Accutane sexual side effects in women

In women, Accutane (isotretinoin) can cause vaginal dryness, lower desire, trouble reaching orgasm and less feeling in the genitals. UK and US labels now say these problems may continue after stopping, which is part of post-Accutane syndrome, or PAS.

PAS is more than sex. The 2022 criteria list changes in thinking, depression and suicidality among isotretinoin’s effects, which can come with the sexual problems or on their own.

Most of what’s written about Accutane and sex is about erections. An expert review for the UK medicines regulator noted that women’s symptoms may be less obvious and noticed later, and that the contraceptive pill can cloud the picture.

Miriam took two low-dose courses of isotretinoin in Spain for what she calls mild acne. She now leads an association there for people affected by the drug.

Play video: Miriam on her body after two courses of isotretinoin

Watch for how she lists her body’s changes one after another: sex is only part of it. At the end of the clip she comes to vaginal dryness, which she had during treatment. “Once I stopped taking isotretinoin it didn’t get better,” she says.

What are the sexual side effects of Accutane in women?

The UK leaflet names four that women can get: lower libido, vaginal dryness, difficulty having an orgasm and reduced sensation in the genitals. It says how often they happen “cannot be estimated from the available data”.

In everyday words, that can mean wanting sex less, needing lubricant you never used to, or touch that feels muted. Some women find sex painful. One woman told the UK review that dryness made her use lubricant during sex, then every day, “because the dryness started causing pain”. She often couldn’t climax, she said, “which was never a problem before”.

Isotretinoin dries the skin, lips and eyes. It can dry the vulva and vagina too, and the UK review noted that changes to the genital skin may not be pointed out to patients.

Can vaginal dryness from Accutane be permanent?

For some women it has lasted years after stopping. Nobody knows yet who will be affected, or whether it will ease.

The UK leaflet says there have been reports of “long-lasting sexual problems where the symptoms have continued despite stopping treatment”. In June 2026 the US regulator told makers to add that sexual problems may continue after stopping. The Absorica label we read, published in August, carries that line, and its list already named vaginal dryness. How the US label changed tells that story.

The UK expert review read the reports people had sent to the regulator. In 4 of 10 reports of vaginal dryness, it hadn’t cleared after stopping. One woman was still struggling six and a half years later. Another woman’s orgasm problems hadn’t eased 19 years after her course.

That’s long after the drug has gone: UK documents say it leaves the body within a month.

Why is it missed in women?

The UK review found that women who reported sexual side effects were older than the men, and suggested two reasons. Women who could get pregnant must use contraception on isotretinoin, and the review said this may affect libido. And some changes in women “may be less immediately obvious and possibly more subjective”, so girls and women may not realise until they’re older.

Doctors at a hospital skin clinic in Dublin asked 50 women on isotretinoin about the genital skin.

About 1 in 3 had vulval dryness. Some needed lubricant more, or for the first time, and some found sex painful. The UK review’s reading was that patients don’t raise these symptoms unless they’re asked.

What 50 women on isotretinoin reported when asked

Vulval dryness 16 of 5016

New or more need for lubricant 12 of 5012

Pain during sex 10 of 5010

The same pattern turns up with antidepressants. PSSD in women covers that.

This short NHS clip is worth 30 seconds because it’s an NHS hospital team telling patients that sexual problems can follow treatment.

Play video: Newcastle Hospitals on sexual side effects of isotretinoin

What can I do?

Isotretinoin helps many people with severe acne. If you have side effects, that’s a decision for you and your prescriber. The UK leaflet says to talk to your doctor about any sexual problems during treatment.

UK prescribers are now told to ask about sexual problems before you start, which gives you a “before” to compare with.

If something hasn’t lifted since your last capsule, tell your GP and give your dates: “Isotretinoin 20 mg from March 2024, last capsule September 2024. Vaginal dryness and less feeling since.” Say which contraception you used, and when.

Many people say it took time to be taken seriously. Bring the leaflet line. You can report it without a doctor agreeing.

Report it: it helps everyone

A doctor’s note helps you. A report to the medicines regulator helps everyone else: it is how patterns get noticed.

• No proof needed. A suspicion is enough, even years after stopping.
• Where: the Yellow Card scheme in the UK, MedWatch in the US.
• Use the right words. PAS has no term of its own in the regulators’ dictionary yet, so say that the symptoms continued after you stopped.

Our reporting guide walks you through it

What else do people ask?

Can Accutane cause pain during sex? It can. The UK review heard from a woman who said painful sex had affected her longer than acne would have. The review says changes to the genital skin can make sex uncomfortable or painful. Tell your doctor, because other causes need checking too.

Does Accutane affect men differently? Most UK reports were about men, and erection problems were the most common complaint. Accutane sexual side effects covers both sexes, including what the leaflet says and when it changed.

