MDMA and Human Sexual Function

Earlier reports and abundant anecdotal accounts suggested that MDMA users often experience enhanced sexual feelings, but published, systematic investigations of MDMA's effects on human sexual function were lacking. The extracted text notes a small unpublished psychotherapy sample in which isolated sexual effects (one report of anorgasmia, one of decreased desire, and one couple reporting enhanced enjoyment) were observed, highlighting the need for broader survey data. Buffum and Moser designed a study to fill that gap by surveying people who had used MDMA about its effects on sexual behaviour, orgasm, erectile function, emotional closeness and any therapeutic effects on sexual inhibition. The investigators used an anonymous self-rating questionnaire distributed in the San Francisco Bay Area to collect descriptive data about users' experiences with MDMA and sex.

The study used a self-administered, four-page anonymous questionnaire to assess sexual function and collect demographic information from people who had taken MDMA. Questionnaires were distributed in the San Francisco Bay Area between December 1985 and September 1986; copies were available from the authors according to the extracted text. Anonymity was emphasised to encourage participation and candid responses. Respondents were self-selected and ranged in age from 20 to 63. The survey asked about frequency and route of MDMA use, typical dose, use of other hallucinogens, health or emotional problems attributed to MDMA, sexual behaviours while under the influence, receptivity to sexual activity, ability to achieve orgasm and erection, perceived quality of orgasm, any temporary or long-term changes in sexual pattern, and whether MDMA had helped overcome sexual inhibitions. The extracted text does not detail any formal psychometric validation of the questionnaire or prespecified statistical analysis plan; results are presented as counts and percentages of respondents.

Of 300 questionnaires distributed, 76 (25%) were returned. Respondents reported ages from 20 to 63 and were primarily based in the San Francisco Bay Area. The majority had used MDMA more than once: 76% of females and 97% of males reported taking MDMA two or more times. Most respondents had prior use of other hallucinogens except for seven females and one male. The most common single dose reported was 125 mg. Oral ingestion was universal; a minority also reported intranasal (11% of women, 15% of men), intramuscular or subcutaneous use, and no respondents acknowledged intravenous MDMA. When asked about health or emotional problems attributed to MDMA, 28 females (76%) and 29 males (76%) answered no; among affirmative respondents, complaints included urinary tract infections, tiredness and malaise, more colds, headaches, and mild next-day depression and low energy. When asked whether MDMA induced desire to engage in behaviours outside usual sexual patterns, 29 women (81%) and 34 men (87%) said no. Those who did report new or intensified behaviours described examples such as increased oral focus, reduced inhibitions about third parties, rougher sexual behaviour, group sex, and desire for multiple partners; several respondents commented on heightened tactile interest. Responses about initiating sexual activity were mixed (tables referenced in the text were not available in the extracted material). Receptivity to being sexual while under MDMA was more clearly shifted: 12 women (34%) and 18 men (46%) reported increased receptivity, whereas 3 women (9%) and 5 men (13%) reported being less receptive; others reported variable or no effect. Of the full sample, 26 women (72%) and 27 men (69%) engaged in sexual activity while on MDMA; among these, 23 women (88%) and 20 men (74%) reported that the sensuality of sexual experience was enhanced. The types of sexual activity reportedly did not differ substantially from non-MDMA occasions, with the exception of ‘‘heavy petting’’ and ‘‘other’’ categories that some respondents indicated occurred more on MDMA. Difficulties achieving orgasm on MDMA were commonly reported, particularly by men: 16 males (62%) and 4 females (17%) reported problems. Four females (17%) reported it was easier to orgasm on MDMA; seven females (29%) and six males (23%) said orgasms were neither harder nor easier, just different. Six women (25%) and two men (8%) stated they had not been able to achieve orgasm on MDMA; two women and two men (8% each) said it was sometimes easier and sometimes harder. On orgasm quality, six females (26%) and seven males (28%) said orgasms were better on MDMA; two females (9%) and four males (16%) said worse; eight women (35%) and eight men (32%) said orgasms were different but not better or worse; three women (13%) and four men (16%) noted no difference; and a small subset had not experienced orgasm while on MDMA. Regarding therapeutic change, a majority reported that MDMA had not helped them overcome sexual inhibitions: 15 females (65%) answered no; the extracted text gives the number 17 males but does not clearly report the matching percentage for men. Those who did report benefit described increased relaxation, reduced jealousy, improved sensual communication, and in a few cases resolution of longstanding issues (for example, one respondent reported using MDMA to forgive childhood molestation and clear ‘‘pelvic blocks’’). On temporary changes to sexual pattern, 15 women (62%) and 20 men (74%) said no; reported temporary effects included increased intimacy, transient reduced sexuality for a few days, increased frequency or duration with a partner, and delayed climax. For long-lasting changes, 16 women (73%) and 18 men (69%) said no; respondents reporting persistent changes described greater openness, increased trust and communication, and lower urgency for orgasm. All 35 women in the sample felt MDMA increased feelings of emotional closeness; 34 men (87%) agreed. Most respondents (about 62% of women and 64% of men as reported) felt MDMA effects on closeness were not dose-related. When asked whether they had ever used MDMA specifically to enhance sexual experience, 17 women (74%) and 22 men (81%) said no; however, 18 women (75%) and 17 men (71%) said they would consider using MDMA for that purpose. The authors summarised that MDMA produced inconsistent effects on female self-reports of lubrication, desire and orgasm ability. Male reports showed clearer patterns: 69% of men stated MDMA increased their ability to delay ejaculation, 46% said it decreased erectile ability (only 4% said it increased), and 70% reported a decreased ability to have an orgasm or ejaculate; no men reported increased orgasmic ability.

Buffum and Moser emphasise that the sample was self-selected, so generalisability is limited. They interpret the data as indicating that MDMA does not act as a classical aphrodisiac because it does not increase sexual arousal or desire in a majority of users. Instead, the drug appears to enhance the sensual aspects of sexual experience for many users, a change the authors link to increased feelings of emotional closeness. Nearly half the men and about a third of the women reported greater receptivity to being sexual while on MDMA, but this did not translate into a parallel increase in initiating sexual activity. The investigators note a consistent finding of difficulty attaining orgasm, particularly among men, and a nearly half-sample decrease in erectile ability. They compare MDMA to MDA, suggesting similarity in limited visual hallucinations and enhanced communication and emotional feeling may underlie MDMA's tendency to facilitate aspects of sexuality without increasing sexual drive. Although the study was not designed to test MDMA as a treatment for sexual concerns, a few respondents reported therapeutic benefits. Finally, the authors comment that further exploration of MDMA's potential for treating sexual problems will be complicated by MDMA's Schedule I legal status, which restricts research.