(267) Ecstasy' - Accurate or Deceptive Name? A Systematic Review of MDMA Effects on the Male Sexual Response Cycle
Authors: Suyama J , Dubinskaya A , Eilber K , Anger J 
Published: May 2023

Abstract

Introduction
3,4-Methylenedioxymethamphetamine (MDMA, ‘Ecstasy’ or ‘Molly’) is a synthetic psychostimulant and entactogenic drug of abuse that augments feelings of pleasure, increases energy, and distorts sensory perception. MDMA increases serotonin, dopamine, and norepinephrine neurotransmission within the mesolimbic reward pathway, which impacts human sexual function. While dopamine is implicated as a facilitator of sexual arousal and orgasm, serotonin is associated with inhibitory effects. Unlike most psychostimulants that function primarily via increased dopaminergic neurotransmission, MDMA generates approximately equivalent and simultaneous increases in both dopamine and serotonin. In alignment with its central neurochemical impact, MDMA is reported to enhance arousal while impairing sexual function in other domains, such as orgasm, erectile function, and ejaculation.

Objective
To evaluate MDMA effects on different domains of the male sexual response cycle.

Methods
We conducted a systematic review of the effects of MDMA on various domains of male sexual response. PubMed, Embase, and MEDLINE were queried, and results were screened using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six search terms, including “MDMA” or “ecstasy” in combination with “desire,” “orgasm,” “pleasure,” “libido,” “erection,” and “ejaculation” were utilized. Inclusion criteria were: MDMA was used by study subjects, outcomes in at least 1 domain of the sexual response cycle were reported, and the manuscript was written in English and published between January 2000 and June 2022. Case reports and studies that did not examine male sexual response were excluded.

Results
We identified a total of 90 studies, and 8 met inclusion and exclusion criteria. Seven studies evaluated the effects of MDMA on desire and/or arousal, 5 on erection, 3 on orgasm, and 2 on ejaculation. The average age of study participants was 25 years. Primary outcome measures were highly variable and largely qualitative; however, common measures included the Sexual Arousal and Desire Inventory (SADI) and the International Index of Erectile Function (IIEF) score. Two studies were double-blind, crossover trials that evaluated MDMA effects relative to placebo or other psychostimulants (methylphenidate, modafinil) with mixed conclusions. One reported no effect of MDMA on sexual arousal compared to placebo and less arousal than methylphenidate, while the other reported increased sexual desire with MDMA compared to both methylphenidate and modafinil. The remaining studies were interview-based, with 5 of 6 evaluating sexual arousal. Sixty percent of interview-based studies reported increased desire, while 40% reported mixed or no effect. Of 5 studies evaluating erection, 2 reported impairment, 2 reported mixed effects, and 1 reported “fear of erection impairment.” All studies evaluating orgasm reported difficulty achieving orgasm, but increased intensity and pleasure if achieved.

Conclusions
This systematic review demonstrates mixed effects of MDMA on different domains of male sexual response. While there are few high-quality studies investigating effects on distinct domains of male sexual response, our findings suggest that MDMA increases sexual desire, enhances sexual pleasure, and intensifies orgasm in males despite potential impairments in erectile and ejaculatory function. Given MDMA's illicit and unregulated nature, these results should be interpreted with caution and MDMA users must consider the potential for adverse drug-related behavioral and health effects.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Abbvie, Coloplast