Sex and Cannabis: Getting Off the Stigma
February 16, 2021
Written by Lindsey Marshall, PharmD

Sexual function is comprised of numerous physical and psychological elements that can be measured in both an objective and subjective fashion. Cannabis has long been believed to provide aphrodisiac effects in its users. As of now, most research on the topic of “sex and cannabis” has been limited to the use of surveys. Participants typically provide feedback about cannabis’ effects on their arousal, sensitivity, desire/libido, ability to reach orgasm, and anxiety/stress levels. These surveys have shown that cannabis may modify the emotional elements that are involved in human sexual dysfunction, and, either directly or consequently, alter our physical response (i.e. pain perception, sensitivity to touch) as well. These physiological/emotional hindrances include anxiety, PTSD symptoms (fear, flashbacks and stress from past incidences of sexual trauma and abuse), and impaired libido. Current data suggests that its effects on sexual function are mostly positive, but incidences of negative effects do exist. These negative effects include increased difficulty to achieve orgasm, sedation, and lack of focus; all of which can decrease one’s overall satisfaction with a sexual experience.

The exact mechanisms by which cannabis may improve sexual function is unknown, but current knowledge of the endocannabinoid system (ECS) does provide some insight. The ECS is an expansive and complex neurotransmitter network that maintains physiological processes and has shown to be found in all mammals. Cannabinoids are chemical compounds within the cannabis plant that elicit pharmacological action on the chemical receptors of the ECS. When this activation occurs, the effects which follow can be related to pain sensation, anxiety, muscle rigidity, and mood. The cannabinoid receptor 1 (CB1) is highly concentrated in the central nervous system (CNS), which includes the brain and spinal cord, but are found in other regions of the body in smaller quantities. Tetrahydrocannabinol (THC) has an affinity to bind more so with CB1 than CB2, which is believed to explain its characteristic psychoactive effects in the CNS. Cannabidiol (CBD) on the other hand does not bind directly to CB1 nor CB2, but regulates their activity through indirect pathways, with more control shown to be expressed on CB2. CB1 receptors have been found in serotonergic neurons which secrete serotonin, the compound that plays a role in pleasure/reward, mood, and consequently sexual function. Thus, the stimulation of CB1 by cannabinoids can lead to anti-depressive effects, and a more pleasurable sexual experience. Due to CB1 modulation of anxiety and pain sensation, one could also speculate that cannabis use can provide relief for patients who experience painful sex, anxiety associated with sexual encounters, and PTSD symptoms triggered by sexual encounters. Painful sex and anxiousness can directly lessen the satisfaction with one’s sexual experience and may even discourage encounters altogether. As for PTSD symptoms, patients have found that cannabis helps to dampen the strength or emotional impact of traumatic memories and/or flashbacks, which may further facilitate a positive sexual experience.

In addition to direct ECS stimulation, cannabis can also lower sex-related pain and anxiety with the medicinal properties of its terpenes. Terpenes are organic aromatic compounds that exist in the essential oils of most flowering plants like lavender, chamomile, and citrus. Terpenes are also found in the cannabis plant. They provide distinctive tastes and scents, along with various medical benefits. Terpenes that have been known to reduce anxiety include limonene, bisabolol, linalool and caryophyllene. Caryophyllene also serves as an analgesic, along with terpinolene. Cannabis strains that contain higher amounts of the previously mentioned terpenes may be the preferred selections in users that suffer from sexual dysfunction.

As promising as cannabis may seem in relation to sexual function, there is still the possibility of unwanted side-effects. These side-effects are also a direct result of ECS stimulation, particularly CB1, and can vary depending on the method on consumption, frequency of use and dosage. Patients have reported over-sedation, lack of focus due to intense psychoactive high/euphoria, and dry mucous membranes. Over-sedation and lack of focus can inhibit ones’ ability to achieve orgasm. Studies have shown this to further aggravate male sexual dysfunction, such as erectile dysfunction, in some men. Dry mucous membranes occur when cannabinoids, particularly THC, decrease the natural self-lubricating properties of the body’s mucous membranes. These mucous membranes include the gastrointestinal tract (mouth, throat, intestines, rectum, etc.) and vagina. Drying effects on these membranes can cause extreme discomfort during penetrative sexual activity, particularly for patients who already struggle with inadequate self-lubrication.

In conclusion, the effects of cannabis on sexual function are psychologically diverse and can lead to both positive and negative emotional and physical manifestations. Further clinical studies are warranted to determine the extent of cannabis’ therapeutic potential to mitigate sexual dysfunction and improve sexual experience, along with any unwanted side-effects of use.

Refrences

Kasman AM, Bhambhvani HP, Wilson-King G, Eisenberg ML. Assessment of the Association of Cannabis on Female Sexual Function With the Female Sexual Function Index. Sex Med. 2020 Dec;8(4):699-708. doi: 10.1016/j.esxm.2020.06.009. Epub 2020 Jul 23. PMID: 32713800; PMCID: PMC7691883.

Passie T, Emrich HM, Karst M, Brandt SD, Halpern JH. Mitigation of post-traumatic stress symptoms by Cannabis resin: A review of the clinical and neurobiological evidence. Drug Test Anal. 2012;4(7-8):649-659. doi:10.1002/dta.1377

Trezza V, Campolongo P. The endocannabinoid system as a possible target to treat both the cognitive and emotional features of post-traumatic stress disorder (PTSD). Front Behav Neurosci. 2013;7:100. doi:10.3389/fnbeh.2013.00100

Fernández-Ruiz J, Galve-Roperh I, Sagredo O, Guzmán M. Possible therapeutic applications of cannabis in the neuropsychopharmacology field. Eur Neuropsychopharmacol. February 2020. doi:10.1016/j.euroneuro.2020.01.013

Simone Tambaro and Marco Bortolato, “ Cannabinoid-related Agents in the Treatment of Anxiety Disorders: Current Knowledge and Future Perspectives”, Recent Patents on CNS Drug Discovery (Discontinued) (2012) 7: 25. doi.org/10.2174/157488912798842269

Bhambhvani HP, Kasman AM, Wilson-King G, Eisenberg ML. A Survey Exploring the Relationship Between Cannabis Use Characteristics and Sexual Function in Men. Sex Med. 2020 Sep;8(3):436-445. doi: 10.1016/j.esxm.2020.06.002. Epub 2020 Jun 16. PMID: 32561331; PMCID: PMC7471121.

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