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Sexual Arousal

Cannabis has been investigated to see if it can improve sexual arousal in both men and women, and how its use is associated with sexual arousability and sexual behavior in men and women, despite it not being a sexual stimulant by itself. 1, 2, 3 Sexual arousal has been reported as an increase in sexual desire, sexual thoughts, and an increase in pleasure and satisfaction.2 Researchers found that at lower doses, cannabis had a positive effect on sexual arousal and satisfaction during sex, but at higher doses, it actually inhibited desire and performance as reported by healthy volunteers (age 17-29) using a questionnaire.3 At the same time, the researchers conclude: “It seems conclusive now that the drug itself is not a sexual stimulant. However, one cannot separate the drug from its surroundings. The social conditions of marijuana use make it act as an aphrodisiac.” Unfortunately, most of the studies are observational {call-out, text:A type of study in which a sample population is observed instead of being subjected to intervention} and are not prospective {call-out, text:A type of trial in which the variables are determined and controlled for in advance} trials. Therefore, the causality associated with cannabis and arousal can’t be definitively determined.3 Androvicova reported in a literature review that 70% of users reported subjectively improved sexual satisfaction and pleasure in both sexes.1 While (the social conditions of) cannabis may increase sexual arousal, there are physiological negative effects. Cohen reported that in daily cannabis users there was a higher prevalence of erectile dysfunction in users (19%) as compared to controls (8%).4 Although there is no scientific evidence for a biologic positive association between cannabis and arousal, one could see the increased association with arousal at low doses and the negative effect on erectile function with protracted use.5 3 The way that biological effects like these are typically explained is via a U-shaped curve, or an inverted U-shaped curve, where there is an effect (e.g. in this case, a benefit) at a low dosage, but as the dose and/or dosing frequency is increased, different (e.g. negative) effects appear. A visualization and further explanation of the (Inverted) U-Shaped Curve is shown in the illustration below.

Sexual Frequency

In the population of men and women aged 15-44 years old in the United States from the National Survey of Family Growth, the use of cannabis was associated with an increase in sex frequency in both men and women.6 It should be noted that cannabis users, in general, may be more open (less inhibited) about sexual relations and that could confound the results in that their personality is less inhibited to cannabis use and sexual relations. There is not a lot of evidence, but it is postulated that the increased satisfaction and frequency in sexual experience may be associated with general relaxation seen with cannabis.7, 8

Mechanism of Action

Arousal and sexual frequency – The exact mechanism of how cannabis effects human sexual arousal and sexual frequency are unknown. Animal studies do not correlate with human data insofar that in animals (rats and mice) cannabis has an inhibitory effect on sexual arousal and frequency.2 This difference could be the result of higher brain functioning in humans, and that human sexuality has evolved beyond copulation for procreation, whereas higher brain functioning is involved with human mating rituals. It has been postulated that cannabis might lower some of the natural inhibitions society has placed on casual sex, and by lowering these inhibitions, a human may become more aroused and may have sex more frequently. Erectile dysfunction – A possible reason that high dose/frequency of cannabis could cause erectile dysfunction is that cannabis interacts with the endocannabinoid system resulting in disruption of testosterone homeostasis, by interacting with the CB1 receptor.2, 9 This in turn disrupts the nitric oxide signaling in the endothelium of the penis {call-out, text:The vascular endothelium is a layer of cells that line the vasculature, veins, and arteries. Nitric oxide modulates and regulates the endothelium and when the nitric oxide signaling is disrupted in the endothelium of the penis, it can lead to erectile dysfunction}, thereby causing erectile dysfunction.2, 10 Illustration: Inverted U-Shaped Dose-Effect Curve – The way that biological effects like these are typically explained, is via a U-shaped curve, or an inverted U-shaped curve, where there is an effect (e.g. in this case, a benefit) at a low dosage, but as the dose and/or dosing frequency is increased, different (e.g. negative) effects appear. In the example above, the “Y”-axis represents the effect (from a strongly negative effect at the bottom, to strongly positive at the top) and the “X”-axis is the dose (from a low dose on the left to a high dose on the right). The green area represents a positive effect, the yellow area represents the zone where the effect is too low to be noticeable, and the red area represents a negative effect. As you start out with a low dose, you need to increase the dose until the drug starts to have a positive effect. Once you reach a certain threshold the effect size starts to decline and at some point, the effect becomes negative. In our example, if the “effect” is sexual arousal/performance: we see that at a very low dose there is no effect, but then we reach a dose that might improve sexual arousal or performance. However, if the dose is too high or taken to often we actually see that there is a deleterious effect on sexual arousal or performance, manifested as a potential general apathy in both sexes and erectile dysfunction in males. References:
  1. Androvicova, Renata; Horacek, Jiri; Stark, Tibor; Drago, Filippo; Micale, Vincenzo (2017). Endocannabinoid system in sexual motivational processes: Is it a novel therapeutic horizon?. Pharmacological Research, 115, 200--208.
  2. Gorzalka, Boris B.; Hill, Matthew N.; Chang, Sabrina C. H. (2010). Male–female differences in the effects of cannabinoids on sexual behavior and gonadal hormone function. Hormones and Behavior, 58(1), 91--99.
  3. Koff, Wayne C. (1974). Marijuana and sexual activity. The Journal of Sex Research, 10(3), 194--204.
  4. Cohen, Sidney (1982). Cannabis and sex: multifaceted paradoxes. Journal of Psychoactive Drugs, 14(1-2), 55--58.
  5. Abel, E. L. (1981). Marihuana and sex: a critical survey. Drug and alcohol dependence, 8(1), 1--22.
  6. Sun, Andrew J.; Eisenberg, Michael L. (2017). Association Between Marijuana Use and Sexual Frequency in the United States: A Population-Based Study. The Journal of Sexual Medicine, 14(11), 1342--1347.
  7. Dawley, H. H.; Winstead, D. K.; Baxter, A. S.; Gay, J. R. (1979). An attitude survey of the effects of marijuana on sexual enjoyment. Journal of clinical psychology, 35(1), 212--7.
  8. McKay, A. (2005). Sexuality and substance use: the impact of tobacco, alcohol, and selected recreational drugs on sexual function. The Canadian Journal of Human Sexuality, 14(1/2)(1/2), 47--56.
  9. Barnett, Gene; Chiang, Chia-Whei N.; Licko, Vojtech (1983). Effects of marijuana on testosterone in male subjects. Journal of Theoretical Biology, 104(4), 685--692.
  10. Aversa, Antonio; Caprio, Massimiliano; Rosano, Giuseppe M. C.; Spera, Giovanni (2008). Endothelial effects of drugs designed to treat erectile dysfunction. Current pharmaceutical design, 14(35), 3768--78.