Psychiatric Medication and Sexual Health
Psychiatric medication plays a crucial role in managing many mental health conditions. It is a tool that can support individuals to lead fulfilling and functional lives. However, these medications often come with a range of side effects, one of the most sensitive and impactful- often neglected- is their effects on sexual health. Note that while we are sharing their potential impact on sexual function and some strategies to manage these effects, each individual is unique and the article is not intended as medical advice. Please consult with your provider about your concerns regarding medication and their impact on your sexual experiences.
Many types of medication can affect sexual health through various mechanisms, including altered neurotransmitter levels, hormonal changes, and overall physiological effects on the body. The impact on sexual function can manifest in different ways, such as changes in desire, arousal, orgasm, and overall sexual satisfaction.
The 7 Most Common Sexual Side Effects Associated with Psychiatric Medication
Psychiatric medications can potentially cause various sexual dysfunctions or difficulties. The specific effects can vary based on the type of medication, the individual's physiology, dosage, and other factors. Common sexual dysfunctions associated with psychiatric medications include:
Erectile Dysfunction (ED): Some antidepressants, antipsychotics, and anxiolytics can affect sexual desire, arousal, or the ability to achieve or maintain an erection in men.
Decreased Libido or Sexual Desire: Antidepressants, antipsychotics, and mood stabilizers may reduce sexual desire or libido, making it challenging to become sexually aroused.
Anorgasmia or Difficulty Achieving Orgasm: Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), are frequently associated with delayed or inability to achieve orgasm in both men and women.
Delayed Ejaculation: Some antidepressants, particularly SSRIs, can delay ejaculation or prevent ejaculation (anejaculation), making it difficult for men to orgasm.
Sexual Arousal Disorders: Certain antidepressants and antipsychotics may reduce sexual arousal and interfere with its physiological aspects such as lubrication and erection.
Genital Anesthesia or Numbness: Although less common, some psychiatric medications may cause a decreased sensation or numbness in the genital area, making sexual activity less pleasurable.
Hormonal Changes or Imbalances: Psychiatric medications can cause changes in menstrual cycles, menstrual irregularities, and changes in the severity of premenstrual symptoms. This may be just about a period of adjustment or you may need to make changes. Consult your provider to discuss any concerns regarding your medication.
5 Common Psychiatric Medications and Effects on Sexual Health:
Antidepressants: Antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are known to cause sexual side effects. These can include decreased libido, delayed ejaculation, erectile dysfunction, and difficulty achieving orgasm. In some cases, SSRIs are prescribed to individuals who experience premature ejaculation to delay or inhibit ejaculation.
Antipsychotics: Antipsychotic medications, used to manage conditions like schizophrenia and bipolar disorder, may also lead to sexual side effects such as decreased sexual desire, erectile dysfunction, and disruptions in menstrual cycles.
Mood Stabilizers: Mood stabilizers, commonly used to treat bipolar disorder, can have varying effects on sexual health. Some individuals may experience changes in libido, while others may have no noticeable impact.
Anxiolytics (Anti-Anxiety Medications): Medications like benzodiazepines, often prescribed to manage anxiety, may cause reduced sexual desire and performance issues.
Stimulants: Stimulant medications, typically prescribed for attention deficit hyperactivity disorder (ADHD), can sometimes lead to changes in libido and sexual function.
Managing Sexual Side Effects
The answer to how to manage sexual side effects is of course very nuanced. To address an issue, we need to understand the issue first. One of the most influential models of modern healthcare is viewing difficulties from a biopsychosocial perspective. Considering the biological, psychological, and sociological factors at play.
In the context of sexual difficulties, we explore predisposing, concurrent, and maintaining sexual difficulties. Predisposing factors set the foundation for vulnerability to sexual difficulties, concurrent factors coexist and interact with these vulnerabilities, and maintaining factors perpetuate or worsen the ongoing sexual challenges an individual experiences. There is often not one thing that causes sexual difficulties but a combination of them and understanding what those are and how they influence one another helps identify what may be the most effective interventions.
Alternative Medications: You can always discuss with your provider how your medications are impacting your sexuality. Finding a provider that validates your concerns and takes the appropriate time to walk with you through them maybe a very important part of the process. It may be possible to adjust the type of medication, brand, dosage, and/or sometimes the time of day it is taken. However, for many, finding the right medication and the right dosage is a journey on its on… When changes in the medication are not possible, it becomes even more important to explore the other options listed below…
Combine Medication with Counseling: It is widely recognized that combining medication with psychotherapy yields better result in treatment than medication alone. There are many types of approaches to therapy and/or coaching, finding what is the best place to go may be difficult, you may want to do some “shopping”. Consider what your goals and struggles are, what you’re interested in and open to learn about, and more practical issues such as availability, billing, and such.
Communication: This could be a conversation with a partner, a trusted friend or family member, a provider who specializes in sexuality, or just with ‘me, myself, and I’… Trying to be open and honest about your sexuality, and noticing any unease around it, is key to address any sexual concerns. Notice your attitudes, beliefs, etcetera, and any reactions or sensations in your body as you talk or think about sexuality. If you’re choosing to talk to a partner about this, click here for some suggestions.
Explore Your “Sexual Career”: As long as it feels safe to do so, travel down memory lane and explore your sexual experiences, including first times you remember hearing things related to sexuality, first masturbatory experiences, and first sexual experiences with others (if any). Explore how your sexuality has flowed through time. This may help you identify some factors that contribute to the present concerns. Please note that there might be experiences that are painful to remember. Be gentle with yourself and seek support when needed.
