February 22, 2010

RX Side Effects: When Meds Aren’t Sexy

by Zoeyjane

Who knew that one little pill daily—a mere 20 milligrams of the selective serotonin reuptake inhibitor (SSRI) Paxil—would cause my entire world to come crashing down?

You can’t always get what you want…

Because I’d been hypersexual and hyperorgasmic for as long as I’d been sexually active, and because it had been a source of contention in my relationship, I assumed that Paxil’s sexual side effects were a good thing. Simply said, I lost my mojo and I started having less orgasms. It wasn’t that I didn’t want to be close to my boyfriend, it was that I didn’t feel the need to constantly prove affection by having sex; it wasn’t that I wasn’t coming, I could just make it through sex without multiple orgasms for the first time in three years.

Because I quickly grew so comfortable being a less sexual person, soon, we weren’t doing it as often as we had been. Then, we were barely doing it at all. Lack of intimacy lead to the knife in our never-to-be marriage’s back: resentment.

We broke up by the fall.

It’s a bittersweet symphony, this life

Paxil isn’t the only drug that can cause side effects in the bedroom. Some anti-psychotics and antidepressants—especially SSRIs, a first-line of defense used by many doctors—are known to cause sexual side effects. Paxil, Prozac, Zoloft, Anafranil, Celexa, Lexapro, Effexor and Cymbalta are only a few brands of the magical pills that can take away what ails and libido.

Author Lauren Slater wrote in her memoir Prozac Diary, “How to make sense of a pill that so severs the sexual from the sensual? Prior to Prozac I had always assumed one’s sensual and sexual capacities were linked, linked in the cortex, linked in the limbs. We smells, we touch, we taste, we crest, we come. Actions and experiences inseparable. Prozac, however, has taught me that one’s sensuality and sexuality are or can be cut.”

How true. It’s saddening to think that a medication that can at once restore people’s lives to health, removing mental anguish and pain, can also break our most base abilities: our capacity to crave sex, become physically aroused, or climax.

Of course, if the relationship strain and personal frustration isn’t quite enough, what makes this even more painful is that for many, medicating isn’t an easy choice to make. Accepting and admitting that they may have a problem with depression or anxiety is hard. Choosing to walk into a doctor’s office, describe their symptoms, fill a prescription to treat it can be even harder—for some, akin to admitting weakness or personal defect. It’s hard to declare that we’re not feeling mentally well and need help with it.

If everything works out well, a piece of paper can change life – that makes getting out of bed, going to work, being with friends and family, and living easier. But what if a few weeks, a month, six months or a year or two later, a shadow creeps into the periphery, making something else about them seem broken?

Bringing sexy back

First thing’s first. At the risk of sounding as if I’m preaching, there’s a dire need to communicate to sexual partners why rising to the occasion may not happen. I learned—painfully, through the end of my relationship—that without open discussions, and sadly, sometimes even in spite of them, one or both partners in a relationship may be resentful of a loss of sexual performance.

Next, addressing the issue with the prescribing doctor is integral. Side effects from any medication should always be discussed, but sexual side effects tend to get “forgotten” because so many feel embarrassed by the admission that their erections just aren’t what they used to be, they’re not having success orgasming, or that they’re simply uninterested in the notion of sex.

Here’s the truth: A physician is the only person fully equipped to dismiss concerns as normal or acceptable, and any physician worth seeing will listen to personal symptoms—even about vaginal dryness—without judgment or mocking.

Okay, I lied. There’s a third reason: All isn’t lost. You can bring sexy back. Orgasms, engorgement and sexual interest aren’t irretrievable. There’s multiple drug-related ways to get back in the saddle.

1. Change medications: If the medication’s otherwise, a doctor may choose to lower the dose until sexual function as long as there’s no return of the initial symptoms. If lowering a dose isn’t possible, medication can be changed to another that achieves the same treatment goals. For example, not everyone who experiences loss of orgasm on Prozac will if they’re prescribed Prozac.

2. Change medication timing: With some antidepressants, such as Zoloft and Anafranil, daily doses can be taken after sexual activity, when the drug is least present in the body. This might be all that someone needs to be able to get some nookie—scheduling their dose for bedtime, after the lovin’s already been had. For others on drugs like Paxil or Zoloft, a weekly mini-vacation can be considered, when two days are unmedicated and the bedroom is home base—with physician’s okay, of course.

3. Take medication: Sure, most people don’t want to take medication, period. But if sexual dysfunction is a serious problem and other options have been exhausted, it might be necessary to add other prescription. The options are bountiful. Viagra, the infamous pill known for helping men find wood where previously there was only barren lands, is a popular choice for men without any other health issues. Amantadine (an anti-viral); Cyproheptadine (an anti-histamine); psychotropics like Wellbutrin and Buspar, and stimulants such as Dextroamphetamine and Tradon have all shown positive results in various trials and clinical cases for combating sexual dysfunction. Additionally, Yohimbine, a natural dietary supplement, has shown both aphrodisiac and stimulant effects.

We also have to consider Occam’s Razor: the simplest explanation is often the right one. For some, sexual dysfunction begets more. A few negative experiences create performance anxiety and soon, they just can’t. Sometimes, it’s just about getting over the mental hurdle. Seeking therapy to discuss problems, engaging in play with toys and stimulating lubricants, reading erotica or self-help books, and viewing pornography in a safe, non-judgmental environment might help some people regain their sexual confidence. Practice makes perfect, you know.

...If you try sometimes, you just might find you get what you need

I chose to discontinue medication when my relationship ended and it turned out to be one of the most regrettable decisions I could have made because being unmedicated exacerbated my bipolar disorder. I got sick just so that I could have sex, because I assumed that I had to choose between the two. I didn’t know that other options existed because sexual dysfunction was more embarrassing than admitting that I needed help with my mood disorder. It was easy to walk into a doctor’s office and say, “Hey. I’m not thinking so well.” But asking me to do that and then later admit that I wasn’t screwing so well... So, I kept silent about it. A decade later, and many different medications tried, I’ve finally found another magic pill. And my sex drive’s in tune with my life.

But if I go off key again? I’ll be at the doctor’s office, singing loudly about it.