The three primary medications used to treat opioid use disorder (OUD) are buprenorphine (the primary component of Suboxone), methadone, and naltrexone, all of which alleviate craving, prevent relapse, and reduce overdose.
Buprenorphine has several advantages over naltrexone and methadone, and is a great option for most patients. Although it has side effects, sexual dysfunction is not commonly listed, nor is it mentioned on the package insert.
However, whether or not buprenorphine can affect sexual function is still unknown, and an area of ongoing research.
This article will provide some background and summarize what’s known about the sexual side effects of Suboxone. We will also discussion what you can do if you experience sexual dysfunction while on buprenorphine.
What Is Sexual Dysfunction?
Sexual dysfunction is a broad term for problems in any aspect of sexual function for men and women. It refers to troubles with:[2,3]
- Sexual desire and libido
- Arousal and vaginal lubrication or penile erection
- Orgasm and ejaculation
- Satisfaction with orgasm
Do Opioids Cause Sexual Dysfunction?
All opioids have long been known to cause sexual dysfunction. This holds true for opioids for OUD treatment, like methadone, and opioids for chronic pain.
The prevalence of sexual dysfunction reported by men taking methadone for OUD treatment varies widely and ranges from 30-100%. Women also experience opioid related sexual dysfunction, although less is known.
Opioids like methadone cause sexual dysfunction by stimulating the μ-opioid receptor. Activating this receptor suppresses release of the brain sex hormones that stimulate production of testosterone.
Buprenorphine also blocks testosterone production directly, at the testicles .
Blocking testosterone production inhibits sexual function in both men and women. μ-opioid receptor activation also inhibits the release of the neurotransmitters that are needed to produce sexual desire.
Buprenorphine and Sexual Dysfunction
Like methadone, buprenorphine activates the μ-opioid receptor. However, unlike methadone, buprenorphine only partially stimulates that receptor.
For this reason, buprenorphine is called a partial opioid agonist, whereas methadone is a full opioid agonist.
It is not yet known, for sure, whether a partial opioid agonist like buprenorphine can affect sexual function.
Several studies have shown high levels of sexual dysfunction in those taking buprenorphine. In a study in men, almost all patients reported some sexual problems, and low sex drive (93%) was more commonly reported than erectile dysfunction (78%).
In another study in women taking buprenorphine, 57% reported sexual dysfunction. However, these studies were not designed to clarify whether the dysfunction was caused by the medication or from other issues like having OUD.
One more recent study followed a group of men with OUD from before starting buprenorphine to four months later.
Results indicate that the sexual dysfunction scores were high to start, but actually increased further over the course of the study, especially in the areas of sexual desire, psychological arousal, erection and ease of orgasm.
This study has caused people to wonder if buprenorphine might indeed be having an adverse effect on sexual function, like the other opioids do.
Does Suboxone Lower Sexual Desire and Libido?
Whether buprenorphine actually lowers sexual desire and libido, in particular, is still not fully known.
Some problem with libido is reported in 23-93% of people taking buprenorphine, depending on the population studied.[2,6,7]
Suboxone and Erectile Dysfunction
Whether Suboxone causes erectile dysfunction (ED) is also not entirely clear.
ED rates in buprenorphine patients have been reported to be as high as 78%, and to exceed healthy controls.
However, other studies report that only 12% of people on buprenorphine had troubles with sexual potency.[6,7,8]
Effects of Suboxone on Sex Hormones
Similarly, it is not known what effects buprenorphine has on sex hormones, a recent review concluded.
Although some studies have shown that a quarter of men taking buprenorphine have low testosterone levels, others have found that people on buprenorphine have testosterone levels that are similar to healthy controls.[1,7]
Are the Sexual Side Effects of Methadone Worse than Suboxone?
Yes, in men, sexual side effects of methadone are worse than Suboxone. One thing that research has shown time and again is that methadone causes more sexual dysfunction than buprenorphine in men.
Men taking methadone for OUD have much lower blood testosterone and higher sexual dysfunction in all facets, including desire and potency than those on buprenorphine.[1,3,4,7]
Sexual dysfunction may be as much as four times higher on methadone than buprenorphine, a large study pooling results from more than 1500 patients concluded.
Far fewer studies have been done in women. Methadone might be associated with more difficulty achieving orgasm than buprenorphine.
However, for the most part, women on methadone and buprenorphine appear to have similar levels of sexual dysfunction, and both groups have higher levels than the general population.
Why is Buprenorphine Better than Methadone from a Standpoint of Sexual Dysfunction?
Recall that stimulating the μ-opioid receptor is what leads to low testosterone and subsequent sexual dysfunction in people taking opioids.
One reason that buprenorphine may not be as problematic is that it only partially activates this receptor, whereas other opioids fully activate it.
The other reason is that buprenorphine also affects, and blocks, another opioid receptor called the κ-opiate receptor.
Experts surmise that this reverses the μ receptor-mediated depression of the sex hormones and sexual behavior and gives buprenorphine a unique protective property.[3,7]
What Can I Do If I Have Sexual Dysfunction While on Suboxone?
For chronic opioid users, like those taking methadone, some medications (trazodone, bupropion) show promise, especially bupropion.
Testosterone replacement for men or women with low blood testosterone levels might also restore sexual function and improve mood. Whether the benefits of these approaches out-weigh the risks are not yet known, however.
Moreover, this early research has only been done in people with sexual dysfunction from full opioid agonists like methadone, not buprenorphine.
Sexual dysfunction can be caused by many things unrelated to OUD or its treatment, including hormonal imbalances, other medications, and medical (e.g. cardiovascular), psychiatric (e.g. depression), or psychological problems.
Both men and women with sexual dysfunction should get a full evaluation from their medical provider.
Is It Safe to Take Viagra and Suboxone?
There are no known interactions between Suboxone and Viagra or any of the other popular ED treatments.
However, it’s always important to talk with your healthcare provider before taking any medicines for ED as some can have serious side effects, especially if you have certain medical conditions.
Should You Start Treatment with Suboxone?
Suboxone might have some effects on sex drive and sexual potency, but research is far from conclusive. What is clear is that Suboxone has much less of a negative impact on sexual function than methadone, the latter of which lowers testosterone in many of the people who take it.
If you experience sexual dysfunction while taking Suboxone, get a medical workup from your health care provider. Consult with them about whether it would be of use to test your testosterone level or try some of the interventions that might work for people with sexual dysfunction on other opioids.
Learn About FDA-Approved OUD Treatment Options from Bicycle Health
Bicycle Health uses Suboxone as a primary medication for dealing with opioid dependence. To learn more about the benefits and the effects of Suboxone, schedule a time to speak with one of our MAT professionals, or call us today at (844) 943-2514.