By Sarah Mann, MD
Cannabis and sex have been deeply intertwined throughout history, from an ancient Chinese aphrodisiac to the free lovin’ hippies, back to its historical roots as a medication. There is very little research on cannabis and sex, and the reports that exist are heavily biased and often conflicting. Despite confusion within the scientific community, medical and recreational users alike feel that cannabis has a distinctly positive effect on their sexual health and experiences. Does cannabis do more than make a good thing better? Does it have the potential to treat sexual dysfunction? Or maintain healthy sexual relationships? What is the impact of cannabis on fertility? It is time to separate myth and conjecture from what we really do (and don’t) know about cannabis and sex.
Cannabis and Sex
Before discussing cannabis as a treatment for sexual dysfunction it is important to understand that there are pros and cons to combining it with sex. Highlighted below are some benefits and risks to using cannabinoid therapy for sexual wellbeing.
Emotional States: Cannabis may enhance emotional bonding and release inhibition, helping the user to “let go”. Many feel the improved perception of sex is related to increased emotional bonding between partners. Couples can relax despite a background of financial stressors, demanding children, and workplace drama. Cannabis is thought to improve sexual function simply by improving anxiety. Cannabis can relieve performance anxiety as it helps people get out of their heads and back into their bodies. On the flip side, too much or the wrong chemovar can lead to a lack of motivation or oversedation, where people may lose the desire for sex. 1
Increased risk-taking: Consuming cannabis won’t make you do something you wouldn’t otherwise. However, it can certainly release you from your inhibitions and impair your decision making. As is sometimes the case with imbibing alcohol, a cannabis user may agree to a sexual experience that they later regret. It may lower sexual inhibitions and increase confidence and a willingness to experiment. 2 Depending on the health of the relationship itself, that can be positive or negative. Given the increased risk-taking and lowered inhibitions, it is best to use cannabis in relationships where you feel safe and these effects are desirable.
Enhanced Touch sensation: Physical contact, including touching, hugging, caressing, and being held release the feel-good hormone oxytocin. It is well established that cannabis enhances skin sensation and physical closeness, likely attributed to the abundance of cannabinoid receptors on the skin. 3,4 The enhanced touch sensation can lead to increased sensitivity and arousal, which can result in heightened pleasure and satisfaction. Cannabis also slows the temporal perception of time, prolonging the feelings of pleasurable sensations. 4,5
Sexual Physiology: The endocannabinoid system is emerging as a key regulator of sexual function. Cannabinoid receptors are found in a high concentration in areas of the brain that control sexual function, including the hypothalamus, prefrontal cortex, amygdala and hippocampus. 6,7 Serum levels of endocannabinoids, the cannabinoids that humans produce within the body, increase in states of arousal and after masturbation, which warrants further research on their specific impact on sexual health.8,9
Sexual Function: Despite long-standing beliefs that cannabis impairs sexual function, recent evidence refutes these myths. It was initially thought cannabis caused impotence due to dopamine increases. However, in clinical practice, sexual function is actually improved. 10 In women, cannabis has actually increased sexual function, including prolonged and multiple orgasms. 1,11,12
Libido: Cannabis has been shown to increase sexual frequency, particularly in lower doses. 10,13 In higher doses, it can impair libido. A 2017 survey of reproductive-age men and women in the United States sought to identify and define the relationship between cannabis use and sexual frequency. Surveys were conducted with 28,176 women and 22,943 men. Groups were divided into male and female, then subdivided into weekly users, daily users and never users. All four cannabis consuming groups had significantly higher coital frequency when compared with gender-matched never users. 10
Genital health: Cannabis can cause drying of all mucus membranes. The effect is most often noticed in the mouth, colloquially referred to as “cottonmouth”. This same process can affect other mucus membranes, including the vagina. Despite the theoretical risk, women reported in a recent study that they did not notice a difference in lubrication. 13
Studies have discovered that smoking tobacco can cause blood vessel damage resulting in poor blood supply to the penis. 14,15 But cannabis use specifically has not been evaluated. So scientists are extrapolating data from cigarette studies. Nicotine is known to be a potent vasoconstrictor, meaning it causes the blood vessels to narrow, decreasing the amount of blood flow to the extremities. Nicotine is not found in cannabis. Further research should be conducted to examine the role of cannabis on blood flow to specific areas of the body before drawing conclusions based on a presumptive relationship and deduced, rather than observed, conclusions.
Orgasms: Multiple studies have reported increased orgasm, enjoyment, and intensity when using cannabis. 5,13,16 In one study, women who used cannabis regularly (and not only prior to sex) had twice the likelihood of having a satisfying orgasm. 13 Non-cannabis using men were more likely to reach orgasm too quickly, too slowly, or not at all. Male cannabis users were able to delay ejaculation for longer. 17 The orgasms themselves are reported to be prolonged, although it is unclear whether this is objectively true, or related to the time distortion that cannabis sometimes causes.
