(236) Does MDMA Have Treatment Potential in Sexual Dysfunction? A Systematic Review of Outcomes Across the Female and Male Sexual Response Cycles

Abstract

Sexual health is a fundamental dimension of overall human well-being, deeply intertwined with physical health, interpersonal relationships, and the overall quality of life. However, sexual dysfunction is prevalent among both men and women. Despite it's common occurrence, it often remains underdiagnosed and undertreated. In an attempt to improve the treatment landscape and offer new hope for those suffering from sexual dysfunction, researchers have turned to explore unconventional therapies, examining substances beyond the traditional medicinal spectrum. Compounds typically associated with recreational use, like cannabis and LSD, have been subjects of recent studies, exploring their potential therapeutic value. Notably, 3,4-Methylenedioxymethamphetamine (MDMA), colloquially known as 'Ecstasy,' has been attracting significant scientific interest. This synthetic amphetamine is known for its psychostimulant and entactogenic properties, and anecdotally noted for its potential effects on the sexual response cycle. To examine the existing literature on the effects of MDMA on male and female sexual responsiveness and the potential role of MDMA in treating sexual dysfunction of various etiologies. We conducted a systematic review on the effects of MDMA on each domain of the female and male sexual response cycles. PubMed, MEDLINE, and EMBASE were queried, and results were screened using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms utilized were “MDMA” or “Ecstasy” in combination with “desire,” “arousal”, “lubrication”, “orgasm”, “pleasure”, “libido”, “erection” and “ejaculation”. Inclusion criteria for this review were MDMA use by study subjects, sexual outcomes in at least one domain of the female and/or male sexual response cycles were described and measured. Randomized control trials (RCT), cohort studies (both prospective and retrospective), surveys, and literature reviews published between January 2000 and June 2022 were included. We identified 181 studies, of which six met criteria for assessment of the female sexual response cycle and eight met criteria for assessment of the male sexual response cycle. Four of six studies reported increased sexual desire with MDMA use among women. Arousal and lubrication were improved with MDMA use in three of four studies, but they were not affected in one randomized control study. In men, seven studies evaluated the effects of MDMA on desire and/or arousal, five studies measured impact on erection, three on orgasm, and two on ejaculation. Sixty percent of interview-based studies reported increased sexual desire in men, while 40% reported mixed or no effect. Two studies reported impairment of erection, two reported mixed effects, and one reported “fear of erection impairment.” In both men and women, all studies evaluating orgasm reported delay in achieving orgasm, but increased intensity and pleasure if achieved. Primary outcome measures were variable and largely qualitative. Our findings suggest that MDMA generally increases sexual desire and intensifies orgasm when achieved. While producing conflicting evidence on sexual arousal in both sexes, MDMA may impair erectile and ejaculatory function in men. No.