Dr. David Fawcett
In men, alcohol is by far the most commonly consumed substance in conjunction with sexual behavior. This might be surprising based on how alcohol impacts sex. For starters, it creates sexual dysfunction by inhibiting orgasms, impeding erections, and generally creating a lack of behavior control that can disrupt sexual activity. Where alcohol excels, however, is with its power to disinhibit. Fear, shame, body dysmorphia, and any other worry that could undermine sex can be soothed with alcohol. “Chemical courage” is an old expression that accurately conveys this notion.
Consuming relatively small amounts of alcohol, one or two drinks at most, tends to increase sexual desire and physical sexual arousal in males. This may be linked to a decrease in sexual inhibitions, or it may be something of a self-fulfilling prophecy where males expect to be sexual in drinking settings and act accordingly. Probably it’s a bit of both.
Consumption of higher levels of alcohol can decrease sexual desire, sexual arousal, sexual performance, and sexual pleasure. This is caused, at least in part, by the metabolism of alcohol, which affects enzymes such as NAD+,[i] an enzyme that is necessary for the production of testosterone—a critical element of male sexual desire and performance.
In addition to issues with NAD+ and testosterone, alcohol has the following effects for men:
- It decreases blood flow to extremities, including the genitals.
- It depresses the central nervous system.
Those two effects can impact a male’s ability to achieve and maintain an erection and to reach and enjoy orgasm.
Many heavy drinkers—daily drinkers, binge drinkers, and alcoholics—suffer from erectile dysfunction (ED). Based on this, many people theorize that there is a direct link between heavy drinking and ED, although research is somewhat inconclusive on this front.[ii] What is clearer is the impact that alcohol has on a male’s ability to achieve and enjoy orgasm. Alcohol consumption beyond one or two drinks can lead to delayed ejaculation and, at times, a complete inability to reach orgasm.[iii]
Stimulant drugs are the next most common substances used by men in conjunction with sex. These include methamphetamine, cocaine, MDMA, caffeine, nicotine, and prescription medications like Adderall, Ritalin, and Vyvanse. Of these substances, meth is the drug that is most commonly used and abused in conjunction with sex, with cocaine next on the list.
Because chronic sex addiction, pornography addiction, and sexualized drug use all create tolerance, which can degrade sexual functioning, many men also turn to ED medications for help. Basically, paired substance and sex addictions reset patterns of arousal, and the baseline level of intensity and stimulation required to create the psychological and physiological responses that result in an erection increases dramatically. Additionally, stimulant drugs such as cocaine and methamphetamine constrict blood vessels which, in turn, impairs a man’s ability to achieve and maintain an erection. Drugs such as sildenafil citrate (Viagra), tadalafil (Cialis), vardenafil hydrochloride (Levitra), and alprostadil (Caverject, MUSE: Medicated Urethral System for Erection) are commonly used by men driven by sexual desire yet unable to perform.
With paired drug use and sex, ED medications can lead to high-risk sexual behavior. In one study,[iv] users combining meth and sildenafil were six and a half times more likely to report anal intercourse without a condom, significantly increasing the risk of transmitting HIV. The chance of acquiring other sexually transmitted infections also increased when meth and erectile dysfunction drugs were combined.
Opioids are also, though infrequently, used by men for sexual activity. In men, opioids have an inhibitory effect on essential hormones such as luteinizing hormone (LH) and testosterone,[v] which can, in turn, lower endorphin levels. This can result in loss of libido, erectile dysfunction, and an inability to reach orgasm.
Opioid use can also result in opioid-induced androgen deficiency (OPIAD). OPIAD symptoms can include fatigue, a sense of reduced vitality, weight gain, and depressed mood—all of which can impact the desire for and ability to have sex. Persons experiencing these symptoms should have a full hormonal workup to establish any opioid-induced biochemical irregularities.
The opposite issues occur during withdrawal from opioids, which is known to result in morning erections, spontaneous ejaculation, and, eventually, a return to normal libido. Such effects can also result from the use of opioid antagonist drugs such as naloxone.
REFERENCES
[i] Frias, J., Torres, J. M., Miranda, M. T., Ruiz, E., & Ortega, E. (2002). Effects of acute alcohol intoxication on pituitary–gonadal axis hormones, pituitary–adrenal axis hormones, β-endorphin and prolactin in human adults of both sexes. Alcohol and Alcoholism, 37(2), 169-173; Mendelson, J. H., Ellingboe, J., Mello, N. K., & Kuehnle, J. (1978). Effects of alcohol on plasma testosterone and luteinizing hormone levels. Alcoholism: Clinical and Experimental Research, 2(3), 255-258; and (among other studies) Mendelson, J. H., Mello, N. K., & Ellingboe, J. (1977). Effects of acute alcohol intake on pituitary-gonadal hormones in normal human males. Journal of Pharmacology and Experimental Therapeutics, 202(3), 676-682.
[ii] Cheng, J. Y. W., Ng, E. M. L., Chen, R. Y. L., & Ko, J. S. N. (2007). Alcohol consumption and erectile dysfunction: meta-analysis of population-based studies. International Journal of Impotence Research, 19(4), 343-352.
[iii] Farkas, G. M., & Rosen, R. C. (1976). Effect of alcohol on elicited male sexual response. Journal of Studies on Alcohol, 37(3), 265-272.
[iv] Mansergh, G., Shouse, R. L., & Marks, G. (2004, March). Crystal use, Viagra use, and specific sexual risk behaviors of men who have sex with men (MSM) during a recent anal sex encounter. Oral presentation. In 2004 National STD Prevention Conference, Philadelphia. Philadelphia, USA.
[v] Vuong, C., Van Uum, S. H., O’Dell, L. E., Lutfy, K., & Friedman, T. C. (2010). The effects of opioids and opioid analogs on animal and human endocrine systems. Endocrine reviews, 31(1), 98-132.
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