Life really is a lottery sometimes. Whether you have a genetic predisposition to a certain disease, or you walk into someone else’s bacteria or virus, you run the risk of getting various diseases and conditions from the day you are born. If you also happen to be HIV positive, these extra problems can really convince you that you drew the short straw. Luckily, most things are treatable if you are lucky enough to live in the right area of the world and have the right health plan. But what does seem unfair is that the very treatments you are given to help you live longer may diminish the quality of your life in other very important areas.
Sexual dysfunction, for both men and women, can bring premature misery to people already shaken to the core by other things. Many people put sexuality high on the list of ‘despite everything, thank god I can still do that’ bodily functions and when it goes wrong it’s a blow to the ego. However, did you know that one of the primary causes of sexual dysfunction is medication?
It’s even estimated that a quarter of all sexual function problems come from prescription drugs and that may be a conservative estimate. I know, ‘estimates’ and ‘maybes’ count for nothing but there’s clearly a link. More information here.
Of course, sexual dysfunction comes from many other causes too and may only be temporary if those causes are resolved. Anxiety, stress, tiredness, smoking, alcohol, recreational drugs and others, all contribute to the moment when you can’t get it up, or for women when dryness prevents pleasure. It’s important then to discuss these external influences with your doctor before going for physical diagnostic tests. Similarly it’s important not to exclude the possibility that prescription drugs you are taking for another complaint are the cause of your sexual disappointment. Even doctors may miss these, so it’s a good idea to look at what you’re taking and research the side effects to see if sexual dysfunction is a possibility and then talk it over with your doctor. There may well be alternatives with less side effects. Reliable info about individual drugs can be found here
So which prescription drugs are we talking about in relation to sexual performance? The following list is by no means exclusive and very often people will react differently to different drugs but these are certainly ones to watch for.
Blood pressure medications
There are many different categories of blood pressure medications but they’re all designed for basically one thing and that is to reduce the pressure in blood vessels, so that the heart doesn’t go into overdrive trying to pump blood around the body.
Now, high blood pressure itself can cause sexual dysfunction but when blood pressure meds lower the blood flow, that can influence desire and as you can imagine, reduce blood flow to the penis and thus make erection and ejaculation difficult. With women, the same process can cause loss of desire, dryness in the vagina and affect the ability to have an orgasm.
The most common blood pressure meds associated with sexual problems are diuretics (“water pills”), beta blockers and alpha blockers. Diuretics can even lead to excess excretion of zinc in the body, which can diminish testosterone. Beta blockers can make you feel sleepy, lacklustre and depressed but also inhibit nerve signals associated with arousal.
Talking frankly with your doctor should lead to prescription of a different blood pressure drug, with less influence on your sex life.
There are many sorts of anti-depressants and maybe surprisingly, they’re not only prescribed for depression. Anxiety, bulimia, OCD conditions, chronic pain symptoms and even stopping smoking are all commonly treated with anti-depressants. To be clearer about the distinctions, you may be given pills that are tricyclic antidepressants, or monoamine oxidase inhibitors (MAOIs), selective serotonin re-uptake inhibitors (SSRIs), dopamine antagonists and lithium, among others.
One of the side effects unfortunately, of all anti-depressants is sexual malfunction. This is in all likelihood caused by their blocking chemicals in the brain that transmit signals between nerve cells and you may have heard of at least one of them: acetylcholine, serotonin and norepinephrine. If you are prescribed clomipramine (Anafranil – a tricycilical antidepressant) for instance, there’s a 40% chance that you may be unable to ejaculate and a 15% chance of impotence and decreased libido.
If this turns out to be a problem, your doctor may be able to lower your dose, as sexual side effects are generally high dose-related. Failing that, you may be able to change the drug for one with less side effects, or even find non-drug means of dealing with the root of the problem. If you’re tempted to throw Viagra or Cialis (sildenafil), or other alternatives at the problem please discuss this first with your doctor; it just may not be a good idea to pile one drug on top of another.
Antipsychotic drugs are not anti-depressants and you shouldn’t let other people convince you that they are comparable. Antipsychotics are used to treat much more serious psychiatric conditions and as people living with HIV, we’re not immune to those either. So bipolar disorder and schizophrenia for instance are treated with antipsychotics. Some doctors will prescribe antipsychotics for severe agitation, or severe depression amongst other illnesses but then they are prescribed ‘off-label’, which means it happens but is not officially approved.
Because all antipsychotic drugs block dopamine; a chemical in the brain that helps to stabilise emotional responses and put the brakes on the brain’s ‘reward’ and ‘pleasure’ centres; this can have a distinct effect on sexual performance. Antipsychotics also increase amounts of the hormone prolactin, which can lead to erectile dysfunction, reduced desire and problems achieving orgasm. They also block the action of acetylcholine (just like anti-depressants) and it is thought that this leads to all sorts of difficulties in sexual function. It is generally thought that the incidence of sexual problems with antipsychotics can range from 45% to 90%!
One warning for older people living with HIV and with beginning or advanced dementia: antipsychotics are linked to increased risks of death for older people with Alzheimer’s and dementia problems and if you discover this with someone you know, get medical advice immediately.
