Cannabis and Sex: What’s the Deal?

The use of cannabis has been associated with a number of anecdotal and empirical accounts describing sexual effects ranging from beneficial aphrodisiac-like properties to destructive and undesirable (Gorzalka & Hill, 2006). With the legalization of cannabis in Canada, contemporary research has expanded its efforts to understand the role that cannabis plays in human sexuality (Balon, 2017). Although controversial, research has suggested that cannabis may have differential effects on sexual functioning and behaviour depending on dose, such that shorter-term use appears to enhance sexual functioning and longer-term use appears to inhibit sexual functioning (Balon, 2017). This blog explores the potential role of cannabis in sensitivity, sexual desire, sexual dysfunction, and fertility.

Anecdotal accounts often point towards the profound effects that cannabis has on the physiological responses of individuals (Gorzalka & Hill, 2006). That’s a fancy way of saying that cannabis use is associated with many different effects on one’s body, ranging from distorted perceptions to loss of coordination and to problems with memory and thinking (perhaps many readers can relate to some of these experiences!). In addition, it also seems to have an effect on how people perceive sensations in their body, and this association has been supported by research finding that, with moderate doses, cannabis appears to enhance sensory (e.g., taste) and tactile (touch) experiences (Balon, 2017). So, if cannabis can enhance sensory experiences, what happens in a sexual context? Does it help make the experience better?

Research has shown that cannabis can enhance one’s sensitivity to touch during sexual activity, levels of sexual desire, and feelings of relaxation and satisfaction (Weller & Halikas, 1984; Gorzalka & Hill, 2006). This finding is important given that, collectively, these experiences can play an important role in the number, quality, and duration of orgasms (Weller & Halikas, 1984) as well as in increased feelings of intimacy (Balon, 2017). So, perhaps some individuals may benefit from using cannabis during sexual activity because it may promote sexual sensation, desire, and response—as long as you have obtained consent from your partner/s and do not experience negative effects like paranoia, panic attacks, and other wonky side effects of the drug (because yes, those can happen as well and they are not usually promoting of positive sexual experiences, unfortunately) (Bolla et al., 2002; Johns, 2001)! Also, because cannabis use can impair one’s judgment, risky sexual behaviour (e.g., inconsistent use of methods to protect against sexually transmitted infections) has been associated with cannabis use (Smith et al., 2010).

So it seems, for some people who use cannabis in moderate doses, there are some potentially positive effects on sexuality. Now, are there any potential negatives? Yes, of course! Research has suggested that the endocannabinoid and cannabinoid system (helps to keep your insides running smoothly) may play a significant role in modulating the biological processes involved in sexual responses that regulate erections and ejaculations (Gorzalka & Hill, 2006), likely involving at least two pathways (brain [hypothalamic] and penile [corpora cavernosa]) (Pizzol et al., 2019). Although this may seem like a good thing, modulation in either direction (increases or decreases) may be associated with sexual dysfunction in people with penises (we don’t know much about what happens on this level in people with vulvas or vaginas right now). This is a fancy way of saying that cannabis use may actually contribute to ejaculation difficulties, like ejaculating too fast, or taking a really really long time to ejaculate (Gorzalka & Hill, 2006). Likewise, cannabis use may also be correlated with problems in erectile function, like difficulties getting and maintaining an erection (Gorzalka & Hill, 2006). Distressing issues with penile function, in those who value erect penises that work in a certain way, can certainly contribute to decreases in sexual satisfaction and motivation (Balon, 2017).

And that’s not all: Cannabinoids and endocannabinoids also appear to be involved in hormonal and reproductive processes (Gorzalka & Hill, 2006), and not necessarily in a good way. Researchers have noted that chronic cannabis consumption may be associated with a decrease in testosterone levels in males (Balon, 2017), and this decrease can play a role in decreased fertility and reduced sperm count, which can pose challenges in those who would like to have children (Balon, 2017). Likewise, researchers have suggested that chronic cannabis consumption may decrease progesterone levels in females (Gorzalka & Hill, 2006), which can also affect fertility, but it also poses challenges for sustaining a pregnancy, given that progesterone plays an important role in supporting the uterine environment (Gorzalka & Hill, 2006). Cannabis use during pregnancy is absolutely not recommended: It contributes to an increased likelihood of miscarriage, and to low birth weights and premature births (Gorzalka & Hill, 2006).

