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Female sexual dysfunction — defined as a sexual problem associated with personal distress — occurs in approximately one in eight women.[1] There are several forms of sexual dysfunction in women, including a lack of sexual desire (often called decreased libido), impaired arousal, inability to achieve an orgasm and pain with sexual activity.
Importantly, medications are a common cause of sexual dysfunction in women (see Table, below, for examples). Knowing which drugs cause sexual...
Female sexual dysfunction — defined as a sexual problem associated with personal distress — occurs in approximately one in eight women.[1] There are several forms of sexual dysfunction in women, including a lack of sexual desire (often called decreased libido), impaired arousal, inability to achieve an orgasm and pain with sexual activity.
Importantly, medications are a common cause of sexual dysfunction in women (see Table, below, for examples). Knowing which drugs cause sexual dysfunction will allow women to take steps to prevent or minimize these common, often troubling adverse drug effects.
Selective serotonin reuptake inhibitors
Sexual dysfunction is a well-recognized adverse effect of selective serotonin reuptake inhibitors (SSRIs) such as citalopram (CELEXA) and fluoxetine (PROZAC). In fact, sexual dysfunction is one of the most common adverse effects of SSRIs, estimated to occur in approximately half of patients treated with these drugs.[2]
SSRIs are a family of drugs that, except for fluvoxamine (LUVOX), are all approved by the Food and Drug Administration (FDA) for treating major depressive disorder.[3],[4],[5],[6],[7],[8],[9] Various SSRIs also are approved by the FDA to treat one or more other psychiatric disorders, including obsessive-compulsive disorder, bulimia, panic disorder, generalized anxiety disorder, social anxiety disorder and post-traumatic stress disorder. A low-dose form of paroxetine sold under the brand name BRISDELLE — which Public Citizen’s Health Research Group has designated as Do Not Use — is approved for treatment of hot flashes associated with menopause.
The FDA-approved product labeling for all SSRIs except trazodone (available in generics only)[10] warns that these drugs may result in decreased libido and delayed or absent orgasm in women.[11],[12],[13],[14],[15],[16] The product labeling advises prescribers of these medications to ask patients about their sexual function prior to starting the drugs and to inquire about changes in sexual function during treatment.
Options for managing SSRI-induced sexual dysfunction include decreasing the dose of the SSRI or switching to a different medication for treating depression or other psychiatric conditions that does not cause female sexual dysfunction.[17]
Other antidepressants
Other antidepressants, including monoamine oxidase inhibitors (MOAs; for example, phenelzine [NARDIL]), serotonin-norepinephrine reuptake inhibitors (SNRIs; for example, venlafaxine [EFFEXOR XR]) and tricyclic antidepressants (for example, nortriptyline [PAMELOR]), also may cause sexual dysfunction in women,[18] including decreased libido and delayed or absent orgasm with use of MOAs and SNRIs.[19],[20],[21],[22]
However, sexual dysfunction with these drugs has been less frequently studied than SSRI-induced sexual dysfunction.[23]
Importantly, major depression itself can cause decreased libido and other forms of sexual dysfunction in women, and treatment with antidepressants can improve such depression-related symptoms.[24] [25] In some cases, distinguishing depression-related sexual dysfunction from that caused by antidepressants can be challenging.[26]
Antipsychotics
Antipsychotic medications can cause sexual dysfunction in women, particularly problems with achieving an orgasm.[27],[28] These medications block dopamine, a chemical substance in the brain known as a neurotransmitter, which may play a role in sexual function.[29],[30] Antipsychotics also can increase levels of the hormone prolactin, which may affect sexual function by suppressing ovarian hormones.
First-generation (typical) antipsychotics (such as haloperidol [HALDOL]) generally increase prolactin levels more than second-generation (atypical) antipsychotics (such as quetiapine [SEROQUEL]) and therefore may be more likely to cause sexual dysfunction.[31]
Hypertension drugs
Drugs known as alpha adrenergic agonists, which are used to treat hypertension (high blood pressure), may cause sexual dysfunction in women.[32] For example, clonidine (CATAPRES-TTS, NEXICLON XR), which we have designated as Do Not Use, may cause loss of libido and decreased sexual activity.[33]
Examples of Drugs That Can Cause Sexual Dysfunction in Women
| Drug Category | Generic Drug Name (Brand Name[s]†) |
|---|---|
| Antihypertensives |
|
| Antipsychotics | First-generation or typical antipsychotics
|
| Monoamine oxidase inhibitors |
|
| Selective serotonin reuptake inhibitors |
|
| Serotonin-norepinephrine reuptake inhibitors |
|
| Tricyclic antidepressants |
|
†Combination brand-name drug products excluded
*Designated as Do Not Use by Worst Pills, Best Pills News
**Designated as Limited Use by Worst Pills, Best Pills Newse
What You Can Do
If you experience symptoms of sexual dysfunction, review all of your medications with your doctor to determine whether any of them may be contributing to your problem. Do not stop taking any prescription medication without first talking to your doctor. Be aware that other drugs not listed in this article can cause sexual dysfunction in women.
