I Need My Sex n’ Drugs
With more depression and anxiety medications being prescribed than ever before, sexual dysfunction has become a common experience for many, and college students aren’t safe from unsatisfactory sex lives.
Iris, who requested to remain anonymous, wakes up to the sound of an alarm blaring from her bedside table. She reaches over a Nintendo Switch and plush sloth stuffed with dried lavender to turn off the noise, and groans as she rubs her eyes. After making breakfast, which usually consists of a meal prepped burrito, Iris takes a women’s multivitamin and 15 milligrams of Lexapro, a common SSRI (selective serotonin reuptake inhibitor) that treats depression and generalized anxiety disorder.
About halfway through her Fall 2020 semester at Syracuse University, Iris, a junior, became one of nearly two million Americans who began taking medication to treat mental health issues during the COVID-19 pandemic. From mid-February to mid-March (around the time when lockdown restrictions began rolling out), prescriptions for antidepressants and anti-anxiety medications increased by 34% and 18%, respectively. Unfortunately for Iris, and everybody else who takes medications that fall under the category of SSRIs, the relief of mental symptoms often comes with a slew of sexual side effects, such as the inability to reach orgasm or delayed ejaculation.
As restrictions lift and the COVID-19 vaccine becomes more widely accessible, a “normal” sex life is once again a realistic possibility for many. Despite this, the increased experience of SSRI-related sexual side effects is getting in the way of getting it on, leaving many to wonder how (or even if) they will be able to navigate a new culture of sex in a mentally and physically healthy way.
According to a study in the Journal of Sex & Marital Therapy, around 38.5% of women and 62.5% of men on psychiatric medications deal with sexual side effects. Sex therapist Terri St. George, who works out of Albany, NY, specifies that these side effects fall into three categories: issues with arousal, desire, and/or climax. To be a bit more specific, these effects range from difficulty reaching orgasm or ejaculating to a lower sex drive (libido) to reduced sexual satisfaction to problems experiencing an erection or naturally lubricating.
At this point, you may be wondering what causes these side effects to occur in the first place. To put it simply, higher serotonin levels can stop our brains from successfully transmitting sexual messages, leading to what are often known as sexual “dysfunctions.” These dysfunctions vary depending on the specific medication one is using — for instance, Prozac correlates with higher difficulty experiencing desire while Zoloft correlates with higher difficulty orgasming.
Despite this, there doesn’t seem to be any clear connection between those who experience these side effects and those who don’t. For lack of a better term, it’s random. Dr. Janet Lefkowitz, an OB/GYN based in West Hartford, CT, wonders if there are genetic components that produce different responses to SSRIs in different people, but her curiosity is all hypothetical.
For now, those who start SSRIs are left to wonder if they will be visited by the sexual dysfunction fairy and, if they are, which dysfunctions they’ll be gifted. Iris received a low libido while Maggie, a sophomore attending the same university who also requested to use a fake name, has faced difficulties experiencing arousal and reaching orgasm since starting Prozac.
These dysfunctions have made Maggie pickier in choosing potential partners — needing to trust the person she’s with before getting it on — and more insecure about herself once she actually begins a hook-up.
Concerns about if she’s aroused enough or if she’s taking too long swirl around Maggie’s head while she’s being intimate, making the experience that much more anxiety-provoking and worsening the sexual side effects already consuming her mind.
“That’s the basics of performance anxiety,” St. George said, “that thought gets in your head, and it will shut down your experience because your focus will be on those worried thoughts and not whatever that moment is.”
While overcoming performance anxiety is a large obstacle in itself, lack of support and understanding from a sexual partner can create even more undesirable situations. Margo Moran, a sophomore at Syracuse University, said that she’s had people not want to be in intimate relationships with her because she was experiencing a low libido at the time.
“Other girls would want to hook up a lot more than I did, so why would I be the person they’d want to be getting with?” Moran said, sharing the mindset she struggled with while taking Lexapro.
According to stereotypes and stigmas, sexual dysfunctions aren’t “supposed to” affect young people, who are meant to be at the peak of their physical ability. “I’m so jealous — you’re in the prime of your life!” your distant aunt who you only see at a family reunion every two or three years may say to you. “You’ll never be this young, hot, and fertile again,” the “cool mom” figure in your life may consistently remind you. And for the most part, they’re right! Sexual dysfunctions do naturally impact people more as age increases, Ellen Grabowitz, a psychiatrist who has been prescribing SSRIs for decades, said. So, what does it mean when young people aren’t able to sexually perform in the way(s) they’re expected to? The short answer: a lot of insecurity and shame.
“One of the most problematic things is that people feel alone and broken and like they’re the only person who has this concern either about mood or about a sexual function, and that perspective, that feeling alone and feeling ashamed and broken, can worsen mood disorders and worsen sexual function,” Dr. Pebble Kranz, a sexual medicine specialist and family physician, said.
This worsening of mood disorders and sexual function that Kranz touched on reveals the twisted cycle that SSRI-induced sexual side effects can create. Someone suffering from depression or anxiety is likely already struggling with their sexuality, and they begin medication seeking relief. Rather than relief, though, the medication may produce even more stress within their sex lives, which can result in an even more intense mood disorder. Cruel, right?
