Research: The Effects of Cannabis and Cannabinoids on Female Sexual Function

Liquid Life: The Effects of Cannabis and Cannabinoids on Female Sexual Function

Introductions and image by @SuperFunker.

1) In the following paper, Klein (2012) assessed the association between the endocannabinoid system and female sexual arousal. Although relevant physiological analysis is limited, numerous indicators suggest that Cannabis can influence the female sexual experience. Cannabinoid receptors involved in controlling sexual function are abundant within the brain/peripheral tissues and self-reporting women attest to heightened sexual episodes associated with the use of Cannabis. As such, Klein endeavored to explore the connection between the endocannabinoid system and sexual arousal among women by measuring both physical and subjective responses.

Recruitment Criteria
21 medically healthy premenopausal heterosexual women between the ages of 19 & 45 were recruited for analysis. Each participant proclaimed an absence of:

  • Chronic medical illnesses.
  • Hormonal disorders.
  • Mental health issues.
  • Acute infections.
  • Sexual difficulties.
  • Use of prescribed medications in the previous six months, other than oral contraceptives.
  • Use of illicit drugs in the previous month.
  • Pregnancy within a year of the study.
  • Current breastfeeding.

Assessment Process
Klein measured physiological and subjective sexual arousal of women who were exposed to erotic films. Each woman engaged in real-time physical and subjective evaluations. Additionally, the participants responded to pre and post film surveys.

Physical Assessment
Physiological sexual arousal was measured using Vaginal Photoplethysmography. This is a process that gauges Vaginal Pulse Amplitude which is comprised of phasic changes in vaginal engorgement with each heart beat, such that higher amplitudes indicate greater genital engorgement.

Real-Time Reporting
A computer program was used to numerically evaluate real-time arousal with values ranging from -2 (least sexually aroused) to 0 (sexual indifference devoid of either positive or negative sexual feelings) to 7 (most sexually aroused). 

Pre and Post Survey
Before and after each film, a measure of arousal was gathered using a self-report film scale that assessed several domains:

  • Overall subjective sexual arousal.
  • Mental sexual arousal.
  • Perceptions of physiological sexual arousal.
  • Autonomic arousal.
  • Anxiety.
  • Positive affects.
  • Negative affects.

Endocannabinoid Serum
Blood was extracted to obtain serum for the measurement of endocannabinoid (AEA and 2-AG) concentrations. Samples were obtained pre and post viewing of each of two erotic films, for a total of four samples. With these samples, Klein found that AEA and 2-AG decreased as both physical and subjective sexual arousal increased. Klein was able to validate a link between endocannabinoid levels and sexual arousal among women. However, Cannabis-induced modulation was not explained.

Circulating Endocannabinoid Concentrations and Sexual Arousal in Women.

Several lines of evidence point to the potential role of the endocannabinoid system in female sexual functioning. These include results from studies describing the subjective effects of exogenous cannabinoids on sexual functioning in humans and the observable effects of exogenous cannabinoids on sexual functioning in other species, as well as results from studies investigating the location of cannabinoid receptors in the brain and periphery, and the effects of cannabinoid receptor activation on neurotransmitters implicated in sexual functioning. While these lines of research suggest a role for the endocannabinoid system in female sexual functioning, no studies investigating the relationship between concentrations of endogenous cannabinoids (i.e., arachidonoylethanolamide [AEA] and 2-arachidonoylglycerol [2-AG]) and sexual functioning have been conducted in any species.

To measure circulating endocannabinoid concentrations in relation to subjective and physiological indices of sexual arousal in women (n = 21).

Serum endocannabinoid (AEA and 2-AG) concentrations were measured immediately prior to, and immediately following, viewing of neutral (control) and erotic (experimental) film stimuli in a repeated measures design. Physiological sexual arousal was measured via vaginal photoplethysmography. Subjective sexual arousal was measured both continuously and non-continuously. Pearson’s correlations were used to investigate the relationships between endocannabinoid concentrations and sexual arousal.

Main Outcome Measures
Changes in AEA and 2-AG concentrations from pre- to post-film and in relation to physiological and subjective indices of sexual arousal.

Results revealed a significant relationship between endocannabinoid concentrations and female sexual arousal, whereby increases in both physiological and subjective indices of sexual arousal were significantly associated with decreases in AEA, and increases in subjective indices of sexual arousal were significantly associated with decreases in 2-AG.

These findings support the hypothesis that the endocannabinoid system is involved in female sexual functioning, with implications for furthering understanding of the biological mechanisms underlying female sexual functioning.

