October is National Talk About Prescriptions Month here in the US.

It’s important to be mindful of the medications we’re on. I often hear from patients who don’t know about the options they have for medications, let alone things like patient assistance programs. Many pharmaceutical companies will help you gain access to their medications in addition to staff familiar with various issues you might run into. One of the things I’ve found them most useful for is discussing side effects and how to handle them.

Side effects aren’t discussed as often as they should be. When I was going untreated for my arthritis, I was made to fear all the side effects listed during pharmaceutical commercials. When I started medications, then, I was understandably quite nervous. I would cry reading the pamphlets that came with my biologics and wonder how long it would be before I experienced a major medical event because of them.

As time went on, I became more comfortable learning and talking about side effects. Part of it was that I learned more in general, like how even vitamins can have side effects. I also do a lot of nerdy research, read journal articles and studies, and talk to people who have been in or helped run clinical trials. There is an art to discussing and reporting side effects.

Why don’t we talk more about side effects?

In general, we don’t talk enough about side effects we may be embarrassed about. It makes sense. Stigma clouds our responses, making us more timid to speak up. We don’t talk about how medications can change our bowel and bladder habits, for example. Everything thinks talking about poop is gross or that Depend products are only for the elderly. Reality is much different.

The biggest area we don’t talk about is sex and sexuality. As a society, we inject sex into everything from burger commercials to hidden jokes in children’s movies. Despite being bombarded by sex, we really don’t talk about it. Even our sexual education system is lacking in current, agenda-free information. That becomes even more true for marginalized groups like disabled and chronically fabulous people.

One thing we absolutely must start doing is discussing sexual side effects of medications we take. Sex is a natural part of the human experience, just like disability. To help start the conversation, I’ve pulled side effects of commonly used medications for various categories. I’ve removed the actual names, but will also share further down how you can look up your medications.

Possible sexual side effects of common medications

ADHD medications

• Increased UTIs

Alzheimer’s medications

• Increased UTIs

Anti-anxiety

• Decreased libido or interest in sex
• Vaginal dryness
• Difficulty orgasming

Antibiotics

• Yeast infection
• Vaginitis
• Vulvovaginal disorder

Anticonvulsants

• Decreased libido or interest in sex
• Difficulty getting or maintaining an erection

Antidepressants

• Long-lasting and painful erections
• Difficulty orgasming
• Decreased libido or interest in sex
• Decreased genital sensation
• Difficulty getting aroused, getting or maintaining an erection, or ejaculating
• Vaginal bleeding
• Increase in UTIs
• Breast discharge
• Vaginitis

Antifungals

• Decreased libido or interest in sex
• Difficulty getting or maintaining an erection

Anti-histamines and allergy medications

• Decreased libido or interest in sex
• Difficulty getting aroused
• Decreased genital sensation
• Difficulty getting or keeping an erection
• Increased UTIs

Anti-hypertensives

• Decreased libido or interest in sex
• Difficulty getting or maintaining an erection
• Vaginal dryness
• Difficulty orgasming
• Difficulty ejaculating
• Long-lasting and painful erections
• Difficulty getting aroused

Antiretrovirals

These medications are utilized to treat HIV and AIDS.

• Decreased libido or interest in sex
• Difficulty getting or maintaining an erection, arousal

Asthma and COPD medications

• Yeast infections
• Painful menstrual cramps
• Increased UTIs

Cancer medications

• Increased UTIs
• Breast enlargement in males
• Difficulty getting or maintaining an erection
• Difficulty getting arousal
• Nipple pain
• Swollen testicles
• Breast inflammation
• Decreased libido or interest in sex
• Bladder spasm
• Testicular pain

Congestive Heart Failure medications

• Decreased libido
• Difficulty getting or maintaining an erection
• Breast enlargement in males

Diabetes medications

• Increased UTIs

Diuretics

• Difficulty getting or maintaining an erection

DMARDs (rheumatic diseases)

Disease-Modifying Anti-Rheumatic Drugs (DMARDs) is a category that encompasses a wide variety of medications. As such, this list looks a little different than the one above. Let’s go medication by medication.

