ABSTRACT

Alcohol, marijuana, and ecstasy (3,4-methylenedioxymethamphetamine [MDMA], ‘Molly’) are among the most prevalent substances used by young adults; however, few studies have focused on the specific sexual effects associated with use. Examining subjective sexual effects (e.g. increased libido) associated with use can inform prevention efforts. Results suggest that compared to marijuana, alcohol and ecstasy were more strongly associated with heightened perceived sexual effects (i.e. perceived sexual attractiveness of self and others, sexual desire, length of intercourse, and sexual outgoingness). Increased body and sex organ sensitivity and increased sexual intensity were most commonly associated with ecstasy use. Sexual dysfunction was most common while using alcohol or ecstasy, especially among males, and females were more likely to report sexual dysfunction after using marijuana. Post-sex regret was most common with alcohol use. Alcohol, marijuana, and ecstasy each have different sexual effects; therefore, each is associated with different risks and benefits for users. Findings can inform prevention and harm reduction as young adults are prone to use these substances.

INTRODUCTION

Alcohol, cannabis (marijuana), and ecstasy (3,4-methylenedioxymethamphetamine [MDMA], ‘Molly’) are amongst the most prevalent psychoactive intoxicating substances used by young adults in India. Among young adults (ages 19–28) in the India, an estimated 28.9 % have used alcohol, 2.8 % have used marijuana, and 1 % have used ecstasy in their lifetime. Compared to other age groups, young adults are at high risk for psychoactive substance use and associated adverse outcome due to depression, peer pressure, euphoria and intense curiosity. Each psychoactive substance is associated with its own level of potential physical, psychological, and social harm – to users and to others.

There has been extensive research on substance use as a factor that leads to sexual risk behaviour (e.g. sex without a condom), but more studies are needed to examine how specific drugs relate to sexual risk behaviour. Most research on substance use in relation to sexual risk behaviour has been correlational in nature, and knowledge about how use of various substances may lead to sexual interactions – via specific sexual effects – is needed to inform prevention to guide safer sexual practices.

Alcohol use and sexual behaviour

An abundance of research has focused on alcohol use as a risk factor for risky sexual behaviour. For example, a research has documented the relationship between alcohol use and multiple sexual partners in the past three months, inconsistent condom use, being in unsafe situations which can place individuals at risk for unwanted sexual encounters, and sexual assault. In addition, alcohol use has been found to be associated with negative health outcomes such as sexually transmitted infections, and unplanned pregnancy. The relationships among alcohol, sexual risk behaviours, and negative sexual health outcomes persist across age groups, racial and ethnic groups, genders, and sexual orientations.

With regards to more specific sexual effects, one study found that alcohol consumption was positively correlated with increased sensation-seeking behaviours and sexual arousal that contributed to inconsistent condom use. Another study focusing solely on men reported similar findings – that alcohol use was positively correlated with increased sexual arousal and decreased condom use among those using substances compared to those who were sober. However, studies are still needed to examine other potential sexual effects associated with alcohol use.

Marijuana use and sexual behaviour

Correlational studies have also examined sexual effects associated with marijuana use and the link between marijuana use and sexual risk behaviour. A study of substance users between the ages of 18–39 found that marijuana users were more likely to report having more than one sexual partner with no regular condom use than those who did not use marijuana. Studies have also found that college-age males and females who use marijuana are more likely to report having multiple partners in the past three months. In a study of sexual risk behaviours among HIV-positive adults who were heavy alcohol drinkers, the number of condomless sexual encounters increased with more frequent marijuana use. Another study found that men who reported smoking marijuana 6 or more times in the past month had an increased risk of engaging in condomless sex and higher odds of reporting having multiple sexual partners than those who did not smoke marijuana.

With regards to more direct sexual effects, studies have found an increase in male and female sexual arousal and effects on the duration of sexual encounters both in prolonged orgasm and inability to achieve orgasm. Marijuana use has also been found to be associated with inability to maintain an erection. Similar to alcohol, more studies are needed to determine the direct sexual effects of marijuana.

