Skip to main content

Verified by Psychology Today

Beware the Sex Killers

Some substances will set you back in bed. Alcohol, nicotine, and drugs can interfere with pleasure.


In Macbeth, Shakespeare wrote that this substance "provokes the desire, but takes away the performance." Truer words were never penned. When people of average weight drink more than two beers, cocktails, or glasses of wine in an hour, alcohol interferes with erection in men and impairs sexual responsiveness in women. Drink too much, and all you'll do in the prone position is pass out.


Smoking narrows the blood vessels, impairing blood flow into the penis in men and increasing their risk of erection impairment. In women, the same mechanism limits blood flow into the vaginal wall, decreasing lubrication.


Antidepressants work—but at a price. All except one (see below) carry a considerable risk of sexual side effects: loss of desire and difficulty reaching orgasm in both sexes, impaired erections in men, and lubrication problems in women. Some of the most popular antidepressants are the selective serotonin reuptake inhibitors (SSRIs): Prozac, Zoloft, and Paxil. According to Jamie Grimes, M.D., chief of outpatient psychiatry at the Walter Reed Army Medical Center in Washington, D.C., SSRIs cause sex problems in more than half of those who use them. Sex-impairing side effects also occur among older antidepressants like Elavil, Tofranil, and Nardil.

If you take an antidepressant, what can you do to preserve sexual function? Jacob Katzow, M.D., a Washington, D.C., psychiatrist, says a lower dose might reduce sexual side effects while preserving antidepressant benefits. Or try a "drug holiday." Anthony Rothschild, M.D., a psychiatrist at MacLean Hospital in Belmont, Massachusetts, had 30 couples—each with one member taking an SSRI and reporting loss of sexual function or desire—go drug-free on weekends, from Thursday morning to Sunday at noon. Among the 20 taking Paxil or Zoloft, half reported better sexual functioning and more desire over the weekend, and only two said they felt more depressed. But of the 10 taking Prozac, only one reported sexual improvement, probably because Prozac takes longer than other SSRls to clear from the blood.

Another option is to ask your physician about switching to Wellbutrin (bupropion). For reasons that remain biochemically unclear, it has no sex-impairing side effects.

Other Legal Drugs

An enormous number of prescription and over-the-counter medications—even the antihistamines people take for allergies—can cause sexual impairment. "If a drug label says, 'May cause drowsiness,"' says sexual medicine specialist Theresa Crenshaw, M.D., "it can impair sexual desire or performance." John Morganthaler, director of the Sex/Drug Interaction Foundation in Petaluma, California, estimates that up to 20 percent of all sex problems are caused by drug side effects or interactions. He recommends asking your doctor and pharmacist about this possibility every time you get a prescription.

Illicit Drugs

There's a good reason why narcotics and tranquilizers are called "downers." That's what happens to the sexual interest of people who use them. But "uppers" are no better. Amphetamines and cocaine stimulate sexual desire, but impair orgasm, making sex decidedly frustrating. With regular use, desire fades as well.

The most sexually unpredictable illicit drug is marijuana. Some say it enhances lovemaking. Chemically, it just might. Pot increases blood levels of phenylethylamine, a neurotransmitter associated with love and lust. But marijuana makes other people withdraw or become anxious or irritable, which can ruin sex.

Finally, all illicit drugs involve risk of involuntary intimacy with the legal system. Fear of possible arrest causes anxiety, and anxiety takes the joy out of sex.