Sex And Weed. How Does Cannabis Actually Affect Sex?
Cannabis (marijuana) has a bit of a mixed reputation when it comes to sex. You may have heard that it’s a traditional herbal aphrodisiac with nearly mythical libido-boosting powers. Or maybe you heard that it can reduce sperm count or contribute to erectile dysfunction and premature ejaculation. In reality? It’s probably far more complicated than any of those assumptions, which is why we’ve compiled everything we know and don’t know about how cannabis affects sex.
There is one huge caveat, though: Thanks to the system of prohibition that’s dominated drug policy in the U.S. for the past few decades - a system that has had and continues to have a disproportionately large impact on communities of color - there’s simply not a whole lot of research to go on.
Another pretty big caveat: Sexual arousal and functioning are incredibly complicated, so analyzing the sexual effects of any substance is inevitably going to be multilayered. “A lot of the understanding that needs to go into a discussion around cannabis and sexuality has less to do with cannabis and more to do with sexuality,” Jordan Tishler, M.D., medical cannabis expert at InhaleMD in Boston.
When researchers examine sexual enjoyment, they may take different aspects of it into account, including biological, social, and psychological factors that may play a role in attraction, arousal, orgasm, and overall satisfaction, Dr. Tishler says. But even if all of those things are accounted for, good sex means different things to different people—and even different things to the same person, depending on the day. So it's inherently a little challenging to study, which is a good thing to keep in mind when interpreting these results.
T H E L I M I T E D R E S E A R C H
Most of what we know about cannabis and sex comes from self-reported surveys. Knowing that cannabis is purported to help with anxiety and pain, it makes sense that the plant may also enhance sex indirectly for some by affecting those other issues. But research directly linking cannabis to sexual enjoyment is somewhat lacking.
Because cannabis is a schedule I drug in the U.S. (meaning the federal government decided it has a high potential for abuse and low potential for medical benefit), it’s difficult to study in a controlled environment. You can’t exactly give participants weed and measure how their sex habits change, for example. (Or at least most U.S.-based researchers can’t do that because it requires a specific type of drug license to use the actual compounds, which has historically been incredibly difficult to acquire.)
So, instead, researchers have often used self-reported surveys - in which participants are asked about their drug use and their sexual experiences - to get an idea of what’s going on. But a study like this comes with a few drawbacks.
For one thing, it requires relying on people to accurately (and honestly) remember how much and how often they’ve used particular substances, as well as what effect those substances had on their sex lives. Researchers also have no way of corroborating what survey respondents say. Scientists can’t test the drug people have been using to see what it actually is (does it have a high THC content? Is it concentrate or an edible?) and they have to trust that they and their study subjects share a common frame of reference for and definition of subjective words to describe a highly personal experience, like “enjoyment."
Surveys also only show us a correlation between two things, like cannabis use and the enjoyment of sex. They can't assess the mechanism behind that correlation or even necessarily tell us why it exists. There can be all sorts of reasons why these answers were correlated the way they were, from something inherent in a person's personality to the self-selecting nature of the survey respondents. It could be that people who are eager to take a survey about cannabis use are more likely to have had a positive experience with cannabis, and so they're disproportionately less likely to report having issues with it.
Plus, many of these studies have historically focused mostly or entirely on the experience of men. For instance, in a study published in 1979 in the Journal of Clinical Psychology, researchers asked a group of 84 grad students (78 percent of whom were male) what they thought the relationship between cannabis and sex would be. Those who had firsthand experience with the topic (39 percent) were asked to answer from that perspective. Although the groups agreed that cannabis increases overall sexual pleasure, only those who were “experienced smokers” also strongly believed that it increased the intensity of an orgasm and that it should be considered an aphrodisiac.
But this study included a small number of participants (and an even smaller number of people who actually had firsthand experience using cannabis for sex), the majority of whom were young and male. So it's not clear how well their results would translate to the experience of people outside those groups.
In another study, published in 1984 in the Journal of Sex Research, the researchers actually interviewed their (all white, 62 percent male) college student participants rather than handing them a questionnaire. The study found similar results: Most participants reported that cannabis improved some aspect of sex—but they added a few interesting details.
For instance, although 58 percent of men in that study reported that it increased the quality of their orgasms, only 32 percent of women said the same. But men and women agreed in about the same amount that cannabis increased their desire for a familiar partner (50 percent of men and 60 percent of women), increased sexual pleasure and satisfaction (70 percent of men and 76 percent of women), and improved the sensation of touching (59 percent of men and 57 percent of women). Additionally, only 34 percent of men said cannabis increased snuggling, but 56 percent of women said it did.
