SSRIs and Your Sex Life

A significant number of people are taking medications for depression or anxiety and they are not always aware of the possible side effects to their sexual health. Truthfully, even if the usual side effects are listed for you, the ones dealing with your sex life are often left off that list.

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed type of antidepressant and the 3rd most often prescribed medication in the United States. They are also prescribed to treat anxiety disorders. While not every person on SSRIs experiences side effects, these types of medication are known to have a potential impact on your sexual health. Studies indicate that these side effects may occur after a few doses, show up years afterward and can possibly persist for decades after use.

Medication Examples include: Prozac, Celexa, Zoloft, Paxil, Lexapro, Luvox

Possible secondary sexual problems caused by these medications are:

• Less interest in sex

• Difficulty becoming aroused

• Sustaining arousal

• Issues reaching orgasm

• Delayed ejaculation

• Erectile problems

• Genital anesthesia

• Nipple insensitivity

• Decreased lubrication of the vagina

• Diminished capacity to experience sexual pleasure

• Pleasureless orgasms

Helpful considerations:

• Keep in mind that depression & anxiety itself may be the underlying cause of some sexual difficulties and this must be taken into account when troubleshooting if what you are experiencing is related to a medication or a mental health condition.

• The majority of side effects are overlapping except for the following that have been found specific to SSRIs: genital anesthesia, nipple or glans insensitivity, and pleasureless orgasms.

• Talk to your medical provider about the side effects you are experiencing. Discuss the possibility of adjusting dosage, or another medication that is known to be sexually sparing, or having less sexual side effects. (tips for talking with your healthcare provider)

• Talk openly with your partner about what you are experiencing. Have an honest conversation about the changes or issues and how the two of you might adapt or work with them together. Revisit this conversation often.

• Notice what time of day you have the least amount of side effects and schedule sex for that time. Try morning sex instead of late at night.

• Consider using a vibrator as a tool for a quicker arousal and warming up with potential to reach orgasm.

• Bring a lube into your sexual tool kit to decrease friction and increase pleasure.

• Try exercising before sex, to increase blood flow to your genitals.

• Work with a trained therapist to talk through issues, problems, and possible solutions.

*photo courtesy of Kristin Scharkey

Erectile Changes vs Erectile Dysfunction

Most people are aware that women experience sexual health changes with midlife and menopause, but are not so aware that men experience changes with midlife and aging as well. ⁣

For men, erection changes are normal as they move into middle age and beyond. ⁣ ⁣⁣⁣⁣⁣

Many people assume the source of the changes is the condition called erectile dysfunction that they get regularly exposed to through the seemingly endless number of ads and commercials on TV and radio for medications to address it.    

⁣Just because you experience 𝘤𝘩𝘢𝘯𝘨𝘦𝘴 as you age, does not necessarily mean you have erectile dysfunction. ⁣⁣⁣

Normal changes that might occur with aging: ⁣⁣⁣

• You don't become erect as quickly 

• You don't become erect with fantasy alone⁣⁣⁣

• To become erect, you need direct stimulation⁣⁣⁣

• Erections may not feel as firm 

• Erections may droop from minor distractions⁣⁣⁣

• It takes longer to get an erection again after orgasm/ejaculation

The changes above are symptomatic of the lesser known term erectile dissatisfaction. (dissatisfaction being the result of a man comparing his current erections to those when he was younger, and feeling his erections aren't quite the same)⁣

Strictly speaking, true erectile dysfunction is the inability to get and keep an erection firm enough for sex.  Perhaps an easier way to think about it is the inability to get and keep an erection despite vigorous and persistent stimulation. ⁣⁣ ⁣⁣⁣

If you are experiencing erectile changes, now is the time to get proactive by educating yourself about why the changes occur and what options are available to help.

Giving up on sex is not the answer!

Have an honest conversation with yourself first and acknowledge what is going on. Then, open up a discussion with your partner about the changes. See if the two of you can figure out ways to adapt your sex life to the changes. 

Here are a few initial adjustments to consider if you are experiencing erectile dissatisfaction:

• Keep your head in the game (!) - stay mentally focused and present

• Plan for sex before big meals and alcohol consumption not afterwards (keep the blood flow going to your genitals, not your digestive system)

• Timing - morning or afternoon sex instead of evening or night hours (you have more energy and testosterone levels are highest in the morning)

• Try exercising before sex to increase blood flow to your genitals for faster arousal

• Reframe penis-centered sex, focus less on your penis and more on full body pleasure

• Keep performance anxiety in check - erection changes do not equal sexual failure

• Have an agreed upon plan in place if you lose your erection during sex - such as we’ll use a toy, or switch to oral or manual stimulation

• Recognize that your refractory period (simply your recovery times between orgasm/ejaculation and your next erection) lengthens as you age. Take this into account and refrain from masturbating 12-24 hours before partnered sex. Scheduling sex can be helpful in managing this. 

Outside of the normal changes with aging, there are many factors that can contribute to, or cause difficulties with erectile function. Though not an exhaustive list, below are some of the potential contributors that need to be considered.

POSSIBLE CAUSES OF erectile issues for men:

• Stress

• Anxiety

• Fatigue

• Excessive alcohol use

• Smoking

• Decline in testosterone or testosterone deficiency

• Conflict in the relationship

• Performance anxiety

• Medications (for example: diuretics, antihistamines, blood-pressure meds, antidepressants, or treatments for cancer)

• Underlying health conditions such as: cardiovascular disease, diabetes, MS, Parkinson’s, clogged blood vessels, high cholesterol

• Thyroid function

• Treatments for prostate cancer

• Sometimes a combination of physical and psychological issues causes dysfunction 

As you can see by the length of the list above, that it may be worth scheduling a visit with your healthcare provider to help determine if any of the issues (or others) are affecting your erectile functioning.  Also, it’s important to understand that this same list can possibly be affecting your sexual desire as well. If opening these kinds of conversations feels daunting, read my talking points to have a game plan in place before you see your healthcare provider.

Erectile issues are a big and sometimes complicated topic. This short blog is just the tip of the iceberg. There is much more to discuss regarding options, medications, and devices available for erectile dissatisfaction and/or erectile dysfunction. My hope is after reading here, you will open this important conversation with yourself, your partner and your medical provider.

Men, you are not alone in this.

As freaked out as you might feel about your penis not doing what it used to, these changes do not make you less of a man or require retirement from sex! Get educated, talk to your partner, make adjustments and schedule an appointment with your healthcare provider for a check up. 

More on this topic:
How Toxic Masculinity Can Invade Your Sex Life
Men and Sex
Misconceptions Men Believe About Sex
Midlife and Beyond