For Leo, a junior at the University of the South who requested to remain anonymous, this cycle feels amplified by his gender identity. “As a man, being depressed is frowned upon, and not having a good sex drive or sexual performance is also frowned upon, even though that may be a side effect of you trying to fix something that is already not being talked about,” Leo said while reflecting on his personal experiences with Zoloft, “it almost creates another problem when you try and help yourself.”
“It almost creates another problem when you try and help yourself.”
For members of the LGBTQ+ community — who are already more likely to suffer from a mental illness than people outside of the community — sex, especially for transgender, non-binary, genderqueer, and genderfluid individuals, is made even more complex with the addition of SSRI-induced sexual side effects.
“A gender-expansive population has a lot of other stressors on their sexual experiences, so it could be a compounding factor that is making sex more complicated because of all of the minority stress that’s already being experienced,” Kranz hypothesized.
“You take these pills to try and feel better, and yet it takes away one of the best parts of life,” Lucy Stover, another sophomore who goes to Syracuse University, said. Stover, who used to take Lexapro but recently switched to Zoloft, has experienced SSRI-induced issues with arousal and desire — side effects that have impacted her physical connection with her long-distance boyfriend.
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For Iris, on the other hand, a low libido barely impacts her sexual relationships with others but largely influences her sexual relationship with herself. For someone who used to consistently masturbate multiple times a week, sometimes even to help ease her anxiety, the jump down to maybe once every three weeks — emphasis on the maybe — has been challenging in a way she hadn’t originally expected.
According to St. George, solo sex (aka masturbation) is extremely important in developing and strengthening someone’s sexual empowerment. In this case, not wanting to masturbate can mean much more than having a harder time falling asleep at night — it can have consequences on one’s sexual relationships in all spheres.
“We can’t have sex with a partner until we have a connection to ourselves and our own bodies,” St. George said, acknowledging that this can be an especially difficult, frustrating process for people adjusting to and maybe even grieving over a new normal.
Despite being an extremely personal, intimate issue, navigating SSRI-induced sexual side effects is something that proves to be systemically challenging, too — even for medical professionals.
“I will admit that there are times when I don’t, at least not off the bat, go into the sexual side effects immediately because I think they’re going to put people off without trying the medicine,” Grabowitz shared.
While her approach is definitely understandable, especially in cases of severe mental health issues, it’s unfortunate that some prescribers feel the need to minimize these side effects, which are — for many people — a really significant aspect of the experience(s) of these medications, to ensure that patients get the help they need.
On the other side of the spectrum, St. George strongly believes in the importance of confronting these side effects head-on to prevent people from any unnecessary suffering. She reflected on patients of hers who had gone six months, eight months, or even a year before realizing that their newfound sexual dysfunctions were actually a result of the medication they had recently — or not so recently — started.
What St. George brings up relates to another overarching theme (and, debatably, downfall) of the medical field when it comes to sex — there’s a general disconnect between providers.
“I think that it would be great to have more integrative care around these issues because a lot of us sex therapists feel like we’re kind of out here on our own when, of course, there’s a biological piece to sexual functioning,” St. George shared. “In general, in our world of medicine and our world of therapy, we don’t assess people’s sexual functioning — that’s an area that’s always been left out, ignored, minimized.”
In her opinion, prescribers, doctors, and even OB/GYNs are too often quick to assume that all patients are willing to sacrifice their sexual wellbeing for mental wellbeing, when, realistically, this isn’t always the case. She expressed a perspective that a few students echoed: sexual pleasure is connected to happiness and stress relief, and health professionals shouldn’t assume that everyone is willing to give up this part of their lives and identities.
“Your sexual identity as someone this young, as someone in college, is so important because you’re just finding it,” Stover said.
Similarly, Maggie shared, “There are days when I’m like, ‘Okay, is it actually worth it?’. I want to be on the same page as everybody else.”
“There are days when I’m like, ‘Okay, is it actually worth it?’”
This specific issue goes beyond medical professionals minimizing the importance of sexual functioning, though. As Kranz pointed out, there isn’t great sex education for medical providers in the United States, even for gynecologists and urologists. Because of this, doctors are less likely to ask their patients about sex because they don’t feel resourceful enough on the topic — they don’t know what they can do to help.
“It would be nice if doctors wanted to really work with us and really validated that issue and said, ‘I’ll keep trying something with you,’ as opposed to, ‘Well, this is a really common side effect,’” St. George said.
The shame surrounding SSRI-induced sexual side effects is not a problem that was created or that can be solved by any one person or group of people. Even with the presence of a sex-positive social movement that has been alive for decades, mainstream society continues to largely ignore conversations about sex that don’t revolve around all-day desire, effortless arousal, and mutual orgasms. Unfortunately, real life is not a romantic comedy or porn or one of the many 50 Shades of Grey books published. Real life is not as sex-positive as most people need it to be. Need more evidence? Just look at how many people chose to use fake names in this article.
And on the off chance our playlist just isn’t cutting it, take a look at “Treatment Made Sexy” to explore other options that may help you get things going.
