Ecstasy and Sex
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.
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"
Studies finding increases in arousal or sexual activity:
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.
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."
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."
Studies finding decreases in arousal or sexual activity
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'."
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."
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"
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."
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
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".
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].
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.
[i] Green AR, Cross AJ, Goodwin GM  Review of the pharmacology and clinical pharmacology of 3,4-methylenedioxymethamphetamine (MDMA or "Ecstasy"). Psychopharmacology (Berl) 119(3):247-60
[ii] Smith KM, Larive LL, Romanelli F. Club drugs: methylenedioxymethamphetamine, flunitrazepam, ketamine hydrochloride, and gamma-hydroxybutyrate. Am J Health Syst Pharm 59(11):1067-76
[iii] Ho E, Karimi-Tabesh L, Koren G.  Characteristics of pregnant women who use ecstasy (3, 4-methylenedioxymethamphetamine). Neurotoxicol Teratol 23(6):561-7
[iv] Strote J, Lee JE, Wechsler H.  Increasing MDMA use among college students: results of a national survey. J Adolesc Health 30(1):64-72
[v] Kalant H. The pharmacology and toxicology of "ecstasy" (MDMA) and related drugs. CMAJ 165(7):917-28
[vi] Buffum J, Moser C.  MDMA and human sexual function. J Psychoactive Drugs 18(4):355-9
[vii] Winstock A [1990?] Unpublished Survey - Hammersmith Hospital Royal Postgraduate Medical School Cited Saunders  op cit
[viii] Sullum J  Sex, Drugs, and Techno Music - Why the rap against Ecstasy has a familiar ring to it. Reason January 2002 - http://reason.com/0201/fe.js.sex.shtml
[ix] Klitzman RL, Greenberg JD, Pollack LM, Dolezal C.  MDMA ('ecstasy') use, and its association with high risk behaviors, mental health, and other factors among gay/bisexual men in New York City. Drug Alcohol Depend 66(2):115-25
[x] Klitzman RL, Pope HG Jr, Hudson JI. MDMA ("Ecstasy") abuse and high-risk sexual behaviors among 169 gay and bisexual men. Am J Psychiatry 157(7):1162-4
[xi] Colfax GN, Mansergh G, Guzman R, Vittinghoff E, Marks G, Rader M, Buchbinder S.  Drug use and sexual risk behavior among gay and bisexual men who attend circuit parties: a venue-based comparison. J Acquir Immune Defic Syndr 28(4):373-9
[xii] Mattison AM, Ross MW, Wolfson T, Franklin D  Circuit party attendance, club drug use, and unsafe sex in gay men. J Subst Abuse 2001;13(1-2):119-26
[xiii] Waldo CR, McFarland W, Katz MH, MacKellar D, Valleroy LA. Very young gay and bisexual men are at risk for HIV infection: the San Francisco Bay Area Young Men's Survey II.J Acquir Immune Defic Syndr 24(2):168-74
[xiv] Bilsky EJ, Hubbell CL, Delconte JD, Reid LD.  MDMA produces a conditioned place preference and elicits ejaculation in male rats: a modulatory role for the endogenous opioids. Pharmacol Biochem Behav 40(2):443-7
[xv] Dornan WA, Katz JL, Ricaurte GA.  The effects of repeated administration of MDMA on the expression of sexual behavior in the male rat. Pharmacol Biochem Behav 1991 Jul;39(3):813-6
[xvi] Rajamani K, Leong S, Lavelle A, Docherty JR.  Prejunctional actions of methylenedioxymethamphetamine in vas deferens from wild-type and alpha(2A/D)-adrenoceptor knockout mice. Eur J Pharmacol 423(2-3):223-8
[xvii] Parrott AC.  Recreational Ecstasy/MDMA, the serotonin syndrome, and serotonergic neurotoxicity. Pharmacol Biochem Behav 71(4):837-44
[xviii] Parrott AC, Milani RM, Parmar R, Turner JD.  Recreational ecstasy/MDMA and other drug users from the UK and Italy: psychiatric symptoms and psychobiological problems. Psychopharmacology (Berl) 159(1):77-82
[xix] Zemishlany Z, Aizenberg D, Weizman A.  Subjective effects of MDMA ('Ecstasy') on human sexual function. Eur Psychiatry 16(2):127-30
[xx] Odwyer T  The Phenomenology of Ecstasy Use, St Thomas' Hospital, Morpeth/Leeds Addiction Unit
[xxi] Henderson S  Women, sexuality and Ecstasy Use - The Final Report 1993, Lifeline Publications, 101 Oldham St Manchester M4 1LW
[xxii] Saunders N  Ecstasy Reconsidered ISBN 0 9530065 0 6
[xxiii] Beck J & Rosenbaum M  The Pursuit of Ecstasy · the MDMA Experience. Albany, NY: State University of New York Press
[xxiv] Solowij N, Hall W, Lee N.  Recreational MDMA use in Sydney: a profile of 'Ecstacy' users and their experiences with the drug. Br J Addict 87(8):1161-72
[xxv] Labbate LA, Grimes JB, Arana GW (1998) Serotonin reuptake antidepressant effects on sexual function in patients with anxiety disorders. Biol Psychiatry. 43(12): 904-907.
