The Medicine Cabinet: Ask the Harvard Experts
By Howard LeWine, M.D.
Q: I know that some blood pressure drugs cause erectile dysfunction in men. Are there other sexual side effects that might affect women as well? Are certain drugs less likely to affect one’s sex life?
A: Yes, other sexual problems in addition to erectile dysfunction can be related to the drugs used to treat high blood pressure. Men may also experience retrograde ejaculation, whereby semen flows backward toward the bladder rather than it coming out through the penis.
In both sexes, the drugs can cause decrease sexual drive (loss of libido) and difficulty reaching orgasm (anorgasmia). Women may notice vaginal dryness secondary to decreased vaginal lubrication, leading to painful intercourse.
It’s important to realize that these sexual problems are often the result of conditions related to high blood pressure, such as hardening of the arteries (atherosclerosis), and not from medications. In fact, a sexual issue may be the first symptom that raises the suspicion of underlying heart disease or peripheral artery disease.
We know why high blood pressure and some of the medications to treat it might affect men. Over time, high blood pressure causes changes in the blood vessels that decrease flow to the penis and impair holding blood inside to maintain an erection. Also with less blood flow sensitivity can diminish. Some blood pressure drugs can compound the problem.
The reasons why high blood pressure and the medications affect a woman’s sexuality are less clear. Perhaps the lower blood flow to the female genitalia affects arousal, vaginal lubrication and ability to achieve orgasm, leading to reduced sexual desire.
Almost all blood pressure drugs can affect one or more aspects of sexual function. This is particularly true for beta blockers and diuretics (water pills) in men who experience erectile dysfunction. In contrast, erectile dysfunction happens less often with the angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and calcium channel blockers.
However, it is unclear if these same statements also apply to women. So, if blood pressure is well controlled in a woman and she has no other side effects, then switching drugs is less likely to improve the situation.
Remember the lifestyle changes that improve your sex life: not smoking, keeping alcohol consumption in check and getting more exercise.
(Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)
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