Sex isn't working for me

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Post by Dr Louise Owen29 Nov 2013

Robert from Sydney writes: I’ve always had a really healthy sex drive. I enjoy sex . . . a lot. While this isn’t really a problem as such, lately it all seems to be getting much harder. I’ve always used porn and occasionally pills or crystal; but now I find that these things aren’t doing it for me. Or I need to use a lot more of everything to be able to get off.

Dr Louise replies: Sexual arousal is a mercurial thing, Robert. It varies widely from person to person and can fluctuate for each person depending on their circumstance.

Many people enjoy external stimulation to assist with arousal. Unfortunately, when that stimulant is a chemical agent then awareness of what is ‘normal' arousal can diminish, and this can lead to problems.

Added to this, there are also medical and psychological factors that can affect your interest in sex. Libido can be lower at different periods in your life, during long-term relationships, with some medical conditions and on certain medications.

Depression is a common cause of lowered libido. Paradoxically, so are many anti-depressant medications.

Do you have trouble getting or keeping an erection or ejaculating? Perhaps something is interfering with the way you function sexually?

Alcohol, some medications, diabetes and cardiovascular disease can all adversely affect sexual performance.

A good place to start might be a full check-up and discussion with your doctor.

But I do want to talk a bit more about your occasional drug use.

Some people find that recreational drugs reduce inhibitions and help them to relax and to experiment with new sexual activities. But drugs can also alter your ability to take into account the risks involved in these activities. Many people report they took risks that they normally wouldn’t when they were under the influence of drugs or alcohol.

Sometimes a drug-induced state or ‘session’ can be prolonged and this may interfere with when you take your HIV meds, raising the likelihood of developing a detectable viral load and drug resistance.

Or your recreational drugs and meds may interact badly.

Ritonavir, which is used to boost some protease inhibitors, can also boost the levels of some recreational drugs, particularly amphetamines. There are other dangerous interactions to be aware of. Viagra and amyl nitrate, for example, should never be taken together.

Different drugs have different addictive potential. Crystal methamphetamine is highly addictive and many people find that ‘once in a while’ becomes more often as they find they need more of the drug to get the desired outcome. This may be your case, Robert, as you say you now need "a lot more of everything to be able to get off".

The addictive nature of recreational drugs means that they often take over people’s lives. Physical cravings lead to dependence and risk-taking and activities out of character in order to acquire more of the drug. And the effects can often be devastating —physically, psychologically and socially.

If you are concerned, I suggest you seek help. Chat to your doctor and see what options there are. Things can get out of control quite quickly, so getting in touch with a counsellor could be a life-saver.

There are also some excellent resources you can consult.

iPlan, NAPWHA’s latest resource, has an excellent section (pages 44-46) on how to monitor and change your alcohol or drug use.

Drugs: recreation or risk, pleasure or pain, hero or villain? is a resource from Queensland Positive People that explores the many facets of drug use through the experiences of HIV-positive men.


  • Erectile dysfunction: inability to get or keep an erection suitable for penetration.
  • Libido: sexual interest or desire.
  • Sexual function: the ability to perform a sexual act.

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Dr Louise Owen has been working as a Sexual Health Physician in HIV sector since 1993. Previously a Director of VAC’s Centre Clinic in Melbourne, she is currently the Director of the statewide Sexual Health Service in Tasmania. Her advice is not meant to replace or refute that given by your own health practitioner, who is best placed to deal with your individual medical circumstances.