Ecstasy use and sexual behaviour

Despite the number of studies examining sexual risk behaviour associated with alcohol and marijuana use, few studies have examined sexual effects associated with the use of ecstasy (the street name for MDMA/’Molly’). The extant literature about ecstasy and sexual risk shows associations with condomless sex, increased number of sexual partners, and younger age at sexual debut and found that ecstasy users were more likely to engage in high risk sexual behaviours including casual sex and condomless sex than those who only drink alcohol. Other studies, however, have found that men who have sex with men (MSM) that use ecstasy before sex are about twice as likely to report having condomless anal insertive sex with a casual partner than those that do not use ecstasy. One of the common effects of ecstasy use has been increased closeness with others as well as increased feelings of sensuality; however, while the use of ecstasy may enhance sexual desire, other sexual effects including delayed orgasm and difficulty maintaining an erection have been reported.

A lack of focus on specific sexual effects of substances

Most of the available literature on sexual risk behaviours associated with use of alcohol, marijuana, and ecstasy focus on sexual behaviours such as unplanned sex, casual sex, multiple partners, decreased condom use, and reduced social and sexual inhibitions. Other studies have focused on the phenomenon of ‘chemsex’ in which substances are used specifically to facilitate or enhance sexual interactions, although focus tends to be on substances such as methamphetamine rather than substances such as alcohol, marijuana, or ecstasy.

While the health risks associated with substance use are important to consider, focusing on risks alone does not take into account specific sexual effects or perceived benefits that substance use may bring to the sexual encounter (i.e. increased sexual pleasure and/or functioning). Perceived benefits to sexual functioning or pleasure, for example, may contribute to an individual’s decision to use alcohol or other substances in specific social contexts, which may in turn influence likelihood of risk behaviour. For example, a European study of 1,341 men and women found that 12.7% of alcohol users, 25.8% of marijuana users, and 22.6% of ecstasy users reported intentional use of these substances to enhance sexual sensation or arousal. However, we know very little about how use of specific substances have effects (i.e. effects determined by one’s own subjective evaluation) such as perception of sexual attraction of self or towards others, social outgoingness, or sexual desire (i.e. libido). We know little about how various substances may influence physiological reactions that may relate to intimacy or sex such as body or sex organ sensitivity. Further, more research is needed focusing on specific effects dependent on sexual interaction such as length of sexual intercourse, sexual enjoyment, length and intensity of orgasm, and sexual dysfunction (e.g. vaginal dryness, trouble achieving/maintaining an erection). In addition, little is known about how use of specific substances before or during sexual interactions may influence adverse psychological consequences such as regret after sex. While some qualitative studies have investigated sexual effects of drugs such as alcohol and marijuana, to our knowledge, researchers have not investigated such phenomena in a quantitative manner. Also, while studies have focused on sexual risk behaviour regarding specific drugs, it is difficult to compare sexual effects of drugs as effects have been queried from different samples. A within-subjects design would allow us to compare reported sexual effects across drugs by the same individuals. To better understand the sexual effects of specific psychoactive substances, which may in turn affect sexual risk behaviour, research is needed to compare the psychosocial and physical sexual experiences of individuals across three of the most prevalent intoxicating substances–alcohol, marijuana, and ecstasy.

The objective of this exploratory research is to better understand the perceived sexual effects of three of the most prevalent psychoactive substances. In this paper, we aim to compare psychosocial and physical sexual experiences of men and women from a high-risk population – nightlife attendees – to add more nuanced information to correlational links between substance use and sex, and also to inform counselling and intervention development. Likewise, this research can determine which substances may be riskier with regards to sexual activity and this can inform prevention.

DISCUSSION

As prevalence of, and acceptance towards use of substances like marijuana and ecstasy have increased, it is important to understand the potential sexual effects associated with use to inform prevention and harm reduction. Examining specific substances and not just ‘substance use’ is important as unique substances tend to have different effects, which may differentially affect sexual risk behaviour such as condomless sex. This study adds to the extant literature providing information about various perceived sexual effects of three of the most commonly used psychoactive substances. Most studies investigating links between drug use and sex have been correlational, focusing largely on associations between use and sex-related outcomes (e.g. condom use). This study helps fill in gaps regarding how use of various drugs may be related to specific sexual effects which – alone or in combination – may influence sex-related outcomes.

Increased attraction – both feeling more attractive and attraction to others – were most commonly associated with consumption of alcohol. These results align with previous research on the social effects of alcohol, which linked alcohol use to increased feelings of self-acceptance and decreased feelings of social anxiety in social situations. Increased self-acceptance and decreased anxiety while under the influence of alcohol may also apply to sexual encounters. When comparing the sexual effects of alcohol between males and females, females reported greater sexual outgoingness than did males. Existing gender norms with regards to sexual activity often imply that women are less likely to express sexual desire than men. The effect of alcohol in social situations may decrease inhibitions and increase a woman’s comfort with expressing her sexual desires.

