How do they affect each other?

Drugs can affect sex in many ways, by both increasing or decreasing libido and sexual response and making sex more or less intense. They can also increase sexual risk-taking and change the way the body responds to sex.

Sometimes, the effects of drugs on sex change with time. Sex and sexuality are complex combinations of behavior and emotions — they both change physical states and rely on certain physical states.

For example, vaginal lubrication requires suitable hormone levels. These hormones may influence interest in sex, and the level of someone’s lubrication may affect their interest in sex.

Drugs that interfere with any stage of a person’s sexual response, including their thoughts and feelings, can affect sex. Often, the effects are unpredictable — a drug that had a positive effect one day might negatively affect sex over time.

Sex requires a coordination of hormones, neurotransmitters, physiological changes, thoughts, and emotions. Both prescription and recreational drugs can change many aspects of this process. For example, antipsychotic drugs can change hormone levels, especially in males, causing sexual issues.

In a 2018 study of 180 people with a substance use disorder, sexual side effects were common. Participants had various substance use disorders, such as alcohol, cannabis, cocaine, and opiate use disorder. People in all groups reported sexual side effects.

Some of the ways drugs may affect a person’s sex life include:

  • Libido: Drugs can alter a person’s libido. They may make someone want sex more often or less frequently. They could also have unpredictable effects on libido. This will depend on the person, the drug they are taking, and many other factors, such as drug dosage and frequency.
  • Physical arousal: Regardless of whether a person psychologically desires sex, drugs can affect physical arousal. For example, they can affect vaginal lubrication or lead to sexual dysfunction. One study even found that recreationally using an erectile dysfunction drug could cause a person to become dependent on the drug, leading to erectile dysfunction when they do not use it.
  • Orgasm and sexual pleasure: People often use drugs to increase pleasure and make it easier to orgasm during sex. However, some drugs may also make it more difficult to orgasm. Alcohol and opioids, for example, may delay ejaculation. A person may perceive this as positive or negative, depending on their sexual goals.
  • Sexual risk-taking: People may take more sexual risks when under the influence of alcohol or drugs. Some people may perceive this as positive when drugs decrease inhibitions or anxiety. However, in some cases, certain potentially harmful sexual behaviors can also lead to sexual assault, sexual abuse, and sexual practices that could lead to negative effects.

Drugs can make sex more or less pleasurable, and the specific effects of drugs on sex may change over time, especially if a person becomes dependent.

Drugs may also affect someone’s ability to remember sex, consent to sex, or communicate about sex.

As an individual becomes dependent on drugs for sex, they may find that their usual sexual feelings and behavior change. Some people may become dependent on drugs to enjoy sex or as a self-medication strategy for managing sexual problems.

This can lead to sexual dysfunction, even when a person no longer uses drugs. For example, someone who uses stimulants to manage erectile dysfunction may continue to experience this issue after they stop using. Generally, this will not resolve until they identify and treat any underlying causes.

Some drugs, such as opioids, may have long-term effects on sexual health. In 2016, the Food and Drug Administration (FDA) Warning that certain opioids may decrease sex hormone levels, leading to erectile dysfunction, missed periods, and infertility.

Mind-altering drugs, almost by definition, change a person’s ability to make decisions. Several studies suggest sexual assaults are more likely to occur in settings where either the victim or the perpetrator is consuming alcohol.

A 2021 study points to key ways that drugs can affect sexual decision-making, including:

  • Drugs may change a person’s sexual norms and expectations.
  • Drugs may make it more difficult to consent to sex or engage in conversations about consent.
  • Drugs can make it more difficult to communicate consent, both verbally and nonverbally.

The 2018 study of people with substance use disorders echoes these findings. Half of these individuals reported that drugs increased behavior that could have harmful effects. Users of gamma-hydroxybutyrate (GHB) reported both an increase in sexual pleasure and potentially dangerous behavior greater than that of other groups.

Any drug can be dangerous during sex, especially during sexual activities that could have harmful effects. They could also negatively affect people with serious medical conditions. There is no class of drugs that is always safe, nor a single class of drugs that is the most dangerous in every situation.

Some especially dangerous drugs include:

  • Poppers: Poppers are a group of drugs that some people use to enhance sex and make anal sex easier. They can cause sexual injuries and side effects such as low blood oxygen and death.
  • Date rape drugs: Some people use drugs to enhance their own pleasure, but others use drugs to reduce resistance and make sexual coercion easier. These so-called date rape drugs include substances such as Rohypnol and GHB. They may contribute to sexual assault and negative sexual experiences when a person cannot fully understand what is happening.
  • Stimulants: Stimulant drugs, such as methamphetamine, ADHD drugs, and cocaine, can cause heart health issues, including sudden cardiac death. In combination with intense sex, the risks may further increase. Stimulants may also increase aggressive behavior, elevating the risk of sexual assault.
  • Alcohol: Alcohol affects judgment and the ability to consent, but because it is such a common drug, users may not perceive it as a drug. Alcohol can affect sexual decision-making and may play a role in sexual assault.
  • Opioids: Opioids are the leading cause of drug overdose. This includes both illegal opioids such as heroin and prescription opioid painkillers. People who use opioids, especially those who take high doses, have a high probability of overdose. Opioids can also change behavior, making sexual consent difficult.

Anyone who uses a potentially addictive drug can develop a substance use disorder. The risk increases when a person uses a drug for recreational purposes or at a higher dose than a doctor recommends. Some signs of substance use disorders include:

  • continuing to use drugs or alcohol despite negative consequences
  • feeling physically or emotionally dependent on drugs or alcohol
  • not being able to quit using despite trying
  • experiencing physical withdrawal symptoms when a person attempts to quit use
  • using alcohol or drugs to feel normal
  • Needing progressively higher doses of alcohol or drugs to get the same high
  • Health, legal, relationship, educational, or other serious issues due to alcohol or drug use

Substance use disorders are a medical problem, not a moral or personal failure. A person with a substance use disorder needs a combination of medical treatment to manage withdrawal symptoms and psychological support to develop new coping skills and resist drug cravings.

An individual could find support from a doctor, support group, or mental health professional. Treatment may involve a combination of therapy, medical detox, medical care for any underlying conditions, lifestyle changes, and avoiding addictive substances.

In addition to treatment for substance misuse disorders, people who use drugs to have sex may also need treatment for sexual dysfunction. A doctor or mental health professional can help identify the underlying cause of the problem and improve a person’s sexual experience.

The effect of drugs on sex is unpredictable. A person may find sex more or less pleasurable, be more or less interested in sex, or find that the effects vary with time and dosage.

Recreational drugs are not a substitute for sexual communication and consent. They are also not a safe option for treating underlying sexual health issues. Numerous interventions can help with sexual dysfunction. Additionally, using drugs to self-medicate may delay treatment and increasing underlying sexual health issues.

Moreover, drugs are harmful when a person does not need them for a medical issue. Over time, recreational drug use can lead to substance use disorder, health issues, and even overdose and death.

A person can speak with a medical professional for help with sexual health issues or for support to overcome addiction.

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