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2) Lynn (2019) conducted a survey that assessed the sexual health, sexual behavior and sexual perceptions of both Cannabis users and non-users. Of 373 obstetrics and gynecology patients, 47% (176) were Cannabis users and 34.1% (127) attested to using Cannabis prior to sex. The majority of the Cannabis users, reported an improvement in sexual satisfaction, desire and orgasm, with a reduction in sexual pain. And, the women who used Cannabis before sex were more than twice as likely to report satisfactory orgasms.

The Relationship between Marijuana Use Prior to Sex and Sexual Function in Women

Scientific research on the effects of marijuana on sexual functioning in women, including libido, arousal, orgasm, and satisfaction, is limited.

To evaluate women’s perceptions of the effect of marijuana use before sexual activity.

A cross-sectional design, from March 2016–February 2017, within a single, academic, obstetrics and gynecology practice, was performed. Patients were given a questionnaire at their visit and asked to complete it anonymously and place it in a locked box after their visit.

Main Outcome Measures
The primary outcome was satisfaction in the sexual domains of drive, orgasm, lubrication, dyspareunia, and overall sexual experience. The secondary outcome was the effect of the frequency of marijuana use on satisfaction.

Of the 373 participants, 34.0% (n = 127) reported having used marijuana before sexual activity. Most women reported increases in sex drive, improvement in orgasm, decrease in pain, but no change in lubrication. After adjusting for race, women who reported marijuana use before sexual activity had 2.13 higher odds of reporting satisfactory orgasms (adjusted odds ratio = 2.13; 95% CI = 1.05, 4.35) than women who reported no marijuana use. After adjusting for race and age, women with frequent marijuana use, regardless of use before sex or not, had 2.10 times higher odds of reporting satisfactory orgasms than those with infrequent marijuana use (adjusted odds ratio = 2.10; 95% CI = 1.01–4.44).

Marijuana appears to improve satisfaction with orgasm. A better understanding of the role of the endocannabinoid system in women is important, because there is a paucity of literature, and it could help lead to development of treatments for female sexual dysfunction.

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3) In the following review, Lynn (2020) details possible effects of cannabinoids on female sexual function. It has been established that the endocannabinoid system is directly involved in female sexual function, but the nature of this action and the influences induced by Cannabis have yet to be fully elucidated. For example, research indicates that low doses of Cannabis may increase sexual desire, while high doses may actually reduce desire. Nevertheless, of those women who use Cannabis in association with sexual activity, most report greater sexual enjoyment, prolonged orgasms and enhanced quality of orgasms. Such sexual improvements may be due to:

  • Cannabinoids directly influencing specific functions.
  • Cannabis-reduced anxiety.
  • Phytochemical activity associated with specific strains/chemovars.
  • A combination of numerous biochemical processes that still need to be rationalized.

Lynn underscores, “Female sexuality is a complex interplay of environmental, psychological, and physiological processes. Multiple neurotransmitters and hormones play a role in sexual excitation and inhibition.” Essentially, more work needs to be done to fully understand how cannabinoids impact sexual function in women.

Effects of Cannabinoids on Female Sexual Function.

With the legalization of both medical and recreational marijuana in some countries and a few US states, its use has become more widely prevalent. Both exogenous cannabinoids such as tetrahydrocannabinol (THC) and endogenous cannabinoids (endocannabinoids) have been shown to affect female gonadotropin pathways and female sexuality. Yet, our understanding of the mechanisms and effects on female sexual function is limited.

To review the literature regarding the effects of both endogenous and exogenous cannabinoids on female sexual function in both animals and humans.

We performed a PubMed search for English-language articles in peer-reviewed journals between 1970 and 2019. We used the following search terms: “cannabinoids,” “endocannabinoids,” “marijuana,” “cannabis,” and “female sexual function” or “sexual function.” The main outcomes of the papers were reviewed.

Main Outcome Measure
The main outcome measure was sexual function in females.

A total of 12 human studies and 8 animal studies that evaluated the relationship between cannabinoids and female sexual function were included. Study types in animals were blinded, prospective, placebo-controlled trials. Human studies were based primarily on questionnaire data. The data indicate dose-dependent effects on female sexual desire and receptivity, such that low doses generally facilitate or have no effect but high doses inhibit.

More research is needed to develop a better understanding of the effects of cannabinoids on female sexual function. There does appear to be an effect on both animals and humans, but whether the effect is positive or negative along dose and species lines requires more study. With the legalization of marijuana occurring in more countries and more US states, there needs to be more well-controlled studies evaluating the effects.

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