The study found that both the Arabic General Health Questionnaire (AGHQ) and the SRQ‑20 are valid screens for ICD‑10 psychiatric disorders in an Arab community in Al Ain (AGHQ: sensitivity 86%, specificity 85%, AUC 0.93; SRQ‑20: sensitivity 83%, specificity 83%, AUC 0.90), with the AGHQ performing significantly better overall, especially in males and those under 30. The abstract appears unrelated to the paper’s title on MDMA and sexual function.
This study compared the ability of the Arabic General Health questionnaire (AGHQ) and Self-Reporting Questionnaire (SRQ-20) to screen ICD-10 psychiatric disorders in an Arab community in Al Ain, United Arab Emirates. Standardised psychiatric assessments of subjects using the Composite International Diagnostic Interview (CIDI) were carried out. The Receiver Operating Characteristic (ROC) analysis was used to determine validity indices for the AGHQ and SRQ-20. For the AGHQ, sensitivity, specificity and area under the curve (AUC) were 86, 85 and 93% respectively, while for the SRQ-20, validity indices were 83, 83 and 90% respectively. Overall performance of the AGHQ was significantly better than the SRQ-20, especially in males and those under the age of 30 years. We conclude that both questionnaires are valid screening instruments in an Arab community in the UAE.
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.
Papers cited by this study that are also in Blossom
Buffum, J., Moser, C. · Journal of Psychoactive Drugs (1986)
Papers in Blossom that reference this study
Dolder, P. C., Müller, F., Schmid, Y. et al. · Psychopharmacology (2017)
Bershad, A. K., Miller, M. A., Baggot, M. J. et al. · Journal of Psychopharmacology (2016)
McElrath, K. · Substance Use and Misuse (2009)
The investigators recruited 35 recreational MDMA users who had previously used MDMA in a sexual context: 20 men and 15 women. Inclusion required physical health, absence of major psychiatric disorder or history of sexual disorders, no alcohol or opiate abuse and no current medication. Nine participants (25%) were interviewed by telephone; the same exclusion criteria were applied in those calls. Most participants had completed secondary or higher education and were either students or employed in professional occupations. A structured interview was used to assess sexual function up to 6 hours after MDMA consumption. Four domains were evaluated: desire, erection (or vaginal lubrication in women), orgasm and satisfaction. Orgasm was further characterised by intensity and ease of achievement (premature, unchanged or delayed). Each item was rated retrospectively by the participant relative to their usual (non‑MDMA) function on a numeric scale from -3 to +3 (0 = unchanged; -1/+1 = mild change; -2/+2 = moderate change; -3/+3 = profound change). Participants reported whether they had used other substances adjunctively; the investigators noted concurrent marijuana use but restricted the primary ratings to episodes involving MDMA alone. The extracted text does not report formal dosing, laboratory confirmation of MDMA content, or a standardised laboratory setting; ratings therefore represent retrospective self‑perception of sexual function following recreational MDMA use.
All 35 participants reported increased sexual desire after MDMA use. Nineteen of 20 men (95%) and all 15 women reported increases that were moderate to profound. Most subjects described the sexual experience as more sensual than usual. Subjective satisfaction was also increased: 90% of the males and 93% of the females reported a moderate to profound increase in satisfaction. Responses for genital arousal differed by sex: among men the effect on erection was mixed, with 40% reporting an impairment and 40% reporting enhancement, while 80% of women reported increased vaginal lubrication. MDMA was commonly associated with delayed orgasm. Sixteen men (80%) and six women (40%) described delayed achievement of orgasm; one man and two women reported complete inability to achieve orgasm (anorgasmia) on the drug. Despite delays, orgasm was perceived as more intense by 85% of men and 53% of women. Concurrent marijuana use was reported by ten males (50%) and ten females (67%), equivalent to 20 of 35 participants (57%). Those who used marijuana as an adjunct reported that it tended to increase sexual desire, but the study’s ratings were restricted to MDMA alone and the investigators reported no differences in the measured sexual parameters between concomitant marijuana users and non‑users in this sample. The detailed tabulated data referenced in the paper (table I) is not reproduced in the extracted text.