Is PAS real if my tests are normal? The criteria an international group of doctors and researchers proposed in 2022 use no blood test. For women they name loss of vaginal lubrication as one sign, and they ask what sex was like before isotretinoin. Is post-Accutane syndrome real? sets out the evidence on both sides.

Miriam’s dryness came during treatment and, she says, didn’t get better when she stopped. If that sounds like you, read about post-Accutane syndrome and report it.

Sources

1. Roaccutane 10 mg and 20 mg soft capsules, patient leaflet, Electronic Medicines Compendium (EMC 100633), revised April 2026, read 21 October 2026. Section 2 lists “problems getting or maintaining an erection, lower libido, vaginal dryness, orgasm difficulties and reduced sensation in the genitals”. It adds “long-lasting sexual problems where the symptoms have continued despite stopping treatment with isotretinoin” and “Talk to your doctor if you experience any sexual problems during treatment”. Section 4: these listed under unknown frequency. Section 2 also sets the pregnancy prevention rules, including contraception.
2. Roaccutane 10 mg soft capsules, summary of product characteristics, EMC 100633, revised 27 April 2026. Section 4.4, sexual disorders: patients asked about sexual dysfunction before starting and monitored during treatment. Section 4.8 lists “Vulvovaginal dryness”, “orgasm abnormal” and “genital hypoaesthesia”, frequency not known.
3. Absorica and Absorica LD (isotretinoin), US prescribing information, DailyMed, US National Library of Medicine, revised August 2026, read 21 October 2026. Section 6, reproductive system. The line reads: “Abnormal menses and sexual dysfunction that may continue after discontinuation of treatment (including erectile dysfunction, decreased libido, decreased vaginal lubrication, and vaginal dryness)”. The words “that may continue after discontinuation of treatment” are new in this version (published on DailyMed 21 August 2026), following the FDA’s request to makers of 16 June 2026 (FDA Small Business and Industry Assistance bulletin, FDA Requests Labeling Updates for Generic Isotretinoin Products, 17 June 2026, read 21 October 2026). The versions revised June 2023 and June 2026 list the same problems without them: “Abnormal menses, sexual dysfunction, including erectile dysfunction, decreased libido, decreased vaginal lubrication, and vaginal dryness” (DailyMed label archive, read 21 October 2026). Our article on the label change tells that story.
4. Commission on Human Medicines, Report of the Isotretinoin Expert Working Group, 26 April 2023, published by the MHRA. Section 5.2: the call for information, including the comment on dyspareunia. Section 5.3.1: of 184 Yellow Card reports of sexual dysfunction, 19% named a female patient. Median age 26 for women and 21 for men. The possible effect of contraceptive pills on libido, and female sexual dysfunction that “may be less immediately obvious”. Section 5.3.4.3.1: 10 reports of vulvovaginal dryness, 4 not resolved on stopping, one still struggling 6.5 years later; the quote about lubricant and pain. Section 5.3.4.3.3: one woman’s orgasm problems not resolved 19 years after stopping. Voluntary reports, often incomplete; they cannot show how often this happens.
5. Cunningham L, Menzies S, Moore E and colleagues. Mucocutaneous adverse effects of the genital and perianal skin from isotretinoin therapy. J Am Acad Dermatol 2020;83(4):1174-5. Questionnaire of 80 patients over 16 with at least three months of treatment, at the Mater Misericordiae University Hospital, Dublin. Of 50 women: vulval dryness 16 (32%), new or increased need for lubricants 12 (24%), dyspareunia 10 (20%). Figures as summarised in section 5.4.1.5 of source 4, which adds that “patients do not voluntarily report these symptoms”.
6. Healy D, Bahrick A, Bak M and colleagues. Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin. Int J Risk Saf Med 2022;33(1):65-76. Proposed expert criteria, section 6. Criteria for post-retinoid sexual dysfunction include “loss of vaginal lubrication (females)” and “No evidence of pre-drug sexual dysfunction that matches the current profile”. Cognitive impairment, depression and suicidality are listed among isotretinoin effects that “can occur independently of any sexual difficulties but may also accompany sexual problems”. The paper says PAS “often refers to what is termed PRSD here but equally often appears to include suicidality and other cognitive effects without sexual difficulties”.
7. Moral Medicine, From Mild Acne to Severe Dry Eyes, Hair Loss and Infertility: Miriam’s Nightmare After Isotretinoin, interview with Miriam, 13 October 2025 (the title is the channel’s). Embedded as an extract from 35:11 to 37:11. Two low-dose courses at about 8:06 and 10:51. Vaginal dryness that “didn’t get better” at about 37:09. Quotes are from YouTube’s automatic captions. Her story on our site: Miriam’s story: 2 courses of isotretinoin.
8. Newcastle Hospitals, Newcastle dermatology - Isotretinoin, 29 November 2024, embedded here as an extract from 5:13 to 5:43: sexual dysfunction “during and following treatment”, including “reduced libido, erectile dysfunction and reduced genital sensation”. Quotes are from the trust’s own captions.