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Keywords:

  • Premature Ejaculation;
  • Burden of Disease;
  • Sexual Disorders;
  • Substance Abuse, Heroin;
  • Cocaine

ABSTRACT

  1. Top of page
  2. ABSTRACT
  3. Introduction
  4. Aim of the Study
  5. Materials and Methods
  6. Results
  7. Discussion
  8. Conclusions
  9. Acknowledgments
  10. References
  11. Appendix

Introduction.  Adolescence is one of the periods in which the risk of initial use of drugs is high. Among the reasons leading to first drug use (FDU), sexual disorders have so far been poorly investigated.

Aim.  To evaluate the prevalence of premature ejaculation, erectile dysfunction, and low sexual desire in former drug addicts in the period prior to FDU; whether or not the former drug addicts claimed that sexual dysfunctions influenced their decision to start illicit drug taking, and whether or not the subjects had sought and used drugs aiming to improve sexual drive.

Methods.  Eighty-six male former drug addicts (18–35 years old) were investigated using a questionnaire.

Main Outcome Measures.  Fisher and Armitage tests.

Results.  Before FDU, 61 (71%) subjects reported having one or more sexual dysfunctions. Only 25 (29%) had no sexual dysfunction prior to FDU. Among those with normal sexual function, only three (3.49%) stated that sexual dysfunctions had influenced their decision, whereas in the sexual dysfunction group, 27 (31.4%) confirmed this experience. This difference is statistically significant, Fisher test, P = 0.0033.

The more severe the sexual dysfunction, the higher the percentage of those who stated that sexual dysfunction influenced their decision to start taking drugs. This trend is statistically significant, P < 0.0025.

About 50% of the entire sample admitted they had used drugs to improve sexual performance.

Conclusions.  Users of illicit drugs report a high prevalence of sexual disorders prior to FDU. A large percentage claimed that sexual dysfunction influenced their decision to start taking drugs. The higher the severity of the sexual disorders, the higher the percentage of those claiming that sexual dysfunction had influenced their decision. In our opinion, these data highlight a possible new strategy in the primary prevention of substance abuse in which sexual education and early treatment of sexual disorders, among adolescents, may prevent them from FDU. La Pera G, Carderi A, Marianantoni Z, Peris F, Lentini M, and Taggi F. Sexual dysfunction prior to first drug use among former drug addicts and its possible causal meaning on drug addiction: Preliminary results. J Sex Med 2008;5:164–172.


Introduction

  1. Top of page
  2. ABSTRACT
  3. Introduction
  4. Aim of the Study
  5. Materials and Methods
  6. Results
  7. Discussion
  8. Conclusions
  9. Acknowledgments
  10. References
  11. Appendix

Several studies have demonstrated that, of the various negative effects, prolonged use of drugs leads to impairment of sexual function and, with time, may lead to onset of sexual disorders [1–5].

These findings, even if not recent, have been confirmed and are, without doubt, of great importance.

Nonetheless, even if the use of drugs can result in sexual dysfunction, this has not been an effective deterrent in preventing young males from starting to take drugs.

For several years, our research group [6–9] has adopted a different approach to the sex and drugs link, proposing the opposite concept to that generally considered valid.

Indeed, it is important not only to focus on the consequences of the use of drugs upon sexuality, but is, in our opinion, much more important to take into consideration the effects that sexual dysfunction, in adolescents, may have upon their behavior and their decision to turn to drugs.

We are well aware that even if various factors may contribute to the decision of these young people to start taking drugs, it is possible to suspect that lack of sexual success or the conviction that they are sexually inadequate may, in some cases, result in severe frustration for the young adolescent, who, if left completely on his own without sufficient support, may be driven to dangerous behavior and even to the temptation of drug-taking.

This different approach to the problem of sex and drugs may be of fundamental strategic importance in programs aimed at the primary prevention of drugs in adolescents, and for this reason, we decided to take a closer look at the presence or absence of sexual disorders in the period preceding first drug use (FDU).

