Public health officials often focus on the known physical and mental health consequences of substance use, while neglecting to discuss its impact on sexual health. Substances can affect sexuality in a number of ways, depending on the type of substance, amount used, and situational contexts. Abusing alcohol and other drugs can lead to decreased libido, erectile dysfunction, trouble achieving orgasm, and increased high-risk sexual behaviors, which will be discussed in this article. [1][2][3]
- Substance use and sexuality are linked in a number of complex ways, and chronic use of drugs and alcohol can have a negative effect on sexual health and functioning
- Lowered sex drive, performance issues, and trouble achieving orgasm are all possible negative impacts of drugs and alcohol on sexuality
- People with substance use problems are more likely to engage in risky sexual behaviors that increase the likelihood of sexually transmitted infections (STIs), unintended pregnancies, and sexual assault
How alcohol and drug use affects your sex life
The use of alcohol and other drugs can affect your sex life in a number of ways. In the short term, many people report that the use of alcohol and drugs increases their sexual drive and enhances sexual experiences. For example, drugs like marijuana or stimulants can make sex feel more pleasurable or seem to enhance performance in the short term. CNS depressants, including alcohol, opioids, and benzodiazepines, can temporarily reduce inhibitions, anxiety, and insecurities, which may also be experienced as a desirable effect.[1][2]
For these reasons, about half of people with substance use disorders reported using drugs or alcohol to enhance sexual experiences. This can present added challenges to the addiction recovery process, as 25% of those in recovery report that they associate drug or alcohol use with sexual thoughts, feelings, and behaviors. For these reasons, sexual thoughts and feelings can be a trigger for people in recovery, even causing drug cravings in some individuals. [2]
While there can be some positive effects on sexuality in the short term, most chronic and problem users of drugs and alcohol describe negative effects and consequences on their sex lives. The specific negative effects vary depending on the type and amount of substance being used, but may include problems like erectile dysfunction, lowered libido, and difficulty achieving an orgasm. [1][2][4] These negative effects often outweigh any perceived benefits of drug and alcohol use, particularly in people who struggle with a substance use disorder. In addition, sexual concerns can have a ripple effect that impacts other aspects of a person’s relationship, such as the ability to experience intimacy, communicate, and spend quality time with romantic partners. Substance use disorders are diagnosed when the use of drugs or alcohol becomes uncontrolled, problematic, and negatively affects important parts of a person’s life or ability to function. [2]
Many drugs, including alcohol, lower inhibitions and cause people to behave in ways that are more impulsive. For example, people who abuse drugs and alcohol are also significantly more likely to engage in risky sexual behaviors, including having multiple partners, unprotected sex, and exchanging sex for money or substances. These high-risk behaviors significantly increase the likelihood of STIs, unwanted pregnancies, nonconsensual sex, and sexual assault or exploitation. [2][3]
Effects of different substances on sexual functioning
While drugs and alcohol affect everyone a little differently, there are some general trends that can help people understand how specific substances are likely to impact sexuality. Some of the effects on sexuality depend not only on the substance being used, but also on the amount and frequency of use. Generally, more positive effects on sexual functioning are seen in lower doses and with occasional use. With heavy or chronic use, the impacts on sexual functioning are almost always reported as being negative and problematic in nature. [1][2]
Here are some of the ways that sexual functioning can be affected by different substances: [1][2][3][4]
Alcohol
- Weaker erections, often leading to difficulty maintaining an erection.
- Increased erectile dysfunction.
- Difficulty ejaculating.
- Lowered arousal.
- Difficulty achieving orgasm.
- Reduced vaginal lubrication.
- Disruptions to the menstrual cycle.
- Lowered sexual responsiveness with chronic or heavy use.
Marijuana
- Increased arousal and desire.
- Enhanced pleasure during sexual experiences.
- Decreased testosterone in chronic users.
- Increased erectile dysfunction.
- Increased sexual anxiety or insecurity.
- Potential changes in libido with long-term use.
Opioids
- Delayed ejaculation.
- Reduced sexual desire.
- Difficulty achieving orgasm.
- Hormonal imbalances.
- Increased risk for erectile dysfunction.
- Increased risk of infertility due to concerns such as low ovarian function and potentially even early onset of menopause.
- Increased risk of hypogonadism in males.
- Lowered libido.
Stimulants
- Temporary increases in libido and arousal.
- Temporary improvements in sexual performance & satisfaction.
- Chronic use leads to decreased libido and desire/arousal.
- Trouble achieving orgasm or delayed ejaculation.
- Increased erectile dysfunction.
Sedatives & benzodiazepines
- Decreased libido, sexual interest, and desire.
- Increased erectile dysfunction.
- Increased sexual dysfunction.
- Difficulty achieving orgasm.
- Sedation that may interfere with arousal or sexual responsiveness.
In addition to these physiological and functional effects, substances can also impair judgment, lower inhibitions, and increase impulsivity, which may contribute to risky sexual decisions, including unprotected sex, multiple partners, or situations involving compromised consent. These behavioral risks are important but distinct from the direct effects substances can have on sexual functioning.
Drug and alcohol use: Effects on decisions and risk-taking
Many mind and mood-altering substances lower their ability to regulate impulses and emotions and make good decisions because of impaired executive functioning. These impairments can affect the choices and decisions a person makes when they are under the influence of drugs or alcohol, leading to risky or impulsive choices. [3]
Reduced inhibitions
When people consume drugs or alcohol, they may experience a temporary lowering of their inhibitions. In small doses, this can result in feeling calmer and more relaxed, but in higher amounts can lead to making decisions that are unwise or even dangerous. For example, research suggests that people who drink heavily often report having sex while intoxicated, rather than people who consume alcohol in lower or more moderate amounts. [3]
Similarly, alcohol and other CNS depressants like opioids and benzodiazepines can lower inhibitions and anxiety in small doses, but become more sedating and impairing in higher amounts. [1][2] When a person consumes too much, they may become unable to consent to sex because they are too sedated, confused, or impaired.
