The sexual cycle is a complex process that can be affected by many factors, at times resulting in sexual dysfunction. Some common risk factors for sexual dysfunction include health issues and substance abuse, which is the recurring desire to take drugs or other substances in a way that is harmful to a person.

Prolonged substance abuse can lead to various sexual dysfunctions, including erectile dysfunction (ED). A recent systematic review aimed to explore the connection between substance abuse and sexual dysfunction in men.

The review was conducted from January 1960 until the end of September 2022, and included all studies related to substance use and male sexual dysfunction. It yielded a total of 148 publications, but after removing duplicates and selecting articles that met the inclusion criteria, 75 studies were included in the analysis.

The following is the information the researchers found about each type of substance in relation to male sexual function.

Cannabis

Some studies suggest cannabis can enhance sexual arousal, thoughts, and performance. However, there is evidence linking cannabis use to ED in men, with mechanisms including effects on the hypothalamus, endothelial damage, and insulin resistance.

Frequent cannabis use is associated with an increased likelihood of multiple sexual partners. Cannabis use, especially in combination with other substances, has been linked to risky sexual behaviors such as sex without a condom.

Opioids

Opioid analgesics, commonly used for chronic pain, are associated with a higher prevalence of ED, severe depression, and low socioeconomic status. This may be due to the fact that opioid use is linked to low testosterone levels, contributing to ED and changes in mood. Illicit opioid users, patients on methadone treatment (MMT), and those on naltrexone report other sexual dysfunctions as well, including premature ejaculation and reduced sexual desire.

Heroin

Heroin, an opioid drug derived from opium poppy plants, has been linked to problems like ED, delayed ejaculation, and reduced libido. The prevalence of ED among male heroin addicts remains high, even with treatment. Additionally, heroin use is associated with lower testosterone levels and may negatively impact overall sexual satisfaction, self-esteem, and relationships.

Tramadol

Tramadol, a synthetic opioid, has complex effects on male sexual function. It is used to treat premature ejaculation in some cases but may also lead to ED and reduced libido with long-term use.

Cocaine

Cocaine, a powerful dopamine agonist, may lead to sexual dysfunction with chronic abuse due to altered dopamine levels. In the short term, cocaine use can result in a hypersexual state, but over time, it may reduce libido and sexual performance. Cocaine users may also engage in risky sexual behaviors, often associated with other substance use and psychological problems.

Chemsex

“Chemsex” refers to the use of psychoactive and non-psychoactive drugs in recreational settings to enhance sexual experiences, which can lead to a heightened risk of sexually transmitted diseases. It often involves substances like GHB, ketamine, and synthetic cathinones, along with ED medications. Prolonged ketamine use has been associated with ED.

Ecstasy

Ecstasy is a synthetic psychoactive drug that produces stimulating and psychedelic effects, altering sensations. Its use often leads to feelings of emotional closeness but may also increase sexual arousal. Some users engage in risky sexual behavior, like multiple partners and unprotected sex, during ecstasy episodes. Erectile function and sexual satisfaction are lower among ecstasy users, and priapism (a prolonged erection that lasts over 4 hours) has been reported in some cases.

Amphetamines

Amphetamine use is associated with ED. Khat, a natural stimulant, can lead to dependence, psychosis, and various physical and psychiatric issues. It is has been linked to risky sexual behavior and sexual violence in some cases. However, not all studies found a significant association between khat use and ED.

Anabolic-androgenic steroids

Anabolic-androgenic steroids (AAS) are potent drugs often misused for performance and image enhancement. AAS abuse is a growing public health concern, affecting both athletes and non-athletes, leading to hormone imbalances, mental health issues, and sexual side effects, at times including ED and reduced libido.

Conclusion

Substance abuse not only has negative effects on a person’s overall health, but it can also have negative effects on one’s sexual health. If you or your partner is struggling with substance abuse issues, consult a trusted health care provider for resources and/or referrals to other experts who can help.

Call the free Substance Abuse and Mental Health Services Administration (SAMHSA) hotline (available 24/7, 365 days a year) for help - 1-800-662-4357.

References:

• Mostafa, T., & Alghobary, M. (2023). Substance abuse and male sexual dysfunction: what lies beneath?. Sexual Medicine Reviews, 11(4), 395-411. https://doi.org/10.1093/sxmrev/qead011.