Substance-/medication-induced sexual dysfunction is defined as a disturbance in sexual function that developed during or soon after substance/medication use, increased dosage, or discontinuation of a substance or medication capable of producing these symptoms.
The precise prevalence of substance-/medication-induced sexual dysfunction remains unclear due to underreporting, but sexual side effects are notably common with psychotropic medications, affecting approximately 25 to 80% of individuals taking serotonergic antidepressants and 50% of those taking antipsychotics (1). Illicit substances such as opioids, alcohol, and stimulants are also frequently implicated.
General reference
1. Piha MOW, Kero K, Tornio A. Female sexual dysfunction as an adverse effect of drugs: a narrative review. Maturitas. 2025;199:108623. doi:10.1016/j.maturitas.2025.108623
Etiology of Substance-/Medication-Induced Sexual Dysfunction
While this diagnosis suggests that biologic factors related to the medication or substance explains the sexual dysfunction, there may be psychological, interpersonal, and sociocultural factors influencing an individual's need or desire to take this medication/substance or their response to it.
(See table for a list of common substances and medications resulting in sexual dysfunction.)
Medications and Substances That May Impact Sexual Function
Category | Type of Medication or Substance |
|---|---|
Hormonal | Hormonal contraception Adjuvant endocrine therapy |
Cardiovascular | Beta-blockers |
Pain | Opioids Tricyclic antidepressants |
Psychiatric/Neurologic | Selective serotonin reuptake inhibitors Serotonin norepinephrine reuptake inhibitors Antiseizure medications Sedatives Antipsychotics Lithium Amphetamines |
Other | Alcohol (at high levels) Stimulants Cannabis (mixed data) Cocaine Heroin |
Symptoms and Signs of Substance-/Medication-Induced Sexual Dysfunction
Substance-/medication-induced sexual dysfunction, includes symptoms such as low desire and difficulty with arousal or orgasm that occur as a result of use, withdrawal, or after exposure to a medication or substance.
Diagnosis of Substance-/Medication-Induced Sexual Dysfunction
History and physical examination
Clinical criteria
A diagnosis of substance-/medication-induced sexual dysfunction is made based on a clinical interview that creates a timeline of the woman's current symptoms, sexual history, and use of medications and substances, including any changes in dosage or frequency of use. (See table .) By creating this timeline, the clinician can identify temporal associations between substances/medications and changes in sexual functioning.
A diagnosis of substance-/medication-induced sexual dysfunction is made, rather than substance intoxication or substance withdrawal, when the sexual symptoms are primary and severe enough to warrant clinical attention.
Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR) criteria for substance-/medication-induced sexual dysfunction require a clinically significant disturbance in sexual function and evidence from the history, physical examination, or laboratory findings of both of the following (1):
The symptoms developed during or soon after substance intoxication or withdrawal or after exposure to or withdrawal from a medication
The involved substance/medication is capable of producing the symptoms
The disturbance is not better explained by a sexual dysfunction that is not substance-/medication-induced, it does not occur exclusively during the course of a delirium, and it causes clinically significant distress in the individual.
Diagnosis reference
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision. American Psychiatric Association Publishing; 2022.
Treatment of Substance-/Medication-Induced Sexual Dysfunction
Treatment of cause
Treating a substance-/medication-induced sexual dysfunction is highly dependent on the type of substance/medication and the individual's reasons for using the substance-/medication. For patients with a comorbid substance use disorder, treatment should first focus on reducing or discontinuing use of the substance, likely with a substance misuse specialist. If sexual symptoms remain, a patient may then benefit from re-evaluation and perhaps, a referral to a sex therapist.
For patients experiencing sexual dysfunction due to a necessary medication, alternative medications with fewer sexual side effects should be considered, and/or the addition of a medication that may promote sexual functioning. Additionally, psychological interventions may be needed to help a patient cope with sexual dysfunction and find alternative ways to enhance sexual satisfaction.
Key Points
Substance-/medication-induced sexual dysfunction is a disturbance in sexual function that develops during or soon after use, dosage change, or discontinuation of a substance or medication capable of causing the symptoms.
Symptoms may include any sexual symptoms, any may impact desire, arousal, orgasm, or sexual pain.
Diagnosis is based on clinical history establishing a temporal relationship between substance/medication use and symptoms and meeting clinical criteria.
Treatment depends on the substance or medication and clinical context and may include reducing or discontinuing the substance, modifying medications, addressing underlying conditions, and using psychological or sex therapy interventions.