Zemishlany and colleagues interpreted their findings as indicating that MDMA enhances subjective sexual desire, overall satisfaction, female arousal and orgasmic intensity, while simultaneously prolonging orgasm latency and producing inconsistent effects on male erectile function. The authors noted that roughly 40% of men reported decreased erectile ability—an observation consistent with at least one previous survey in a different population which likewise found increased sensuality, more difficult orgasm and reduced erection in a substantial subset of men. The investigators related their results to prevailing neurobiological hypotheses: increased dopaminergic activity is thought to facilitate sexual desire and possibly erectile responses, whereas increased serotonergic activity is associated with inhibition of erection and orgasm. MDMA’s ability to release both dopamine and serotonin could therefore plausibly account for the mixed pattern observed—heightened desire and satisfaction alongside delayed orgasm and some erectile dysfunction. The authors also suggested that peripheral sympathomimetic effects of MDMA might contribute to erectile problems. They acknowledged the potential influence of expectancy or placebo effects, noting analogue evidence that substances such as alcohol can produce self‑reported increases in sexual arousal despite objective decreases in reactivity. Several methodological limitations were emphasised: the non‑random, self‑selecting sample of people willing to discuss illegal drug use; reliance on retrospective self‑report; lack of information on MDMA dose and pill purity; and the frequent concomitant use of marijuana, which may confound attribution of effects. Despite these caveats, the authors concluded that in sexual settings MDMA appears to boost subjective desire and satisfaction while often impairing aspects of sexual performance, notably orgasm timing and, for some men, erectile ability.
The recreational use of 3,4-methylenedioxymethamphetamine (MDMA or 'Ecstasy') has gained increased popularity during the last decade despite legislative actions to limit its distribution. An estimated half-million people in England have taken MDMA. There have been reports of MDMA use in three types of settings: in psychotherapeutic sessions to facilitate interpersonal communication; in small social gatherings where its most common reported effect was a heightened sense of closeness with other people; and in the more recent setting of large, organised all-night dance parties known as 'raves'. The short-term psychological and physical (mainly sympathomimetic) effects of MDMA last for 3-6 hours. Although many users describe sexual arousal by what is commonly believed to be a 'love drug', the effects of MDMA in a sexual setting have not been systematically examined. MDMA is structurally related to the stimulant amphetamine and the hallucinogen mescaline. Its acute effects, at least in animal models, appear to be mediated by the release and reuptake inhibition of brain monoamines, particularly serotonin and dopamine. These biogenic amines have been implicated as facilitatory (dopamine) and inhibitory (serotonin) mediators of sexual desire, arousal and orgasm. Therefore, MDMA-related changes in sexual function may provide some insight into the role of serotonin and dopamine in human sexuality. The aim of this study was to determine the effects of MDMA on the different stages of the sexual activity cycle in healthy recreational users.
Twenty males and 15 females who had occasionally used MDMA before engaging in a sexual encounter consented to undergo a structured interview in order to evaluate their sexual function while under the influence *Correspondence and reprints. of MDMA (up to 6 hours after drug consumption). We included only physically healthy subjects who did not have a major psychiatric disorder or history of sexual disorders, did not abuse alcohol or opiates, and were medication-free. Most of them (94%) had achieved a high school or academic education level. Six subjects were full-time university students and the rest were steadily employed in professional occupations. All subjects had prior recreational experience with MDMA. Nine subjects (25%) were interviewed by telephone; however, the same exclusion criteria were addressed. Four major domains of sexual activity were evaluated in the structured interview: desire, erection (lubrication in women), orgasm and satisfaction. Orgasm was further assessed for intensity and ease of achievement (premature, reserved or delayed). Each item was rated in comparison to the baseline function of the subject on a scale of -3 to +3 [0 = unchanged, -1, +1 = mild, -2, +2 = moderate, -3, +3 = profound; decrease (-) or increase (+), respectively]. The ratings represent the individual's retrospective, self-percieved experience with MDMA in a sexual setting.
