Isotretinoin (Accutane): vaginal, urinary and sexual effects

Author: Jessica Lloyd
Senior Vulvovaginal Specialist Naturopath | BHSc(N) | ISSVD, ISSWSH, BSSM, ATMS

Last reviewed: July 20, 2026

Isotretinoin (you might know it as Accutane or Roaccutane) is a powerful acne drug, and it doesn’t just work on the skin of your face. It affects hormones like testosterone, and it dries out mucous membranes all over the body – including the vagina, vulva and urinary tract. The whole point of the drug is to shrink oil glands and dry things up, so it should come as no surprise that the drying reaches places you’d rather it left alone.

There is a growing movement of people who took isotretinoin as teenagers and young adults reporting side effects – particularly sexual ones – that stuck around for years after they stopped. Sexual side effects are not formally listed as a complication of the drug, but part of how it works is by shifting hormones like testosterone, so it’s worth taking these reports seriously.

Side effects of isotretinoin

Isotretinoin is known for some serious, sometimes severe side effects. These limit its use, but the drug is still widely prescribed to young people around the world because there aren’t many other options for severe, scarring acne.

The best-known and most serious side effect is birth defects. Isotretinoin is a potent teratogen, which is why anyone who could become pregnant has to be on strict contraception before, during and after treatment (more on that below).

Everyday effects include fragile skin, mood changes, fatigue, eczema, nosebleeds, muscle aches, eye problems and infections – but for some people it doesn’t stop there.

Other, more severe effects can include anxiety, deep fatigue and an inability to feel pleasure. Those with vaginas may notice dryness, painful sex, loss of libido, numbness and trouble reaching orgasm, along with a loss of periods, ovulation and fertility. Yeast infections become more likely.

A survey¹ amongst 50 female patients found 32 per cent experienced vaginal dryness, 22 per cent reported vulvar discomfort, 20 per cent had painful sex, 10 per cent reported cuts and tears (fissures), and 24 per cent had a new or increased need for lubricant.

Others reported perianal dermatitis, fissures and bleeding. Higher doses tended to mean worse effects. Your skin barrier is one of your most important defences against invading microbes, so skin fragility is a big deal – and it contributes to infections in people using isotretinoin².

Side effects in those with a penis include low libido, erectile dysfunction, impotence, numbness, trouble reaching orgasm, changes to ejaculate fluid, penile shrinkage and reduced blood flow to erectile tissue. Unwanted breast tissue development (gynaecomastia) has also been reported³. For some, sexual desire and function are wiped out entirely.

Some effects don’t respond to treatment or improve with time, while others clear up once the course finishes. The longevity of certain side effects – the sexual ones especially – is a genuinely serious, potentially lifelong issue for those affected. And remember, no sexual side effects are listed in the official warnings.

A Spanish study⁴ found that six out of 20 patients taking isotretinoin developed erectile dysfunction (ED) during the study, versus two in the control group. Twelve out of 20 taking isotretinoin developed depression, versus three in the control group. There are several other studies on the general side effects^5,6 and the sexual side effects^4,7 of retinoid drugs like this one.

How isotretinoin affects your vagina, vulva and urinary tract

Here’s the part that gets skipped in most consultations. Isotretinoin works by drying up the oil-producing (sebaceous) glands in your skin. Those glands aren’t only on your face – the vulva has them too, and they help keep the vulvar and vaginal tissues supple, lubricated and protected. Dry them out and the whole area can become tight, sore and easily damaged.

That’s why the survey figures above matter: vaginal dryness, vulvar discomfort, painful sex, tiny cuts and tears (fissures), and a sudden need for lubricant are all reported by people on this drug¹. The urinary tract and other mucous membranes are lined with the same kind of tissue, so dryness and irritation there aren’t unusual either.

Fragile, cracked skin is also a doorway for microbes. When the vulvar and vaginal barrier is compromised, and when hormones shift, the balance of your vaginal microbiome can wobble – which is part of why thrush (yeast infections) tends to show up more often. If you’re on isotretinoin and suddenly can’t shake recurrent thrush or irritation, the drug is a reasonable suspect.

Practical things that help while you’re on it: a good fragrance-free lubricant for sex, gentle non-soap washing (water is plenty), breathable cotton underwear, and telling your prescriber promptly if you develop fissures, bleeding or pain rather than pushing through. A lower dose often means milder effects, so it’s a conversation worth having.

Contraception and pregnancy: the non-negotiable bit

Isotretinoin causes major birth defects. This isn’t cautious box-ticking – exposure in pregnancy carries a very high risk of serious malformations affecting the face, heart, brain and other organs, plus a raised risk of miscarriage. There is no safe dose during pregnancy.

Because of that, pregnancy-prevention programmes (such as iPLEDGE in the US) require anyone who can become pregnant to use two reliable forms of contraception at the same time – starting a month before treatment, continuing throughout, and for a month after the last dose – alongside regular pregnancy tests. The birth control pill alone is often mentioned, but the rules ask for two methods, not one. If pregnancy is a possibility for you, this is the single most important thing to get right before you fill the prescription.