Aim of the Study

  1. Top of page
  2. ABSTRACT
  3. Introduction
  4. Aim of the Study
  5. Materials and Methods
  6. Results
  7. Discussion
  8. Conclusions
  9. Acknowledgments
  10. References
  11. Appendix

Because of the relevance of a possible new approach to primary prevention of substance abuse on public health, a population of former drug addicts has been studied, focusing, in particular, on the following aspects:

  • 1
    Prevalence of premature ejaculation (PE) and/or other forms of sexual dysfunction in the period prior to FDU;
  • 2
    Whether or not the former drug addicts claimed that sexual dysfunctions influenced them in their decision to start illicit drug-taking;
  • 3
    To what extent do the former drug addicts claim that sexual dysfunction influenced them in their decision;
  • 4
    Whether or not the former drug addicts had sought and used drugs aiming to improve their sexual drive and, in particular, to delay the ejaculatory reflex;
  • 5
    And, if yes, to what extent had drugs helped to improve sexual performance.

Materials and Methods

  1. Top of page
  2. ABSTRACT
  3. Introduction
  4. Aim of the Study
  5. Materials and Methods
  6. Results
  7. Discussion
  8. Conclusions
  9. Acknowledgments
  10. References
  11. Appendix

Recruitment of Participants

Invited to take part in the study were male subjects, aged between 18 and 35 years, who, at the time of the study, were in rehabilitation centers.

The research was carried out at the following drug rehabilitation centers, all located in the area surrounding Rome.

  • • 
    “Magliana ‘80”
  • • 
    “Giacomo Cusmano”
  • • 
    “Cotrad”
  • • 
    “Massimina”
  • • 
    “Villa Maraini”

All male subjects in the rehabilitation centers aged between 18 and 35 years, who had been off drugs for at least 3 months, were invited to take part in the study.

Of the 93 subjects present in the centers and invited to answer the questionnaire, all except two, accepted, no reason having been given for refusal.

As far as exclusion criteria are concerned, the subjects who had had their first sexual relationships after FDU were omitted from the final evaluation because it would not be possible to evaluate their potency and their control over the ejaculation reflex. Only five subjects were not considered in the final statistical analysis.

Use of derivatives of cannabis, in the period prior to their first sexual experience, was not taken into consideration, in the exclusion criteria, as the use of these so-called “light” drugs is an extremely widespread phenomenon in young males, and it is difficult to discriminate between recreational use and substance abuse according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DMS-IV) definition [10].

The subjects were studied with the aid of a questionnaire aimed at investigating early sexual experiences and the use of drugs, particular attention being focused on the sexual situation prior to the onset of FDU (see Appendix 1).

For this purpose, a series of specific questions were prepared by means of three focus groups with 16 opinion leaders in the field of drug addiction, based upon the construct previously described by Rossi et al. [11–14]. Another three focus groups were performed together with 18 young males, with a history of drug addiction. The focus-group technique is based upon the classic method of Morgan et al. [15,16], with the group meeting being observed and video- or audio-recorded through a mirror.

The questionnaires were then validated for the comprehensiveness of the items according to the techniques of Converse and Presser [12]. Thus, in the discussion of the focus groups, all participants were in agreement concerning the meaning of the questions, and there were no misunderstandings regarding possible answers. All participants then received an evaluation scale from 0 to 100 on which they expressed the degree of comprehension and univocal interpretation of the questions listed in the questionnaire. A value of 0 meant that the question was absolutely incomprehensible or could be interpreted in more than one way, whereas 100 meant that the question was clearly comprehensible and could be interpreted only in one way. All questions on the questionnaire that had not been assigned a minimum score >90 were eliminated or rewritten on the basis of the agreement reached by the participants at the focus group.

The questions, which concerned the period of time from the first complete sexual experience to the FDU, were of the multiple-choice and close-ended type.

The time required to complete the questionnaire ranged between 20 and 30 minutes, depending upon the subject.

The questionnaire investigated the subject's family background, the toxicological characteristics of the study population (FDU, period of drug abuse, type of drugs used, etc.), and the sexual history of the subject prior to FDU (first sexual intercourse, sexual preferences, desire, erection, and control of ejaculatory reflex). In the third part of the questionnaire, two questions were addressed to explore whether the subjects used drugs (heroin or cocaine) to improve sexual performances, and if yes, to what extent heroin and/or cocaine was helpful in improving sexual performances (see Appendix 1).

Before using the questionnaire, the exact meanings of the definitions, concerning erectile dysfunction (ED), decreased libido, and PE, were explained to the subjects in accordance with the “consensus” obtained as a result of the previous six “focus groups.”

