Wegovy Sexual Side Effects: Evidence and Clinical Guidance

Wegovy (semaglutide) is a GLP-1 receptor agonist licensed in the UK for weight management in adults with obesity or overweight with weight-related comorbidities. Whilst patients may have concerns about Wegovy sexual side effects, current clinical evidence and MHRA-approved product information do not identify sexual dysfunction as a recognised adverse reaction. Understanding the relationship between weight-loss treatment and sexual health involves considering both direct pharmacological effects and the broader impact of obesity and weight reduction on sexual function. This article examines the evidence surrounding Wegovy and sexual wellbeing, helping patients and healthcare professionals navigate this important aspect of treatment.

Understanding Wegovy and Its Primary Effects

Wegovy (semaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for weight management in adults with obesity or overweight with weight-related comorbidities. It is administered as a once-weekly subcutaneous injection, with a target dose of 2.4 mg reached through a 16-week dose escalation schedule (starting at 0.25 mg and gradually increasing).

The medication's primary mechanism of action involves slowing gastric emptying, reducing appetite, and increasing feelings of fullness after eating through actions on the brain's satiety centres. Clinical trials have demonstrated that Wegovy, when combined with lifestyle modifications including reduced-calorie diet and increased physical activity, can lead to significant weight reduction—with the STEP 1 trial showing approximately 15% weight loss over 68 weeks, though real-world results may vary. The MHRA approved Wegovy in September 2023 following robust evidence from the STEP clinical trial programme.

In the UK, NICE recommends Wegovy for adults with a BMI of ≥35 kg/m² (or ≥30 kg/m² with weight-related comorbidities), with lower thresholds for certain ethnic groups, as part of a specialist weight management service.

Common side effects predominantly affect the gastrointestinal system and include nausea, diarrhoea, vomiting, constipation, and abdominal pain. These effects are usually most pronounced during dose escalation and often diminish over time. Other reported adverse effects include fatigue, dizziness, and injection site reactions. Serious but rare complications can include pancreatitis, gallbladder disease, and hypoglycaemia (particularly in patients taking other glucose-lowering medications).

Patients prescribed Wegovy undergo careful assessment to ensure suitability, with particular attention to contraindications such as personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2. Regular monitoring and follow-up are essential components of safe prescribing practice within NHS weight management services.

Suspected adverse reactions should be reported via the MHRA Yellow Card Scheme at yellowcard.mhra.gov.uk.

Sexual Side Effects: What the Evidence Shows

There is currently no established direct link between Wegovy (semaglutide) and sexual dysfunction in the clinical literature or product characteristics approved by the MHRA. Sexual side effects are not listed among the known adverse reactions in the Summary of Product Characteristics (SmPC) for Wegovy, nor were they identified as significant concerns in the pivotal STEP clinical trials involving over 4,500 participants. The comprehensive safety data from STEP 1 and STEP 2 trials, published in the New England Journal of Medicine (2021), did not highlight sexual dysfunction among reported adverse events.

Unlike some medications where sexual dysfunction represents a recognised pharmacological effect—such as certain antidepressants or antihypertensives—GLP-1 receptor agonists do not have a known direct mechanism that would interfere with sexual function. The drug primarily acts on GLP-1 receptors in the brain, pancreas, and gastrointestinal tract, with no documented direct effects on reproductive hormones or sexual response pathways.

Patient reports and anecdotal evidence occasionally mention changes in libido or sexual function whilst taking weight-loss medications, but establishing causation is challenging. Such reports may reflect the complex interplay of multiple factors including the underlying health conditions that prompted treatment, psychological adjustments during significant weight loss, relationship dynamics, or concurrent medications. Post-marketing surveillance through the MHRA's pharmacovigilance system continues to monitor for any emerging safety signals.

It is important to distinguish between direct pharmacological effects and coincidental associations. When patients report sexual concerns whilst taking Wegovy, healthcare professionals should conduct a thorough assessment to identify contributing factors, which may include pre-existing conditions such as diabetes, cardiovascular disease, depression, or hormonal imbalances—all of which can independently affect sexual function and are often present in individuals seeking weight management treatment.

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Indirect Effects on Sexual Function Through Weight Loss

Weight loss achieved through Wegovy treatment may actually improve sexual function for many individuals, contrary to concerns about negative effects. Obesity is independently associated with sexual dysfunction in both men and women through multiple mechanisms including hormonal imbalances, reduced cardiovascular fitness, psychological factors, and mechanical considerations.

In men, obesity is linked to reduced testosterone levels and increased oestrogen due to aromatisation of androgens in adipose tissue. This hormonal shift can contribute to erectile dysfunction and reduced libido. Excess weight also increases the risk of conditions that impair sexual function, including type 2 diabetes (which can cause neuropathy and vascular damage), hypertension, and atherosclerosis. Systematic reviews, such as Khoo et al. (Obesity Reviews, 2021), indicate that weight loss of 5-10% can lead to improvements in erectile function, with studies showing enhanced sexual satisfaction following bariatric interventions.

