What Does Xanax Do Sexually? Everything You Need to Know

Xanax Sexual Side Effects

Xanax reduces nerve activity in brain cells and spinal cord by stimulating the brain’s inhibitory neurotransmitter GABA, reducing muscle contractions and making it difficult to get or maintain an erection. Erection requires coordination between senses, hormones, blood flow, and mood. Additionally, Xanax prevents dopamine release and activates the release of GABA neurotransmitters, which leads to reduced libido or sex drive. Studies show that after several weeks of Xanax (3–20 mg/day), it was found that the majority of individuals reported a decline in sexual functioning (decreased libido, inability to maintain an erection).¹

Other factors responsible for ED are drugs, chemicals, stress, alcohol, smoking, and psychological issues that directly and indirectly have adverse effects on sexual performance and quality of life. The research data on Xanax’s direct impact on ED are limited. ED affects up to 20 million men in the US. The prevalence of partial or complete ED is more than 50% in men aged 40 to 70, and prevalence increases with aging. According to the few available studies, 10-52% of men experience sexual side effects and 25-63% of women.¹

Sexual side effects linked with taking Xanax:

• Low libido (reduced sexual desire)
• Inability to maintain an erection
• Delayed or retrograde ejaculation
• Erectile dysfunction (ED)
• Anorgasmia
• Undesired sexual urges

*All medications, including Xanax, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and understand the potential side effects and benefits of any medication.

Xanax and Erectile Dysfunction (ED)

ED is the inability to achieve or maintain an erection and affects a considerable proportion of men. Erectile dysfunction (ED) mainly relates to enhanced GABA secretion, which reduces penile erection. Xanax activates GABA-A receptors in the brain to increase GABA, an amino acid inhibiting the neural circuit in the brain and spinal cord.²

According to the current report, Xanax may cause a dose-dependent ED in individuals taking higher drug doses to 2.5 mg and up total daily dose. However, the problem got resolved by reducing the total daily drug dose to 1.5 to 2 mg. Further studies are needed to determine whether the association between Xanax and erectile dysfunctions is independent of underlying health conditions, and to further explore the relationship between Xanax and ED.²

Mental Health & Erectile Dysfunction

Regardless of the underlying cause, erectile dysfunction (ED) can have a profound psychological effect on those affected, as well as their partners. Individuals experiencing ED may suffer from mental health issues such as depression, body image issues, and stress. These can lead to relationship problems, marital dissatisfaction, performance anxiety, and substance abuse. Meanwhile, partners may experience feelings of guilt, shame, rejection, frustration, and a lack of intimacy.³

Anxiety & Erectile Dysfunction

There is a bidirectional relationship between anxiety symptoms and ED. In fact, up to 37% of the ED population has reported the presence of anxiety disorders. Moreover, ED has also been linked to an ongoing sense of fear or restlessness without a specific cause (free-floating anxiety). While the exact role of anxiety in ED is not yet fully understood, it is believed that anxiety contributes to a vicious cycle that impairs communication between partners, leading to sexual dysfunctions.⁴

Unfortunately, both ED and anxiety disorders are often underdiagnosed, putting men at a higher risk of having a poor quality of life. A multidisciplinary approach, involving both psychiatric clinicians and urology teams, is necessary to achieve the best outcomes for these individuals.⁴

Depression & Erectile Dysfunction

Men with moderate or severe depression disorders or taking antidepressant medication may experience ED, which in turn may independently cause or exacerbate depressive mood. This can worsen existing depressive moods. Studies have found a strong link between ED and depressive symptoms, suggesting a bidirectional relationship.⁵

In some individuals, depression or its medication may cause ED, while in others, ED may lead to reactive depressive disorder. Men with ED may also experience reactive depression due to negative partner reactions to loss of sexual function and stress. This can result in low self-esteem, self-confidence issues, and other negative emotions such as anger, chronic anxiety, and depressive symptoms.⁵

Furthermore, anger and anxiety can release chemicals that cause blood vessel constriction, leading to ED. ED may be an early sign of depression. Successful ED treatment often leads to improvement in depressive symptoms, supporting the reactive depression theory. Men using antidepressants may experience more severe ED than those who do not use them.⁵

Other Causes of ED

In order to have an erection, the penis requires a sufficient amount of blood flow, proper functioning of the nerves, adequate levels of the male sex hormone testosterone, and sufficient libido. If any of these systems are disrupted, it can result in ED. The majority of cases of ED are caused by vascular disease, hormonal, the use of certain medications, or psychological problems.⁶

