Study links cannabis and synthetic cannabinoid use to poorer male sexual function

Men who regularly use cannabis or synthetic cannabinoids report significantly lower sexual satisfaction, desire, and erectile function compared to non-users, according to a new study published in The International Journal of Psychiatry in Medicine. The research, conducted by a team at Cairo University, found that men dependent on these substances not only experienced poorer sexual function overall, but also struggled with sexual esteem and elevated sexual-related depression. Synthetic cannabinoid users, in particular, showed the most severe sexual impairments.

Cannabis refers to the psychoactive preparations made from the Cannabis sativa plant, which contain a compound called delta-9-tetrahydrocannabinol, or THC. THC is known to alter perception, reduce inhibition, and affect hormone levels—factors that can influence sexual experience both positively and negatively. While some users report heightened sexual pleasure and arousal, especially with low doses, others experience long-term effects such as decreased libido, erectile dysfunction, or reduced satisfaction. Scientific studies over the years have offered conflicting evidence, making it unclear whether cannabis helps or harms sexual health.

Synthetic cannabinoids are man-made chemicals that mimic the effects of THC by activating the same receptors in the brain and body. These substances are often sold under names like “Spice,” “Strox,” or “Voodoo” and are typically sprayed onto dried plant material and smoked. Unlike natural cannabis, synthetic cannabinoids are complete agonists of cannabinoid receptors, meaning they bind more strongly and produce more intense and unpredictable effects. They can be significantly more potent, which may increase their potential for harm.

The motivation for this study arose from a lack of clear evidence regarding how both natural and synthetic cannabinoids affect male sexual health. While some earlier studies explored cannabis use and sexual behavior, the findings were inconsistent, and very few had focused on synthetic cannabinoids specifically. Given the increasing use of these substances in Egypt and the widespread belief among users that cannabis can enhance sexual performance, the researchers wanted to investigate whether this belief held up in reality.

To conduct the study, the researchers recruited 90 sexually active Egyptian men between the ages of 21 and 45. They divided them into three matched groups: one group of men who were dependent on cannabis, another dependent on synthetic cannabinoids, and a third group of non-users who served as controls. Each group had 30 participants. All patients were recruited from Kasr Al-Ainy Hospital’s outpatient addiction clinic between August 2021 and July 2022. Individuals with psychiatric illnesses, medical conditions, or other drug use were excluded from the sample to isolate the effects of cannabis and synthetic cannabinoids.

Participants were evaluated through lengthy, structured interviews conducted by trained psychiatrists. The interviews covered personal history, substance use patterns, and sexual functioning both before and after substance use began. The researchers used several standardized tools to assess sexual performance and related psychological traits, including the International Index of Erectile Function—a questionnaire measuring aspects like erectile quality, orgasm, sexual desire, and satisfaction—and the Sexuality Scale, which evaluates sexual self-esteem, sexual preoccupation, and sexual depression.

The findings showed a clear and consistent pattern: both cannabis and synthetic cannabinoid users scored lower than the control group across almost every domain of sexual functioning. Men who used synthetic cannabinoids had the most severe impairments. Compared to the control group, they reported poorer erections, lower sexual desire, reduced orgasmic satisfaction, and greater dissatisfaction with their sexual experiences. They also scored higher on measures of sexual depression and lower on sexual esteem. In fact, men in the synthetic cannabinoid group had worse scores than cannabis users in nearly every category.

The study also revealed that the longer a man had used these substances—and the higher the daily or maximum dose—the worse his sexual outcomes were likely to be. In both cannabis and synthetic cannabinoid users, higher use levels were associated with poorer sexual performance, greater sexual-related distress, and lower confidence about their sexual lives. These patterns held true even after adjusting for other factors, suggesting a strong link between substance use and sexual dysfunction.

Interestingly, about 23 percent of cannabis users in the study said they first started using cannabis to address sexual problems like low desire or premature ejaculation. This group hoped cannabis would improve their sex lives, but the data suggests that, over time, the drug may have worsened the very issues they aimed to solve. Synthetic cannabinoid users, in contrast, did not report initiating use for sexual reasons. Regardless of the reason for starting, both groups ended up with poorer sexual health outcomes than the non-users.

The researchers pointed out several possible explanations for these results. Cannabis and synthetic cannabinoids act on receptors in the brain and body that are involved in sexual behavior and arousal. Synthetic cannabinoids in particular are much more potent than natural cannabis and bind more aggressively to these receptors, which may explain their more damaging effects. In addition, chronic use of these substances has been linked to lower testosterone levels, vascular problems, and disruptions in brain regions that regulate sexual function.

But the authors noted a few limitations. The study was conducted at a single hospital and used a relatively small sample size. Cultural attitudes about sexuality and substance use in Egypt may also limit how widely the results can be applied. Moreover, synthetic cannabinoids vary widely in their chemical structure and potency, and the study did not explore differences between specific types. Larger studies across multiple sites would be helpful in confirming the results and identifying possible variations based on substance type or usage patterns.

The study, “Psychosexual dysfunction in male patients with cannabis dependence and synthetic cannabinoid dependence,” was authored by Abdelrahman A. Asal, Doaa R. Ayoub, Mohamed E. Mazen, and Shirin M. El Makawi.