Transcript Recreational Drug Use and Sexual Functioning

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)
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Wilson & 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
GTP  cGMP
Nitrix oxide synthesized in nerve
and vascular tissue of penis
Nitrix oxide activates
guanylate cyclase
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
GTP  cGMP
Nitrix oxide synthesized in nerve
and vascular tissue of penis/clitoris
Nitrix oxide activates
guanylate cyclase
cGMP relaxes smooth muscles of
corpus cavernosum and arterioles
in penile/clitoral tissue
Vasocongestion
of 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
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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
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