Recreational Drug Use and Sexual Functioning

Recreational Drug Use and Sexual Functioning

Presentation by: Dr. Penny Frohlich
University of Texas at Austin

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: FemalesSelf-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)

Alcohol: FemalesSelf-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

MDMA “Ecstasy”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?

MDMA “Ecstasy”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
20 SextasyCombining 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”

CocaineInhibits 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: HeroinStimulate 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 be “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

AntidepressantsMAO inhibitors, SSRIs
Impair all aspects of the sexual response cycle in men and women
Serotonin 5-HT2 receptor implicated
Nephazadone (serzone) SSRI and 5-HT2 antagonist – fewer sexual side effects
Stimulation of the 5-HT2 receptor (peripherally) causes vasoconstriction

AntipsychoticsDecreases dopamine activity
Males
Enhances erection
Several reported cases of priapism
Females
Enhances vaginal lubrication?
Delayed and inhibited orgasm

Anti-Parkinsonian drugsIncreases 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

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Paraphilias - sexual interest other than in copulatory

Paraphilias
Presentation by: Dr. Penny Frohlich
University of Texas at Austin

Definition: According to wikipedia, Paraphilias refers to powerful and persistent sexual interest other than in copulatory or precopulatory behavior with phenotypically normal, consenting adult human partners.


DSM-IV

* 6-months, recurrent, intense, sexually arousing fantasies/sexual urges
* fantasies/urges involve a specific act
* involving:
o non-human objects
o suffering or humiliation of oneself or another
o children or non-consenting persons
* cause significant distress or impairment


Paraphilias

* Fetishes
* Transvestic fetishism
* Voyeurism
* Exhibitionism
* Frotteurism
* Sadism/masochism
* Pedophilia

Fetishes

* Sexual arousal by:
o using or thinking about an inanimate object
o viewing a particular part of the body
o Common items:
+ womens’ clothing (shoe, stockings, underpants, bras)
+ feet
* Characteristics:
o male
o 25% homosexual
* Causes:
o temporal lobe abnormalities
o learned behavior - classical conditioning
+ 5/7 men conditioned to become sexually aroused to a knee length leather boot
+ 3/7 generalized to other shoes (Rachman & Hodgson, 1968)

Transvestites & Transvestic Fetishism

* Sexual arousal by dressing in clothes of the opposite sex
* crossdressing
* Characteristics:
o broad age range
o broad religious affiliation
o well educated
o in committed relationships
o parents
o heterosexual
o began before age 10
* Causes
o Family:
+ positive paternal role model
+ negative maternal relationship
o associated with learning disabilities
o temporal lobe abnormalities

Sex Offenders

* Voyeurism
* Exhibitionism
* Frotteurism
* Preferential Rape Pattern
* Pedophilia
* Psychopathic Sexual Sadism

Courtship Disorders

* Voyeurism:
o “peeping tom”
o sexual arousal by observing nude individuals without their knowledge or consent
o intense urges and recurrent behavior
* Exhibitionism: sexual arousal by exposing genitals to unsuspecting strangers - typically in inappropriate settings
* Frotteurism: sexual arousal by rubbing one’s genitals against others in public
* Preferential rape pattern: prefer rape over consensual sex

Voyeurism

* Characteristics:
o youngest child
o few sisters
o good relationship with parents
o parents with poor relationship
o underdeveloped socially
+ later 1st sexual experience
+ less likely to marry
* Females:
o rare
o peeping fantasies not uncommon (Friday, 1975)

Exhibitionism

* Characteristics:
o almost exclusively male
o timid/unassertive
o undeveloped social skills
o uncomfortable with anger/hostility
o more likely to be raised in puritanical background
* Females:
o do not derive pleasure
o motivation: money (e.g., strippers) or attention (e.g., Marti Gras)

Frotteurism

* Characteristics:
o comorbidity: 79%
o Average number of acts:
+ 849 (Abel et al., 1987)
o in females: molestation secondary to erectile failure, low desire (Sarrel & Masters, 1982)

Sadism & Masochism
* Sadism: sexual arousal by inflicting pain on another
* Masochism: sexual arousal by having pain inflicted upon oneself
* History
o “masochist” (1886) Krafft-Ebing, after Leopold von Sacher-Masoch
o “sadist” (1700s) after Marquis de Sade

Sadomasochism (S & M)

* Major vs minor sexual sadism
* Sadomasochism (S & M)
o pre-determined acts
o activities & themes (Arndt, 1991; Weinberg et al., 1984):
+ flagellation
+ bondage
+ water sports (urophilia, coprophilia, mysophilia)
+ penis and nipple torture
+ master & slave
+ severe boss and naughty secretary
+ queeen and many slavves
+ arrest
+ military training
* Characteristics
o predominantly male
o female: 25% prostitutes
o meet through S & M magazines
o come from all walks of life, SES, educ. etc
o 1/3 heterosexual, 1/3 bisexual, 1/3 homosexual

