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Recreational Drug Use and Sexual Functioning

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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

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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)

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Farkas & Rosen, 1976

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Malatesta, Pollack, Wilbanks, & Adams, 1979

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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)

7Wilson & Lawson, 1975

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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)– 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)

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Malatesta, Pollack, Crotty, & Peacock, 1982

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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.

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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

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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

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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?

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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)

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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

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Physiology of penile erection

Sexual stimulation Nitrix oxide synthesized in nerveand vascular tissue of penis

Nitrix oxide activates guanylate cyclaseGTP cGMP

cGMP relaxes smooth muscles of corpus cavernosum/penile arterioles

Vasocongestion of penile tissues

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Viagra (Sildenafil): Inhibitor of cGMP PDE5

cGMP GMP

cGMP PDE5

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Nitric Oxide & Penile/Clitoral Tumescence

Sexual stimulation Nitrix oxide synthesized in nerveand vascular tissue of penis/clitoris

Nitrix oxide activates guanylate cyclaseGTP cGMP

cGMP relaxes smooth muscles of corpus cavernosum and arterioles in penile/clitoral tissue

Vasocongestionof penile/clitoral tissues

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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%)

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Amyl Nitrate “Poppers”

• Organic nitrate

– Short-acting vasodilator

– Increased blood flow to heart and brain

• Purported to make sexual organs feel “Herculean”

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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

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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

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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.

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Psychotropic Drug Use and Sexual Functioning

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Antidepressants

• MAO 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

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Antipsychotics

• Decreases dopamine activity

• Males

• Enhances erection

• Several reported cases of priapism

• Females

• Enhances vaginal lubrication?

• Delayed and inhibited orgasm

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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