The obtained detailed data is presented in table I. All subjects reported an increased sexual desire after MDMA use. In 19 out of the 20 male subjects (95%) and in all the female subjects, the increase was moderate to profound. The sexual experience was described by most subjects as more sensual than usual. Similarly, 90% of the males and 93% of the females reported a moderate to profound increase in satisfaction. Equivocal responses were obtained with regard to erection: 40% of the males reported a negative effect and 40% a positive effect. In women, 80% reported that lubrication was enhanced. Delay in achieving orgasm while under the influence of MDMA was reported by 16 males (80%) and six females (40%). One male and two females had not been able to achieve orgasm at all on MDMA. Although the orgasm was delayed in many users, it was perceived to be more intense in 85% of the men and 53% of the women. Ten males (50%) and ten females (67%) reported an occasional concomitant use of marijuana. These subjects noted that the main effect of marijuana adjunction was enhancement of sexual desire. Ratings for this study, however, were restricted to the use of MDMA alone. There were no differences in any of the sexual parameters between concomitant marijuana users and nonusers.
The results of the present study suggest that MDMA has an enhancing effect on sexual desire, satisfaction, female arousal, and orgasmic intensity, but an inhibitory effect on orgasm latency (delay). The effects on male erection were inconsistent, although 40% experienced a decrease in erectile ability. These findings are in line with the only existing survey we are aware of that specifically addressed the influence of MDMA on sexual function. In that study, which used self-rating questionnaires distributed in the San Francisco area, subjects reported that MDMA enhanced sensuality, made orgasm more difficult to achieve, and decreased erectile ability in 46% of the males. The neurobiological substrate of human sexuality is still poorly understood. Current hypotheses suggest that central dopaminergic activity is associated with sexual desire and erectile responsewhile central serotonergic activity is inhibitory to erectile and orgasmic function. The reported effects of MDMA on sexual activity may support these hypotheses. The activation of the dopaminergic system by MDMA may account for the increase in desire and satisfaction. This assumption may be supported by the high proportion of subjects (57%) who used marijuana, a cannabinoid with some dopamine-releasing activity, as an adjunct to MDMA for further facilitation of desire. The inhibitory effect on orgasm is similar to that induced by the widely prescribed antidepressants, including the selective serotonin reuptake inhibitors, and may be related to stimulation of the serotonergic system. The inhibitory activity of serotonin on erectionmay play a role in the emergence of erectile dysfunction reported by some (40%) of the MDMA users. The peripheral sympathomimetic effects of MDMA may contribute to the reported erectile dysfunction. The possibility that some of the self-reported changes in sexual functioning might be due to expected effects of the substance ('placebo effect') should not be disregarded. It has been shown, for example, that alcohol consumption in women led to self-perceived increased sexual arousal and increased sexual activity when it actually induced decreased reactivity and less sexual activity. There are several methodologic limitations associated with studies of this type. The sample was not randomly selected and included only subjects who were willing to describe their experience with an illegal substance. The reports were retrospective and prone to inaccurate subjective recollections, and the dose and purity of MDMA in the pills could not be determined. Finally, the associate use of marijuana in about half of the subjects may be a serious confounding factor. Despite these difficulties, the present study indicates that when MDMA is used in a sexual setting, its main effect is enhancement of sexual desire and subjective satisfaction. The increased desire, however, is associated in most subjects with orgasmic or erectile dysfunction. Thus, it seems that MDMA impairs sexual performance in spite of the perception of greater satisfaction. Numbers represent ratings as compared to regular sexual function (without MDMA): 0 = no change; 1 = mildly changed; 2 = moderately changed; 3 = markedly changed; (+) = increase, (-) = decrease. A = anorgasmia.
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