Major Sexual Sadism

* Seto & Kuban (1996)
o sadistic rapist, non-sadistic rapist, controls
o penile volume changes
o Five films:
+ nonviolent, non-sexual w/ female
+ consensual sex w/ female
+ non-sexual violence against female
+ rape
+ violent rape
* Seto & Kuban (1996) continued
o both types of rapist equally aroused by different types of sex
o controls differentiated between consensual and non-consensual sex
* Temporal lobe abnormalities (Langevin et al., 1988)

Psychopathic Sexual Sadism

* DSM-IV
o sexual sadism
o antisocial personality disorder (ASPD)
* Serial murderer
o arousal from inflicting pain
o arousal from killing
* Characteristics
o Lack of guilt or compassion for victim
o Euphoria during murder
o mentally disturbed, rarely psychotic
* Geberth & Turco (1997)
o 387 serial murders
o 248 sexually assaulted victims
o 68 met criteria for sexual sadism & ASPD
+ childhood aggressiveness
+ childhood antisocial behavior
+ killing involving sexual violence, humiliation, domination and control
+ derived pleasure from killing
o examples: Ted Bundy, Gary Ridgeway

Pedophilia

* Sexual fantasies, urges, or behavior involving children under 14 years old
* prevalence
* Characteristics/Causes:
o 40% homosexual
+ high maternal age
+ low IQ
+ developmental disorder?
o history of childhood sexual abuse (49%) by a male abuser

Development of Paraphilias

* Physiological characteristics:
o higher baseline cortisol, prolactin, body temperature
o stronger cortisol response
o disturbance in serotonin regulation --> OCD
o showed slides of nude male and female children
o pedophiles and controls
o measured penile volume changes
o Results: pedophiles less differentiation between slide types

Treatment of Paraphilias

* 1900 castration, psychosurgery
* Cognitive-Behavioral Therapy - Aversion Therapy
o effective in lowering arousal
o relapse high
* Pharmaceutical
o agents that lower testosterone/produce pharmaceutical castration
o SSRIs

Additional Paraphilias

* Bestiality & zoophilia
* coprolalia
* coprophilia
* klismaphilia
* mysophilia
* necrophilia
* pedophilia
* scoptophilia
* stigmatophilia
* telephone scatologia
* troilism
* urophilia
* kleptomamia
* pyromania
* salirophilia
* somnophilia
* sotophilia

Paraphilia-Related Disorders

* compulsive masturbation
* protracted promiscuity
* dependence on pornography (more common in men)
* dependence on cybersex

Check regarding diagnosing if no distress - with regard to pedophilia etc.


Generalized to:
Family:
Results
pharmaceutical:
Bestiality & zoophilia: sexual arousal through contact with animals
coprolalia: need to hear filthy language to become sexually aroused
coprophilia: need to smell or riew feces to become aroused
klismaphilia: sexual arousal by being given an enema
mysophilia: arousal by filth or filthy surroundings
necrophilia:
scoptophilia: by observing others engaged in sexual intercourse
stigmatophilia: marking body, inserting objects into the body
telephone scatologia: arousal by making obscene phone calls
troilism: arousal by sharing partner and looking on
urophilia: “golden showers” on or watching
kleptomamia; aroused by act of steeling
pyromania: aroused by setting fires, watching fires
salirophilia: injestion of anothers sweet or saliva
somnophilia: having sex with someone who is sleeping
sotophilia: aroused by sight of certain foods.

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Diaphragms

Diaphragms

Diaphragms: Definition

A dome-shaped latex (rubber) cup that is inserted into the vagina before intercourse and covers the cervix

Types of Diaphragms
* Flat spring (flat metal band)
* Coil spring (coiled wire)
* Arching spring (combination metal spring)

Diaphragms: Mechanism of Action
Prevent sperm from gaining access to upper reproductive tract (uterus and fallopian tubes) and serve as holder for spermicide

Diaphragms: Contraceptive Benefits
* Effective immediately
* Do not affect breastfeeding
* Do not interfere with intercourse (may be inserted up to 6 hours before)
* No method-related health risks
* No systemic side effects

Diaphragms: Noncontraceptive Benefits
* Some protection against STDs (e.g., HBV, HIV/AIDS) especially when used with spermicide
* Contain menstrual flow when used during menses

Diaphragms: Limitations

* Moderately effective (6B201 pregnancies per 100 women during the first year of use if used with spermicide)
* Effectiveness as contraceptives depends on willingness to follow instructions
* User-dependent (require continued motivation and use with each act of intercourse)
* Pelvic examination by trained service provider (may be nonphysician) required for initial fitting and postpartum refitting
* Associated with urinary tract infections in some users
* Must be left in place for 6 hours after intercourse
* Supplies must be readily available before intercourse occurs
* Resupply must be available (spermicide required with each use)

