Substance-/Medication-induced sexual dysfunction is a disturbance in sexual function that develops during or soon after use of a substance or medication. An increase in dosage or discontinuation of a substance or medication can also produce symptoms of substance-/medication-induced sexual dysfunction.
Cause of Substance-/Medication-Induced Sexual Dysfunction
Biologic factors related to medication or substance use often explain the sexual dysfunction, but there may also be psychological, interpersonal, and sociocultural factors involved. These factors can both prompt a person to take a particular medication or substance and influence their response to it.
Medications and Substances That May Impact Sexual Function
Category | Type of Medication or Substance |
|---|---|
Hormonal | |
Cardiovascular | |
Pain | |
Psychiatric/Neurologic | Selective serotonin reuptake inhibitors Serotonin norepinephrine reuptake inhibitors Sedatives |
Other | Alcohol (at high levels) Cannabis (mixed data) |
Symptoms of Substance-/Medication-Induced Sexual Dysfunction in Women
Symptoms associated with substance- and/or medication-induced sexual dysfunction include low desire and difficulty with arousal or orgasm related to use of, withdrawal from, or exposure to a medication or substance.
Diagnosis of Substance-/Medication-Induced Sexual Dysfunction in Women
A doctor's evaluation, based on specific criteria
A doctor diagnoses substance-/medication-induced sexual dysfunction based on the person's responses to a comprehensive series of questions asked while taking the general medical and sexual histories. The diagnosis is made when the symptoms of sexual dysfunction are the focus. Other diagnoses (for example, intoxication with or withdrawal from a substance) may be made if the use or misuse of the substance itself is the problem.
Components of the Sexual History for Assessment of Female Sexual Dysfunction
Area | Specific Elements |
|---|---|
Identity | Gender identity, sexual orientation, racial/ethnic identity, religious education or practice (past/current) |
Medical history and current health status | General health (including chronic disease, physical energy), mental health (including level of stress and anxiety, psychiatric history, mood), medications, substance use; gynecologic and obstetric history (including procedures, obstetric complications, pregnancy terminations, pelvic trauma, STIs, contraception, use of safer sex practices) |
Relationship with partner | Emotional intimacy, trust, respect, attraction, communication, fidelity, anger, hostility, resentment, intimate partner violence in current or past relationships |
Current sexual context | Sexual function of partner, activities and behaviors during the hours before attempts at sexual activity, adequacy of sexual stimulation, adequacy of sexual communication, timing (ie, too late at night, too hurried), degree of privacy, masturbatory practices |
Triggers of desire and arousal | Setting; visual, written and spoken sexual cues; activities (ie, showering together, dancing, listening to music); types of stimulation (nonphysical, physical nongenital, nonpenetrative genital) |
Inhibitors of desire and arousal | Fatigue, sleep deprivation, stress, anxiety, depression, negative past sexual experiences, fears about outcome (including loss of control, pain, unwanted pregnancy, and infertility), focus or distraction related to other activities or issues, relationship issues, poor physical health, hormonal status |
Orgasm | Presence or absence, response to absence (whether a woman is distressed or not), differences in responses with partner and with self-stimulation |
Outcome | Emotional and physical satisfaction or dissatisfaction |
Pain during sexual intercouse (dyspareunia) | Quality of pain: burning, tearing, rubbing, stretching, or dull Location: superficial (introital), intravaginal, or in pelvis Timing: During partial or full entry, deep thrusting, penile movement, or the man's ejaculation; immediately after penetration; or during urination after vaginal penetration |
Self-image | Self-confidence; feelings about desirability, body, genitals, or sexual competence |
Developmental history | Relationship with caregivers and siblings, past or present traumas, loss of a loved one, abuse (emotional, physical, or sexual), consequences of expressing emotions as a child, cultural or religious restrictions, upbringing, sex education |
Past sexual experiences | Type (whether desired, coercive, abusive, or a combination), subjective experience (how rewarding, varied, and pleasing), outcomes (positive or negative [ie, unplanned pregnancy, STIs, parental or societal disapproval, guilt due to religious teachings]) |
Interpersonal factors | Ability to trust, comfort level with being vulnerable, suppressed anger causing suppression of sexual emotions, need to feel in control, unreasonable expectations of self, hypervigilance to self-harm (ie, worry about pain, which inhibits enjoyment), obsessiveness, anxiety, depressive tendencies |
Medications or substance use | Specific medications or substances and the timing of their use in relation to sexual dysfunction |
STIs = sexually transmitted infections. | |
Treatment of Substance-/Medication-Induced Sexual Dysfunction
Withdrawal from substance or medication
Referral to a substance misuse specialist or sex therapist
Treatment for a substance-/medication-induced sexual dysfunction is highly dependent on the type of substance/medication and the person's reasons for using the substance or medication.
For people with a recognized substance- or medication-use disorder, treatment should first focus on reducing or discontinuing use of the substance, likely with a substance misuse specialist. If sexual symptoms remain, the person may be reevaluated and referred to a sex therapist.
For people whose sexual dysfunction is due to a necessary medication, the doctor will consider alternative medications with fewer sexual side effects, and/or add a medication that may promote sexual functioning. If necessary, psychological interventions may be implemented to help the person cope with sexual dysfunction and find alternative ways to enhance sexual satisfaction.
