Sexual complaints are common in the general population, but are significantly higher among patients with a psychiatric or medical diagnosis, likely due to changes in sex hormones and neurotransmitters such as serotonin, dopamine, and norepinephrine. Depressive and anxiety disorders, psychotic illness, and medical conditions commonly occurring with psychiatric disorders, such as endocrine disorders, neurological illness, cardiovascular disease, and urinary conditions may negatively impact all aspects of sexual function. The medications used to treat these conditions may also cause or contribute to sexual dysfunction. The presence of multiple conditions increases the likelihood of sexual problems, and use of more than one medication may further contribute to reduced function.
Potential problem medications include antidepressants, benzodiazepines (medications for anxiety), narcotic pain medications, blood pressure medications, antipsychotic medications, antihistamines, seizure medications, and steroids/hormones (including hormonal contraceptives). Risk factors for sexual dysfunction associated with antidepressant therapy include genetic predisposition, age > 50 years, lower education and work performance, and poor prior sexual functioning. Some differences between men and women have been identified in drug effects on specific phases of the sexual response cycle (desire, arousal, orgasm).
Monitoring of sexual side effects of medications is recommended throughout treatment. Once sexual dysfunction has been identified, interventions include a watch-and-wait strategy (the problem may improve in 5 – 10% of those affected over 4 – 6 months), patient education about sexual dysfunction (reassurance), lowering the dose of the problem medication, change of medication to one less likely to cause sexual dysfunction, adding a potential antidote (bupropion, buspirone, sildenafil, sex hormones, etc.), and psychological interventions.
Don’t assume that nothing can be done. Tell your healthcare provider about your concerns; usually these problems can be improved without compromising treatment of the psychiatric condition.