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

Recreational Drug Use and Sexual Functioning.ppt