For women, obesity is associated with hormonal disruption including polycystic ovary syndrome (PCOS), insulin resistance, and altered sex hormone-binding globulin levels. These changes can affect libido, arousal, and sexual satisfaction. Additionally, obesity-related conditions such as urinary incontinence, reduced mobility, and body image concerns can negatively impact sexual confidence and activity. Research published in BMC Endocrine Disorders (2022) has demonstrated improvements in female sexual function following significant weight reduction.

Psychological benefits of successful weight management—including improved self-esteem, body confidence, and mood—often translate into enhanced sexual wellbeing. Increased energy levels and physical fitness following weight loss can also contribute to improved sexual function. However, the timeline and extent of these improvements vary considerably between individuals, and some people may experience a temporary adjustment period as their body composition and self-perception change during active weight loss.

When to Seek Medical Advice

Patients should contact their GP or prescribing clinician if they experience new or worsening sexual difficulties whilst taking Wegovy, particularly if these concerns are distressing or affecting quality of life. Whilst sexual dysfunction is not a recognised side effect of semaglutide, any significant change in health or wellbeing warrants professional assessment to identify underlying causes and appropriate management strategies.

Urgent medical attention is required if sexual symptoms are accompanied by other concerning features that might indicate serious complications. These include:

• Chest pain, breathlessness, or palpitations during sexual activity (potential cardiovascular concerns)

• Severe or persistent abdominal pain (possible pancreatitis or gallbladder disease)

• Symptoms of hypoglycaemia including confusion, sweating, or tremor

• Signs of allergic reaction such as rash, swelling, or difficulty breathing

• Persistent painful erections lasting more than 4 hours (priapism—a medical emergency)

Routine review appointments provide an appropriate opportunity to discuss sexual health concerns in the context of overall treatment response. Healthcare professionals can assess whether symptoms might relate to the medication, underlying health conditions, psychological factors, or relationship issues. A comprehensive evaluation may include review of concurrent medications (as some drugs commonly prescribed alongside Wegovy, such as antihypertensives or antidepressants, can affect sexual function), assessment of cardiovascular health, and consideration of hormonal status.

Patients should discuss with their healthcare provider before changing their treatment regimen due to concerns about sexual function. While semaglutide can be safely discontinued without physiological withdrawal effects, stopping treatment may lead to weight regain. The prescribing clinician can discuss the balance of benefits and risks, explore alternative explanations for symptoms, and consider whether adjustments to the treatment plan might be appropriate. Open communication about sexual health, though sometimes difficult, enables healthcare professionals to provide comprehensive, patient-centred care.

Managing Sexual Health While Taking Wegovy

A holistic approach to sexual wellbeing during Wegovy treatment involves addressing multiple dimensions of health. Patients should maintain open communication with healthcare providers about any concerns, as sexual health is an important component of overall quality of life and should not be overlooked during weight management programmes.

Lifestyle modifications that support both weight loss and sexual function include:

• Regular physical activity: Exercise improves cardiovascular fitness, enhances mood through endorphin release, and can boost testosterone levels. NICE guideline NG90 recommends at least 150 minutes of moderate-intensity activity weekly.

• Balanced nutrition: A healthy eating pattern that supports weight management while providing adequate nutrients is important for overall health, including sexual function.

• Sleep hygiene: Quality sleep is essential for hormonal regulation, including testosterone production and stress hormone management.

• Stress management: Chronic stress elevates cortisol, which can suppress sex hormones and reduce libido. Techniques such as mindfulness, cognitive behavioural approaches, or counselling may be beneficial.

• Limiting alcohol: Excessive alcohol consumption can impair sexual function and interfere with weight loss efforts.

Medical optimisation involves ensuring that concurrent health conditions are well-managed. For individuals with diabetes, maintaining good glycaemic control reduces the risk of neuropathy and vascular complications that affect sexual function. Blood pressure management, lipid control, and addressing any hormonal imbalances (such as low testosterone or thyroid dysfunction) are equally important.

Psychological support may be valuable for individuals experiencing body image concerns, relationship difficulties, or adjustment challenges during significant weight loss. Some NHS weight management services offer access to psychological therapies. GPs can refer patients to NHS psychosexual services where available, in line with NICE Clinical Guideline 97 for male sexual dysfunction or local protocols for female sexual health concerns. Relationship counselling or psychosexual therapy can address interpersonal dynamics and sexual concerns that may emerge during this transitional period.

Medication review with a healthcare professional can identify whether any concurrent prescriptions might be contributing to sexual difficulties. In some cases, alternative medications with different side effect profiles may be available. Patients should never adjust medications independently but should discuss concerns with their prescribing clinician to explore options that optimise both metabolic and sexual health outcomes.

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