Lexapro Sexual Side Effects: How Escitalopram Affects Sex Drive

Last Updated: June 3, 2020

Authored by Sharon Levy, MD, MPH

Escitalopram, an antidepressant and anxiety medication, has been used to help lift people from depression. Trading under the brand Lexapro, this medication has been associated with some side effects especially connected to Lexapro sex drive performance. Patients have reported issues linked to Lexapro and sex such as reduced interest in sex, difficulties in becoming aroused, reaching orgasms, or even a general inability to have an orgasm.

Lexapro Sexual Side Effects Common In Both Genders

Selective serotonin reuptake inhibitors (SSRIs) such as Lexapro have been reported to cause sexual dysfunction in both men and women treated for depression. The sexual side effects of Lexapro may begin to appear a few days or weeks following medication. The following are common sexual side effects of the antidepressant in both genders.

  • Delayed or blocked orgasm
  • Decreased libido
  • Reduction in physiological arousal

However, gender difference has been highlighted in studies as a potential variable affecting the metabolism and distribution of antidepressants in patients. Men and women on Lexapro for anxiety, therefore, may experience different mechanisms of action and varying Lexapro side effects sexually.

Lexapro Sexual Side Effects in Men

Exposure to antidepressants can cause sexual side effects in men that persist for several months, but in some cases, Lexapro sexual side effects go away a few weeks after beginning treatment. The known Lexapro sexual side effects in men include:

  • Reduction in Sex Drive – Since this treatment works in the brain to minimize depression, it can affect sex lives as well. During the first stages of taking the drug, most men experience Lexapro libido complications, but this regularizes once their bodies become accustomed to the medication. Once the body acclimatizes the combined effect of Lexapro and weight loss can cause an increase in sexual desire.
  • Difficulty in Ejaculationmale impotence pills – During sexual relations, it is not a surprise to find that men on Lexapro cant orgasm or experience delayed ejaculation. However, the link between Lexapro and orgasm is considered non-serious and on a typical case, may cease after the body adjusts to the medication.
  • Inability to Achieve an Erection – Commonly associated with impotence, Lexapro erectile dysfunction is one of the unintended problems of the antidepressant. The impotence may persist even with sexual stimulation, but in some cases, the man may achieve an erection only to lose it in the course of the sexual activity.
  • Drop in Blood Pressure – In medical terms, this anomaly is referred to as postural hypotension. When the patient on this medication is in a standing position or getting up from a sitting position, they may experience dizziness or even faint. This phenomenon further causes Lexapro sex problems. Luckily like other Lexapro side effects, this problem also often ends without additional medical intervention.

Lexapro Sexual Side Effects in Women

Women are not spared either when it comes to Lexapro side effects in females. As earlier indicated, the mechanism through which this antidepressant works in women is slightly different due to the presence of estrogen. This hormone influences neuronal function and its molecular targets may overlap with those of Escitalopram. Whatever the case, the following are among the reported Lexapro side effects in women.

  • Delayed Lubrication – This antidepressant can cause vaginal dryness in women by interfering with the natural secretion of the thin layer of fluid that moisturized the vaginal linings. This leads to burning, itching, and painful sensations during intercourse. In some cases, lubrication may come later during the sexual activity.
  • Difficulties with Orgasm – This is one of the common side effects of Lexapro in females. Women lose sensitivity in their nipples and vaginas thereby having a direct impact on their orgasm experiences. Since Escitalopram inhibits the absorption of serotonin, the increased levels of the hormone make it difficult to climax or even achieve an orgasm.
  • Low Libido – The relationship between Lexapro and libido centers on the inhibition of the reuptake of 5-HT (5-hydroxytryptamine) which effectively increases synaptic 5-HT. The stimulation of the 5-HT2A receptors has been established to have an adverse impact on sexual function.

Why Does Escitalopram Affect Sexual Drive?

Sexual interest and desire are affected by neurotransmitters and hormones such as serotonin and dopamine. SSRIs antagonize serotonin transporters, and this inhibits 5-HT receptors also known serotonin receptors. This increase in serotonin levels leads to an increase in calmness, wellbeing, and happiness. However, on the flipside, the increase in 5-HT diminishes sexual function.
Close to 80% of serotonin is found at the periphery. When the levels of this hormone go up, they reduce the sensation in the reproductive system structures and as a consequence, Lexapro decreased libido characterized by diminishing vagina lubrication, penile erection, orgasm, and ejaculation.
Serotonin has also been found to inhibit the production of nitric oxide. This inhibition negatively affects the level of blood supply to the sexual organs and vasodilation. This directly affects sexual response and gives rise to Lexapro ejaculation difficulties.
young couple in bedWhen the 5-HT2A receptors are stimulated, they affect the different stages of sexual experience which are desire, libido, arousal, and orgasm. A study that was done in rodents also shows that when 5-HT2 and 5-HT3 receptors are stimulated, they can impair the sexual drive. This helps to further strengthen arguments on such linkages as Lexapro and erectile dysfunction.

