What the Rybelsus® documents contain
Sexual function does not appear in any of the tablet’s adverse-reaction sections [1][2][3]. The documents touch on the subject only indirectly.
| Document | What it says | Relevance |
|---|---|---|
| US, EU and Canadian adverse-reaction sections [1][2][3] | No erectile dysfunction, libido or other sexual reaction listed | Not a recognised side effect |
| EU summary of product characteristics, section 5.3 [2] | Delayed sexual maturation in juvenile rats; no effect on their later fertility | Animal finding; Rybelsus® is not used under 18 |
| EU summary of product characteristics, sections 4.6 and 5.3 [2] | Male fertility and mating in rats unaffected; human fertility effect unknown | No human data |
| US Prescribing Information, sections 5.4 and 7.1 [1] | Higher risk of low blood sugar with insulin or a sulfonylurea | Relevant to sex as physical activity |
Diabetes, the heart and the medicine cabinet
NIDDK explains that high blood glucose can damage the blood vessels and nerves involved in sexual response, that men with diabetes may develop erectile dysfunction 10 to 15 years earlier than men without it, and that women with diabetes can have low desire and arousal, vaginal dryness and painful sex from nerve damage, reduced blood flow and hormonal change [7]. Low testosterone is also more common in men with diabetes, especially older and heavier men [7]. A 2025 review put the proportion of people with diabetes affected by erectile dysfunction at up to three in four [4].
Many people who take Rybelsus® also have heart disease. In the four-year trial behind the tablet’s cardiovascular indication, participants had type 2 diabetes plus heart or kidney disease; at the start, 79% took an ACE inhibitor or angiotensin receptor blocker, 64% a beta blocker and 89% a lipid-lowering medicine [1]. Cleveland Clinic lists blood pressure medicines, diuretics, antiarrhythmics and antidepressants among common prescription drugs that list erectile dysfunction as a possible side effect, and notes that erection problems can be an early sign of heart disease [8]. A change in sexual function is therefore worth raising even if the tablet turns out to be irrelevant.
What research on semaglutide shows
A 2026 study of the FDA adverse event database identified 49 reports of erectile dysfunction with semaglutide, a reporting odds ratio of 1.53, but found almost identical signals for sitagliptin (1.52) and dapagliflozin (1.51), two diabetes medicines that work in different ways; dulaglutide, linagliptin and metformin showed no signal [5]. Reports appeared at random times during treatment rather than clustering early, and the authors describe the results as preliminary and unable to establish cause [5]. The study did not separate tablets from injections.
For semaglutide tablets alone, a 2024 FAERS analysis found 28 reports in the reproductive-system and breast category from 2019 to 2023, not more than expected (reporting odds ratio 0.81) [6]. The 2025 review concludes that GLP-1 medicines were expected to help erectile function through weight loss and better metabolic control, that some reports raise the opposite concern, and that the evidence is still inconsistent [4]. No trial has measured sexual function as an outcome with Rybelsus®.
Why sex might change after starting the tablet
- Feeling unwell: nausea, diarrhoea and vomiting are most common in the first weeks, and fatigue was reported in 3.7% on 7 mg and 2.8% on 14 mg against none on placebo in Canada’s trial table [1][3]. NIDDK notes that tiredness, depression and anxiety can reduce interest in sex [7].
- Blood sugar swings: NIDDK says both high and low glucose can affect arousal and cause problems during sex [7]. With insulin or a sulfonylurea, Rybelsus® raises the risk of hypoglycaemia [1].
- Infections: high glucose favours yeast infections, which can make sex uncomfortable [7]. Canada’s trial table lists urinary tract infections in 1.7% on 7 mg, 3.7% on 14 mg and 3.3% on placebo, so they were not clearly more frequent on the tablet [3].
- Other medicines and habits: blood pressure, heart and mood medicines, alcohol and smoking all affect sexual function [7][8].
Planning around low blood sugar
NIDDK describes sex as physical activity and suggests checking blood glucose before and after, especially if you take insulin [7]. The Rybelsus® Medication Guide lists shakiness, sweating, a fast heartbeat, confusion and mood changes among the signs of low blood sugar, and asks you to talk to your provider about how to manage it [1]. Having a fast-acting carbohydrate within reach is part of the plan most diabetes teams teach; ask yours what they advise.
Getting help
NIDDK encourages people with diabetes to see a health care professional about any change in sexual or bladder function, noting that these problems may be a sign that diabetes care needs adjusting, and that counselling and involving a partner can help [7]. For erectile dysfunction, Cleveland Clinic suggests starting with a primary care physician or a urologist [8]. For women, MedlinePlus says occasional problems are common and advises seeing a provider if they last more than a few months or cause distress [9].
Treatments for erectile dysfunction are tablets too. Because Rybelsus® must be taken alone with at least 30 minutes before other oral medicines [1], tell your prescriber about any medicine you add, including ones bought without a prescription, so the timing and any interactions can be checked.
Rybelsus® and Ozempic® are registered trademarks of Novo Nordisk A/S. PepLabo is not affiliated with or endorsed by Novo Nordisk.
When to get help
| Sign | Who to contact | How fast | Source |
|---|---|---|---|
| An erection lasting longer than two to four hours after taking an erectile dysfunction medicine | Emergency room | Emergency | Cleveland Clinic [8] |
| Shakiness, sweating, confusion or a fast heartbeat during or after sex on insulin or a sulfonylurea | Treat low blood sugar as you were taught, then tell your prescriber | Today | Rybelsus® Medication Guide [1]; NIDDK [7] |
| New difficulty getting or keeping an erection | Your primary care physician or a urologist | At your next appointment | Cleveland Clinic [8] |
| Low desire, dryness or painful sex lasting more than a few months or causing distress | Your health care provider | At your next appointment | MedlinePlus [9]; NIDDK [7] |
| Repeated genital itching or discharge that may be a yeast infection | Your health care team | At your next appointment | NIDDK [7] |