Benzodiazepins (BZD, Benzo’s)
I remember Bennies and Tranqs as being ‘downer’ drugs of choice in the 70’s. Basically benzodiazepine is used to treat insomnia, anxiety, muscles spasms and to prevent seizures. It’s an amphetamine mix and helps people who suffer from emotional extremes in their lives. It’s yet another medication that can affect your sex life. It’s a sedative, or tranquilizer and works on relaxing the muscles and will lessen sexual interest, excitement and sensation. Benzodiazepines may also interfere with testosterone production and as we all know, testosterone is an important hormone in sexual function (in women as well as men). So if you are taking benzodiazepine and have reduced orgasms, or pain during sex, or ejaculation and erection problems, benzodiazepines may well be the root cause.
As always with these things, you need to talk it over with your doctor or specialist. Many people don’t need benzodiazepines at all if their anxiety or insomnia is mild and even if that’s not the case, there are alternatives available, both drug and non-drug. Melatonin for instance, in doses between 3mg and 10 mg before bed, may well help stabilise sleep-patterns. Furthermore, benzodiazepines are again, not advised for elderly people. In fact any sleeping aid for the elderly with a name ending in ‘PM’ should be avoided – always discuss it with a professional.
You may have heard of drugs named Tagamet (cimetidine), or Zantac (ranitidine) or Pepcid (famotidine) and maybe Axid (nizatidine). These are all known as H2 Blockers (or H2-receptor antagonists) and are used to treat gastrointestinal problems as well as ulcers of various sorts.
What most people don’t know is that H2 Blockers can also cause impotence when taken over a long period of time. They can also cause breast enlargement in men! Tagamet (cimetidine) for instance, is the one causing the most known cases of sexual problems and can be responsible for reduced libido, reduced sperm count and the ever-worrying erectile dysfunction.
So if you’ve been prescribed any of these drugs for reflux problems, read the pamphlet inside and discuss it with your doctor, especially if you are used to an active sex life. It’s possible other options like changes of diet and sleep habits may help enough to not need H2 Blockers.
Anticonvulsants (anti-epilepsy drugs) are generally used to control seizures in people with epilepsy but they are also prescribed for chronic pain conditions that may be familiar to people living with HIV: neuropathy and migraines. They weren’t designed for that purpose but work for some people very well. You may also hear of anticonvulsants being prescribed off-label for conditions like bi-polar disorder.
The down side is that they can have uncomfortable side effects, amongst which is sexual dysfunction. Anticonvulsants can lower testosterone levels to the point where desire is suppressed and erectile dysfunction for men and lubrication for women, become problems. They can also prevent full orgasms.
The good news is that newer anticonvulsants like gabapentin (Neurontin) and topiramate (Topomax) probably have fewer side effects than the older drugs like carbamazepine (Tegretol) and phenytoin (Dilantin). It may be worth asking your doctor then to switch you to the other options.
The final group of drugs on this list is statins. Statins and fibrates are very widely prescribed for high cholesterol problems (a fast-growing health issue in the Western world), however their side-effects should not be underestimated. Apart from being very bad for patients with neuropathy and other problems, they can markedly affect your sex life.
It’s said that by reducing cholesterol in your system, statins can interfere with your testosterone, oestrogen and other sex hormones. Cholesterol is actually necessary as a building block for those hormones and reducing it can have a knock on effect. They can also cause a break-down of muscle tissue, which may lead to joint problems and fatigue (on their own, not conducive to an active sex life!) In 2002, there was a study which showed that both statins and fibrates may cause erectile dysfunction and in 2009, a US government-funded study concluded that both men and women had difficulty achieving orgasms while using statins. More info here.
However, millions of people suffering from coronary problems due to high cholesterol (the wrong sort) certainly need to reduce cholesterol levels and statins are effective at doing that. If you want to avoid sexual problems as a result, talk to your health care provider about other options such as vitamins B12, B6 and Folic Acid (fairly high doses necessary). It’s possible that your cholesterol levels can be reduced without resorting to statins or fibrates. Exercise and diet also play an important role; that surely goes without saying.
This is by no means an exclusive list of drugs which may cause sexual problems as a side effect but it does cover the most common examples. Remember, the first thing to check is if any drug you are prescribed clashes with your HIV meds. After that, you can assess the risk of other side effects. It’s also true that it’s easy to become paranoid about these things and that in itself can take the lust out of love. If you are at all concerned, talk it over with your doctor, or HIV specialist, after all, sex is still an important part of our lives, so why reduce your pleasure if it’s not necessary?
N.B We all know about the newer medical solutions for sexual dysfunction (especially for men). Viagra, Cialis and the like also have side effects, (although generally not too serious for the healthy man) and will clash with certain other prescription drugs and certain HIV medications. If they can be avoided, or postponed for as long as possible, you’ll be doing your body a favour over the long term. Eliminating stress, stopping smoking and drinking in moderation, will help your sexual well-being, but also trying to find the best prescription medications for your individual case will be another step on the road to sexual recovery. It may not always be possible: your condition may require that you are treated with certain drugs and they may lead to sexual dysfunction but the little blue pill family is available when all else seems to fail.