Ecstasy & Sex

1 Summary

1.1 Ecstasy is often described as an "entheogenic" drug, giving the user greater empathy and closeness to fellow users. However, this increase in intimacy between users does not normally translate into overtly sexual activity.

1.2 There have been a number of human studies providing conflicting results, some authors finding an increase in libido and sexual activity (particularly within the gay scene), with others finding a loss of interest in sex, and sexual dysfunction (impotence) following ecstasy use.

1.3 Sexual dysfunction is also a common side effect with SSRI-type antidepressant drugs (e.g. Prozac & Seroxat) which have similar pharmacological effects (increased serotonin levels) to ecstasy-type drugs. Green et al[i] noted "The drug produces both hyperthermia and the "serotonin syndrome", a series of behavioural changes which result from increased 5-HT function"

2 Studies finding increases in arousal or sexual activity:

2.1 Smith et al[ii] report "The desired effects are euphoria, a feeling of intimacy, altered visual perception, enhanced libido, and increased energy. The most common adverse effects are agitation, anxiety, tachycardia, and hypertension." In a Canadian study of pregnant women, Ho et al[iii] reported "The 132 pregnant women who used MDMA were significantly younger and had more unplanned pregnancies compared to 122 pregnant nonusers. MDMA users were also more likely to be single". Studying students in California, Strote et al[iv] reported "Ecstasy users were more likely to ... engage in binge drinking, smoke cigarettes, have multiple sexual partners" Kalant[v] reports ecstasy to be used to "enhance energy, endurance, sociability and sexual arousal."

2.2 Buffum & Moser[vi] considered MDMA not to an aphrodisiac, but to enhance the sensual aspects of sex. They found half the men and a third of the women felt more receptive to sex on MDMA, and commented "it is curious that a drug which can increase emotional closeness, enhance receptivity to being sexual and would be chosen as a sexual enhancer, does not increase the desire to initiate sex". Winstock[vii], in a survey of 88 London ecstasy users in 1989/90 found the most pronounced effect reported by users was sexual arousal (89%), and increased sexual activity (67%), in contrast to most studies.

2.3 Sullum[viii] noted "MDMA has been linked not just to regrettable sexual encounters but to rapes in which drugs are used as weapons. The connection is usually made indirectly, by way of other drugs whose effects are quite different but which are also popular at raves and dance clubs.", concluding "As the alleged connections between MDMA and sex illustrate, the concept of an aphrodisiac is complex and ambiguous. A drug could be considered an aphrodisiac because it reduces resistance, because it increases interest, because it improves ability, or because it enhances enjoyment. A particular drug could be effective for one or two of these purposes but useless (or worse) for the others. Shakespeare observed that alcohol "provokes the desire, but it takes away the performance." Something similar seems to be true of MDMA, except that the desire is more emotional than sexual, a sense of closeness that may find expression in sex that is apt to be aborted because of difficulty in getting an erection or reaching orgasm. Also like alcohol, MDMA is blamed for causing people to act against their considered judgment. The concern is not just that people might have casual sex but that they might regret it afterward."

2.4 Studies of gay communities: In a study involving the New York Gay community, Klitzman et al[ix] found "MDMA users were found to be younger, less educated, to have had more male partners, more one night stands with men, more visits to bars or clubs and sex clubs or bathhouses, to have unprotected anal sex with a male, to be likely to have been the victim of physical domestic violence, to have more gay/bisexual friends, to have disclosed their sexual orientation to more friends, family members, and coworkers, and to have higher levels of gay community participation and affiliation. Among MDMA users, higher frequency of MDMA use was associated with being younger, having more visits to bars or clubs, more gay/bisexual friends, and having an HIV negative test result or never having been tested. MDMA users thus constitute a group at risk for sexually transmitted diseases, including HIV, and other problems." Their earlier study[x] had found "MDMA use was strongly and significantly associated with a history of recent unprotected anal intercourse. This association remained equally strong even after controlling for age, ethnicity, and all other forms of drug use, including alcohol. " Colfax et al[xi] found 80% of males attending gay-scene parties used ecstasy at the time. Similarly, Mattison et al[xii] found "Frequent (rather than occasional) use of Ecstasy, Special K, and poppers had an association with unsafe sex at parties.", and Waldo et al[xiii] found "use of amphetamines, ecstasy, and amyl nitrate was associated with unprotected anal intercourse."

