Sex and Medication

Medications provide enormous relief from acute or chronic pain, dysthymia and depression. When physical or psychic pain interrupts optimal functioning, opiates and anti-depressants can relieve suffering and help debilitated people lead normal lives. But even when taken as directed to address pain, side effects from these medications can cause serious sexual dysfunction. In addition, opiates are rife with the danger of addiction and abuse.

Many people taking these medications end up choosing between relief from pain and an active sex life. When those taking medication are in a relationship, both partners can contribute to the decline of physical intimacy.

Medications can cause lust to dissipate and sex drive to plummet. For men, failing to achieve or maintain an erection can cause frustration and leave the partner feeling rejected. Healthy communication can alleviate some of the discomfort, but because sexual issues within a couple are so difficult to talk about, communication easily breaks down, leaving each partner in the couple isolated and distressed. If this issue festers long enough, a couple’s sexual dysfunction becomes the norm such that even after discontinuing medication, sexual dysfunction can be very difficult to reverse. Both partners must be willing to risk discomfort talking about sexual issues and establish open dialogue to repair what has been lost.

Since discontinuing needed pain medication is not a beneficial option — pain itself inhibits sexual performance – couples must learn to override a lack of lustful feelings with sensitivity and empathy. If one partner is experiencing feelings of rejection because of the other partner’s lack of interest in sex, it’s helpful for both partners to establish an open dialogue. Such a dialogue permits the couple to distinguish between drug-induced rejection and rejection that might arise from other causes. Above all, it’s important to remember that pressure inhibits sexual feelings. By expressing hurt and rejection, caused by insecurity, one partner can exacerbate the problem by pressuring the other to continually reassure sexual interest and attraction.

Penetrating the wall of drug-induced frigidity takes diligence and work. Sensitive touch and physical openness without pressure to perform can help the medication-taking partner relax and enjoy non-genital physical intimacy for its own sake. Relaxation can open up sexual intimacy and break through a partner’s medication-induced disinterest in sex.

I worked with a couple who for many years had a healthy sex life. However, when the husband was put on Oxycontin, a time-released opiate, for chronic pain, their sex life broke down. The medication managed the pain so the husband could function normally but it left him with no interest in sex. Because Oxycontin was by far the most effective medication for his pain, he became resigned about his disinterest with sex and his wife felt shut out and undesirable. While the couple was able to address and work through most of the problems in their relationship, when it came to sex, the issue was fraught with discomfort. Instead of being able to talk through the problem, the wife would try and seduce her husband or ask for sex, only to be rejected. This left the wife feeling hurt and isolated. Both were aware of their loss of physical intimacy but were not able to help each other reestablish a physical connection. Finally, through suggestion and exploration, I helped the couple establish a reawakening of their physical intimacy. Beginning with non-sexual touch, without sexual pressure, and slowly adding sensuality, the couple learned new ways to be physically intimate. The slow progression took the sting out of hurt feelings and helped the couple communicate physically without needing to have lust drive the physical encounter. Both the husband and wife were able to relax around this issue and build a satisfying sex life. It was not the same sex life as before, when it was driven by lust, but one equally rich, deep and connected.

Our society teaches us that sex is driven by lust; if people are attracted to each other, sex is unproblematic and easy. If and when sexual problems arise, people rush to the conclusion that the relationship is dysfunctional and needs to be reassessed. Any sexual problem in a relationship needs to be addressed with compassion and empathy. When medication is deemed appropriate for physical or psychic pain, the solution should not be a choice between pain and sex. When a couple learns to incorporate changes within their sexual relationship, there comes about a new and satisfying sexual intimacy.

Love and Substance Use

Drugs and alcohol provide an illusion, an illusion that ranges from love to despair. Many substances evoke both positive and negative feelings, euphoria and anxiety, side by side, with the negative emotions typically following the positive. This affects the user’s emotions and perception of reality, and subsequently the stability and wellbeing of a couple.

The affect of drugs and alcohol on a couple will vary with the frequency, the social context, the kind of dependence and the kind of substance. A relationship is also affected by whether one or both partners partake. When feelings experienced while “high” are confused with “real” feelings, serious ruptures and rampant misunderstandings are likely to adversely affect healthy romantic interactions. While this phenomenon can occur in any kind of relationship, the intimacy of romantic relationships exacerbates this dysfunction.

Keep in mind there is a difference between use and abuse. When individuals choose to put a substance into their body, they aren’t necessarily affecting their relationships or their ability to function. However, addictive use and, at times, periodic recreational use, may cause a serious rupture within a couple. This may be followed by recrimination, dishonesty, misunderstanding, and a breakdown of empathy.

Many substances foster feelings of omnipotence that lead to narcissistic behavior. This clouds empathy and sensitivity and makes it easy to disregard others’ feelings and needs. When feelings of euphoria are prominent, one can seem to be highly empathic to others when, in fact, the feelings are originating from the user’s own narcissistic needs. Although being high may seem to heighten connection between people, it ultimately separates people in a haze of unreality. This can be most acute and damaging within a couple – particularly when such feelings and behavior exacerbate dysfunctional communication already problematic in the relationship.

I am working with a gay male couple who have been together for 6 years. The partners have different cultural histories which causes some friction in the relationship. They both use drugs and alcohol recreationally, mostly when going out together to socialize. When they are home alone together, they claim to be content and argue little. They do, however, have issues of trust and when they go out and take club drugs, the trust issues explode and feelings of insecurity, paranoia, and heightened sexuality come to the forefront, exacerbating the milder mistrust that already exists. While this couple uses drugs relatively infrequently (they say 5 times a year), they will binge for days at a time, leaving them rife with drug-induced depression. This occasional drug use has caused havoc in the relationship and has led the couple to seek treatment. Most of my work has involved separating the issues caused by the substance use from those occurring in the couple’s everyday lives. It is not an easy task since the conflict provoked by the drug use bleeds so easily into the pre-existent mistrust.

Another couple I worked with had been together over two decades. They had a loving healthy relationship and had come into treatment, not because there were major problems, but rather to keep and maintain open lines of communication. They both enjoyed a nightly glass of wine before dinner. One of the partners started drinking a strong margarita instead of wine during their pre-dinner ritual. While a glass of wine didn’t affect either’s ability to relate, the margarita drinker became very high and lost his ability to communicate in any realistic way. Because of this, his partner felt shut out and asked that his partner refrain from drinking hard liquor at those times and go back to a glass of wine. Because both in the relationship were sensitive to each others’ needs, and listened to and respected each other, the margarita drinker, not wanting his inebriation to cause conflict in the relationship, went back to wine. If the couple hadn’t already had good communication skills, the drinking could have created a major rupture.

Substance use often creates volatility and unpredictability in couple relationships. Unless monitored with honesty, understanding, and open communication, drugs and alcohol can cause serious ruptures between partners. Left unaddressed, these ruptures can develop into a breakdown of the relationship. Unreality and erratic mood overtake any ability for healthy communication.