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Hormonal conditions
A sustained rise in prolactin suppresses the signal that drives sex hormone production, so desire, arousal, lubrication, and erection all drop together. It can also stop periods and produce unexpected breast milk. It is worth knowing about because it is one of the very few sexual complaints with a single, cheap, definitive test behind it.
See someone about this if
Editorial categories, not percentages, and never a prediction about you. Each links to the fuller picture of that change.
Wanting sex less often, or losing the spontaneous interest that used to arrive on its own. This is the effect people most often assume is psychological and most often is not only psychological.
The body responds less, or much more slowly, even when the interest is there. Blood flow, nerve signalling, and hormone levels all feed this, and medicines can act on any of the three.
Erections that are slower, softer, or do not hold. Because this depends on blood vessels and nerves, it can also be an early signal of something cardiovascular — which is why it is worth a clinical conversation rather than only a product.
Less natural lubrication, a tight or raw feeling, or discomfort that arrives during rather than before sex. Medicines cause this either by drying mucous membranes generally or by lowering oestrogen.
Arousal works but orgasm does not arrive. When this starts within weeks of a new medicine and had never happened before, the timing itself is information.
Condition or treatment?
The most common reason for a raised level is a medicine rather than a tumour — antipsychotics in particular, and risperidone, paliperidone and amisulpride most of all within that class. A benign pituitary tumour is the other main cause and is treatable, which is why the level is worth measuring rather than assuming.
For almost every condition on this site, the condition and the medicines that treat it both affect sex — by different mechanisms, on different timescales, and with different answers. Being able to say which half you are asking about is the single most useful thing you can bring to an appointment, and it is the thing patients are least often given.
Never stop, pause, reduce, or change a prescribed medicine because of anything on this page. Some of the medicines listed here are dangerous to stop suddenly, and the condition being treated does not pause while you experiment. Everything here exists to make your next conversation with a prescriber more specific — not to replace it.
A sustained rise in prolactin suppresses the signal that drives sex hormone production, so desire, arousal, lubrication, and erection all drop together. It can also stop periods and produce unexpected breast milk. It is worth knowing about because it is one of the very few sexual complaints with a single, cheap, definitive test behind it.
The effects reported most often are lower sexual desire, arousal is slower or harder to reach, and difficulty getting or keeping an erection. Reported does not mean inevitable — the picture varies a great deal between people, and most people have more than one thing contributing at once.
The most common reason for a raised level is a medicine rather than a tumour — antipsychotics in particular, and risperidone, paliperidone and amisulpride most of all within that class. A benign pituitary tumour is the other main cause and is treatable, which is why the level is worth measuring rather than assuming. Timing is the most useful clue you have: an effect that appeared within weeks of starting or changing a treatment points at the treatment, while one that predates it points at the condition. Never stop, pause, or change a prescribed treatment to find out — take the timeline to the person who prescribed it.
The classes commonly used here that carry documented sexual effects are antipsychotic medicines, tricyclic antidepressants, and ssri antidepressants. Each has its own profile, so which one you are on matters — and that is a prescribing conversation, never a reason to stop anything.
Ask for the level to be measured rather than inferred; it is a single blood test. If a medicine is the cause, that is a specific and answerable prescribing question rather than something to live with.
Sooner than most people do, and specifically without waiting: Unexpected breast milk, breast tenderness, or periods stopping alongside low desire warrants a prompt appointment and a prolactin test.
Educational information about what a diagnosed condition tends to do — not a diagnosis, not a way to work out whether you have something, and not advice about your treatment. Conditions on this page overlap, and most people with a long-term condition have more than one thing affecting them at once. Nothing here can examine you or run a test. Pain, bleeding, or a new and unexplained symptom always deserves assessment.