3 Studies finding decreases in arousal or sexual activity

3.1 Animal studies: In rats, Bilsky et al[xiv] found MDMA elicited ejaculation in male rats, and concluded "endogenous opioids modulate the reinforcing properties of stimulant drugs and affect male sexuality", however Dornan at al[xv] found "repeated systemic administration of MDMA to sexually vigorous male rats produced a transient disruption of the expression of male copulatory behavior. In addition, in MDMA-treated males that did display copulatory behavior, both the ejaculation latency and postejaculatory interval were dramatically lengthened when compared to saline injected controls." Rajmani[xvi] et al found ecstasy inhibited contractions of the vas deferens in mice.

3.2 Human Studies: Parrott[xvii] observed "The acute boost in monoamine activity can generate feelings of elation, emotional closeness, and sensory pleasure... Abstinent regular Ecstasy users often show... memory problems, higher cognitive deficits, various psychiatric disorders, altered appetite, and loss of sexual interest." Parrott et al[xviii] also found "Heavy ecstasy polydrug users reported significantly higher scores than non-drug users on several SCL-90 factors, including phobic anxiety, obsessive-compulsive behaviour, anxiety, psychoticism, somatisation, and significantly higher rates of 'loss of sex interest or pleasure'."

3.3 Zemishlany et al[xix] studied the subjective effect of ecstasy on sexual activity: desire, erection (lubrication in women), orgasm and satisfaction, finding "Desire and satisfaction were moderately to profoundly increased by MDMA in more than 90% of subjects. Orgasm was delayed but perceived as more intense. Erection was impaired in 40% of the men. It seems that MDMA impairs sexual performance, in spite of enhancement of sexual desire and the perception of greater satisfaction." O"Dwyer[xx] noted "Thoughts about sex when on E were not always matched by real desire. Establishing a 'meaningful relationship' was felt to be an essential part of foreplay. Some found sex while on Ecstasy disappointing while for others it was enhanced."

3.4 Henderson[xxi] reported " Sex is not one of the foremost pleasures offered by Ecstasy. The motivation for raving is more likely to be sensations of the mind, body and soul. The pleasure of dancing with expression and empathy pushes sex into the background. Interviews indicated that sex is the last thing women have in mind when going to a rave... The sexual safety of raves is an attraction for girls, compared to alcohol-based clubs, which are seen as cattle markets. Girls sometimes enjoy kissing at raves because it feels good but is 'safe', i.e. is not going to involve sex... Sex is not one of the foremost pleasures offered by Ecstasy. . . Most men have the opposite to an erection: a shrinking penis"

3.5 Saunders[xxii] reported "Although the media portray Ecstasy as an aphrodisiac, sexual arousal is not an effect of taking MDMA. In fact the drug tends to inhibit erections in men (and male rats). However, people who are already feeling in a sexy mood as the drug takes effect may become aroused. Many users never become sexually aroused on E and find the state quite incompatible. However, for others it depends on their libido at the time and this in turn depends on who they are with and the surrounding atmosphere, so that a place with sexual vibes such as a club may induce sexual behaviour while this virtually never happens at raves. In general, there is a tendency away from sexual desire but the drug allows one to continue on that energy level, although erections are inhibited and orgasms suppressed", and noted "A group of Swiss psychotherapists who have experience of some hundreds of people in group and individual sessions, tell me that they have never come across a participant becoming sexually aroused while on MDMA, although it does sometimes happen on LSD. They say that sexual longings are sometimes expressed, but not the immediate desire for sex. The Swiss therapists appear to take it for granted that MDMA suppresses sexual arousal, and that men cannot have erections while on the drug."

