1 Recreational Drug Use and Sexual Functioning

2 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

3 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)

4 Farkas & Rosen, 1976

5 Malatesta, Pollack, Wilbanks, & Adams, 1979

6 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)

7 Wilson & Lawson, 1975

8 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)

9 Malatesta, Pollack, Crotty, & Peacock, 1982

10 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.

11 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

12 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

13 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?

14 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)

15 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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17 Physiology of penile erection Sexual stimulation Nitrix oxide synthesized in nerve and vascular tissue of penis Nitrix oxide activates guanylate cyclase GTP  cGMP cGMP relaxes smooth muscles of corpus cavernosum/penile arterioles Vasocongestion of penile tissues

18 Viagra (Sildenafil): Inhibitor of cGMP PDE5 cGMPGMP cGMP PDE5

19 Nitric Oxide & Penile/Clitoral Tumescence Sexual stimulation Nitrix oxide synthesized in nerve and vascular tissue of penis/clitoris Nitrix oxide activates guanylate cyclase GTP  cGMP cGMP relaxes smooth muscles of corpus cavernosum and arterioles in penile/clitoral tissue Vasocongestion of penile/clitoral tissues

20 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%)

21 Amyl Nitrate “Poppers” Organic nitrate –Short-acting vasodilator –Increased blood flow to heart and brain Purported to make sexual organs feel “Herculean”

22 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

23 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

24 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.

25 Psychotropic Drug Use and Sexual Functioning

26 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

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

28 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