So, as with many things in life, there are advantages and disadvantages associated with cannabis use and the story isn’t as clear as we may assume. Some research has shown that dose matters, such that low doses of cannabis may have faciliatory effects and large doses may have inhibitory effects on sexual functioning (Balon, 2017). It’s difficult to gauge an appropriate dosage, as individual differences probably play a role on the effects of cannabis on the body (Gorzalka & Hill, 2006). So, should people use cannabis for sexual purposes, or not? Well, that is something that this blog will not answer for you. You need to do more research, weigh the pros and cons, and decide what is best for you, knowing the potential benefits and risks. What research suggests is that, with shorter-term use and lower doses, cannabis may enhance sexual functioning in some people, and that longer-term use with higher doses is associated with more negative effects in some people (Balon, 2017). The big take-away here is be sure you think, research, take precautions, discuss consent and cannabis use with your partner/s, and see what works for you (and what doesn’t).

SexLab has just launched a study examining cannabis use and sexuality! If you are interested in participating, please click here for more information.

Philip Travado (BAH, Psychology, 2021)


References

  • Balon, R. (2017). Cannabis and Sexuality. Current Sexual Health Reports, 9(3), 99–103. https://doi.org/10.1007/s11930-017-0112-7

  • Bolla, K. I., Brown, K., Eldreth, D., Tate, K., & Cadet, J. L. (2002). Dose-related neurocognitive effects of marijuana use. Neurology, 59(9), 1337–1343. https://doi.org/10.1212/01.wnl.0000031422.66442.49

  • Gorzalka, B. B., & Hill, M. N. (2006). Cannabinoids, Reproduction, and Sexual Behavior. Annual Review of Sex Research, 17(1), 132–161. https://doi.org/10.1080/10532528.2006.10559840

  • Johns, A. (2001). Psychiatric effects of cannabis. British Journal of Psychiatry, 178(2), 116–122. https://doi.org/10.1192/bjp.178.2.116

  • Pizzol, D., Demurtas, J., Stubbs, B., Soysal, P., Mason, C., Isik, A. T., Solmi, M., Smith, L., & Veronese, N. (2019). Relationship Between Cannabis Use and Erectile Dysfunction: A Systematic Review and Meta-Analysis. American journal of men's health, 13(6), 1557988319892464. https://doi.org/10.1177/1557988319892464

  • Smith, A. M., Ferris, J. A., Simpson, J. M., Shelley, J., Pitts, M. K., & Richters, J. (2010). Cannabis use and sexual health. The journal of sexual medicine, 7(2 Pt 1), 787–793. https://doi.org/10.1111/j.1743-6109.2009.01453.x

  • Weller, R., & Halikas, J. (1984). Marijuana use and sexual behavior. The Journal of Sex Research, 20(2), 186–193. https://doi.org/10.1080/0022449840955121

Surrogate Partner Therapy: Why Aren’t We Doing It?

As diverse sexual experiences continue to appear in mainstream society, and sexual expression becomes an encouraged practice, the modern field of sex therapy must be evaluated. Rooted in the work of Masters and Johnson, sex therapy applies a behavioural model consisting of psychoeducation, improving communication, and breaking down and refocusing on sensations as opposed to performance (Rosenbaum et al., 2014). However, an important component of this therapeutic approach is a cooperative partnership. As such, surrogate partner therapy (SPT) was suggested by Masters and Johnson for individuals who were not in a relationship. The role of the surrogate is to implement the therapist’s instruction with the client, and to create an atmosphere in which the client can practice various skills with the goal of increasing sexual comfort and confidence (Rosenbaum et al., 2014). Therefore, the surrogate is to act as a mentor under the supervision of a therapist (Freckelton, 2013). Interestingly, while many components of the Masters and Johnson model have remained consistent over time, the practice of SPT is highly controversial today. To be honest, the legalities are highly complex and although not “illegal” per se (like sex work), it is not really legal…

Below, I explore arguments for and against the practice and SPT, ultimately making the case that, upon careful implementation, this practice should be reintroduced into the mainstream practice of sex therapy.

SPT is commonly misunderstood and mistaken as a sex work. Indeed, sex work involves engaging in sexual activity for a reward, commonly monetary compensation, and this aspect overlaps quite significantly with SPT, in which the surrogate engages in sexual activity with a client and is paid for such services (Freckelton, 2013). However, one must understand the complexities of the role of the surrogate and the range of services provided in addition to sexual activity in order to appreciate the therapeutic nature of this work. In fact, it has been found that 87% of the time spent in SPT sessions consist of nonsexual activities (Rosenbaum et al., 2014). These activities include training in communication, relaxation, and social skills. Moreover, having specific guidelines in place to reduce overlap between sex work and SPT has also proven effective. This includes acting in accordance with goals outlined by the therapist, rather than the demands of the client, and arranging services and monetary compensation through the sex therapy clinic rather than between the SPT and client (Rosenbaum et al., 2014). Evidently, a more complete understanding of SPT makes it clear that there are important distinctions between the work of surrogates and prostitutes.

