventing intercourse) – both the antianxiety and muscle relaxant properties of benzodiazepines can help this condition

Higher doses of benzodiazepines may lead to negative sexual effects, including:

Decreased sexual desire
Diminished orgasms
Pain during intercourse (dyspareunia)
Erectile dysfunction (impotence)
Ejaculation problems

How Benzodiazepines Can Affect Sexual Function

Sexual dysfunction associated with benzodiazepines is believed to be caused by the sedative and muscle-relaxant properties of these medications. By increasing central nervous system relaxation, benzodiazepines can lead to lessened excitement and sensation. They also may decrease levels of testosterone, a hormone essential for sexual desire.

The positive sexual effects of benzodiazepines relate to their psychological effects on anxiety. From a biological perspective, there is some evidence that they may influence the level of serotonin, a neurotransmitter in the brain. Increased levels of serotonin are believed to interfere with sexual function, and benzodiazepines may reduce serotonin levels.

Unlike other benzodiazepines, clonazepam causes an increase in serotonin levels, and therefore, tends to lead to decreased sex drive and orgasm.

Treatment Options

Though some sexual side effects may be troubling, do not stop taking your medication without first discussing it with your doctor. There may be other options, including:

Wait it out

Some people find that the sexual side effects go away once their bodies have adjusted to the new medication. This can take 1-3 months.

Decrease the dose

Most negative sexual side effects of benzodiazepines occur with higher doses. Ask your doctor if you can take a lower dose.

Switch medications

Depending on your condition, there may be other medications that can manage your medical symptoms without affecting your sexual function. However, some of these drugs have been associated with sexual dysfunction as well. If switching is appropriate for you, these are some of your options:

For anxiety: buspirone (BuSpar)
For panic/phobia disorders: fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil)
For a nocturnal sedative or to treat dyspareunia: trazodone (Desyrel)

Treat the dysfunction

Sildenafil (Viagra) – commonly known as a treatment for male impotence, sildenafil may also help women with sexual dysfunction. However, the expense of this drug may prohibit many patients from using it.

Consider herbal supplements

The efficacy of herbal supplements to treat sexual side effects of various medications is not clear. There have not been many well-designed clinical studies, only case reports, some of which have shown positive effects and others that have shown no effects. Care should also be taken with herbal products because they are not strictly regulated, as drugs are, and may interact negatively with medications. Two herbs commonly used to treat the sexual dysfunction associated with medications are:

Yohimbine
Ginkgo