Opioids and Changes in Sexual Health
Being in pain and taking opioids can cause changes to your sexual health. It can be easy to overlook the importance of sexual intimacy. But feeling intimacy and connection can be an important part of coping with pain and cancer in general. It is important to talk with your care team and with your partner about these issues.
How do opioids affect sex?
Opioids change messages in your nerves and your brain. These are some of the same messages involved with sexual function (for example feeling interested in sex, being sexually aroused, or having an orgasm). Cancer and cancer treatment can also affect your sexual health. Your care team can help you figure out what’s going on and come up with tips to help.
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Always follow the instructions on your prescription bottle.Never take a higher dose of your opioids, or take them more often than prescribed. Instructions on medicine bottles can be confusing. Short-acting opioids are often prescribed with a range of doses you can take. For example: “Take 1-2 tablets every 3 hours as needed for pain.” This means it’s OK to take up to 2 tablets within a 3-hour time window. You can also choose to take less than this, or not take it at all (if your pain is controlled). Take them with a sip of water, with or without food.
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Take them when you have pain and need quick relief.These take about 30 minutes to start working and 1 ½ hour to get the most relief, so take them early on when you feel your pain creeping up.
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If you don’t have pain, don’t take them.If your pain is manageable and you don’t expect it to get worse, you shouldn’t take this medicine. It should be used “as needed” when you have pain.
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Take them before your pain gets severe.Try to “stay ahead” of your pain by taking your short-acting opioid early on when you notice your pain getting worse. If you wait until your pain is severe, it often takes more medication and a longer time to get your pain under control. Pay attention to your body as you learn about your pain and how you react to opioids. Most people start recognizing their body’s signals about when they need to take their short-acting opioid for breakthrough pain.
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Choose the dose that matches your pain level.Most short-acting opioid prescriptions have a range of doses you can choose to take within a given time-period. A common example is take 1-2 tablets every 3 hours as needed. If your pain is severe, start with the higher dose (for example: 2 tablets). If your pain is less severe, you can start with the lower dose (for example: 1 tablet). If your pain isn’t significantly better after 30 minutes to an hour, you can take the rest of the dose.
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Take them about 30 minutes before painful activities.Some people know they will have pain with certain activities, like walking or taking a long car ride. Think of activities that usually worsen your pain. To help you be more active, you may want to take your short-acting opioid 30 minutes beforehand.
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If your short-acting opioid is not working well, talk to your care team.Every person is different and it can take some time to find the right medicines and right doses for you. Your care team might decide to increase the dose of your opioid or change to a different medication. The important thing is to let them know how you are doing.
Talk to your doctor about concerns you may have about sexual health. Opioids may not be the only reason you have noticed a change, but your care team can help you figure out options.
Here are some ideas for ways to start the conversation with your provider. You can start by saying something like:
“I know this isn’t the main focus of my treatment, but I need to talk about changes I’ve noticed in my sexual health since taking opioids...”
“This is hard for me talk about, but I have noticed...”
Next, you can bring up specific issues you may have with sexual health. Here's some language you can try using:
“I’m having trouble reaching an orgasm. It seems to be worse since starting opioids.”
“I’m having a hard time getting aroused or keeping an erection. It seems worse since starting opioids.”
“I have a lot of pain during intercourse, and I have a lot of dryness. I’ve noticed it getting worse since going up on my pain medications”
“My sex drive is a lot lower since being on opioids.”
Starting the conversation can be hard. But remember, you’re not the only one going through this. Your care team may have special ideas to help.
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