The Relationship between Marijuana Use Prior to Sex and Sexual Function in Women

In our study, the majority of women who used marijuana before sex reported positive sexual effects in the domains of overall sexual satisfaction, desire, orgasm, and improvement in sexual pain but not in lubrication. Women who used marijuana before sex and those who used more frequently were more than twice as likely to report satisfactory orgasms as those who did not use marijuana before sex or used infrequently.

Our study is consistent with past studies of the effects of marijuana on sexual behavior in women. In the above-mentioned study by Palamar et al,² 38.6% of respondents were women. Participants were asked questions similar to this study’s questions regarding sexual domains, including sexual enjoyment, desire, and orgasm intensity and how these were affected by being under the influence of marijuana. The majority of respondents noted an increase in sexual enjoyment (53.5%) and orgasm intensity (44.9%), whereas 31.6% noted an increase in desire, and 51.6% noted no difference.² Our data showed a higher percentage of participants reporting improvements in each domain across the board. However, their data included both men’s and women’s responses, and their questions were worded differently.

Dawley et al¹⁰ evaluated a group of marijuana using students (men and women) and found that marijuana smokers reported increased sexual pleasure, increased sensations, and increased intensity of orgasm. Only more-frequent users felt that marijuana was an “aphrodisiac,” a surrogate measure of desire. This study included only 22% women.¹⁰ Finally, Koff¹¹ evaluated sexual desire and sexual enjoyment after marijuana use in women via a questionnaire. The majority of the female respondents reported that sexual desire was increased (57.8% vs 60.6% in our study). Sexual enjoyment increased 42.9% of the time.¹¹ Interestingly, Sun and Eisenberg¹² reported a higher frequency of sexual activity in marijuana users, even when controlling for multiple variables (ie, age, socioeconomic status). The authors surmise from their data that marijuana use does not seem to impair sexual function. However, it is important to note that marijuana use may be harmful.

Our study provides an interesting insight into women’s perceptions of the effect of marijuana on the sexual experience. It differs from other studies in that it is one of the largest series to date and has a wider range of ages. It also differed in that it was a cross-section of healthy women presenting for routine gynecologic care, where most studies target younger patients and include both sexes. For this reason, it is difficult to directly compare the studies, because the sexual activity, frequency, and expectation of these groups may be very different. However, we believe it is important to understand the potential effect in this patient population.

The question of how marijuana leads to these positive changes in sexual function is unknown. It has been postulated that it leads to improvement in sexual function simply by lowering stress and anxiety.¹³ It may slow the temporal perception of time and prolong the feelings of pleasurable sensations.^{5, 14} It may lower sexual inhibitions and increase confidence and a willingness to experiment.⁷ Marijuana is also known to heighten sensations such as touch, smell, sight, taste, and hearing.¹⁵ Although this was not specifically addressed in this article, according to Halikas et al,⁵ the regular female marijuana user reported a heightened sensation of touch and increased physical closeness when using marijuana before sex.

It is postulated that marijuana works through a variety of mechanisms. It is recognized that marijuana and the hypothalamic-pituitary-gonadal axis, which controls the sex hormones, interact with each other. There are cannabinoid receptors in the hypothalamus that regulate gonadotrophin-releasing hormone and oxytocin release, both of which play a role in normal sexual functioning.¹⁶ In addition, marijuana has been shown to affect testosterone levels, which play a role in sex drive, but how and in which direction in women is unclear.^{17, 18}

Female sexual function is not only regulated by hormones, but also by centrally acting neurotransmitters, such as dopamine and serotonin. Dopamine is a key pro-sexual modulator in normal excitatory female sexual function.^{19, 20} Activation of cannabinoid receptors has been shown to enhance dopamine,¹⁹ which may be another pathway by which marijuana affects sexual function. Cannabinoid receptors have also been localized to other areas of the brain that control sexual function, including the hypothalamus, prefrontal cortex, amygdala, and hippocampus.^{21, 22} Serum levels of endocannabinoids have been correlated with both subjective and objective measures of arousal.⁶

The strength and weakness of this study is that it is a single-center study, which allows consistency of patient recruitment but does not allow for assessment of generalizability. It relied on women’s memory and perceptions of the sexual experience; however, it is real life, and all questionnaires rely on recall. It did not address the context of the relationship, co-use with other drugs, or the timing and quantity of marijuana use before sex, all of which contribute to the memory of the sexual experience. It does not specifically ask whether the marijuana was taken because the patient had the perception that it would enhance performance, which would be an inherent bias. This may be less likely because women who were frequent users (that is not specifically timed with intercourse) had the same positive relationship with improvement in satisfying orgasm. A further study could address the specific timing of marijuana use on the sexual domains though this would be difficult unless patients were enrolled in a study that required certain timing (a very challenging study to get though the Institutional Review Board).