High blood pressure and certain medications used to treat it can cause sexual dysfunction in some people. In men, it typically shows up as erectile dysfunction (ED; the inability to attain or maintain an erection); in women, it often appears as painful intercourse because of problems with arousal and vaginal dryness.
Fortunately, there are steps you can take to minimize these effects and continue to have a satisfying sex life.
Unhealthy blood vessels
Research shows that men and women with hypertension are twice as likely to experience sexual problems as individuals without high blood pressure. The reason: Healthy blood vessels are essential to sexual function, but high blood pressure damages blood vessels and impairs their ability to work properly.
Hypertension does this in two ways: First, it leads to narrowing of the arteries because of plaque buildup; second, it causes endothelial dysfunction, meaning that the arteries are unable to relax and dilate to accommodate an increase in blood flow. In both cases, the result is reduced blood flow to the sex organs. However, sufficient blood flow is a crucial step in sexual arousal and function in both men and women.
Drug side effects
If you’re taking blood pressure medication and experience sexual function problems, ask your physician if your medication might be contributing to the problem.
While treating high blood pressure typically improves sexual problems by improving the function of the blood vessels, diuretics and beta-blockers have been linked to sexual dysfunction. However, blood pressure medications such as ACE inhibitors, angiotensin II receptor blockers (ARBs) and calcium-channel blockers are much less likely to lead to sexual problems. In fact, studies show that ARBs like losartan (Cozaar) and valsartan (Diovan) may actually improve sexual function when used to treat hypertension.
What to do
Sexual dysfunction can be treated. Here are five steps to take.
1. Adopt a healthy lifestyle. Many of the same lifestyle measures recommended to lower blood pressure can also help improve sexual function. These measures include not smoking, losing excess weight, and increasing physical activity.
2. Ask your doctor about changes to your blood pressure drugs. If you’re taking a diuretic or beta-blocker, ask whether you can take a lower dosage or switch to another type of blood pressure medication—like an ACE inhibitor, ARB or calcium-channel blocker—that is less likely to have sexual side effects. However, never stop taking your blood pressure medication on your own.
3. Get other health conditions under control. Hypertension is not the only health issue that can impair sexual function. Diabetes, heart disease, and depression are contributing factors as well. Getting treatment for these conditions may help improve your sex life, too.
4. Try an ED drug if you’re a man. ED medications such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra) help improve endothelial function and are safe for men on most blood pressure medications. Close monitoring of blood pressure is recommended, however, when ED drugs are used in combination with alpha-blockers such as doxazosin (Cardura) and terazosin (Hytrin).
In addition, ED medications should never be used in combination with nitrates taken to control angina (chest pain), because potentially life-threatening low blood pressure can occur.
If you are using an ED drug and develop chest pain during sex, do not take a nitrate medication. Instead, rest for five to 10 minutes. If pain persists, call 911 and be sure to tell the emergency responders that you have taken an ED drug.
If you cannot take one of the ED medications already mentioned, ask your doctor about other options. These include the synthetic hormone alprostadil (Caverject, Edex, Muse), which is injected or inserted as a suppository just before sex to enhance blood flow to the penis, and penis pumps, which are used to pull blood into the penis to achieve an erection.
5. Try lubricants if you’re a woman. If vaginal dryness is causing you pain during sexual intercourse, using an over-the-counter lubricant may solve the problem. Prescription creams containing estrogen also can help. However, these creams should not be used if you have ever had a heart attack, stroke, or blood clot in the legs.
Many people hesitate to bring up sexual function concerns with their physician. However, do not be embarrassed. Satisfaction with your sex life is an important part of your overall well-being and something your physician can help you address.
Reviewed by Lawrence Appel, M.D., M.P.H., the C. David Molina Professor of Medicine at the Johns Hopkins University School of Medicine, Baltimore. Dr. Appel has joint appointments in the departments of epidemiology and international health of the Johns Hopkins Bloomberg School of Public Health. He is also an internist.