Characterization of Sexual Dysfunction

ED and Low Sexual Desire (LSD)

We defined the variable of ED and sexual desire using the International Index of Erectile Function (IIEF) questionnaire [17]. The questions pertained to the period before the subject's FDU. Although the question on the original IIEF questionnaire began “in the last for weeks,” our version used a language referring to the period before FDU. We considered as pathological those subjects who scored less than 4 in questions Q3 and Q4, and less than 3 in questions Q11 and Q12.

PE

The PE definition adopted was based upon Helen S. Kaplan's definition [18,19], in which ejaculation occurs before the subject wants it to, due to the absence of voluntary control over ejaculation. We also asked if ejaculation occurred within 15 strokes or 15 seconds after penetration in the vagina.

Normal Sexual Function Subjects

All those subjects not presenting ED, PE, and/or LSD according to the definition discussed previously were considered having normal sexual function.

Statistical Analysis

Concerning the statistical tests, we used Fisher exact test and Armitage test for trend, which statistically analyzes the trend course of the proportions [20].

Results

  1. Top of page
  2. ABSTRACT
  3. Introduction
  4. Aim of the Study
  5. Materials and Methods
  6. Results
  7. Discussion
  8. Conclusions
  9. Acknowledgments
  10. References
  11. Appendix

All the subjects enrolled in the study correctly completed the questionnaire. Of these, five subjects were excluded as they had started to use drugs before the first experience of sexual intercourse. Thus, the 86 subjects (mean age 30.24 ± 4.98 standard deviation [SD] years [range 22–35]) were analyzed.

Characteristics of Sample Population

As far as marital status is concerned, 63 (73.3%) were single, 15 (17.4%) were married, 6 (7%) were separated, 1 (1.2%) was divorced, and 1 (1.2%) was a widower.

The self-declared sexual preferences were heterosexual in 81 (94.2%) subjects, bisexual in 2 (2.3%), and homosexual in 3 (3.5%).

Comorbidity

In the group under study, 46 subjects were found to present liver disease, 31 infectious diseases, 24 depression, and 13 various disorders (diabetes, arterial hypertension, etc.).

Education Level

Overall, six (7%) of those interviewed had a junior school certificate, 50 (58.1%) had a junior high school certificate, 28 (32.6%) had a high school diploma, and two (2.3%) had a degree (Table 1).

Table 1.  Educational level of recruited subjects in drug rehabilitation centers
Junior school67%
Junior high school5058.10%
High school diploma2832.60%
Degree22.30%

Even if 29 (33.7%) of the subjects reported being unemployed, the majority of the subjects had a professional qualification (specialized worker, mechanic, and clerk).

From the answers to the questionnaire, it emerged that the mean age at the time of first experience of complete sexual intercourse was 16 years (median 17 years, range 11–21), whereas the mean age at the first use of drugs, with the exception of cannabis, was 17 years (median 17 years, range 11–35).

The mean time elapsing between FDU and the present survey was 14.47 ± 4.76 SD (median 16 years, range 1–22).

Drug Used

When we considered the whole sample, 13 (15.1%) took only one kind of drug, namely, heroin 9 (10.5%) or cocaine 4 (4.6%), while the remainder 73 (84.9%) were polydrug users.

Sexual Disorders

In the period before FDU, the sexual disorders revealed were as follows:

  • • 
    Twenty-five subjects (29.06%) were considered having normal sexual function as they did not suffer from ED or PE or LSD;
  • • 
    Nineteen (22.09%) had one sexual dysfunction and were affected by PE according to Kaplan definition;
  • • 
    Fourteen (16.27%) subjects had one sexual dysfunction and were reported as having ED;
  • • 
    Sixteen (18.6%) had two sexual dysfunction, 15 both PE and ED, and 1 LSD and ED;
  • • 
    Twelve (13.95%) subjects had three sexual dysfunction, that is, LSD, PE, and ER.

None of the patients with LSD presented only one disorder, but when LSD was present, it was always associated with PE and/or with ED (Table 2).

Table 2.  Distribution of normal sexual function and sexual dysfunction subjects
  1. PE = premature ejaculation; ED = erectile dysfunction; LSD = low sexual desire.

