Diazepam, a benzodiazepine prescribed for anxiety, muscle spasms, and seizures, can affect sexual function in some men. Sexual dysfunction, including erectile difficulties and reduced libido, is listed as a recognised adverse effect in UK product information, though the frequency is not well established. The relationship between diazepam and erectile function is complex, involving the medication's sedative properties, effects on neurotransmitter systems, and interactions with psychological factors. Anxiety itself—the condition often treated with diazepam—can also contribute to sexual difficulties, making it challenging to distinguish medication effects from underlying symptoms. Understanding this connection helps patients make informed decisions and seek appropriate support when needed.

Understanding Diazepam and Its Effects on Sexual Function

Diazepam is a benzodiazepine medication licensed in the UK for short-term relief of severe anxiety (when disabling or causing unacceptable distress), muscle spasms, seizures, and alcohol withdrawal symptoms. According to the British National Formulary (BNF) and Medicines and Healthcare products Regulatory Agency (MHRA) guidance, benzodiazepines should generally be prescribed for short-term use only—typically 2 to 4 weeks—due to risks of dependence and tolerance. Diazepam works by enhancing the activity of gamma-aminobutyric acid (GABA), a neurotransmitter that reduces nerve activity in the brain, producing calming and sedative effects.

Whilst diazepam is effective for its licensed indications, patients may experience various side effects that can impact quality of life, including effects on sexual function. Sexual dysfunction encompasses a range of problems including reduced libido, difficulty achieving or maintaining an erection, delayed ejaculation, and decreased sexual satisfaction. These issues can significantly affect relationships and psychological wellbeing. When taking any medication, it is important to understand potential effects on sexual health, as this knowledge enables patients to make informed decisions and seek appropriate support when needed.

The relationship between diazepam and sexual function is complex and multifaceted. Sexual performance relies on an intricate interplay of psychological factors, hormonal balance, adequate blood flow, and nervous system function. Medications that affect the central nervous system, such as benzodiazepines, have the potential to influence any of these components. Understanding how diazepam may impact sexual function requires consideration of both its direct pharmacological effects and indirect consequences, such as sedation and changes in mood or anxiety levels.

It is worth noting that the underlying condition being treated with diazepam—particularly anxiety—can itself contribute to sexual difficulties. Distinguishing between medication effects and symptoms of the original condition can be challenging but is essential for appropriate management. Other medications commonly prescribed for anxiety or depression, such as selective serotonin reuptake inhibitors (SSRIs), are more frequently associated with sexual dysfunction and may confound attribution when taken alongside benzodiazepines.

Can Diazepam Cause Erectile Dysfunction?

Sexual dysfunction, including changes in libido and erectile difficulties, is listed as a recognised adverse effect of diazepam in UK product information approved by the MHRA and in the BNF. The frequency of this side effect is classified as 'not known' (cannot be estimated from available data), reflecting that evidence derives largely from post-marketing reports and spontaneous case reports rather than controlled clinical trials. Individual experiences differ significantly, and not all men taking diazepam will experience erectile difficulties.

Clinical reports and patient surveys suggest that some men taking diazepam do experience erectile dysfunction or reduced sexual desire. The mechanism is thought to involve the medication's sedative properties and its effects on neurotransmitter systems involved in sexual arousal and response. Diazepam's enhancement of GABA activity produces generalised central nervous system depression, which can dampen the neural signals necessary for achieving and maintaining an erection.

Key considerations include:

• Dose-dependent effects – Higher doses of diazepam are more likely to cause sedation and may have greater impact on sexual function

• Duration of treatment – Long-term use may be associated with more pronounced effects compared to short-term or occasional use

• Individual variation – Susceptibility varies based on age, overall health, other medications, and underlying conditions

• Timing of symptoms – If erectile dysfunction develops shortly after starting diazepam or increasing the dose, a medication-related cause is more likely

• Confounding factors – Anxiety itself, alcohol use, other psychotropic medications (especially SSRIs and antipsychotics), and comorbid health conditions can all contribute to erectile dysfunction, making it difficult to isolate diazepam's specific role

It is important to recognise that correlation does not always indicate causation. Many factors can contribute to erectile dysfunction, and a comprehensive assessment by your GP is essential to identify all contributing causes.