Concern also arises over the lack of governing bodies for sex surrogates, compared to many sex therapists who are regulated and required to meet strict ethical guidelines. As Freckelton (2013) explains, most surrogates do not have professional or ethical guidelines to follow. Moreover, they do not possess psychological training. However, with proper guidelines and training, one would argue that this critique has no standing. Such is the case in the sex clinic of Dr. Ronit Aloni, a sex therapist in Tel Aviv (Rosenbaum et al., 2014). Dr. Aloni utilizes SPT for some clients, and these surrogates are thoroughly screened and trained in accordance with the International Professional Surrogates Association (IPSA). IPSA has published goals and training recommendations as well as a code of ethics for sex surrogates. Dr. Brian Hicks, an Australian psychologist, has also found success with SPT when strict guidelines are followed and the surrogates are properly trained (Freckelton, 2013). Undoubtedly, SPT can be implemented in a regulated and ethical manner if guidelines are followed and surrogates are adequately trained and supervised.

Lastly, one may question the nature of the surrogate-client relationship and whether this can mirror a true partnership, as well as the lasting effects on both the surrogate and client. Even Masters and Johnson acknowledged the stresses that such a relationship can put on those involved (Apfelbaum, 1977). In contrast to a relationship established outside of therapy, a surrogate-client relationship may lack affection and attachment (Freckelton, 2013). Moreover, Apfelbaum (1977) acknowledged the pressure on the surrogate to create a low stress environment while putting their own needs aside, both during sessions as well as at the termination of the program. However, the emotional hardships of such a relationship can be mitigated by providing the client and surrogate emotional support once the program is complete. In fact, Rosenbaum et al. (2014) argue that “separation is part of life, and learning to deal with it effectively is considered to be a positive learning experience” (p. 326).

Moreover, the opportunity to create a relationship, rather than working within a pre-existing one, may actually result in several advantages. For instance, Lavee (1991) argues that various cultural belief systems influence what is considered appropriate in a relationship and sexual activity. While some of these beliefs may be in contrast to those of traditional sexual scripts, creating a relationship in which a client feels that their cultural values and boundaries are being respected can be beneficial. These dominant beliefs also affect who has the opportunity to engage in meaningful relationships and sexual activities. Exclusion is often faced by those with sexual dysfunctions and individuals with disabilities due to misconceptions that they are ‘abnormal’ or ‘asexual’ (Freckelton, 2013; Rosenbaum et al., 2014). SPT would therefore create an opportunity for these individuals to learn and practice engaging in relationships and sexual activities that may not otherwise exist. Further, a client-surrogate relationship can circumvent complex dynamics that may exist between romantic partners, thus allowing for a greater focus on the physical nature of the sexual dysfunction and implementation of good communication skills in future relationships (Rosenbaum et al., 2014). In fact, a study done in Dr. Aloni’s clinic revealed higher success rates of treatment for vaginismus among women working with surrogates, compared to those being treated with their own partners, as well as earlier completion of therapy (Rosenbaum et al., 2014). Masters and Johnson advocated for the importance of undergoing sex therapy as a couple and doing so in a client-surrogate partnership may not only accomplish this need when a partner is not available, but may actually be superior to working within an existing romantic relationship.

Evidently, SPT is a viable addition to mainstream sex therapy. There is a clear distinction between the work of sex workers and that of sex surrogates, an existing association which can govern such work to ensure professional and ethical standards, and the ability to mitigate any issues that may arise as a result of the nature of the client-surrogate relationship. Moreover, SPT provides an avenue for un-partnered clients to learn and practice the skills of sex therapy. Perhaps the reason for society’s hesitancy towards SPT reflects the dominant cultural ideology and traditional sexual scripts that have permeated Western society (Lavee, 1991). Therefore, we must challenge our existing beliefs and look to others who have had clear success with such programs, such as Drs. Aloni and Hickman. Modelling SPT programs after these will allow for proper implementation and success of SPT, only advancing the work of modern sex therapy.

Julia Friedman, B.A.H. Psychology, 2022

References

Apfelbaum, B. (1977). The myth of the surrogate. The Journal of Sex Research, 13(4), 238-249.

Freckelton, I. (2013). Sexual surrogate partner therapy: Legal and ethical issues. Psychiatry, Psychology & Law, 20(5), 643–659. https://doi-org.proxy.queensu.ca/ 10.1080/13218719.2013.831725

Lavee, Y. (1991). Western and non-Western human sexuality: Implications for clinical practice. Journal of Sex & Marital Therapy, 17(3), 2013-213, DOI: 10.1080/00926239108404344

Rosenbaum, T., Aloni, R. and Heruti, R. (2014). Ethical considerations in surrogate‐assisted sex therapy. The Journal of Sexual Medicine, 11, 321-329. https://doi-org.proxy.queensu.ca/10.1111/jsm.12402