Again, this study had a small number of participants, most of whom were not women and all of whom were white. That makes it difficult to know how accurately the responses from women here reflect the feelings of women in general.
A more recent study (that received plenty of headlines), published in 2017 in the Journal of Sexual Medicine, used data from the large nationally representative National Survey of Family Growth. Rather than asking people anything about how their sex lives interact with their drug use, the researchers here simply correlated participants’ self-reported frequency of cannabis use with the frequency that they reported having sex.
They found that people who reported using cannabis monthly, weekly, or daily also reported slightly more frequent sex than those who never smoked. (Women who used cannabis daily had an average of 7.1 sexual encounters in the previous four weeks compared to 6 for those who never used it.) But these results can’t answer any questions about whether or not cannabis use is correlated with the enjoyment or satisfaction of those sexual experiences.
Although this study did include a large number of participants, the researchers had to work with data that had already been collected, meaning that the original survey wasn't necessarily designed to answer the questions the researchers here asked. Another study of the same size using questions specifically designed to examine the relationship between cannabis use and sex would, theoretically, give more accurate results, but it still wouldn't tell us why people answered the way they did.
Not satisfied with the data from previous studies, Becky Lynn, M.D., director of the Center for Sexual Health and associate professor of obstetrics and gynecology at Saint Louis University, tells that she set out to conduct her own survey. “I wanted to know what women really thought,” she says. “Did they think that marijuana was improving their sex life?”
To find out, she worked with other people in her practice to offer a survey asking about cannabis usage with regards to sex—whether or not it had any effect on sex drive, orgasm, lubrication, pain, and the overall sexual experience—to everyone who came through their doors. Some of the more than 30 experts at that center are ob/gyns like Dr. Lynn, but there are also obstetricians, urogynecologists, gynecological oncologists, and reproductive endocrinology and infertility specialists. Every patient who saw any doctor there was offered the survey, so “it wasn’t only people coming in with sexual problems” who were offered it, Dr. Lynn says.
Ultimately, over 300 women filled it out and the results became the basis of two studies recently presented at the World Meeting on Sexual Medicine and the annual meeting of the International Society for the Study of Women's Sexual Health—and just published in Sexual Medicine.
Of 373 respondents, 176 reported ever using cannabis, with about half of them reporting frequent use (anywhere from once a week to several times a day) and half of them reporting infrequent use (anywhere from once a year to a few times a year). And 127 of the 176 cannabis users reported ever using cannabis before sex.
There were a few major findings, like that people who reported ever using cannabis prior to sex were more likely to report having satisfying orgasms than those who did not use cannabis before sex (and this was a statistically significant difference). And those who reported frequent cannabis use (not necessarily before sex) were also significantly more likely to report having satisfying orgasms than people who reported infrequent cannabis use. People who reported using cannabis before sex were also more likely to say that they use cannabis specifically to decrease pain (though this wasn’t a statistically significant difference).
This study does have many of the same limitations as those that came before it (such as small sample size and a possible self-selection bias), but it’s unique in that it primarily focuses on the experience of women. However, like many of the other studies on this topic, the participants were primarily white and heterosexual.
H O W C A N N A B I S C O U L D 'T H E O R E T I C A L L Y' I M P A C T S E X ?
In case you didn’t know, your body makes its own natural version of cannabinoids (endocannabinoids), and there is a significant amount of receptors for those compounds “in areas of the brain that deal with sexual function,” Dr. Lynn says, such as the amygdala and hypothalamus. Recent research suggests that 2-AG, an endocannabinoid, is released in humans after orgasm, suggesting that these compounds may be involved in normal sexual processes.
But what happens when you add cannabis to the mix? We do have some answers: Cannabis is a vasodilator (meaning it opens blood vessels and increases blood flow), Dr. Tishler explains. It has direct effects on the cannabinoid receptors in the skin and nerve pathways that are involved in perceiving pain. It can also affect some higher-order functions, including memory and feelings of fear and anxiety.
And it’s easy to see how all of those effects could contribute to better sex for some people, but we still don’t have a full, conclusive understanding of what cannabis is doing physiologically in the context of sex. “There are just theories on why this works,” Dr. Lynn says. “There’s really no definitive answer.”
Indeed, there are some studies in humans using functional magnetic resonance imaging (fMRI) that show those sex-related areas are activated even more with the addition of cannabis, Dr. Tishler says. But, again, these studies have their drawbacks—they’re not measuring arousal or libido directly.