[xxvi] Labbate LA, Grimes J, Hines A, Oleshansky MA, Arana GW (1998) Sexual dysfunction induced by serotonin reuptake antidepressants. J Sex Marital Ther 24(1):3-12
[xxvii] Labbate LA, Grimes JB, Hines A, Pollack MH. (1997) Bupropion treatment of serotonin reuptake antidepressant-associated sexual dysfunction. Ann Clin Psychiatry. 9(4): 241-245.
[xxviii] Zajecka J, Mitchell S, Fawcett J (1997) Treatment-emergent changes in sexual function with selective serotonin reuptake inhibitors as measured with the Rush Sexual Inventory. Psychopharmacol Bull 33(4):755-760
[xxix] Modell JG, Katholi CR, Modell JD, DePalma RL (1997) Comparative sexual side effects of bupropion, fluoxetine, paroxetine, and sertraline. Clin Pharmacol Ther 61(4):476-487
[xxx] Montejo-Gonzalez AL, Llorca G, Izquierdo JA, Ledesma A, Bousono M, Calcedo A, Carrasco JL, Ciudad J, Daniel E, De la Gandara J, Derecho J, Franco M, Gomez MJ, Macias JA, Martin T, Perez V, Sanchez JM, Sanchez S, Vicens E (1997) SSRI-induced sexual dysfunction: fluoxetine, paroxetine, sertraline, and fluvoxamine in a prospective, multicenter, and descriptive clinical study of 344 patients. J Sex Marital Ther. 23(3): 176-194.
[xxxi] Montejo AI, Llorca G, Izquierdo JA, Ledesma A, Bousono M, Calcedo A, Carrasco JL, Daniel E, de Dios A, de la Gandara J, Derecho J, Franco M, Gomez MJ, Macias JA, Martin T, Perez V, Sanchez JM, Sanchez S, Vicens E (1996) [Sexual dysfunction secondary to SSRIs. A comparative analysis in 308 patients] Actas Luso Esp Neurol Psiquiatr Cienc Afines 24(6):311-321
[xxxii] Rothschild AJ. (1995) Selective serotonin reuptake inhibitor-induced sexual dysfunction: efficacy of a drug holiday. Am J Psychiatry. 152(10): 1514-1516.
[xxxiii] Shen WW, Hsu JH (1995) Female sexual side effects associated with selective serotonin reuptake inhibitors: a descriptive clinical study of 33 patients. Int J Psychiatry Med 25(3):239-248
[xxxiv] Clayton AH, Owens JE, McGarvey EL (1995) Assessment of paroxetine-induced sexual dysfunction using the Changes in Sexual Functioning Questionnaire. Psychopharmacol Bull 31(2):397-413
[xxxv] Stewart JT, Shin KJ (1997) Paroxetine treatment of sexual disinhibition in dementia. Am J Psychiatry 154(10):1474
[xxxvi] Opinion (1998) The Examiner (Ireland) 5-10-98
[xxxvii] MacHale S, et al. (1994) SSRIs to treat sexual dysfunction. Br J Psychiatry. 164(6): 854
[xxxviii] Waldinger MD, Hengeveld MW, Zwinderman AH (1997) Ejaculation-retarding properties of paroxetine in patients with primary premature ejaculation: a double-blind, randomized, dose-response study. Br J Urol 79(4):592-595
[xxxix] Giammusso B, Morgia G, Spampinato A, Motta M (1997) [Paroxetine in the treatment of premature ejaculation]. [Article in Italian] Arch Ital Urol Androl 69(1):11-13
[xl] Isaksen PM (1995) [The effect of an antidepressive agent on premature ejaculation].[Article in Norwegian] Tidsskr Nor Laegeforen 115(13):1616-1617
[xli] Ludovico GM, Corvasce A, Pagliarulo G, Cirillo-Marucco E, Marano A, Pagliarulo A (1996) Paroxetine in the treatment of premature ejaculation. Br J Urol 77(6):881-882
[xlii] Balon R (1996) Antidepressants in the treatment of premature ejaculation. J Sex Marital Ther 22(2):85-96
[xliii] Ferini-Strambi L, Oldani A, Zucconi M, Castronovo V, Montorsi F, Rigatti P, Smirne S (1996) Sleep-related painful erections: clinical and polysomnographic features. J Sleep Res 5(3):195-197
[xliv] Bertholon F, Krajewski Y, el Allali A (1996) [Adverse effects: priapism caused by paroxetine].[Article in French] Ann Med Psychol (Paris) 154(2):145-146
[xlv] Hunter KD, Wilson WS (1995) The effects of antidepressant drugs on salivary flow and content of sodium and potassium ions in human parotid saliva. Arch Oral Biol 40(11):983-989