Normal sexual function2529%
All sexual dysfunction6171%
PE1921.90%
ED1416.43%
PE + ED or ED + LSD16 (15 + 1)19.17%
PE + ED + LSD1213.69%

Incidentally, of those presenting PE, 12 (13.9% of the whole sample or 26% of those with PE) declared that ejaculation occurred within 15seconds or 15 strokes after vaginal penetration.

Of the 25 subjects classified as not having sexual disorders and thus considered with normal sexual function prior to onset of FDU, in reply to the question of whether a sexual disorder had influenced their decision to start drug-taking, 3/25 (12%) (3.49% of the whole sample) subjects confirmed that a sexual disorder had influenced their decision to start taking drugs, whereas the remaining 22/25 (88%) (25.58% of the whole sample) subjects denied that this had influenced their FDU.

Of the 61 subjects who had at least one sexual disorder, that is, LSD, PE, or ED, 27/61 (44.3%) (31.4% of the whole sample) subjects reported that the sexual disorder had influenced their decision to start taking drugs. The remaining 34 (55.7%) (39.53% of the whole sample), on the other hand, reported that the sexual disorder had no influence on their decision. The difference between these two groups is statistically significant (Fisher exact test = 0.0033) (Table 3).

Table 3.  In reply to the question of whether a sexual disorder had influenced their decision to start drug taking, the two groups, the normal sexual function group and that with sexual dysfunction, gave different percentages. This difference is statistically significant; Fisher exact test, P = 0.0033. Q: Did sexual problem sinfluenced your decision to have your first drug use? Fisher exact test, P = 0.0033.
 Yes, it influencedNo, it did not influenced
  1. PE = premature ejaculation; ED = erectile dysfunction; LSD = low sexual desire.

Normal sexual function3 (3.49%)22 (25.58%)
PE + ED + LSD27 (31.4%)34 (39.53%)

The distribution of the replies, taking the series according to each disorder (normal sexual function, LSD, PE, and ED), is illustrated in Tables 4 and 5, and in graph in Figure 1.

Table 4.  The subjects are grouped according to the different sexual pathologies. Please note the progressive increase in the percentage of subjects who declared that sexual disorders had influenced their decision to start taking drugs as sexual disorder became more severe 1, 2 or 3 sexual disorders. This trend is statistically significant. Q: Did sexual problems influenced your decision to have your first drug use?
 YesNo
  1. PE = premature ejaculation; ED = erectile dysfunction; LSD = low sexual desire.

Normal sexual function3 (12%)22 (88%)
1 Sexual dysfunction: PE = 19 + ED = 1411 (33.3%)22 (66.6%)
2 Sexual dysfunctions: PE + ED or ED + LSD7 (43.7%)9 (56.2%)
3 Sexual dysfunctions: LSD + PE + ED9 (75%)3 (25%)
Chi-square for trend14.333
P < 0.0024Degrees of freedom
Table 5.  Among those former drug addicts who claimed that sexual dysfunction influenced their decision to have their first drug use (FDU); we also asked to what extent this condition was important. Q: Did sexual problems influence your decision to have your FDU?
 Yes, influenced a littleYes, influenced a lotYes, have been determinant
  1. PE = premature ejaculation; ED = erectile dysfunction; LSD = low sexual desire.

Normal sexual function2 (66.7%)1 (33.3%)0
PE or ED8 (72.7%)2 (18.2%)1 (9.1%)
PE + ED or ED + LSD4 (57.1%)2 (28.6%)1 (14.3%)
LSD + PE + ED4 (44.4%)3 (33.3%)2 (22.2%)
image

Figure 1. Subjects with only one dysfunction, namely, only PE and only ED, were grouped together. Patients with ED and PE, or ED and LSD were grouped in two sexual dysfunction groups. Subjects with ED and PE and LSD were grouped in three sexual dysfunction group. Please note the progressive increase in the percentage of subjects who declared that sexual disorders had influenced their decision to start taking drugs as sexual disorder became more severe 1, 2 or 3 sexual disorders. This trend is statistically significant. ED = erectile dysfunction; PE = premature ejaculation; LSD = low sexual desire.

Download figure to PowerPoint

Subjects with only one dysfunction are grouped together, namely, 19 with PE and 14 with ED. Six PE and 7 with ED stated that sexual dysfunction influenced their decision. It is worthwhile to draw attention to the progressive increase in the percentage of subjects who declared that a sexual disorder had influenced their decision to start taking drugs as the sexual disorder became more severe—1, 2, or 3 sexual disorders. This trend is statistically significant (Chi-square = 14.33 and P < 0.0025; Armitage test for proportion).

