Effects of Drugs on Sexuality

Many drugs adversely affect sexuality (see Tables 114-1 and 114-2). Assessing the effects of drugs on sexuality is difficult in women; in men, sexual dysfunction is more obvious and measurable. In general, drugs that have an adverse effect on sexual desire in men are assumed to have an adverse effect in women as well.

Physicians should inform patients about the possibility of adverse drug effects on sexual function and encourage them to report any problems. Otherwise, patients who attribute their sexual dysfunction to drugs may discontinue the drugs or decrease the doses without informing their physician.

Drugs that dramatically affect sexuality include antipsychotics, which may inhibit erection or the ability to ejaculate, even when the capacity for erection remains; sedative-hypnotics, which can depress sexual arousal in men and women; and some antidepressants, which can inhibit sexual desire. Many antihypertensives, cardiac drugs, and other drugs cause erectile dysfunction. (see below) When drugs that affect sexual functioning cannot be avoided and sexual dysfunction results, patients may benefit from encouragement to explore other forms of intimacy and physical pleasure.

Alcohol, if used excessively, commonly causes sexual dysfunction; however, it is seldom considered a cause by the general public, because moderate use may stimulate desire and reduce inhibitions. Up to 80% of men who drink heavily experience erectile dysfunction. Alcohol's depressant action can also decrease a woman's sexual function. Many of the effects of moderate to heavy drinking are reversible if the drinking is stopped in time. Because alcohol tolerance decreases with age, the elderly are impaired by smaller amounts than younger persons. Persons who drink alcohol regularly should abstain for several hours before sexual activity and should limit themselves to 1.5 oz (45 mL) of hard liquor, 6 oz (180 mL) of wine, or 16 oz (0.5 L) of beer over 24 hours.