Does Valium cause erectile dysfunction? Diazepam (brand name: Valium), a benzodiazepine prescribed for anxiety, muscle spasms, and seizures, lists sexual side effects including decreased libido and impotence in its Summary of Product Characteristics, though the frequency is not well established. Whilst benzodiazepines enhance GABA activity to reduce neuronal excitability, this calming effect may potentially affect neural pathways involved in sexual arousal and erectile function. However, no definitive causal relationship has been established through large-scale clinical trials. This article examines the evidence linking diazepam to erectile difficulties, explores other medications that may impact sexual function, and outlines management strategies for patients experiencing these concerns.

Does Valium Cause Erectile Dysfunction?

Diazepam (brand name: Valium) is a benzodiazepine medication commonly prescribed for anxiety disorders, muscle spasms, and seizure management. The Summary of Product Characteristics (SmPC) for diazepam lists sexual side effects including 'decreased libido' and 'impotence' with a frequency of 'not known', indicating that these effects have been reported but their frequency cannot be estimated from available data.

Benzodiazepines work by enhancing the effect of gamma-aminobutyric acid (GABA), a neurotransmitter that reduces neuronal excitability throughout the central nervous system. This calming effect, whilst therapeutically beneficial for anxiety, may potentially affect the neural pathways involved in sexual arousal and response. This could theoretically involve reduced libido, delayed arousal, or difficulty achieving or maintaining an erection.

Key considerations include:

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

• Individual variation – Not all patients experience sexual side effects, and the severity varies considerably between individuals

• Indirect effects – Anxiety itself can contribute to erectile dysfunction, making it challenging to distinguish whether symptoms relate to the underlying condition or the medication

It is important to note that there is no definitive causal relationship established in large-scale clinical trials. The evidence linking benzodiazepines to erectile dysfunction is largely based on case reports and observational studies rather than randomised controlled trials.

If you are experiencing erectile difficulties whilst taking diazepam, it is essential not to stop the medication abruptly, as this can lead to withdrawal symptoms. Instead, discuss your concerns with your GP or prescribing clinician.

If you suspect diazepam is causing sexual side effects, you can report this through the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk or via the Yellow Card app).

Other Medications That May Impact Erectile Function

Erectile dysfunction can be influenced by numerous medications across different therapeutic classes. Understanding which drugs may contribute to sexual difficulties is important for both patients and healthcare professionals when considering treatment options.

Antidepressants are among the most commonly implicated medications. Selective serotonin reuptake inhibitors (SSRIs) such as sertraline, fluoxetine, and citalopram are commonly associated with sexual dysfunction. According to NHS information, these medications alter serotonin levels, which can suppress libido and interfere with arousal mechanisms. Tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs) may also affect erectile function, though the mechanisms differ slightly.

Antihypertensive medications frequently contribute to erectile difficulties. Beta-blockers (such as propranolol and atenolol) can reduce blood flow to the penis and affect vascular function. This effect varies between agents, with older non-selective beta-blockers generally having more impact than newer, more selective ones. Thiazide diuretics may also affect erectile function, though the exact mechanisms remain uncertain. Newer antihypertensives like ACE inhibitors and calcium channel blockers generally have a lower risk profile for sexual side effects.

Other medication classes that may impact erectile function include:

• Antipsychotics – Particularly those that raise prolactin levels such as risperidone, amisulpride and haloperidol

• 5-alpha-reductase inhibitors – Finasteride and dutasteride used for prostate enlargement or male pattern baldness

• Antiandrogens and hormonal therapies – Used in prostate cancer treatment, these directly affect testosterone levels

• H2-receptor antagonists – Cimetidine (though rarely used now) has anti-androgenic properties

• Opioid analgesics – Chronic use can suppress testosterone production and reduce libido

• Corticosteroids – Long-term use may affect hormone balance

NICE Clinical Knowledge Summary (CKS) guidance on erectile dysfunction emphasises the importance of medication review when assessing erectile dysfunction. If you are taking multiple medications, a comprehensive review with your GP or pharmacist can help identify potential contributors to sexual difficulties.

Managing Erectile Dysfunction While Taking Diazepam

If you are experiencing erectile dysfunction whilst taking diazepam, several management strategies can be considered in consultation with your healthcare provider. The approach should be individualised, taking into account the severity of your symptoms, the indication for diazepam, and your overall health status.