Risky sex
Risky sex is defined as sex that carries a higher likelihood of sexually transmitted infections, unintended pregnancies, or sexual assaults. When people consume drugs and alcohol, they can experience a range of impairments to their executive functioning, making them less able to make smart choices for themselves. [2][3]
At the extreme, this can lead to people engaging in high-risk sexual behaviors like having sex with multiple partners, unprotected sex, or engaging in the exchange of sex for drugs or money. Research suggests that a significant correlation exists between substance use disorders and risky sexual behaviors. [3]
Problem sexual behaviors
A growing number of people describe struggling with problematic sexual behaviors and feeling as though they struggle with sexual addiction. While sexual addiction (clinically known as compulsive sexual behavior) is not currently listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), the experiences of people who struggle with problem sexual behaviors closely match the experiences of those struggling with substance addictions. [5]
Research suggests that there may be a link between problematic sexual behaviors and other forms of addiction, with overlapping risk factors. In the coming years, it is possible that compulsive sexual behaviors will be recognized as diagnosable forms of addiction, similar to drug and alcohol use disorders. [5]
Drug use to enhance sex
According to some studies, about half of people who abuse substances report that they have relied on drugs or alcohol to enhance their sexual experiences. The same study reported that 25% of individuals with substance use disorders reported that they associate drug use with sexual thoughts, feelings, and behaviors. [2] This can present challenges for people trying to recover and overcome an addiction to drugs and alcohol, since sexual thoughts and feelings can trigger cravings in some individuals.
What is chemsex and why is it risky?
Chemsex describes a trend of gay or bisexual men having sex with other men while under the influence of illicit substances like amphetamines, opioids, gamma-hydroxybutyric acid (GHB), gammabutyrolactone (GBL), and other drugs. [6] While chemsex can feel more exciting or pleasurable than having sex while sober, it carries many potential risks. Depending on the level of impairment, people who have taken drugs or alcohol may not be able to consent to sex, increasing the likelihood of nonconsensual sex and sexual assault.
Because of the way drugs can affect impulsivity, risk-taking, and decision-making, people engaging in chemsex may take fewer precautions when approaching sexual encounters. Multiple partners, group sex, and unprotected sex may be more common practices among people who engage in sex while under the influence of drugs. [2][3][6]
How addiction can impact your sex life
When substance use escalates into a substance use disorder, it means the person has lost control and become dependent on drugs or alcohol. Addiction has several negative impacts on physical and mental health, as well as other important areas of life like personal relationships, work, and sexuality. [1]
Here are some of the ways drug or alcohol addiction can affect your sex life:
- Increased conflicts, reduced trust, and intimacy within relationships.
- Lowered libido, sexual interest, or arousal.
- Increased risk of impulsive or risky sexual choices.
- Increased sexual dysfunction, including erectile dysfunction or inability to orgasm.
- Impaired sexual performance.
- Increased risk of nonconsensual sex and sexual assault.
Signs of a substance use disorder
In some cases, sexual problems and dysfunctions are part of a larger set of symptoms that suggest a person is struggling with a substance use disorder. Knowing the signs and symptoms of a substance use disorder can aid in recognition, intervention, and interruption of the progression of an addiction disorder. [1]
Here are the signs and symptoms of a substance use disorder: [7]
- Using more than intended.
- Significant time spent obtaining, using, or recovering from use.
- Inability to control use, cut back, moderate, or stop using.
- Reduced interest or engagement in social and recreational activities.
- Strong cravings, desires, or urges to use that are increasingly difficult to ignore and often get in the way of school, work, or social functioning.
- Physical health problems resulting from use, which vary based on the particular substance used, but may include liver disease, heart disease, stroke, cancer, lung disease, and forms of hepatitis.
- Mental health problems (such as depression and anxiety) resulting from use.
- Problems in work or school resulting from use.
- Using it in situations where it is risky or potentially unsafe to do so.
- Development of tolerance (needing increased amounts for the same effects).
- Physical or psychological withdrawal symptoms when stopping or cutting back.
According to the DSM-5, a person who exhibits 2-3 of the above symptoms is struggling with a mild substance use disorder. Exhibiting 4-5 of the above symptoms suggests a moderate substance use disorder, and 6 or more suggest a severe substance use disorder. [7] A diagnosis of a substance use disorder can only be given during a formal evaluation with a licensed medical or mental health professional.
Safety and precautionary steps
The sexual risks and consequences of substance abuse can often be prevented or reduced by taking the following precautions:
- Do not use drugs or alcohol frequently or in excess.
- Do not engage in sex if you are impaired by drugs or alcohol.
- Do not engage in sex with someone who is impaired by drugs or alcohol.
- Do not accept drinks or drugs from strangers.
- Monitor your sexual health and functioning for the negative impacts of drugs or alcohol.
- Seek professional consultation or treatment for concerns about problem drug or alcohol use.
Final thoughts
Substance use can affect sexual health and functioning in a number of complex ways. While many people report using drugs or alcohol to reduce anxiety or enhance pleasure during sexual experiences, chronic and frequent substance use is more likely to have negative effects on your sex life. Lowered libido, sexual dysfunction, and trouble achieving an orgasm are some of the more common negative ways substances can impact sexual functioning. [1][2][4] Research also suggests there is a link between substance use and risky sexual behaviors that increase the likelihood of STI’s, unintended pregnancies, and sexual assault. [2][3]
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