Sexual outgoingness was more commonly associated with use of ecstasy; however, ecstasy use was less likely to be reportedly used in comparison to alcohol or marijuana use. Due to a lower likelihood of reporting sexual encounters on ecstasy (which may also be dependent on prevalence and/or number of times used), ecstasy users reported the greatest sexual pleasure when compared to levels of sexual pleasure associated with use of alcohol or marijuana. These findings add to previous research regarding the association between substance use and sexual pleasure; specifically, that the use of ecstasy may increase feelings of sexual desire and engagement even though ecstasy use is more typically associated with sensuality rather than actual sexual intercourse. Thus, it is important to keep in mind that some participants may have been more aware of sensuality as a form of sexual interaction. Increased sexual desire was more associated with alcohol and ecstasy use than marijuana use for both men and women in this sample. Studies have found that ecstasy use is often associated with increased sexual desire as has alcohol use.

For men, sexual dysfunction was more often associated with alcohol and ecstasy use than with marijuana use. However, for women, sexual dysfunction was more often associated with marijuana and ecstasy use than with alcohol. Previous studies have found an association between erectile dysfunction and use of marijuana and ecstasy. Studies on female sexual dysfunction are often contradictory. For example, in contrast to our findings, a study on females who used ecstasy reported increased vaginal lubrication. Similarly, a study of sexual dysfunction among women found that alcohol use can increase the risk for vaginal dryness and painful sexual intercourse. Findings about sexual dysfunction among men and women who use substances should be interpreted carefully because sexual dysfunction is more easily recognised in men than women. Furthermore, arousal non-concordance (the difference between mental arousal and signs of physical arousal like vaginal wetness) is more common among women than men and is not inherently a marker of sexual dysfunction.

General body and sex-organ sensitivity were more commonly associated with ecstasy and marijuana use as compared to alcohol, which tends to numb the body and sex organs. This study adds to previous literature that reports an association between ecstasy use and increased physical sensitivity, marijuana use and increased physical sensitivity and decreased physical sensitivity on alcohol. When comparing associations regarding orgasm intensity, ecstasy use was more commonly associated with more intense orgasm than alcohol or marijuana. The literature about the effects of ecstasy on orgasm is currently inconclusive. Previous research has found an association between ecstasy use and increased orgasm intensity, yet other studies have found that ecstasy use is associated with greater difficulty in achieving orgasm. The findings of this study support previous research that marijuana use may inhibit the ability to achieve orgasm as does alcohol use.

Regret after sex was more commonly associated with alcohol use as compared to marijuana and ecstasy use. Previous studies indicate that regret after sex may be related to less attraction to partners after the encounter is over. Moreover, regret often occurs after having sex with partners that are not known very well. Alcohol use also has been reported to decrease social inhibitions that may lead individuals to engage in sexual encounters they would not usually engage in, and, thus, may lead to regret.

CONCLUSION

This study contributes to the growing body of research demonstrating that these substances may enhance sexual experiences, or increase the likelihood of engaging in such experiences. Enhanced experiences, or increased pleasure, coupled with fewer inhibitions, may result in condomless sex and other sexual risk behaviours. The extent to which participants used substances specifically to enhance their sexual experiences, that is – engage in chemsex, is unclear. Although typically described as a phenomenon in the gay community, chemsex also occurs among heterosexuals. Future epidemiological research is needed to determine whether and how specific sexual effects influence commonly studied outcomes such as condomless sex as this information can more adequately inform prevention (e.g. rather than common information such as that use of a given drug is associated with increased risk of unsafe sex).

Substance abuse and sexual education programmes should address harm reduction related to having sex while using psychoactive substances. These programmes may help inform substance users about the effects of these substances on sexual experiences. Similarly, sexual education programmes may expand the topics covered to include the effects of substance use on sexual decision-making. Harm reduction strategies for those having sex while using psychoactive substances may include helping people recognise the need to carry condoms and lube as well as developing strategies for partner selection and negotiating condom use while inebriated. This is especially important if an individual feels he or she is acquiring positive sexual effects from use of such substances. In addition, both substance and sexual education programmes should address reasons why individuals engage in these behaviours (i.e. the pleasure derived from substance use and sex). Pleasure is an important factor in the decision to use substances or engage in sexual activity yet these discussions are often excluded from health education.

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