Medication review and adjustment should be the first consideration. Your GP may assess whether:

• The dose of diazepam can be reduced to the lowest effective level

• An alternative anxiolytic with a different side effect profile might be appropriate

• The duration of treatment can be shortened, as benzodiazepines are generally recommended for short-term use (2–4 weeks) according to BNF and NICE guidance

• Psychological therapies such as cognitive behavioural therapy (CBT) could replace or complement pharmacological treatment for anxiety

It's important to note that diazepam can cause dependence, and any dose reduction should be gradual under medical supervision to avoid withdrawal symptoms.

Lifestyle modifications can significantly improve erectile function regardless of medication use. Evidence-based interventions include:

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

• Weight management – Obesity is strongly associated with erectile dysfunction

• Smoking cessation – Smoking damages blood vessels and impairs circulation

• Alcohol moderation – Excessive alcohol consumption can worsen erectile difficulties

• Stress reduction techniques – Mindfulness, relaxation exercises, and adequate sleep can improve both anxiety and sexual function

Phosphodiesterase-5 (PDE5) inhibitors such as sildenafil, tadalafil, or vardenafil may be prescribed if erectile dysfunction persists. These medications enhance blood flow to the penis and are effective for many causes of erectile dysfunction. However, they are absolutely contraindicated in patients taking nitrates or nicorandil (for angina) or riociguat, and caution is needed with alpha-blockers. Your GP will need to assess your cardiovascular risk and suitability before prescribing. In some cases, sildenafil 50mg (Viagra Connect) may be available from pharmacies after an assessment.

Psychological support should not be overlooked. Erectile dysfunction can create anxiety and relationship stress, which may perpetuate the problem. Psychosexual counselling or couples therapy may be beneficial, particularly if psychological factors are contributing to the difficulties.

When to Speak to Your GP About Sexual Side Effects

Open communication with your GP about sexual side effects is essential for optimal healthcare, yet many patients feel embarrassed or reluctant to raise these concerns. It is important to remember that sexual health is a legitimate aspect of overall wellbeing, and healthcare professionals are accustomed to discussing these matters sensitively and confidentially.

You should contact your GP if:

• Erectile difficulties develop or worsen after starting diazepam or any new medication

• Sexual side effects are affecting your quality of life, relationships, or mental health

• You are considering stopping your medication due to sexual side effects (never stop benzodiazepines abruptly without medical supervision)

• Erectile dysfunction is accompanied by other symptoms such as reduced libido, fatigue, mood changes, or physical symptoms

• You have cardiovascular risk factors (hypertension, diabetes, high cholesterol) alongside erectile dysfunction, as this may indicate underlying vascular disease requiring investigation

Seek urgent medical attention if you experience:

• Chest pain or shortness of breath during sexual activity

• Painful penile curvature or deformity (possible Peyronie's disease)

• An erection lasting more than 4 hours (priapism) – this requires emergency treatment

• New neurological symptoms alongside erectile dysfunction

What to expect during your consultation:

Your GP will take a comprehensive history, including the timeline of symptoms, medication history, and relevant medical conditions. They may perform a physical examination and arrange blood tests to assess:

• Testosterone levels (morning samples, with repeat if low/borderline, possibly with LH/FSH)

• Glucose and HbA1c (to screen for diabetes)

• Lipid profile (cholesterol levels)

• Thyroid function

• Prolactin levels if indicated

According to NICE Clinical Knowledge Summary guidance on erectile dysfunction, initial assessment should identify reversible causes and cardiovascular risk factors. Your GP may use validated questionnaires such as the International Index of Erectile Function (IIEF-5) to assess severity.

Referral to specialist services may be appropriate if:

• First-line treatments are ineffective

• There are complex psychological factors requiring specialist input

• Underlying endocrine conditions (to endocrinology) or vascular conditions (to cardiology) need further investigation

• Penile deformity is present (to urology)

• You are a young man with erectile dysfunction (to exclude rare causes)

Remember that sexual side effects are a valid reason to request a medication review. Your healthcare team can work with you to find a treatment balance that addresses both your primary condition and maintains your quality of life, including sexual health.

Frequently Asked Questions