References
[1] Shifren JL. Overview of sexual dysfunction in females: Epidemiology, risk factors, and evaluation. UpToDate. January 5, 2022.
[2] Hirsch M, Birnbaum RJ. Sexual dysfunction caused by selective serotonin reuptake inhibitors (SSRIs): Management. UpToDate. July 8, 2021.
[3] Allergan. Label: citalopram (CELEXA). February 2022. https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/020822s041lbl.pdf. Accessed May 2, 2022.
[4] Allergan. Label: escitalopram (LEXAPRO). September 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/021365s038,021323s053lbl.pdf. Accessed May 2, 2022.
[5] Eli Lilly and Company. Label: fluoxetine (PROZAC). October 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/018936s111lbl.pdf. Accessed May 2, 2022.
[6] ANI Pharmaceuticals, Inc. Label: fluvoxamine (LUVOX). July 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/021519s018lbl.pdf. Accessed May 2, 2022.
[7] Apotex Inc. Label: paroxetine (PAXIL). September 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/020031s012,020710s047lbl.pdf. Accessed May 2, 2022.
[8] Pfizer. Label: sertraline (ZOLOFT). September 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/019839s100,020990s057lbl.pdf. Accessed May 2, 19, 2022.
[9] Torrent Pharmaceuticals, Inc. Label: trazodone. February 2022. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=1510cf89-a2ec-4ed5-80cb-bae84f9ec0a7&type=display#section-12. Accessed May 2, 2022.
[10] Torrent Pharmaceuticals, Inc. Label: trazodone. February 2022. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=1510cf89-a2ec-4ed5-80cb-bae84f9ec0a7&type=display#section-12. Accessed May 2, 2022.
[11] Allergan. Label: citalopram (CELEXA). February 2022. https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/020822s041lbl.pdf. Accessed May 2, 2022.
[12] Allergan. Label: escitalopram (LEXAPRO). September 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/021365s038,021323s053lbl.pdf. Accessed May 2, 2022.
[13] Eli Lilly and Company. Label: fluoxetine (PROZAC). October 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/018936s111lbl.pdf. Accessed May 2, 2022.
[14] ANI Pharmaceuticals, Inc. Label: fluvoxamine (LUVOX). July 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/021519s018lbl.pdf. Accessed May 2, 2022.
[15] Apotex Inc. Label: paroxetine (PAXIL). September 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/020031s012,020710s047lbl.pdf. Accessed May 2, 2022.
[16] Pfizer. Label: sertraline (ZOLOFT). September 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/019839s100,020990s057lbl.pdf. Accessed May 2, 2022.
[17] Hirsch M, Birnbaum RJ. Sexual dysfunction caused by selective serotonin reuptake inhibitors (SSRIs): Management. UpToDate. July 8, 2021.
[18] Ibid.
[19] Pfizer Inc. Label: phenelzine (NARDIL). May 2007. https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/011909s038lbl.pdf. Accessed May 2, 2022.
[20] Pfizer Inc. Label: desvenlafaxine (PRISTIQ). November 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/021992s047lbl.pdf. Accessed May 2, 2022.
[21] Eli Lilly and Company. Label: duloxetine (CYMBALTA). July 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/021427s056lbl.pdf. Accessed May 2, 2022.
[22] Allergan USA, Inc. Label: levomilnacipran (FETZIMA). September 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/204168s007lbl.pdf. Accessed May 2, 2022.
[23] Hirsch M, Birnbaum RJ. Sexual dysfunction caused by selective serotonin reuptake inhibitors (SSRIs): Management. UpToDate. July 8, 2021.
[24] Ibid.
[25] Bella AJ, Shamloul R. Psychotropics and sexual dysfunction. Cent European J Urol. 2014;66(4):466-471.
[26] Ibid.
[27] Shifren JL. Overview of sexual dysfunction in females: Epidemiology, risk factors, and evaluation. UpToDate. January 5, 2022.
[28] Bradford A. Female orgasmic disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis. UpToDate. May 13, 2021.
[29] Shifren JL. Overview of sexual dysfunction in females: Epidemiology, risk factors, and evaluation. UpToDate. January 5, 2022.
[30] Bradford A. Female orgasmic disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis. UpToDate. May 13, 2021.
[31] Shifren JL. Overview of sexual dysfunction in females: Epidemiology, risk factors, and evaluation. UpToDate. January 5, 2022
[32] Stadler Th, Bader M, Uckert S, et al. Adverse effects of drug therapies on male and female sexual function. World J Urol. 2006;24(6):623-629.
[33] Boehringer Ingelheim International GmbH. Label: clonidine (CATAPRES-TTS). October 2011. https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/018891s028lbl.pdf. Accessed May 2, 2022.