In reply to the question “Have you ever used drugs to improve your sexual performance?”, no difference was observed between the two groups (P value not significant) even if it should be pointed out that 50% of the series, including also the normal sexual function subjects, had used drugs to improve their sexual performance (Table 6 and Figure 2).

Table 6.  The subjects were asked to answer to the question “Did you ever take drug to improve sexual performances?” Q: Did you ever use drug to improve sexual performances? P = ns
 YesNo
  1. PE = premature ejaculation; ED = erectile dysfunction; LSD = low sexual desire; ns = not significant.

Normal sexual function13 (52%)12 (48%)
1 Sexual dysfunction: PE10 (52.7%)9 (47.3%)
1 Sexual dysfunctions: ED9 (64.3%)5 (35.7%)
2 Sexual dysfunctions: PE + ED or ED + LSD10 (62.5%)6 (37.5%)
3 Sexual dysfunctions: LSD + PE + ED5 (41.7%)7 (58.3%)
image

Figure 2. The subjects were asked to answer to the question “Did you ever take drug to improve sexual performances?” In this figure, the subjects with only one dysfunction, only ED or only PE, were grouped together. ED = erectile dysfunction; PE = premature ejaculation; LSD = low sexual desire.

Download figure to PowerPoint

We also asked those who answered “yes” to the previous question, to what extent drugs were helpful in improving sexual performance. Results are given in Tables 7 and 8. It is worthwhile pointing out that very few subjects who used substances to improve sexual performance denied any positive effect on sexual performance. On the contrary, the majority of them reported an improvement.

Table 7.  Among the subjects who answered “yes” to the question in Figure 2, we also asked “If yes, to what extent heroin helped you?” Q: To what extent did heroin help you in improving sexual performances?
 Not at all/a littleA lotVery much
  1. PE = premature ejaculation; ED = erectile dysfunction; LSD = low sexual desire.

Normal sexual function123
PE 44
ED222
PE + ED 22
LSD + PE + ED  2
Table 8.  Among the subjects who answered “yes” to the question in Figure 2, we also asked “If yes, to what extent cocaine helped you?” Q: To what extent did cocaine help you in improving sexual performances?
 Not at all/a littleA lotVery much
  1. PE = premature ejaculation; ED = erectile dysfunction; LSD = low sexual desire.

Normal sexual function241
PE 33
ED151
PE + ED142
LSD + PE + ED122

It is very interesting to note that PE subjects used heroin (eight subjects) and cocaine (six subjects) to improve sexual performance. All of whom reported a significant improvement (Tables 7 and 8). None of them reported that the two drugs used were not effective in the improvement of sexual performance. All patients but three, with only ED, gave similar replies.

Discussion

  1. Top of page
  2. ABSTRACT
  3. Introduction
  4. Aim of the Study
  5. Materials and Methods
  6. Results
  7. Discussion
  8. Conclusions
  9. Acknowledgments
  10. References
  11. Appendix

One of the possible shortcomings of this investigation is the fact that it is a retrospective study, analyzing a period of life that may be far from the present time, particularly if the subject under study is over 30 years of age, therefore, there could be some bias because of a distorted memory of earlier experiences. Furthermore, the time elapsing between FDU and the interview was particularly long, that is, approximately 16 years.

Another possible bias of the investigation resides in the fact that the data refer to information gleaned from subjects and not from objective measurements, such as intravaginal ejaculatory latency time (IELT) [21,22] or other diagnostic criteria [23–25]. Although this type of study would be more accurate from a scientific point of view, it would not be possible from an ethical viewpoint, inasmuch as it would be unacceptable to invite a subject to use heroin and then to evaluate the IELT. At present, it is not possible to establish the role of these aspects on the basis of the final results.

One of the limits of this study is the fact that the subjects did not report which aspect of their sexual performance they had hoped to improve, that is, rigidity, desire or duration of the sexual relationship. Albeit, presumably, those affected only by PE, with no other disorders, turned to drugs to prolong the duration of the performance, while those presenting only ED took drugs only to improve rigidity.

