Cannabis: 70–85% of users reported increased sexual pleasure/satisfaction, 25–40% prolonged duration of intercourse, 55–70% heightened sensation; & reported more coital frequency; but placebo effect cannot be ruled out

Cannabinoid signalling and effects of cannabis on the male reproductive system. Mauro Maccarrone, Cinzia Rapino, Felice Francavilla & Arcangelo Barbonetti. Nature Reviews Urology, November 19 2020. https://www.nature.com/articles/s41585-020-00391-8

Rolf Degen's take: https://twitter.com/DegenRolf/status/1331146898682638336

Key points

* Marijuana has the highest consumption rate of any recreational drug in the Western world.

* Endocannabinoids and their receptors, enzymes and transporters, which together form the endocannabinoid system (ECS), are present in various components of the male reproductive tract, including male genital glands, testis and sperm.

* Preclinical studies have shown that the ECS is involved in negative modulation of testosterone secretion by acting at both central and testicular levels.

* As yet, clinical data are insufficient to conclude that cannabinoids have a harmful effect on human male sexual function and fertility.

* Although cannabinoid receptors are present in the testes and sperm, the effects of cannabinoid exposure on spermatogenesis largely remain to be clarified.

* The ECS has the potential to provide new drug targets in male reproductive disorders, and its components might be useful as biomarkers of male infertility.

Abstract: Marijuana is the most widely consumed recreational drug worldwide, which raises concerns for its potential effects on fertility. Many aspects of human male reproduction can be modulated by cannabis-derived extracts (cannabinoids) and their endogenous counterparts, known as endocannabinoids (eCBs). These latter molecules act as critical signals in a variety of physiological processes through receptors, enzymes and transporters collectively termed the endocannabinoid system (ECS). Increasing evidence suggests a role for eCBs, as well as cannabinoids, in various aspects of male sexual and reproductive health. Although preclinical studies have clearly shown that ECS is involved in negative modulation of testosterone secretion by acting both at central and testicular levels in animal models, the effect of in vivo exposure to cannabinoids on spermatogenesis remains a matter of debate. Furthermore, inconclusive clinical evidence does not seem to support the notion that plant-derived cannabinoids have harmful effects on human sexual and reproductive health. An improved understanding of the complex crosstalk between cannabinoids and eCBs is required before targeting of ECS for modulation of human fertility becomes a reality.

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Despite data suggesting that cannabis use can affect human sexual function, its effects remain under debate, as favourable effects on sexual behaviour and motivational, hedonic and/or perceptual aspects of sexual intercourse have been also reported. Some studies77have suggested that 70–85% of marijuana consumers experience increased sexual pleasure and satisfaction, 25–40% prolonged duration of intercourse, and 55–70% heightened orgasmic sensation78,79. Furthermore, the National Survey of Family Growth (NSFG), a representative cross- sectional survey on a well- controlled cohort of almost 23,000 men in the USA, showed that increased frequency of marijuana use was associated with increased coital frequency, even after adjustment for demographic, socio- economic and anthropometric variables80(Table 3). Notably, these data are all self-reported and, therefore, are at risk of both recall bias and exaggeration by participants; thus, they should be interpreted with caution. The authors hypothesized that individuals who engage in marijuana use might be more psychologically disinhibited than those who do not, which could be reflected in their sex life as high coital frequency80. Furthermore, although sexual pleasure could be at least partially attributed to an actual enhancement of sensory experience, especially in terms of an increased sensitivity to touch, which has been reported in cannabis users78, a placebo effect cannot be ruled out, given the anecdotal reputation of cannabis as an aphrodisiac77. These aspects should be taken into account when interpreting the increased sexual pleasure and satisfaction among marijuana consumers reported in previous studies77.