Things suddenly not working in the love department? Before you suspect a relationship fizzle, find out if any prescription or over-the-counter drugs could be to blame, then learn how to get your mojo back
Combining drugs with sex can be a prescription for frustration. From oral contraceptives to antidepressants and over-the-counter antihistamines, dozens of medicines commonly used by midlife women can inhibit desire, slow down sexual response or interfere with orgasms. As one disgruntled 40-year-old Paxil-taker put it, “What’s the point of having sex if you can’t have an orgasm? It’s like going on a trip and never arriving at the destination.”Yet sexual side effects are rarely discussed when a physician recommends a course of treatment. For one thing, doctors and patients are notorious for clamming up about sex. What’s more, the physician may not even know that a specific drug can constitute a chemically induced cold shower. “These connections are barely touched on in medical school,” notes Anita Clayton, MD, professor of psychiatry and neurobehavioral sciences at the University of Virginia in Charlottesville.
Even popular over-the-counter drugs can cause trouble in the bedroom. Consider antihistamines -- such as Benadryl, Claritin and Zyrtec -- which are commonly used for allergy relief. “Women take them from the time leaves appear in the spring until they drop in the fall, without recognizing that the drugs can inhibit orgasms,” says Judith Seifer, PhD, a professor at the Institute for Human Sexuality and former president of the American Association of Sexuality Educators, Counselors and Therapists. The problem: “Antihistamines can act as a muscle relaxant, and you need a certain amount of muscle tension to build to the crescendo of orgasm.”
Some case reports in medical journals have also suggested that regular use of nonsteroidal anti-inflammatory medications (NSAIDs) -- a category that includes Advil, Aleve and Motrin -- might reduce lubrication, desire and arousal. Scientists are not sure why these over-the-counter drugs might cause these unwelcome reactions.
Sexual side effects are especially common with two types of medications that are being prescribed more frequently for midlife women.
Birth Control Pills
Oral contraceptives are showing up more often in the medicine chests of perimenopausal women -- not only to prevent pregnancy but also to quell migraines, heavy bleeding due to fibroids, and hassles like hot flashes and night sweats. Unfortunately, the Pill can also squash desire, possibly for a long time.
Here’s how it happens: the Pill gets processed through the liver, where it increases levels of a protein called sex hormone-binding globulin (SHBG). This affects your sexual appetite because the SHBG binds with testosterone, the primary libido hormone, making it less available to the body -- which can leave you less interested in sex. This can occur in any woman who’s on the Pill, but midlife women are more affected because they’re already experiencing hormonal changes.
Even if you go off the Pill, the libido-reducing levels of SHBG remain in your body for at least several months, according to new research from Boston University. Some doctors believe the effect may last for years, though there is no firm data. “Women who started on birth control pills when they were relatively young and stayed on them for several years seem most likely to be affected,” Clayton says.
Mood Boosters
The run-up to menopause is the time of life when women are likeliest to develop depression serious enough to require treatment -- which often takes the form of antidepressants, the most bothersome of all sex-dampeners. Particularly potent are SSRIs (selective serotonin reuptake inhibitors), a category that includes the widely prescribed Prozac, Zoloft and Paxil. SSRIs counter depression by making the neurotransmitter serotonin more available in the brain. “Unfortunately, too much serotonin can inhibit orgasm and sexual interest,” says Richard Balon, MD, a professor of psychiatry at Wayne State University School of Medicine, in Detroit.
Probably 40 to 50 percent of women on SSRIs have sexual side effects, Balon estimates, and their ranks are likely to grow because many women over 40 are switching from treating hot fl ashes with hormones to relying on antidepressants, especially Paxil, Zoloft and Effexor (an SSRI relative).
How to Switch Your Sex Life Back On
Talk to your doctor. If your sex drive is stuck in low gear or you often stop short of climaxing, it may be possible for you to switch drugs or reduce the dosage. Be sure to do so under your doctor’s care; altering a drug regimen is a risky move to make without medical supervision.
Find an alternative to the Pill. If oral contraceptives are causing you problems, discuss with your doctor whether you should switch to the Nuva Ring, a contraceptive device inserted into the vagina once a month. Because its hormones are absorbed through the vaginal walls, they are not metabolized in the liver and don’t increase SHBG levels.
Take a drug holiday. With your doctor’s approval, you might take a brief break from treatment. For example, if you stop taking a medication on Friday and resume it on Monday, that might allow you to have great sex over the weekend without diminishing the drug’s benefits. (This strategy is sometimes used for antidepressants, but it will not work with Prozac, which clears out of your body too slowly.) Doctors tend to see drug holidays as a last resort, however, partly because of the possibility that withdrawal may cause side effects or get patients out of the habit of taking their medicines, Balon says.
Add a sex-enhancing drug. If you’re taking problematic antianxiety drugs or antidepressants, you may be able to counter sexual side effects with the antidepressant Wellbutrin (studies show it may even heighten sexual response); the antianxiety drug Buspar; the male hormone testosterone; or amantadine, which boosts the feel-good neurotransmitter dopamine.
Think ahead. Before you start a new prescription, ask your physician if the medicine is likely to cause problems with your sex life.
Read the package insert that comes with your medication. With over-the-counter drugs, if the printed material reads, “Do not drive or operate a moving vehicle,” that’s a tip-off that the medication affects the central nervous system and may interfere with arousal and orgasm.
In the end, some midlife women may decide to put up with adverse sexual reactions because they don’t want to tinker with drug regimens that are helping them. Still, says Vicki Radner, MD, author of The Biggest Skeleton in Your Doctor’s Closet, “Patients should know there is often a solution.”