In this study, we did not explore the other relevant variables that lead to FDU. That is because it was not the aim of this study to weigh the importance of the different risk factors but rather to draw attention to the presence of sexual dysfunction among the former drug addicts before the onset of FDU, and that these young men claim that a given percentage of these men started to use drugs because of sexual dysfunction; heroin and cocaine were used to improve sexual performance, and that heroin and cocaine led to the improvement in sexual performance.

A multivariate analysis of the various risk factors will be possible once we establish that there is an association between sexual disorders and FDU.

This article refers to data emerging from a preliminary investigation showing, and indeed, stressing the existence of a phenomenon, namely, heroin as “self treatment” of PE or ED.

There are other uncontrolled variables that cannot be fully evaluated such as the fact that cannabis has not been considered. This variable is very difficult to evaluate not only because its use is very widespread and it is difficult to discriminate between recreational use and abuse [10], but also because very often, its use starts much earlier than first sexual experiences. At present, it is not possible to weigh its role on the basis of the final results.

Although we performed six focus group to validate the questionnaire, it should be mentioned as possible limitation of the study the use of a modified IIEF questionnaire to measure ED and LSD.

As far as the interpretation of this data is concerned, this study shows that the percentage of subjects with PE, who used drugs to improve sexual performance, is comparable to that of the so-called “normal sexual function” subjects. The same goes for those with ED or association of sexual dysfunctions (Table 6). Accordingly, it could be argued that a significant percentage of males starting to use drugs have a personality trait that render them not confident with sexuality, irrespective of the real existence of a sexual problem. This could also explain the finding that also so-called “normal sexual function” subjects reported having improved sexual performance with both heroin and cocaine.

Among those who use heroin, there is a high frequency of subjects with sexual disorders. This observation offers the possibility to contribute more fully to evaluating the burden of the disease of PE and DE. In particular, the burden of the disease of PE was not, until now, considered a pathological disorder with severe reflections upon health such as drug addiction or substance abuse [26]. Indeed, it is worthwhile stressing that the management of PE should be borne in mind in treatment aimed at detoxification from opioids. In fact, it is well known that the syndrome due to abstinence leads to worsening or onset of PE [27]. This aspect could be the cause of relapse or lack of respect of the therapeutic schedule of tapering with methadone or with buprenorphin.

Furthermore, the experience gained led us to change our approach in our andrological practice and to always ask PE patients, in clear terms, whether they were taking, or had ever taken, psychotropic substances.

Finally, in our opinion, these data offer a further contribution to the conjecture, sometimes indicated as the “La Pera hypothesis”[6–9], which suggests that sexual disorders may be a possible and important cause of the beginning of drug use, and indeed, substance abuse in young males.

According to this hypothesis, young males, in a larger percentage with respect to the general population, turn to drugs in order to obtain some kind of help and self-administered cure, to overcome the embarrassment related to their inadequacy, their initial sexual dysfunction, typical of adolescence (PE, DE, etc.), as well as to improve sexual performances.

This hypothesis includes also another construct in which the biological need enhances the development of a certain mode of thought. In other words, the sexual handicap, the sexual difficulty, or the conviction of being sexually inadequate, would drive young males to assume dangerous behavior in a desperate search to find a solution to the sexual problem that characterizes one of the most important phases of growing up, namely, from youth to manhood.

These data, according to our experience, lend further support to the validity of this hypothesis for three reasons: (i) sexual activity, almost always, precedes FDU and only five out of 91 subjects in the present investigation reported that the first use of drugs occurred after having had their first sexual experience; (ii) as the symptoms become more severe, so the prevalence of those who state that the sexual disorder influenced their decision to start illicit drugs increases; (iii) this point emerges from an objective finding: it should not be underestimated that 34% of the subjects clearly admitted having started to use drugs on account of one or more sexual dysfunctions.

Conclusions

  1. Top of page
  2. ABSTRACT
  3. Introduction
  4. Aim of the Study
  5. Materials and Methods
  6. Results
  7. Discussion
  8. Conclusions
  9. Acknowledgments
  10. References
  11. Appendix

Results emerging from the series analyzed in the present study show that in the period prior to FDU, sexual disorders were particularly frequent, and approximately 71%, that is, more than two out of three youths, presented a sexual disorder.

Of the subjects interviewed, 30 (34.8%) declared that a sexual disorder had influenced their decision to start taking illegal drugs. This percentage is statistically higher in those presenting a sexual disorder prior to FDU.