What we know about cannabis in this context comes entirely from animal studies, she explains, which can be done by altering the way endocannabinoids and their receptors work (something that can’t easily be done in humans). “Animal research suggests that stimulating the CB1 receptor delays ejaculation, so reports about the time of the act in humans could be true (and not just a result of impaired time perception),” Mitch Earleywine, Ph.D., professor of psychology at the University at Albany, SUNY, tells which may contribute to the increased level of enjoyment the human participants reported in the surveys we mentioned previously.
In some cases though, delayed ejaculation may become problematic. For example, in a 2010 survey of 8,656 Australian adults published in the Journal of Sexual Medicine, men who used cannabis daily were more likely to report reaching orgasm too slowly or not at all compared to those who never used. But that study also found that cannabis use was associated with premature ejaculation. As a reminder, this is a self-reported study, so these findings are based on men assessing their own sexual performance, not some sort of objective measure of what happened.
There is also some evidence in humans to suggest that frequent use of cannabis can cause undesirable effects. For instance, among chronic, heavy cannabis users, the drug can negatively affect sperm production, Dr. Earleywine says. In a study published in 2015 in the American Journal of Epidemiology, researchers looked at the semen quality of about 1,200 Danish men between the ages of 18 and 28. Nearly half of that sample (45 percent) reported using cannabis within the previous three months. Their results showed that those who used cannabis frequently—more than once a week—had a 28 percent reduction in sperm concentration and a 29 percent lower sperm count compared to those who used once a week or less.
Interestingly, a study published this month in Human Reproduction did not find the same results. Instead, in a longitudinal survey of 662 men who provided semen samples between 2000 and 2017, those who reported ever using cannabis had significantly higher sperm count than those who had never smoked. The researchers suspect that there may be some reproductive benefits to moderate cannabis use but that “this relation reverses at higher doses, resulting in adverse effects,” which could explain their contradictory findings.
Ultimately, though, there’s nothing definitively proving that cannabis enhances sex or that it could contribute to or be used to treat specific sexual dysfunctions (such as premature ejaculation). But, if you’re in a position to try it, our experts do have some words of wisdom.
W H A T T O K N O W B E F O R E M I X I T ?
Cannabis is a psychoactive drug and different people react differently to it. So, especially if this is your first time using the substance, it’s important to start low, go slow, and take some precautions to make sure you have the most enjoyable and safe experience possible.
As a reminder, cannabis is legal for medical use in 33 states plus the District of Columbia, and it’s legal for adult (recreational) use in 10 states plus D.C. But it remains illegal at the federal level, so there are some obvious legal risks inherent in using cannabis for any reason in the U.S. It’s also important to remember the age restrictions within those states.
Dr. Tishler suggests trying cannabis on your own before incorporating a partner. “What I tell everybody is that the first time you want to think about using cannabis for sex, that should be a masturbation event,” he says. That way, you’ll know how you react to cannabis and how it affects your level of arousal and your orgasm before bringing in a partner and all of their variables.
But Dr. Lynn says there may be some benefits to trying it the first time with a trusted partner “in case you freak out,” she says. (Although some people find that cannabis can sometimes relieve anxiety, in other cases, it can increase anxiety and feelings of paranoia. So, if that happens or you’re nervous about it happening, having a buddy could be helpful to calm you down.) Either way, know that you can say no to sex at any time—whether or not you’re using cannabis with another person specifically to enhance sex. The same rules of consent apply.
Speaking of consent, when you are ready to use cannabis to enhance sexual experience with someone else, make your boundaries known and seek affirmative consent for anything you do. Our understanding of giving consent while using cannabis is still developing, Dr. Tishler says, but it’s crucial that you and your partner have a discussion ahead of time—before you get stoned—about what is and is not OK for you. Of course, consent is important whether or not you’re using cannabis, Dr. Lynn says, but this adds yet another layer to the conversation, and everyone needs to be on the same page.
It’s also important to differentiate between whether you want to use cannabis to enhance your sexual experience or to help manage a diagnosable sexual dysfunction, a factor that research hasn’t been able to tease out yet. If you are experiencing symptoms of sexual dysfunction or pain during sex, check in with your doctor or a sex therapist to talk about that.
And know that, as with all drugs, there is a potential for some unpleasant side effects with cannabis. We know that cannabis (especially when smoked) can affect the lungs and exacerbate conditions like asthma. It can also increase heart rate and cause anxiety in some cases.
