Does Suboxone Cause Sexual Side Effects

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If you or someone you know is affected by opioid use disorder (OUD), you're not alone. It's estimated that over 6 million people in the U.S. are living with opioid use disorder (OUD).

Medications are the gold standard for treating OUD. This approach is called medications for OUD, or MOUD for short. MOUD can help prevent relapse to opioids, lower the risk of overdose, and improve your quality of life.

Of the FDA-approved OUD medications, Suboxone (buprenorphine / naloxone) is a first-choice option. But Suboxone can cause side effects, including ones that might impact your sex life. Here, we'll discuss possible sexual side effects of Suboxone and how to manage them.

Does Suboxone cause sexual side effects?

It's possible, but Suboxone is less likely to cause side effects compared to continued opioid use. In fact, some research shows that starting Suboxone improvessexual function compared to continued opioid use. Suboxone is also less likely to cause sexual side effects compared to methadone (Methadose), another FDA-approved medication for OUD.

Still, some people may experience sexual side effects from Suboxone. Here's why.

How does Suboxone cause sexual side effects?

Suboxone is a partial opioid agonist. It attaches to opioid receptors in the body. But it doesn't have the same effect as a regular ("full") opioid, such as hydrocodone or morphine (MS Contin).

Opioids (even "partial" ones like Suboxone) decrease the level of sex hormones in your body, including estrogen and testosterone. This can affect your sexual functioning.

However, other factors - such as stress levels, life events, and personal beliefs - can also affect your sex drive and ability to get an erection (erectile dysfunction).

Not to mention, chronic conditions like high blood pressure, uncontrolled diabetes, and kidney disease can cause sexual dysfunction. And many people with OUD also have mental health conditions that can affect sexual functioning. Depression, for example, can increase ED in men and lower arousal and desire in women.

How common are sexual side effects with Suboxone?

Early studies of Suboxone didn't report sexual side effects. At this time, most of what we know about Suboxone and sexual side effects is based on studies of all opioids. So, it's hard to know for sure how common sexual side effects are with Suboxone. However, smaller studies have reported that over 80% of men taking Suboxone may experience sexual problems.

Research on sexual side effects of Suboxone in women is even more limited than it is in men. Historically, women - especially women of color - have been underrepresented in clinical research overall. A new law passed in 2024 may change this going forward. But for now, there's often less information on how medications, including Suboxone, affect women.

Sexual side effects of Suboxone in men

In men, lower-than-normal testosterone levels (hypogonadism) can lower sex drive and cause erectile dysfunction. And it's possible for Suboxone to lower testosterone levels.

But as mentioned, Suboxone is less likely to cause sexual dysfunction than continued opioid use. It's also less likely than methadone to lower testosterone.

Still, sexual side effects with Suboxone can happen. Possible risks include:

• Decreased sexual drive (low libido)

• Trouble getting or maintaining an erection (erectile dysfunction)

• Reaching orgasm too soon (premature ejaculation)

• Trouble reaching orgasm (delayed ejaculation)

• Lower sexual satisfaction

As mentioned earlier, it can be hard to tell if sexual problems are from Suboxone or something else. For example, Suboxone is just one of many medications that can cause erectile dysfunction. And there are many other possible causes, too.

Sexual side effects of Suboxone in women

Like men, opioids can have sexual side effects in women, including decreased sexual desire or trouble reaching orgasm. But still, sexual side effects are less likely with Suboxone versus continued opioid use.

And although Suboxone can lower testosterone production, we don't know for sure whether decreased testosterone levels affect women's sex drive like they do men's. But your body can change testosterone into estrogen. So by decreasing testosterone, Suboxone may indirectly lower estrogen levels (estrogen mainly influences women's sexual health).

In a survey of 56 women taking Suboxone, they didn't report more sexual problems than people who weren't taking Suboxone.

How can you manage sexual side effects from Suboxone?

Concerns about sexual health are common, so your healthcare team is used to discussing them. While starting a conversation about this may feel uncomfortable at first, your care team can help you figure out what's causing your specific concerns and how to help.

Nonmedication methods

Taking a look at daily habits is a good place to start when addressing sexual concerns. A few science-backed tips to help improve your sex life include:

• Quit smoking

• Limit alcohol intake

• Eat more fruits, vegetables, and whole grains

• Get regular exercise, and practice yoga and/or meditation

• Consider taking a sex education class (yes, there are ones for adults, too)

Medications

For men, ED medications, like sildenafil (Viagra) or tadalafil (Cialis), can help. And testosterone- replacement therapy has been shown to improve opioid-related low testosterone.

For premenopausal women, bremelanotide (Vyleesi) and flibanserin (Addyi) are FDA-approved options to improve sex drive. During or after the menopause transition, hormone therapy with estrogen (and a progestin like progesterone when needed) may help with sexual function, too. But it's not approved for treating sexual dysfunction. Talk to your prescriber about your options.

Is Suboxone more or less likely to cause sexual side effects than other medications for opioid use disorder?

Methadone and buprenorphine-containing medications like Suboxone are the most commonly used types of medications for OUD. Naltrexone is also FDA approved for OUD, but it isn't prescribed as often.

As mentioned, sexual side effects are more likely with methadone versus Suboxone. In fact, people sometimes switch from methadone to Suboxone for this reason.

We don't have a lot of research comparing the sexual side effects of naltrexone and Suboxone. But one small study showed they cause a similar degree of sexual side effects.

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