Effects of drugs of abuse on the sexual response

Drugs of abuse, like alcohol, opiates, cocaine and cannabis, are used by many young people for their presumed aphrodisiac properties. It is well known, instead, that, apart from the subjective effects, they negatively affect the sexual response. Alcohol has direct toxic effects on the gonads (testes and ovaries) and the liver (it increases the catabolism of testosterone and its transformation in estrogens). Besides, it inhibits the hypothalamus-pituitary-gonads axis (HPG). The opioids inhibit the HPG axis and increase the prolactin levels which, in turn, interferes with the male and female sexual response. The acute effects of cocaine are stimulants mainly for its dopaminergic properties but in the long run it causes sexual dysfunctions (erectile, etc.) mainly due to hyperprolactinemia. Cannabis, at high doses, could inhibit the HPG axis and reduce fertility. The knowledge of these effects should be better disseminated among subjects at risk for deterrent purposes.