Subjective effects of MDMA ('Ecstasy') on human sexual function

Introduction

Recreational use of 3,4-methylenedioxymethamphetamine (MDMA, or 'Ecstasy') increased markedly in the decade prior to this study, with use reported in psychotherapy, small social gatherings and large all-night dance events ('raves'). Short-term psychological and sympathomimetic physical effects of MDMA last about 3–6 hours, and many users describe heightened interpersonal closeness and increased sexual arousal. Despite widespread anecdotal claims that MDMA is a "love drug", the specific effects of MDMA on discrete stages of human sexual function had not been systematically examined. Zemishlany and colleagues set out to assess how MDMA affects four major domains of sexual activity—desire, erection (lubrication in women), orgasm and satisfaction—in healthy recreational users. The study was motivated in part by MDMA’s pharmacology: it promotes release and inhibits reuptake of monoamines, especially serotonin and dopamine, neurotransmitters previously implicated in facilitation (dopamine) and inhibition (serotonin) of aspects of sexual function. The investigators therefore aimed to characterise subjective changes across the sexual cycle in people who used MDMA in sexual settings.