Why Benzodiazepines May Affect Sexual Performance

Benzodiazepines like diazepam can influence sexual performance through several proposed mechanisms. Understanding these pathways helps explain why some men experience erectile difficulties whilst taking these medications, though the effects are not universal and the evidence base is limited.

Central nervous system depression is the primary mechanism. Sexual arousal and erectile function require coordinated activity across multiple brain regions, including areas responsible for desire, sensory processing, and autonomic nervous system control. Diazepam's enhancement of inhibitory GABA neurotransmission reduces overall neural excitability, which can dampen the signals necessary for sexual arousal. The sedative effects may also reduce interest in sexual activity and decrease the physical energy required for sexual performance.

Psychological factors also contribute significantly. Whilst diazepam is prescribed to reduce anxiety, the medication can sometimes cause emotional blunting or reduced emotional responsiveness. This dampening of emotional experience may extend to sexual feelings and desire. Additionally, concerns about medication side effects can themselves create performance anxiety, establishing a cycle that perpetuates erectile difficulties. It is important to note that anxiety disorders themselves are strongly associated with sexual dysfunction, independent of medication effects.

Other proposed mechanisms include possible hormonal and vascular influences, though evidence for these pathways in humans is limited and inconsistent. Some research has suggested that chronic benzodiazepine use might affect testosterone levels or vascular function, but these findings are not well-established and require further investigation. The muscle-relaxant properties of benzodiazepines, whilst beneficial for conditions like muscle spasms, have also been theorised to influence erectile function, though this mechanism remains speculative.

It is also important to recognise that other medications commonly prescribed for mental health conditions—particularly SSRIs, serotonin-noradrenaline reuptake inhibitors (SNRIs), and antipsychotics—are more frequently and consistently associated with sexual dysfunction than benzodiazepines. When multiple medications are used together, attributing sexual side effects to a single agent can be challenging.

Managing Erectile Dysfunction While Taking Diazepam

If you are experiencing erectile dysfunction whilst taking diazepam, several management strategies may help, though any changes to medication must only be made under medical supervision. Never stop taking diazepam abruptly, as benzodiazepine withdrawal can cause serious complications including seizures, severe anxiety, and other potentially dangerous symptoms. The BNF and NICE guidance (NG215: Medicines associated with dependence or withdrawal symptoms) emphasise the importance of gradual dose reduction under medical supervision.

Medication review should be your first step. Speak with your GP or prescribing clinician about your symptoms. They may consider adjusting your diazepam dose to the lowest effective level, as lower doses may reduce side effects whilst still providing therapeutic benefit. NICE guidance emphasises that benzodiazepines should generally be prescribed for short-term use only (2–4 weeks for anxiety), and long-term use should be reviewed regularly with a view to gradual withdrawal where appropriate. In some cases, switching to alternative treatments for anxiety—such as psychological therapies (NHS Talking Therapies, cognitive behavioural therapy) or other medications—may be appropriate.

Important safety considerations:

• Avoid alcohol – Alcohol compounds the sedative effects of diazepam and independently impairs sexual function; the combination increases risk of excessive sedation and respiratory depression

• Opioid co-prescribing – The MHRA has issued a Drug Safety Update warning that concomitant use of benzodiazepines and opioids increases the risk of sedation, respiratory depression, coma, and death. If both are necessary, use the lowest effective doses for the shortest duration with close monitoring

• Other sedatives – Avoid other central nervous system depressants unless specifically advised by your doctor

Lifestyle modifications can support erectile function regardless of medication use:

• Regular physical exercise improves cardiovascular health and blood flow, both essential for erectile function

• Maintaining a healthy weight reduces risk factors for erectile dysfunction

• Smoking cessation, since smoking damages blood vessels and impairs circulation

• Stress management techniques such as mindfulness or cognitive behavioural therapy may help address underlying anxiety without relying solely on medication

Timing considerations may also help. If you take diazepam on an as-needed basis, you might discuss with your doctor whether timing doses away from anticipated sexual activity could reduce impact on sexual function, though this approach requires careful consideration of your treatment needs and should not compromise symptom control.