Who Can Use Diaphragms
Women who:

* Prefer not to use hormonal methods or who should not use them (e.g., smokers over 35 years of age)
* Prefer not to or should not use IUDs
* Are breastfeeding and need contraception
* Want protection from STDs and whose partners will not use condoms
Couples:

* Who need a temporary method while awaiting another method
* Who need a backup method
* Who have intercourse infrequently
* In which either partner has more than one sexual partner (at high risk for STDs), even if using another method

Diaphragms: Conditions Requiring Precaution (WHO Class 3)
Diaphragms are not recommended unless other methods are not available or acceptable if a woman has:

* A history of Toxic Shock Syndrome (TSS)
* An allergy to rubber or spermicides
* Repeat urinary tract infections (UTIs)
* Uterine prolapse
* Vaginal stenosis
* Genital anomalies

Diaphragms: Who May Require Additional Counseling

* Women whose age, parity or health problems make pregnancy high risk
* Women with physical disabilities or who find it unpleasant to touch their genitals
* Women who do not want any inconvenience
* Couples who want a highly effective method of contraception
* Couples who want a method not related to intercourse
* Couples not willing to use correctly and with each act of intercourse
* Couples who do not have soap and water readily available

Diaphragms: Management of Side Effects
Toxic Shock Syndrome (TSS):

* Examine for signs/symptoms of TSS (e.g., fever, rash, nausea, vomiting, diarrhea, conjunctivitis, weakness, decreased blood pressure and shock).
* If suspected, refer client to center where intravenous fluids and antibiotics are available.
* Give oral rehydration as needed and a non-narcotic analgesic (NSAID or aspirin) if fever is high (> 38EC).
Urinary tract infection (UTIs):

* Treat with appropriate antibiotic.
* If client has frequent UTIs and diaphragm remains her first choice for contraception, advise emptying bladder (voiding) immediately after intercourse.
* Offer client postcoital prophylactic (single-dose) antibiotic. Otherwise, help client choose another method.

Diaphragms: Management of Side Effects continued

* Suspected allergic reaction to diaphragm or spermicide:
* If allergic, help client choose another method
* Pain from pressure on bladder or rectum B Assess diaphragm fit. If current device is too large, fit with smaller device. Follow up to be sure problem is solved.
Allergic reactions, although uncommon, can be uncomfortable and possibly dangerous.

Diaphragms: Management of Side Effects continued
* Vaginal discharge and odor if left in place for more than 24 hours:
* Check for STD or foreign body. If not, advise client to remove diaphragm as early as is convenient after intercourse, but not less than 6 hours after last act.
* If symptoms recur, counsel regarding vaginal hygiene.
* Vaginal lesion caused by diaphragm rim pushing against vaginal wall:
* Temporarily stop use and provide backup method. When healed, check diaphragm fit (may be too large).

Diaphragms: Client Instructions

* Use diaphragm every time you have intercourse.
* First, empty your bladder and wash your hands.
* Check diaphragm for holes by pressing rubber and holding it up to light or filling with water.
* Squeeze small amount of spermicidal cream or jelly into cup of diaphragm.
* To make insertion easier, place small amount of cream/jelly on leading edge of diaphragm or in vaginal opening. Squeeze rim together.

Diaphragms: Client Instructions continued

* The following positions may be used for inserting diaphragm:
* One foot raised up on a chair or toilet seat
* Lying down
* Squatting
* Spread lips of vagina apart.
* Insert diaphragm and cream/jelly back in vagina and push front rim up behind pubic bone.

Diaphragms: Client Instructions continued

* Put your finger in the vagina and feel the cervix (feels like your nose) through the rubber to make sure it is covered.
* The diaphragm can be placed in the vagina up to 6 hours before having intercourse.
* If intercourse occurs more than 6 hours afterwards, another application of spermicide must be put into vagina.
* Additional cream or jelly is needed for each repeated intercourse.
* Leave diaphragm in for at least 6 hours after the last time intercourse occurs. Do not leave it in more than 24 hours after intercourse.
* Vaginal douching is not recommended at any time. If done, it should be delayed for 6 hours after intercourse.
* Remove diaphragm by hooking finger behind front rim and pulling it out. If necessary, put your finger between diaphragm and pubic bone to break the suction before pulling out.
* Wash diaphragm with mild soap and water and dry it thoroughly prior to returning it to container.

When to Consider Emergency Contraception

If a client does not wish to be pregnant, and she:

* forgot to use the diaphragm when she had intercourse
* thinks she may have used the diaphragm incorrectly
* had intercourse more than 6 hours after inserting the diaphragm but did not apply more spermicide
* did not leave the diaphragm in for 6 hours after having intercourse

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