Can isotretinoin affect sexual function? What UK patients should know
Isotretinoin has been associated with reports of sexual-function problems, including reduced interest in sex, erection difficulties, vulval or vaginal dryness, difficulty reaching orgasm and altered genital sensation. Their true frequency is unknown, and research has not established with certainty that isotretinoin causes them.
UK safety guidance nevertheless treats the reports seriously. Patients should be asked about sexual-function concerns before treatment and monitored throughout the course. If you notice a new or worsening problem, tell your prescriber rather than waiting for the next routine review.
What sexual side effects have been reported?
The current British Association of Dermatologists (BAD) patient guide and UK product information describe reports of:
reduced libido or less interest in sexual activity;
difficulty getting or maintaining an erection;
vulval or vaginal dryness;
difficulty reaching orgasm; and
reduced or altered sensation around the genitals.
Some product information also lists breast enlargement in males. Pain during sex, reduced arousal, ejaculation changes or a general change in sexual function are all reasonable things to discuss.
These are possible adverse effects, not an inevitable part of treatment. Product information notes reports in which symptoms continued after treatment. A report does not prove causation, but persistent symptoms deserve assessment.
How strong is the evidence?
Uncertainty remains. The MHRA and Commission on Human Medicines reviewed case reports, patient experiences, clinical studies and safety data. They recommended clearer counselling and monitoring while calling for more research.
A 2024 scoping review found that published studies used different definitions and methods, making results difficult to combine. Some reports and pharmacovigilance analyses have identified a possible signal. Conversely, cohort studies published in 2024 and 2025 did not find an increased risk of sexual dysfunction among isotretinoin-treated acne patients.
Clinicians should neither dismiss symptoms nor tell every patient to expect them. Acne, stress, depression, medical conditions, alcohol and other medicines—particularly some antidepressants—may also affect sexual function. An individual review should consider the whole picture.
What should happen before treatment starts?
Under the MHRA measures updated in January 2026, the lead prescriber must have expertise in systemic retinoids for severe acne and understand the risks and monitoring requirements. Before prescribing, the clinician should:
confirm that isotretinoin is clinically indicated and that there is no other appropriate effective treatment;
explain potential benefits, alternatives and important risks;
ask about existing sexual-function concerns;
assess mental health, using patient-reported measures where appropriate; and
complete the current risk-minimisation process, including the Acknowledgement of Risk Form.
The discussion should be private, respectful and age appropriate. A young person may be offered time without a parent or carer where appropriate. The purpose is to create a baseline and make later changes easier to recognise.
Isotretinoin is considered for severe acne that has resisted adequate standard treatment or risks permanent scarring. It is not right for everyone.
How is sexual function monitored during treatment?
No routine blood test detects sexual-function changes. Monitoring involves conversation at follow-ups about any change in desire, arousal, erections, comfort, orgasm or genital sensation.
The January 2026 MHRA guidance says counselling and monitoring for potential mental-health and sexual side effects should continue throughout treatment. Follow-ups may be face to face or remote when clinically appropriate under the updated arrangements, but the review still needs to be meaningful.
Note when a symptom began, whether it is constant or intermittent, and what else changed. Include new medicines, contraception, illness, stress or mood symptoms. Do not stop prescribed medicines or buy treatments online without advice.
What should I do if I notice a change?
Contact your prescriber promptly rather than waiting for the next appointment. Sexual health is part of the required safety monitoring.
The clinician may:
clarify the symptom and its timing;
review isotretinoin dose, other medicines and possible alternative causes;
consider physical and mental-health factors;
discuss whether treatment should continue, change or stop; and
arrange GP, sexual-health, urology, gynaecology or other specialist assessment if needed.
The safest decision depends on the individual situation. Do not alter the dose yourself. If symptoms continue after the course ends, arrange further review rather than assuming nothing can be done.
You or a healthcare professional can report a suspected side effect through the MHRA Yellow Card scheme. Reports help identify patterns and do not require proof of causation.
Sexual function is not the same as fertility
Low libido, erectile difficulty or vaginal dryness does not automatically mean reduced fertility. Sexual function, reproductive health and pregnancy risk are related but separate issues. Ask your clinician if you have concerns about fertility or are planning a pregnancy.
Isotretinoin must not be taken during pregnancy because it can seriously harm an unborn baby. Patients who can become pregnant must follow the current Pregnancy Prevention Programme. Read our separate guide to isotretinoin and pregnancy prevention for the UK requirements.
Frequently asked questions
Are sexual side effects common?
Their frequency is not known. Reports exist and UK product information includes possible sexual dysfunction, but research findings are mixed and a causal link has not been established with certainty.
Can symptoms continue after stopping isotretinoin?
Long-lasting symptoms have been reported. This does not show how often they occur or prove causation in an individual, but persistent symptoms should be assessed and may be reported through Yellow Card.
Will my prescriber ask about sexual health?
They should ask about concerns before treatment and continue monitoring during treatment. You can raise the subject at any time, including between routine reviews.
Should I stop isotretinoin immediately?
Contact your prescriber promptly for individual advice and do not change the dose on your own. The response depends on the symptoms, severity, timing and other possible causes.
Taking the next step
If acne is severe, persistent, scarring or significantly affecting your wellbeing, a structured acne assessment can review your previous treatment and appropriate alternatives. mySkinDoc provides information about its doctor-led acne and isotretinoin pathway, including counselling and monitoring for suitable patients. The purpose of consultation is to decide what is clinically appropriate; it does not guarantee isotretinoin or any other prescription.
References
Medicines and Healthcare products Regulatory Agency. Isotretinoin: changes to prescribing guidance and additional risk-minimisation measures. Published 22 January 2026.
British Association of Dermatologists. Isotretinoin patient guide.
National Institute for Health and Care Excellence. Acne vulgaris: management—recommendations.
Electronic Medicines Compendium. Isotretinoin 10 mg capsules: Summary of Product Characteristics.
Healey A, et al. Exploring the association between isotretinoin and sexual dysfunction: a comprehensive scoping review. Clinical and Experimental Dermatology. 2024;49(11):1396–1404.
Thakare S, et al. Isotretinoin exposure does not appear to be associated with risk of adverse male sexual health outcomes in acne patients. Journal of Sexual Medicine. 2024.
Neubauer ZJK, Lipner SR. No association between isotretinoin and sexual dysfunction in a large retrospective cohort study of acne patients. Journal of the American Academy of Dermatology. 2025.