Phosphodiesterase type 5 (PDE5) inhibitors such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil may be considered for erectile dysfunction. These medications are generally safe to use alongside diazepam, though you should discuss this option with your GP, who can assess suitability and provide an NHS prescription if appropriate. Important safety information for PDE5 inhibitors:

• Contraindicated with nitrates (e.g., glyceryl trinitrate for angina) or riociguat due to risk of severe hypotension

• Caution required with alpha-blockers (used for prostate problems or hypertension); your doctor may need to adjust doses or timing

• Avoid recreational nitrates ('poppers') as these can cause dangerous interactions

• Seek urgent medical help if you experience chest pain during sexual activity or an erection lasting more than 4 hours (priapism)

It is important to note that PDE5 inhibitors address the physical aspects of erectile dysfunction but do not resolve underlying causes. A holistic approach addressing psychological, lifestyle, and medical factors is most effective.

When to Speak to Your GP About Sexual Side Effects

Open communication with your GP about sexual side effects is essential for optimal health management, though many men find this topic difficult to discuss. Healthcare professionals recognise that sexual health is an important component of overall wellbeing and quality of life, and your GP will approach the conversation professionally and confidentially.

You should contact your GP if:

• Erectile dysfunction develops or worsens after starting diazepam or increasing the dose

• Sexual difficulties are causing significant distress or affecting your relationship

• You are considering stopping or reducing diazepam due to sexual side effects (never stop benzodiazepines suddenly without medical guidance)

• You experience other concerning symptoms alongside erectile dysfunction, such as reduced energy, mood changes, or physical health problems

• You wish to explore alternative treatments for the condition for which diazepam was prescribed

Seek urgent medical attention (same-day or emergency care) if:

• You experience chest pain, dizziness, or shortness of breath during sexual activity (may indicate cardiovascular disease)

• You have an erection lasting more than 4 hours (priapism—a medical emergency requiring immediate treatment to prevent permanent damage)

• You experience acute penile trauma or severe pain

Your GP can conduct a comprehensive assessment to identify contributing factors. This may include reviewing all your medications (as many drugs can affect sexual function), checking for underlying health conditions such as diabetes, cardiovascular disease, or hormonal imbalances, and assessing psychological factors including depression or relationship issues. Erectile dysfunction can be an early marker of cardiovascular disease and diabetes, so your GP may recommend cardiovascular risk assessment and diabetes screening where appropriate.

Blood tests may be arranged if clinically indicated, which may include morning total testosterone (if low libido or erectile dysfunction persists), blood glucose (HbA1c), lipid profile, and thyroid function. NICE Clinical Knowledge Summaries (CKS) on erectile dysfunction provide detailed guidance on assessment, investigations, and referral thresholds.

Preparing for your appointment can help ensure a productive discussion. Consider noting when the erectile difficulties began, their frequency and severity, any other symptoms you have noticed, all medications and supplements you take (including over-the-counter and herbal products), and questions you wish to ask. Remember that erectile dysfunction is a common problem affecting many men, and discussing it with your doctor is an important step towards finding an effective solution.

Your GP may refer you to specialist services if needed, such as urology, endocrinology, sexual health clinics, or psychological therapy services. NICE guidance supports a holistic approach to managing erectile dysfunction that addresses both physical and psychological factors, ensuring you receive comprehensive care tailored to your individual circumstances.

Reporting side effects: If you experience any side effect whilst taking diazepam, including sexual dysfunction, you can report it via the MHRA Yellow Card Scheme at yellowcard.mhra.gov.uk or through the Yellow Card app. Reporting suspected side effects helps improve the safety information available about medicines.

Frequently Asked Questions