Why do long-term side effects occur?

We don’t know for sure. One theory as to why some drugs cause long-term side effects revolves around epigenetic changes to the way DNA is expressed.

These changes may be triggered by an indirectly acting drug like isotretinoin. Isotretinoin has transcription factor activity, meaning it can alter what happens at gene promoters, changing the expression of receptors, signalling molecules and other proteins that make up your genetic regulatory circuits. In plain terms, the drug may be able to alter the instructions a gene gives the body.

When a drug is taken for an extended period, cells adapt, with more lasting modifications to DNA methylation and chromatin structure. This is the kind of process that could let a drug’s effects continue even after you’ve stopped taking it.

This epigenetic hypothesis has been proposed to explain other post-treatment conditions too, such as tardive dyskinesia and drug-induced systemic lupus erythematosus (SLE).

The authors of this hypothesis⁸ put it like this:

If this hypothesis is correct the consequences for modern medicine are profound, since it would imply that our current understanding of pharmacology is an oversimplification.

We propose that epigenetic side-effects of pharmaceuticals may be involved in the etiology of heart disease, cancer, neurological and cognitive disorders, obesity, diabetes, infertility, and sexual dysfunction.

Understanding how isotretinoin works

Isotretinoin treats cystic acne by shrinking the oil (sebaceous) glands in the skin, so they produce far less sebum. Androgens directly stimulate those glands – more androgen activity means more oil, and more oil means more acne – so anything that dampens androgen signalling in the skin helps calm things down.

Because it acts on mucous membranes and glands generally, its effects aren’t limited to your face. The vagina, urinary tract, digestive tract and respiratory tract are all lined with tissue that can dry out on this drug.

The impact of isotretinoin on hormones

Research has looked at how isotretinoin shifts hormones, and the picture isn’t fully settled. Its main job is to shrink the oil glands directly – nudging the oil-gland cells to die off – rather than flipping one hormonal switch. That said, several studies show it lowering circulating androgens, the testosterone-family hormones that drive oil production, with DHT (the most potent one) dropping most consistently; a handful of studies show the reverse, so it’s not uniform.

In one study⁹ of people on three months of the drug, testosterone and luteinising hormone (LH) levels were both decreased.

In another study¹⁰, androstenedione was reduced after 12 weeks of treatment. In short, the drug appears to lower circulating androgens, which tips the androgen-to-oestrogen balance – a change that shows up most obviously in the male body.

What to do if you think you’ve been affected by isotretinoin

Talk to a doctor you trust, ideally the one who prescribed it, and be specific about what changed and when. Bring up sexual and vaginal symptoms plainly – they’re real, they’re relevant, and they won’t get onto your notes if nobody says them out loud.

For further reading and patient stories, the advocacy site RxISK collects reports of persistent side effects after isotretinoin.

Frequently asked questions

Can isotretinoin cause vaginal dryness?

Yes. Isotretinoin dries out mucous membranes and the oil glands that keep vulvar and vaginal tissue supple, so dryness, soreness and painful sex are recognised effects. In one survey of 50 female patients, 32 per cent reported vaginal dryness and 24 per cent needed new or extra lubricant¹.

For most people this eases once the course finishes, but it can be uncomfortable while it lasts. A fragrance-free lubricant, gentle washing and a chat with your prescriber about your dose all help.

Does isotretinoin affect your libido?

It can. Because isotretinoin lowers testosterone and shifts other hormones, some people notice reduced desire, numbness or difficulty reaching orgasm. These sexual effects are not listed in the official warnings, which is part of why they catch people off guard.

For many, libido recovers after stopping. For a minority, sexual side effects have been reported to persist long after treatment ends. If this happens to you, it’s worth documenting and raising with your doctor rather than assuming it’s in your head.

Why do I need two forms of contraception on isotretinoin?

Because isotretinoin causes serious birth defects, and no dose is safe in pregnancy. Using two reliable contraceptive methods at once (rather than relying on a single one that might fail) dramatically lowers the chance of an accidental pregnancy while the drug is in your system.

Pregnancy-prevention programmes typically ask for two methods from a month before treatment until a month after the last dose, plus regular pregnancy tests. It’s strict for a good reason.

Can isotretinoin cause more yeast infections?

It can make them more likely. Dryness, tiny fissures and a disrupted skin barrier give yeast an easier ride, and hormonal shifts can nudge the vaginal environment out of balance.

If you’re getting recurrent thrush or persistent irritation that started after you began isotretinoin, mention the timing to your doctor. Treating the thrush and easing the dryness usually both help.

This article is general information, not medical advice, and it isn’t a substitute for a consultation with your own doctor. Isotretinoin is a prescription medicine with serious risks, including birth defects – never start, stop or change your dose without medical guidance, and don’t stop contraception on your own. If you’re worried about side effects, speak to the prescriber who knows your history.