Sperm count: The belief that cannabis decreases sperm count has been challenged. A recent Harvard study reported men who had never used cannabis before had sperm that were 28% less potent than men who formerly used cannabis. Current users were slightly less potent than former users. 18 This may or may not be a contributing factor in other findings showing the legalization of cannabis was associated with increased frequency of sex, decreased condom sales, and an increase in birth rate. The authors presumed this was a result of heightened risk-taking behavior and not couples increasing bonding and intimacy. 19 Whether it is due to an increase in fertility, risk-taking, or family bonding, the ability to conceive does not seem to be an issue.
Chronic Pelvic Pain: Both men and women can suffer from pelvic pain that can result in functional disability and impair quality of life. A 2019 study evaluated 135 women with pelvic pain, more than half of who had already tried other medications without relief. Seventy-nine of those women had improvement in pain, and three reported no change. Pain levels weren’t documented in the remaining 48 respondents. There were no reports of increased pain. 20
The evidence is lacking for the treatment of Urologic Chronic Pelvic Pain Syndrome, which can affect both men and women. This can include conditions like chronic prostatitis and interstitial cystitis. Despite the lack of controlled trials, cannabis has been used extensively in clinical practice with good results. 21
Alleviating anxiety and trauma- Cannabis may help to facilitate mindfulness and keep your thoughts on the present moment. The lowered inhibitions, increased libido, decreased anxiety and increased perception of pleasure all add up to a healthy sexual relationship. The short term memory loss associated with cannabis may be of additional benefit for the extinction of fear memories associated with PTSD and sexual trauma. 22,23,24 This is a considerably important topic and one that should be addressed more fully with care.
Practical applications of Cannabis and Sex
There are as many people who will swear cannabis ruins sex as there are who think it enhances it. The difference in perceived benefits is related to the choices made before consuming the cannabis – the chemovar (or cannabis variety) and dose. Selecting the correct product is paramount in enhancing your experience. If you are considering augmenting your sex life with cannabis, taking these steps may help ensure a more positive experience.
Chemovar Selection: Different varieties of cannabis will have different effects, depending on an individual’s genetics and metabolism. It is a good idea to experiment ahead of time to make sure you pick a variety that will be most conducive to your sexual encounter. Some chemovars may be too stimulating, preventing you from focusing on the experience. Others could be too sedating.
Stop and smell your flowers: While CBD and THC are stealing all the headlines, terpenes are quietly working in the background. Terpenes are the compounds in cannabis and other plants which give them their aroma. A skunky variety probably won’t make a very sexy mood, but a citrus or pine smelling one might. The bottom line is, if the product doesn’t smell good to you, your body may be trying to warn you of negative effects (like oversedation).
Keep the dose low: Picking the right dose can be more difficult. When something feels good, we tend to want more of it. However, if you use too much you might not be able to engage fully. The most benefit has been seen in low doses, although the optimal dose will depend on your genetics, cannabis consumption history, strain and route of consumption. Low dose cannabis can have some of the relaxing and sensory effects without the impairment and sedation often associated with cannabis consumption. Everyone is encouraged to discuss this topic with a qualified practitioner.
Choosing the route of administration: There are more choices than ever when it comes to consuming cannabis.
- Smoking – easy to use, with a quick onset and a titrated dose. The effects come on in less than three minutes and can last anywhere from 1-3 hours.
- Vaping – Similar to smoking, it will take effect in 1-3 minutes and lasts 1-3 hours, making dosing very easy. When vaporizing the cannabis flowers, you extract the highest number of cannabinoids and terpenes possible. Vaporizing oil (vape pens or cartridges) releases some terpenes in the process. But it is convenient and has little to no odor.
- Edibles – These long-acting medications can take anywhere from 30-120 minutes to take effect. The dosing can be inconsistent from one batch and even individual item to the next. Some of the most unpleasant dosing errors can occur with edibles, so new users should use caution. If you have the foresight to consume your edible 60-120 minutes prior to your sexual encounter, then this might be a good choice. Many users report increased tactile sensitivity with edibles.
- Tinctures – For practical purposes, think of a tincture as anything that absorbs into the mouth instead of the stomach. That would include oil and alcohol-based tinctures, RSOs, mouth sprays, etc. They take effect in 15-30 minutes and last 4-6 hours. Unlike edibles, they will produce a consistent and predictable effect.
- Lubes – Cannabis-infused lubes are gaining in popularity, but have little scientific backing behind them. It is said that they can relax the blood vessels which support arousal and enhance sensation. Some claim you can’t get high from the lube. While the mucus membranes of the vagina will readily absorb THC, the dose and quantity of cannabinoids will be so low as to likely not produce a psychoactive effect 
There are still more questions than answers when it comes to cannabis and sex. With the research in its infancy, it is difficult to draw general conclusions. There is as much genetic variation between cannabis plants as there is between individuals consuming it. If you think cannabis may benefit your sexual health, perhaps you now have some information to start experimenting in a safe and therapeutic way.
Dr. Sarah Mann is a physician board-certified in Internal Medicine, Critical Care Medicine and Neurocritical Care; she will be eligible for board certification in Integrative Care Medicine in 2021. She divides her critical care time between the ICU and the Mindful Medicine Clinic, which she founded. She is heavily involved in cannabis education, including curriculum development and teaching, with several higher-level educational institutions.
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