Other potential causes of ED may include:⁷

• Age: Aging decreases the capacity for dilation of arterial blood vessels and smooth muscle relaxation, limiting the blood amount entering the penis, resulting in an inability to maintain erection and potentially developing ED with age.
• Taking other medications: ED can be a side effect of many common medications, such as blood pressure medications, prostate cancer therapy, antidepressants, tranquilizers, prescription sedatives, appetite suppressants (medications that make you less hungry), and ulcer medications.
• Health conditions: ED is often a symptom of other health conditions. Men who have diabetes are two to three times more likely to develop ED than men who do not have diabetes.
• Lifestyle factors: Certain factors and behaviors like smoking, drinking too much alcohol, using illicit drugs (cocaine, amphetamines), and not being physically active may contribute to ED.
• Hormonal disturbances: Abnormally low levels of testosterone tend to decrease sex drive resulting in ED.
• Atherosclerosis: Hardening of the arteries that affects the arteries.
• High blood pressure: Certain drugs, such as those used to treat high blood pressure or an enlarged prostate, and those that act on the central nervous system, such as drugs used to treat depression
• Chronic kidney disease (CKD): Sexual dysfunction is highly prevalent in individuals with CKD, especially those receiving dialysis. Almost 70% of men with CKD report ED.
• Psychologic problems: Performance anxiety, depression, or factors that decrease a man’s energy level (illness, fatigue, or stress) contribute to ED. ED may be situational, involving a particular place, time, or partner.
• Priapism: Prolonged, painful erection may damage the erectile tissue of the penis, leading to ED.
• Peyronie’s disease: Swelling inside the penis causes scar tissue to form, which does not enlarge during an erection, the erect penis is curved, making penetration during sexual intercourse difficult or impossible. The scar tissue may extend into the erectile tissue causing ED.
• Prostate cancer surgery and radiation therapy: Because nerves to the penis run along the prostate gland, prostate surgery (such as for cancer or an enlarged prostate) often causes ED.
• Injury to the penis, bladder, spinal cord, or pelvis: If the nerves sending messages to the penis are damaged, ED can occur. Also, prolonged pressure on the nerves in the buttocks and genital area (saddle area) may occur during long-distance bicycle riding, causing temporary ED.
• Nerve disorders: Spinal cord injury, multiple sclerosis, stroke, seizures, diabetic neuropathy, and surgical injuries are common causes.

How to Manage Sexual Side Effects on Xanax

Managing ED can be challenging as it involves assessing physical and mental conditions. While physical causes can contribute to ED, emotional factors can worsen it, so managing it may require behavioral measures. Initially, specialists may try sex education and relaxation exercises. People must always discuss with their doctors any psychological and drug-related sexual side effects that may have impacted their sex life.⁸

Wait and See Approach

This approach for a spontaneous recovery is occasionally used as the drug’s side effects are often more severe in the initial weeks, and later diminish. Studies suggest that spontaneous and partial recovery of drug-associated sexual dysfunction occurs only in 10% of individuals. Therefore this approach will not be suitable for everyone.⁹ It might be prudent to give the drug a few months to take effect and determine if any improvements are observed before deciding whether to continue with the treatment.⁹

Talk to a Therapist

When there are no underlying medical conditions causing ED, psychotherapy can be a helpful solution to manage sexual side effects. Those experiencing psychological stressors such as performance anxiety, relationship issues, or other current life stressors may benefit from cognitive behavioral therapy (CBT) and counseling with a healthcare professional who specializes in sexual dysfunction. The therapist needs to emphasize the positive aspects of the couple’s relationship.¹⁰

Before choosing a therapist, counselor, or psychologist it is important to ensure that they are highly trained professionals with expertise in the areas of human behavior, mental health assessment, diagnosis and treatment, and behavior change. They are skilled in applying scientifically validated procedures to help people change their thoughts, emotions, and behaviors. Additionally, an online therapy platform may be a good option for those struggling with ED. Studies have shown that for individuals with ED, online treatment is convenient, lessens treatment barriers, and provides easier access to the healthcare system.¹¹

Treatment of Underlying Causes

Drugs that are temporally related to the onset of erectile dysfunction (ED) might need to be stopped or replaced. Underlying organic disorders (diabetes, brain tumor, hypogonadism, Peyronie disease) require appropriate treatment. Depression may require treatment. For all individuals, reassurance and education, including of their partner, are important. Clinicians should use this encounter to discuss behavior modifications like dietary changes and weight loss.¹⁰

Drugs for Erectile Dysfunction

Initial treatment with sildenafil, tadalafil, and vardenafil has been safe and effective for men with ED. Men with diminished libido due to low testosterone levels may benefit from hormone replacement. These hormones are available as injections, skin patches, gel, and oral forms.¹⁰

For Further Reading

• Sexual Disorders: Types, Symptoms, Causes & Treatments
• How Depression Impacts Sex & How To Cope
• It Could be Drugs You’re Taking
• Erectile Dysfunction Service: What To Expect
• Naturally Overcoming Erectile Dysfunction Issues