3.6 Beck & Rosenbaum[xxiii] concluded "MDMA and sex do not go very well together. For most people, MDMA turns off the ability to function as a lover, to put it indelicately. It"s called the love drug because it opens up the capacity to feel loving and affectionate and trusting." At the same time, however, it makes the "focusing of the body and the psychic energy necessary to achieve orgasm -- very difficult. And most men find it impossible. -- So it is a love drug but not a sex drug for most people." Solowij et al[xxiv], interviewing recreational users in Australia, found subjects reported ecstasy to improve sex (70%) and lower inhibitions (67%), although 45% reported that ecstasy inhibited arousal and/or climax, and 12% reported a loss of sexual urge related to ecstasy use, lasting for an average of 48 hours

 

4 SSRI drugs

4.1 Many studies and reviews report sexual dysfunction to be a common side effect of selective serotonin reuptake inhibitor (SSRI) drugs. Labatte et al[xxv][xxvi] reported that orgasm quality was lower and delay longer for both sexes, with women reporting higher rates of anorgasmia. The same authors report bupropion treatment to result in improvements in SSRI-mediated sexual dysfunction[xxvii]. Zajecka et al[xxviii] reported that 60% of male and 57% of female outpatients reported differing levels of sexual dysfunction following SSRI therapy. Modell et al[xxix] found 73% of outpatients reporting symptoms of sexual dysfunction, including adverse changes in "libido, arousal, duration of time from arousal to orgasm, intensity of orgasm, and duration of orgasm relative to that experienced before the onset of the patients' psychiatric illnesses", and concluded "SSRI-induced adverse sexual effects appear to be the rule rather than the exception and may be substantially underreported unless patients are specifically asked about the effects of these medications on various aspects of sexual function." Montejo-Gonzalez et al[xxx][xxxi] reported "Sexual dysfunction was positively correlated with dose. Patients experienced substantial improvement in sexual function when the dose was diminished or the drug was withdrawn. Men showed more incidence of sexual dysfunction than women, but women's sexual dysfunction was more intense than men's." The effect of discontinuation of SSRI drugs in increasing sexual function was described by Rothschild[xxxii] who stated "...brief drug holidays may allow for significant improvement in sexual functioning...".

4.2 Shen et al[xxxiii] reviewed female patients receiving a variety of SSRI drugs identifying sexual inhibition in 21 of 110 cases, with symptoms including loss of or decreased libido, and orgasmic disturbances (anorgasmia or delayed orgasm). Clayton et al[xxxiv] identified three types of sexual function in depressive patients treated with parotexine, including patients who reported "increased libido without sexual dysfunction, anorgasmia with possible spontaneous resolution (medication side effect and development of tolerance), and long-term sexual dysfunction unaffected by the medication".

4.3 Stewart et al[xxxv] proposed parotexine as a treatment for sexual disinhibition in patients with dementia, current press reports indicate Seroxat to be considered for treatment of shyness[xxxvi]. McHale[xxxvii] suggested SSRIs as a treatment of sexual dysfunction. Waldinger et al[xxxviii] reported parotexine to be effective in increasing ejaculation latency in male patients referred for premature ejaculation, Giamusso et al[xxxix] concluded "In patients with primary premature ejaculation, paroxetine represents, in our opinion, the best therapeutic option for its efficacy and lack of significant side effects.", and Isaksen[xl], Ludovico et al[xli] and Balon[xlii] reached similar conclusions. Ferini-Strambli et al[xliii] reported parotexine to be effective in reducing painful nocturnal erections, however Bertholon et al[xliv] reported parotexine to have caused such a condition in one patient, and reported other side effects including "delayed ejaculation, anorgasmy, erectile dysfunction and decreased libido." Parotexine was not found to depress saliva production, unlike tricyclic antidepressants[xlv].

4.4 Summary: The scientific evidence suggests parotexine and other SSRIs commonly to cause sexual dysfunction by reducing sexual desire and arousal, delaying or abolishing orgasms and ejaculations, and reducing tumescence of erectile tissue such as the penis or clitoris. The influence of parotexine would tend to make an individual less interested in sex. The improved mood, increased sociability, decreased shyness and anxiety, and affiliative behaviour might lead to misinterpretation by a third party of a more friendly disposition as signals of sexual availability.