This article summarizes Chapter 19: Effects on Sexuality of Medication Used in Pregnancy and Childbirth↗️ of the Midwifery and Sexuality: Beers, E., Jaeken, A. (2023). Effects on Sexuality of Medication Used in Pregnancy and Childbirth. In: Geuens, S., Polona Mivšek, A., Gianotten, W. (eds) Midwifery and Sexuality. Springer, Cham.
Introduction
Pregnancy introduces significant complexities when it comes to the effects of medication, primarily because pregnant women are typically excluded from clinical drug trials due to concerns about potential harm to the unborn child. Consequently, knowledge is scarce regarding the safety and efficacy of drugs during pregnancy. Assessing the risks of untreated medical conditions against the potential risks of medication is crucial during pregnancy planning or when pregnancy is desired.
Understanding pharmacokinetics (PK) and pharmacodynamics (PD) provides insights into medication side effects. Pharmacokinetics involves how drugs move through the body, including absorption, distribution, metabolism, and excretion. Pregnancy alters these processes, affecting drug concentrations and elimination rates. On the other hand, pharmacodynamics focuses on a drug’s effects on the body, including therapeutic and side effects, which can be influenced by changes in drug distribution and metabolism during pregnancy.
Physiological changes during pregnancy, such as increased cardiac output and blood volume, impact both pharmacokinetics and pharmacodynamics. Drugs may be metabolized and eliminated more rapidly, affecting their efficacy and potential side effects. Additionally, changes in enzyme activity and protein binding alter drug concentrations and effectiveness. These changes persist postpartum but eventually normalize.
In daily practice, healthcare providers distinguish between medications taken before, during, and after pregnancy. Dosage adjustments are often necessary to maintain therapeutic levels and avoid toxicity or ineffectiveness. Consultation of drug manuals or summaries of product characteristics is essential, although standard dosage recommendations may not always be suitable for pregnant women.
In essence, pregnancy significantly alters how medications are processed and their effects on the body. Addressing your healthcare providers is essential to ensure safe and effective medication management during pregnancy and beyond.
Sexual responsiveness↗️ is influenced by biological, psychological, and social factors. Medication, which primarily affects the biological aspect, can lead to secondary psychological and social problems, exacerbating sexual side effects even after the medication is discontinued. However, some medications may also have positive effects on sexual function.
How to deal with suspected sexual side effects
When considering suspected sexual side effects of medication, it’s crucial to navigate through various potential causes. These symptoms could arise from the medication itself, the underlying condition being treated, or external factors like psychological or social dynamics. For instance, in a case where a woman experiences difficulty reaching orgasm while on antidepressants, it’s essential to weigh factors such as the impact of depression on sexual satisfaction, changes in self-esteem due to weight gain, or relational dynamics with her partner.
Clinically, establishing a causal relationship between medication and sexual side effects relies heavily on the judgment and experience of healthcare professionals (HCPs). Tools like the Naranjo score or WHO-UMC criteria aid in assessing the probability of adverse drug reactions, though they may vary in efficiency.
When broaching the topic of sexual side effects with your healthcare professional feel comfortable in sharing your concerns. They might inquire more about the specific issues since this is necessary for accurate assessment. In managing sexual side effects, most cases require simple explanations, but when symptoms persist, dose reduction may be considered. However, this decision must be carefully weighed against the therapeutic benefits of the medication, especially in cases like pregnancy, where the health of both the woman and the unborn child is at stake.
For instance, in the case of a pregnant woman with epilepsy experiencing sexual side effects from levetiracetam, reducing the dose might exacerbate the risk of seizures, posing a greater threat than the sexual side effects. It’s crucial to recognize that even if medication adjustments are made, sexual problems may persist, potentially evolving into secondary psychological or relational issues.
Overall, cessation of medication due to sexual side effects is rare. However, it’s essential for healthcare providers to inform patients about potential side effects, including those related to sexuality, and provide adequate support and information throughout the treatment process. Therefore, in case you need more information on the potential side effects of the medication received, including sexual side effects, do not hesitate to ask additional questions to your healthcare provider.