• Methotrexate: vaginal dryness, fertility issues, decreased libido
• Prednisone: decreased libido
• Hydroxychloroquine: difficulty getting aroused/erections
• Sulfasalazine: difficulty getting aroused/erections, reversible fertility issues
• Cytoxan: fertility issues
• Biologics and Biosimilars haven’t really been researched enough to really say what any long-term side effects are, especially on sexy things

Heartburn medications

• Decreased libido or interest in sex
• Difficulty getting or maintaining an erection

Mood disorder medications

• Difficulty getting or maintaining an erection
• Long-lasting, painful erections
• Decreased libido or interest in sex
• Difficulty ejaculating
• Difficulty orgasming
• Increased UTIs
• Vaginitis
• Breast enlargement and pain

Muscle relaxers and nerve damage medications

• Difficulty orgasming
• Decreased libido or interest in sex
• Difficulty getting or maintaining an erection
• Difficulty ejaculating
• Inability to achieve orgasm
• Pelvic pain
• Enlarged breasts
• Inflammation in the foreskin and head of the penis
• Swollen cervix
• Pain during sexual activity

Multiple Sclerosis medications

• Yeast infections
• Missed periods
• Difficulty getting or maintaining an erection
• Breakthrough bleeding
• Decreased libido or interest in sex
• Breast enlargement
• Long-lasting, painful erections
• Swelling in the urethra

NSAIDs

Non-steroidal anti-inflammatory medications are things like ibuprofen, naproxen, and other (possibly over-the-counter) pain relievers.

• Increase in UTIs
• Difficulty getting aroused
• Difficulty getting or maintaining an erection
• Urinary incontinence
• Vaginitis
• Fertility issues

Osteoporosis medications

• Vaginitis
• Increased UTIs
• Endometrial pain

Sleeping medications

• Decreased libido or interest in sex
• Breast enlargement
• Vaginitis
• Swelling of the urethra
• Increased UTIs

Statins

• Difficulty getting or maintaining an erection
• Difficulty getting aroused

Didn’t find your medication category listed?

If you’re curious to find out more about sexual side effects, there is a relatively easy way to go about it.

I use Drugs.com to look up medications. I’ve just always found it the easiest site to use for any med-related research. You can see variants on pills, look up interactions, and more!

The problem is a lot of sexual side effects aren’t listed on the patient/consumer page. For the most info, you’ll have to scroll down to the section labeled “For Healthcare Professionals.” Look for things in the category ‘Genitourinary.’

It’s okay if what’s listed isn’t easily understandable. Googling a word is always acceptable.

What do you do if you think one of your medications is causing sexual side effects?

The most important thing to do is bring up your concerns with a physician. This could either be the prescribing physician (i.e., rheumatologist), primary care doctor, or a health care provider specializing in that area (i.e., gynecologist).

Before you bring it up, though, it may help to track some information. I always feel better when I can show my health care team what I’m talking about.

I find it best to keep track of symptoms. It always helps when we have data to backup what we say, even if it’s basic. You could do something like write down each time you have difficulty becoming aroused. You could go super nerdy, too, and plot things like vulvar pain in Excel. Plot points tend to do better when you can create a numerical value for what you’re plotting, so keep that in mind.

You can then look at if the medication is helping you, other medications you could try, or ways to combat the effects you’re dealing with. There isn’t always a way to get off a prescription or switch to a different one, and that can be hard to deal with.

The key is to figure out what is most important to you and work within your wants and needs.

Were you surprised by anything?

I know I was! The Lyrica I’ve been on for years sits in the muscle relaxers and nerve damage medication category. In fact, that’s what the last few side effects really reference. As someone going through pelvic floor therapy for pelvic pain and spasms, I was surprised to see that this medication might be contributing to this problem. Since this is a relatively new issue, I don’t believe Lyrica caused this for me. That doesn’t mean it doesn’t play a role.

The tough thing is that Lyrica is the only thing that really helps me medically to lower my fibromyalgia pain. Since I work for myself now (and know flogging helps me), maybe it’s a good time to consider lowering my dose.