There is also a relationship between the increase in serotonin and the levels of dopamine in the body. Dopamine is generally a hormone that stimulates body systems thus causing sexual arousal. The increase in serotonin suppresses dopamine levels thereby lowering sex drive and increasing Lexapro impotence tendencies.

Orgasm, ejaculation, and other aspects of sexual function are regulated by the autonomic nervous system. Antidepressants inhibit this system and as a consequence interfere with the normal sexual function. This also explains why patients that use Lexapro last longer in bed than when off the drug.

Lexapro Sexual Side Effects And Those Caused by Depression

Distinguishing between medication-induced sexual dysfunctions such as Lexapro delayed ejaculation from those purely caused by depression can be a tough call. On its own, depression can cause social withdrawal and irritability both of which impair intimacy in relationships.

Depression dampens sexual desire instead of decreasing arousals or diminishing the ability to attain orgasm. It is therefore imperative that before medication is started, sexual symptoms of the patient are examined. Also, going into weeks and months after beginning medication and the cloud of depression lifted, an assessment should be done.

The before and after assessments can be instrumental in clarifying matters. It should also not be ruled out that sexual problems can come from relationship issues separate from medication and depression.

Patients having sexual problems with specific partners, but not others or those who orgasm through other forms of stimulation apart from intercourse, cannot be said to suffer from antidepressant medication. Others may be hooked on addictions that may require help from centers that treat drug abuse and other substances.

Coping Strategies: Managing Escitalopram Sexual Side Effects

Effective management of Escitalopram-induced sexual dysfunctions should begin with an assessment to ascertain causality and attribution to antidepressant treatment. Once this is established, the next big challenge is to manage the dysfunction without causing undesirable mental consequences on the patient.  The following are some of the mechanisms on how to manage escitalopram sexual side effects.

  • Drug adaptation – Patients can choose to endure the short-term effects of the drug as their bodies align with the medication. It must also be pointed out that drinking on Lexapro can slow the adaptation process thus lengthen the effects of the antidepressant.
  • Reducing drug dosage happy couple with restored sexual life– Those wondering how to get the sex drive back on Lexapro while still using the medication, the solution is dosage moderation. The practitioner can prescribe an optimum dosage to manage the illness, which may be lower than the current dosage.
  • Switching medications – This is recommended if the side effects of Lexapro in males and females are severe and specific to the drug and not other brands. The practitioner may recommend a switch between Wellbutrin and Lexapro.
  • Other strategies include adjunct treatment to counter the side effects and a drug holiday where medication is omitted before engaging in sexual activity. This can help combat antidepressant sexual problems such as Lexapro premature ejaculation.

To increase positive coping, cognitive behavioral therapy and other counseling therapies are recommended. This can help the patient in analyzing the links between behavior, feelings, and thoughts as a way of managing the problem. Rehab services may help manage Lexapro withdrawals and avoid severe discontinuation symptoms.

In case of difficulties getting off this medication after recovery from depression, enrolling in an addiction clinic can help in the recovery process.

Page Sources

  1. https://www.ncbi.nlm.nih.gov/pubmed/12243609
  2. https://www.ncbi.nlm.nih.gov/pubmed/11305697/
  3. https://www.ncbi.nlm.nih.gov/pubmed/12385082/

Published on: February 20th, 2019

Updated on: June 3rd, 2020

About Author

Sharon Levy, MD, MPH

After successful graduation from Boston University, MA, Sharon gained a Master’s degree in Public Health. Since then, Sharon devoted herself entirely to the medical niche. Sharon Levy is also a certified addiction recovery coach.


Leave a comment

  • Marion
    Such an honest article! For once, it’s not denying or minimising sexual side effects of SSRI’s & how debilitating withdrawals or Discontinuation Syndrome can be. Thank you!
  • Lee
    I am 68 yr. old man. I started taking escitalopram a month ago. Prior I was having erections twice daily and 4 times at sleep and am having trouble. I have an erection one time at night and unable to reach ejaculation. Will this drug cause me sexual problems . I am also concerned about this drug affecting my prostrate health since I am not ejaculationg.
  • Doug
    I was on lexapro for several years, during that time when I masturbated I was totally unable to ejactulate. No matter how much or how long I would do it. My physician at the time gave me ED medication, I tried to explain that wasn’t the problem, I was able to get erect I just wasn’t able to orgasm. Finally I asked to be taken off it, because that was worse than the depression.
  • Bill
    I’ve been taking Lexapro and Wellbutrin for about 7 years. I had problems and could not get an erection. My doctor gave me Cialis. This works most of the time and it takes a long time to climax and sometimes I stop before then because I am out of breath but not too often lately. Overall I am satisfied with the Cialis. I can not masturbate to climax even with an erection. It takes too much time.
  • Helen
    How long will it take to get a normal orgazm back after stopping Lexapro? I have been on it for one year (10mg)and have been off it for 6 months. Thanks.