Marijuana’s unexpected effects on sex

By Naveed Saleh, MD, MS
Published February 3, 2021

Key Takeaways

The legalization and widespread popularization of marijuana has been followed by countless purported health and wellness benefits. Ads on the internet, for instance, claim that marijuana products boost libido, arousal, and orgasm. In reality, limited research has been done on the subject. 

Endocannabinoids do play a role in sexual function, however, with the cannabinoid receptor mapped to several brain areas involved in sexual function, according to a cross-sectional study published in Sexual Medicine. Both cannabinoids and endocannabinoids interact with hormones and neurotransmitters that mediate sexual behavior. 

Let’s take a look at what evidence exists on the relationship between sexual function and marijuana use. Intriguingly, the drug may have disparate sexual effects in men compared with women.

Sexual frequency

In a population-based study published in the Journal of Sexual Medicine, researchers examined the relationship between marijuana use and sexual frequency. Based on the results of a survey, they found that after adjustment for covariates, male and female marijuana users had more monthly and daily sex compared with those who never used. Moreover, they noted a trend indicating that higher levels of marijuana use was linked to increased coital frequency.

“Marijuana use is independently associated with increased sexual frequency and does not appear to impair sexual function,” they concluded.

Sexual function in women

Researchers in the aforementioned Sexual Medicine study surveyed levels of satisfaction in women with regard to drive, orgasm, lubrication, dyspareunia, and overall sexual experience, as well as the frequency of marijuana use on satisfaction. 

In total, 34% of 373 participants surveyed reported using marijuana before sex, with most noting increases in sex drive, improved orgasm, and decreased pain. No change in lubrication, however, was noted. After controlling for race, those using marijuana before sex had a 2.13 higher odds of reporting a satisfactory orgasm compared with abstainers. 

In other results, those who used marijuana frequently had a 2.10 times higher rate of reporting satisfactory orgasms compared with infrequent users, after adjusting for race and age.

These results held regardless of whether marijuana was used before sex.

The authors highlighted that the effects of marijuana on sex in women is influenced by multiple mechanisms. For instance, marijuana and the hypothalamic-pituitary-gonadal axis, which regulates sex hormones, interact with each other. Furthermore, there are cannabinoid receptors in the hypothalamus that control gonadotropin-releasing hormone and oxytocin release, both of which contribute to normal sexual functioning in yet unrealized ways.

“The question of how marijuana leads to these positive changes in sexual function is unknown. It has been postulated that it leads to improvement in sexual function simply by lowering stress and anxiety,” the authors wrote. 

“It may slow the temporal perception of time and prolong the feelings of pleasurable sensations. It may lower sexual inhibitions and increase confidence and a willingness to experiment. Marijuana is also known to heighten sensations such as touch, smell, sight, taste, and hearing,” they added. “[T]he regular female marijuana user reported a heightened sensation of touch and increased physical closeness when using marijuana before sex.”

Sexual function in men

What’s good for the goose may be bad for the gander. Specifically, marijuana use may cause erectile dysfunction in men. Of note, erectile dysfunction is the most frequent male sexual disorder.

In a systematic review published in the American Journal of Men’s Health, which spanned five case-control studies including 3,395 healthy men (1,035 cannabis users), the overall prevalence of erectile dysfunction was 69.1% vs 34.7% in the control group. Furthermore, the odds ratio of erectile dysfunction in marijuana users was nearly four times that of control. Put another way, the rates of erectile dysfunction in male users is nearly twice that of those who abstain from the drug.

The link between erectile dysfunction and cannabis use is likely a mix of organic and psychological factors, according to the authors. 

“One of the possible mechanisms is attributed to the endocannabinoid system through the binding of receptors in the paraventricular nucleus of the hypothalamus which regulates erectile function and sexual behavior of males,” the authors wrote. “This mechanism could also explain why cannabis can improve sexual function in some patients affected by conditions or symptoms such as depression, anxiety disorder and pain. Growing evidence, both in animal and human studies, reported a peripheral effect of cannabis on ED [erectile dysfunction], specifically on corpus cavernosum where cannabinoid receptors are present.”

Bottom line

Although emerging research suggests that marijuana use may enhance sexual function in women, the contrary may be true in men, with erectile dysfunction an issue among users. Nonetheless, much more research needs to be done to elucidate causality.

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