Impact of Side Effects: Once you have specified the medication’s effects on sexual desire, arousal, orgasm, and overall satisfaction, it does well to identify what are their repercussions. How is it impacting your sexual experience? If in a relationship, how is it impacting the relationship? Is it creating any other concerns (such as increased anxiety, depression, etcetera)?
Paying Attention: Dan Siegel says “Where attention goes, neural firing flows, and connections grow”. What we pay attention to has the capacity to alter our brain! Trying to talk, think, and create sexual experiences in a positive light can help strengthen the connections in the areas of your brain, and their connection to the rest of the body, that register sensations and reward networks as well as, at times, networks dedicated to connection with others.
Mindfulness Exercises: Somatic (body-based) mindfulness exercises that can allow you to connect more with your body and with the ‘feel good’ sensations it can bring. You can practice mindfulness as part of every day activities such as doing dishes or taking a shower. Pay attention to your senses and experiences, when thoughts come just let them pass and refocus on the present moment. There are many other practices such as breathing, body scans, and mindful masturbation that can help improve sexual experiences.
Expand Your Concept of What Sex is: What counts as sex? I assure you that if we ask 100 people, we might get a lot of different answers! Expanding what constitutes as sex for you may help ease any discomfort associated with side effects such as vaginal dryness or erectile issues. You may also want to consider exploring new ways to experience your sexuality such as engaging your whole body in sexual encounters, exploring kinks, searching for erotica, and more.
What Sex Can Offer: Just as above, if we ask people the reasons why they have sex we could create a very long list. In one of the biggest studies of its kind, researchers got more than 200 answers regarding the reasons why participants engaged in sex. It may range from physical and emotional pleasure, to avoiding negative consequences in a relationship, boredom, feeling sad, or wanting to feel loved and/or desired. Figuring out the different circumstances and reasons why you used to engaged in sexual events may help you either focus on that, use to your advantage to address the side effects, and/or find different ways to get those needs met.
Focus on Pleasure: In her work, Dr. Stella Resnick talks about The 8 Core Pleasures. Good feelings come from many areas of our lives and identifying them can get us into the practice of connecting with pleasure. Furthermore, detaching sex from any goal (such as having an erection or an orgasm) and focusing on the pleasures it can give also help ease difficulties. Please note that this does not mean to ignore pain, sex shouldn’t be painful (unless that’s what brings you pleasure, of course!). Focus on feeling good and not on sexual function.
Extend Foreplay: I loved when I learned the saying “Foreplay starts at the end of the last orgasm.”. This applies even if you’re doing it solo! Treat yourself, prepare a nice area, take yourself on a nice day out or prepare yourself a nice meal… If partnered, notice your connection “outside the bedroom”. Research findings suggest couples that touch more and talk more about sex have sex more frequently and report higher sexual satisfaction.
Self-changes: After starting medication, many areas of our psychology and physiology change. Being open and honest with yourself about the effect of those changes in how you view yourself, your body, and- if partner- the relationships you’re in is crucial to addressing potential issues that are not directly medical but influence sexual function.
Desire Science: There is a lot of information about how desire work and a lot more yet to be discovered! The research and literature on sexual desire is fascinating. Good resources for this are the book, workbook, and podcast “Come As You Are” by Emily Nagoski (all by the same name). Desire: An Inclusive Guide to Navigating Libido Differences in Relationships is a very good book as well.
Breaks and Accelerators: Breaks are inhibitors and accelerators enhancers; this is known as the Dual Control Model… Think of a car, you can push the accelerator but if you have the break on it may not move at all. If you don’t have the break but aren’t really touching the accelerator it may not move at all or it may move very slowly just due to gravity… Explore and identify what things act as breaks and accelerators for you and the contexts in which they happen (what is an accelerator in one context isn’t necessarily going to work in all circumstances).
Lifestyle: There is of course the things that most of us already know we should do for our well-being, even if we don’t always keep up with it! Balanced eating and getting all the nutrients you need, physical activity, taking care of your mental health, spending time nurturing your relationships, adequate sleep, connecting with others and nature, etcetera, can help your body- and mind- manage challenges with more resilience.
Technique: There are no mental hoops or gymnastics that will do the trick if the actual technique isn’t working… Everyone has their own way of experiencing pleasure and it may not even be consistent from time to time. We may frequently need to find ourselves again and again as time passes. If you’re with a partner, talk to them about what and how you like it. You may also add toys and such to your sexual repertoire.
Address Concerns in a Timely Manner: The more you wait, typically things get more complicated. Sex is an incentive motivation system, our motivation to engage in sex requires the perception that the rewards will be greater than the cost. If we aren’t anticipating pleasure and in turn we are actually anticipating pain, discomfort, disappointment, or conflict, that isn’t really very motivating.
Final words…
Balancing mental health treatment and maintaining a satisfying sexual life can be challenging for individuals taking psychiatric medications. Open communication with healthcare providers, considering alternatives, and seeking additional support are essential steps toward managing sexual side effects and optimizing overall well-being. Remember, your mental health journey should be tailored to suit your unique needs, and advocating for your well-being is a crucial aspect of the process.
There is no “one-size-fits-all”. Managing adverse effects on sexuality include a variety of approaches and techniques. Just by starting to talk about it and create a space to signal how important sexual satisfaction -and/or your partner’s- is for you is a great first step.
If you’d like personalized support exploring any of the above, click here to request a session.
I am a PhD in Clinical Sexology candidate at Modern Sex Therapy Institutes and have a Master of Science in Educational Psychology. I work with individuals, couples, non-monogamous relationships, and groups in topics related to sexuality, emotional regulation, communication dynamics, and changing behaviors.
