Sexual Side Effects: What They Are and How to Handle Them

Sexual side effects are common but rarely talked about. They can show up as low desire, trouble getting or keeping an erection, delayed or absent orgasm, or vaginal dryness. These problems often start after beginning a medicine, changing the dose, or adding a new drug. Knowing what causes them and what to do next makes a big difference.

Common causes and how they work

Some meds interfere with hormones, blood flow, or nerve signals that drive sexual response. Typical culprits include:

• Antidepressants (SSRIs like sertraline or fluoxetine): often cause reduced libido and delayed orgasm; reports range from 30% to 70% of users.
• Antipsychotics (risperidone, haloperidol): can raise prolactin and lower libido or cause erectile problems.
• Opioids: long-term use lowers testosterone and reduces desire and performance.
• 5-alpha-reductase inhibitors (finasteride, dutasteride): linked to decreased libido and erectile issues; a small number report persistent problems.
• Some blood pressure meds and beta-blockers: can contribute to erectile dysfunction in some people.

Timing matters. If symptoms begin soon after a new medication or dose change, the drug is a likely cause. Keep a simple diary of symptoms and when you take meds—it helps discussions with your clinician.

Practical steps you can try

Don’t stop or change medicines on your own. Talk to your prescribing clinician with specific details: when symptoms began, what they are, and how they affect you. Useful options your doctor may consider:

• Lowering the dose or switching to a drug with fewer sexual side effects—bupropion and mirtazapine commonly have less impact on orgasm and desire.
• Add-on treatments: sildenafil (Viagra), tadalafil, or other PDE5 inhibitors can help erectile problems; testosterone may be checked if opioids or low libido are an issue.
• Non-drug changes: sexual counseling, couples therapy, and pelvic-floor exercises can improve function and satisfaction.
• Tactical timing: taking short-acting meds at certain times can sometimes reduce daytime sexual problems—only under doctor advice.
• Topical lubricants and moisturizers for vaginal dryness—simple and effective.

Some strategies like “drug holidays” are occasionally used but carry risks and aren’t safe for many medicines. Always get medical guidance first.

Get urgent care if you experience painful, long-lasting erections (priapism) or sudden severe sexual pain. For persistent problems, ask for a referral to a urologist, endocrinologist, or sexual health specialist. A clear, honest conversation with your clinician gives you the best chance to fix the problem without losing the benefit of the medicine you need.

Quick tip: write down one clear example of how the side effect affects your life—your doctor will take that seriously and it makes finding the right fix faster.