Recreational Drug Use and
Sexual Functioning
Nicotine
•
•
•
•
(Complex impact on hormones & neurotransmitters.)
Short term = interferes with erection
–
–
Decreases blood flow to penis
Increases venous outflow from penis
Long term use destroys penile tissues = erectile dysfunction
Passive smoking can have similar impact
Alcohol
•
•
(Diffuse affects on neurotransmitter processes)
(Affects hippocampus)
Males
• Self-report
•
•
•
Increased latency to orgasm (reduced likelihood of premature ejaculation)
Increased likelihood of erectile failure
Alcoholic males: erectile dysfunction (59%); anorgasmic dysfunction (48%); at
• least one sexual dysfunction (84%) (Mandell et al., 1983)
Laboratory Studies
•
•
Inhibits erection (dose dependent)
Increased latency to ejaculation (dose dependent)
•
Alcohol: Females
Self-report:
–
–
No change in sexual functioning when intoxicated
Moderate alcohol use (2 per week
– 2 per day) associated with lowest rates of sexual dysfunction
– Alcoholic females report decrease in sex drive and difficulty achieving orgasm/anorgasmia
•
•
•
Laboratory Studies:
– Decreased arousal (Wilson & Lawson, 1976)
Self-report:
–
–
No change in sexual functioning when intoxicated
Moderate alcohol use (2 per week – 2 per day) associated with lowest rates of sexual dysfunction
– Alcoholic females report decrease in sex drive and difficulty achieving orgasm/anorgasmia
Laboratory Studies:
–
–
–
–
Decreased arousal (Wilson & Lawson, 1976)
Longer latency to orgasm (Malatesta et al, 1982)
Decreased intensity of orgasm (Malatesta et al, 1982)
Increased subjective arousal and orgasm pleasure (Malatesta et al, 1982)

Marijuana
•
•
•
•
•
•
•
(THC (active ingredient) – THC receptors rich in the hippocampus) lowers testosterone (mixed evidence)
Enhances sexual enjoyment in both men and women (83% and 81% respectively)
Does not affect erection, lubrication, or orgasm.
Increases relaxation, sociability, touch, and comfort. high doses = sedation and impaired sexual performance.
In animals, decreases sexual activity – general decrease in physical activity.
Amphetamines “speed”
•
•
• (Enhanced release and block reuptake of norepinephrine, and at higher doses, dopamine.)
Can cause vasoconstriction of genital tissue
Sexual Performance:
–
–
–
Increased libido (increased energy)
Erectile failure; prolonged erection (up to 18 hours!)
Anorgasmia; multiple orgasms
Long term use: loss of interest in sex •
MDMA “Ecstasy”
•
•
•
•
•
•
(Similar to amphetamines, stimulates SNS)
Purported effects:
–
–
–
–
–
–
– increased energy increased endurance feelings of euphoria increased sociability feelings of intimacy altered visual perception enhanced libido
Sexual functioning
– Subjective ratings: 20 men, 15 women (Zemishlany et al., 2001)
•
•
•
•
Desire: moderately to profoundly increased
Erection: impaired in 40%
Orgasm: delayed but more intense
Satisfaction: moderately to profoundly increased
– Laboratory studies?
Acute side effects/adverse effects (Smith, Larive & Romanelli, 2002):
–
– agitation, anxiety, tachycardia, hypertension arrhythmias, hyperthermia
Chronic adverse effects:
– Toxicity to serotonin system
•
• cardiovascular system
CNS serotonin
Overlap between recreational and fatal dose (Kalant, 2001)
Crystal Methamphetamine
“Crank,” “Crystal,” “Speed”

•
•
•
•
•
•
•
•
•
(Increased release of dopamine, adrenaline)
Purported effects:
–
–
– sense of exhilaration sharpening of focus sense of sexual liberation
Sexual Functioning
– constricts blood vessels
– erectile dysfunction
Risks: similar to amphetamines, risk greater •
Physiology of penile erection
Viagra (Sildenafil): Inhibitor of cGMP PDE5
Nitric Oxide & Penile/Clitoral Tumescence
Sextasy
•
•
•
Combining Viagra with ecstasy, “hammerheading”
–
–
– headache, prolonged erection (priapism) high risk sexual behavior long-term heart damage
Viagra with:
–
–
– crystal methamphetamine amyl nitrate any drug that produces erectile dysfunction
Viagra and illegal recreational drugs (40%)
Amyl Nitrate “Poppers”
•
Organic nitrate
– Short-acting vasodilator
– Increased blood flow to heart and brain
Purported to make sexual organs feel “Herculean”
Cocaine
Inhibits reuptake of dopamine
Potent vasoconstrictor
Increased sexual desire
Arousal:
– Men:
•
• low doses – prolonged erection high doses – erectile failure
– Women: reports of both increased and decreased subjective arousal
Delayed or absent orgasm
Opioids: Heroin

•
•
•
•
•
•
•
•
•
•
•
•
•
Stimulate opiate receptors (enkephalins (body) and endorphins (brain)) – results in reduction in circulating testosterone
Produce relaxation/sense of well being
Analgesic affect – opiate receptors in female genital tract
Few reports of acute use: lowers drive, delays orgasm
Male Heroin addicts:
• loss of drive, erectile dysfunction, orgasmic dysfunction
• Withdrawal: increased morning erections, spontaneous ejaculation, slow return of sex drive, erectile and orgasmic dysfunction
Female Heroin addicts:
•
•
Decreased drive, increased drive, anorgasmia
Withdrawal: loss of libido
Hallucinogens (LSD, PCP)
•
•
•
•
Purported to b e “ultimate sex drug.”
Affects dopamine, serotonin, and with PCP, glutamate.
Sexual pleasure enhanced (all pleasure enhanced – e.g., watching paint dry is equally pleasurable)
Sexual Performance (animal studies):
– low doses:
–
• Males: premature ejaculation
• Females: normal receptivity
Moderate to high doses – lack of physical coordination precludes any sexual activity.
Psychotropic Drug Use and Sexual Functioning
Antidepressants
•
MAO inhibitors, SSRIs
Impair all aspects of the sexual response cycle in men and women
Serotonin 5-HT
–
2 receptor implicated
Nephazadone (serzone) SSRI and 5-HT
2 antagonist – fewer sexual side effects
–
Stimulation of the 5-HT
2 receptor (peripherally) causes vasoconstriction
Antipsychotics
Decreases dopamine activity
Males
•
•
Enhances erection
Several reported cases of priapism
Females
•
•
Enhances vaginal lubrication?
Delayed and inhibited orgasm
Anti-Parkinsonian drugs
Increases dopamine activity
Sexual drive:
–
–
Increases sex drive
Several cases of hypersexuality in men (<1%)

•
– One reported case of hypersexuality in a woman (levodopa/carbidopa)
Sexual arousal: L-dopa increases erection in men with erectile failure