Furthermore, this percentage tends to increase with the increase in sexual disorders (Figure 1).

Indeed, of the subjects presenting only one sexual disorder, this percentage is 33.3%, while in those with two sexual disorders, that is, PE and ED, this percentage reaches 43%. On the other hand, when three sexual disorders are present, that is, PE and ED and LSD, this percentage rises to 75%. This trend is statistically significant.

Another very interesting aspect concerns the fact that drugs are used to improve sexual performance, both by normal sexual function subjects as well as those with ED (Figure 2).

Indeed, 50% of both groups reported using drugs to improve sexual performance; heroin being the most used (95% of the subjects).

In particular, of those presenting only EP, heroin was reported to be effective in 100%, whereas in those presenting only ED, the improvement was 66.%.

Although it is well known that cocaine improves sexual performance, it is a completely new finding for heroine, which, at the best of our knowledge, has never been reported to improve sexual performance. It should not be forgotten, however, that heroin increases blood levels of nitric oxide [28], and that heroin is a sedative [29], and therefore reduces or eliminates anxiety, which, in young subjects, may be the cause of lack of success in terms of rigidity and control over ejaculation.

Even if it clearly emerges from the interviews that these youths explicitly stated that their choice had been triggered by sexual disorders, it is also clear that from an epidemiological point of view, it would be extremely difficult to perform a scientific experiment that would demonstrate this social phenomenon. It would therefore be premature to state with any certainty that sexual disorders are one of the causes, not only of drug addiction, but also of dropouts from detoxication programs following heroin and opioids.

While awaiting confirmation, based on longitudinal studies analyzing the different causes of addiction and the cause-and-effect relationship between sexual dysfunction and the onset of drug use, it would be wise not to abandon young adolescents to face the problem of PE and ED alone, but rather to provide them with appropriate information, and when necessary, to offer them early treatment for sexual disorders particularly PE.

Acknowledgments

  1. Top of page
  2. ABSTRACT
  3. Introduction
  4. Aim of the Study
  5. Materials and Methods
  6. Results
  7. Discussion
  8. Conclusions
  9. Acknowledgments
  10. References
  11. Appendix

We wish to thank the following colleagues for their help in the recruitment of patients in the rehabilitation centers: Vincenzo Barca, Leandro Cavalieri, Germana Cesarano, Mosè Montefusco, Annalisa Pilia, Tonino Ribaldi, Ettore Rossi, and Stefania Iannicello. The authors also thank Marian Shields for the help in the translation.

Conflict of Interest: None declared.

References

  1. Top of page
  2. ABSTRACT
  3. Introduction
  4. Aim of the Study
  5. Materials and Methods
  6. Results
  7. Discussion
  8. Conclusions
  9. Acknowledgments
  10. References
  11. Appendix
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Appendix

  1. Top of page
  2. ABSTRACT
  3. Introduction
  4. Aim of the Study
  5. Materials and Methods
  6. Results
  7. Discussion
  8. Conclusions
  9. Acknowledgments
  10. References
  11. Appendix

Appendix 1

Here are the items of the questionnaire.

Now, try to be concentrated in the period before you had your first drug use.

(Q11) In that period, how often have you felt sexual desire?

Almost never/never

A few times

Sometimes

Most times

Almost always/always

(Q12) In that period, how would you have rated your level of sexual desire?

Very low/none at all

Low

Moderate

High

Very high

(Q3) In that period when you had erections with sexual stimulation, how often were your erections hard enough for penetration?

Never or almost never

A few times

Sometimes

Most times

Almost always or always

(Q4) In that period during sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?

Never or almost never

A few times

Sometimes

Most times

Almost always or always

In that period, were you able to control the ejaculation and for the most part decide when to have an orgasm?

Yes

No

Did you ever use drug to improve sexual performances?

Never

Sometimes

Often

Very often

And if yes, to what extent did it help you?

Heroinnot at alla bitmuchvery much
Cocainenot at alla bitmuchvery much
Ecstasyno at alla bitmuchvery much
Allucinogens/LSDno at alla bitmuchvery much
Other (specify)not at alla bitmuchvery much

Did sexual problems influence your decision to have your first drug use?

I did not have yet sexual intercourses at that time.

No, never

Yes, influenced a little

Yes, influenced a lot

Yes, they have been determinant