Int J High Risk Behav Addict. 2016 September; 5(3):e29640. doi: 10.5812/ijhrba.29640.

Published online 2016 June 13. Research Article

A Qualitative Study of the Relationship Between Methamphetamine

Abuse and Sexual Dysfunction in Male Substance Abusers

Behrouz Dolatshahi,1 Ali Farhoudian,1,* Mozhgan Falahatdoost,2 Mahmoud Tavakoli,1 and Ebrahim

Rezaie Dogahe2
1
Substance Abuse and Dependence Research Center, Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
2
Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
*
Corresponding author: Ali Farhoudian, Substance Abuse and Dependence Research Center, Department of Clinical Psychology, University of Social Welfare and Rehabilitation
Sciences, Tehran, IR Iran. Tel: +98-9111517707, E-mail: a.farhoudian@uswr.ac.ir

Received 2015 May 06; Revised 2015 June 14; Accepted 2015 July 27.

Abstract

Background: Increased prevalent use of methamphetamine is a global public challenge. Information on drug use can be helpful
in preventing high-risk behavior related to drug abuse.
Objectives: This study aims to investigate the sexual function changes related to methamphetamine use in the male clients of
public and private addiction treatment centers.
Patients and Methods: In this qualitative study, 45 men (35 methamphetamine users, 5 family members of the users, and 5 psy-
chiatrists or physicians who were famous for treating or researching addiction) are involved. An in-depth interview was done with
therapists and key individuals.
Results: The results show that the effects of methamphetamine on sexual function are not identical. The first usage is concomi-
tant with the increased duration of sex, an increase in the quality and quantity of sexual pleasure, a delighted orgasm, and feeling
more control of the sex act. These effects gradually decrease. A decreased libido and various sexual dysfunctions such as erectile
dysfunction, premature ejaculation, and losing control during the sex act will appear over time.
Conclusions: There are differences in the libido and sexual functions of methamphetamine users. Personal perceptions of one’s
sexual function may be affected by cognitive changes resultant from the drug. Drug-use prevention, addiction treatments, appro-
priate sexual behavior education, and harm reduction are priorities.

Keywords: Qualitative Research, Sexual Dysfunction, Amphetamine

1. Background ments, poisoning, and death are the long-term effects (1).
The absence of methamphetamine after long-term con-
Methamphetamine (also known as meth) use and de-
sumption leads to withdrawal syndrome such as dysphoric
pendency are serious public health problems across mul-
mood, weakness, lethargy, anxiety, nightmares, insomnia,
tiple areas, from societal impact to burdens on psychiatric
sweating, and tension (5). Methamphetamine increases
and medical resources (1). Methamphetamine is a potent
sexual desires, which is directly related to high-risk behav-
form of amphetamine, administered through inhalation,
iors (1).
smoking, injection, and ingestion (1). Cravings are one
of the main reasons for abuse of the drug; Ekhtiari et al. The use of drugs and committing substance-related
reported that methamphetamine is a common stimulant problem behaviors are presumably due to deficits in the
substance in Iran that produces high levels of cravings (2). inhibitory control and are commonly associated with a
A study at the methadone maintenance treatment loss of inhibitory control of sex behavior, or sexually com-
clinic of the Baharan Psychiatric hospital in Zahedan city, pulsive behavior (6). Research indicates that most con-
in the east of Iran, shows that methamphetamine abuse sumers believe that methamphetamine may increase the
increased from 6% among the patients in 2009 to approxi- pleasure of their sexual experiences (7). This may be one of
mately 20% in 2011 (3). The short-term effects of metham- the most important factors of sexual deviation in metham-
phetamine are increased level of energy, appetite, and a phetamine users (8). Previous research findings indicate
general sense of well-being (4); addiction, mood distur- that other factors may be responsible for high-risk behav-
bance, paranoia, agitation, psychosis, cognitive impair- iors (9) and factors such as impulsiveness are more impor-

Copyright © 2016, Zahedan University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial
4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the
original work is properly cited.
 Dolatshahi B et al.

tant (10). clinics in Tehran. The participants included 45 men: 35

Sexual intercourse marathons, in which intercourse methamphetamine users, 5 family members of the users,
lasts for several hours, are prevalent among metham- and 5 psychiatrists or physicians who were famous for
phetamine users. There is an extreme shortage of specific treating or researching addiction. In this study, the data
research on these marathons, especially among metham- saturation occurred after interviewing the participants.
phetamine users. It seems that methamphetamine facil- This study was done in 2012.
itates this condition by increasing sexual desire, reduc-
ing behavioral inhibition, increasing the duration of erec- 3.2. Procedure
tions, and reducing the refractory period (11). We explained the goals of this study to the participants
In a previous study, 138 opium users, 57 cocaine and and got their written permission for recording their voice
methamphetamine users, and 75 alcohol users completed and publishing the data. We then gathered data from
a sexual behavior assessment checklist. The goal was to those who were qualified to enter the study. We used a fo-
understand the relationship between sexual behavior and cused group discussion to get information from metham-
four types of narcotic/stimulant substances. It was found phetamine users and their family members. In-depth in-
that opium users believed less that drug use increased terviews were done to get information from therapists
their thoughts, feelings, sexual desires, and sexual perfor- and key individuals. The methamphetamine users and
mance. They also believed less that their drug use made their family members were selected using the opportunis-
them involved with sex in an obsessive and/or excessive tic and peer referral methods of sampling. The metham-
way. The possibility of high-risk behaviors was also lower phetamine users were selected from different economic
in opium users; they needed less treatment compared to and social classes. We used a checklist and open question-
other groups. However, methamphetamine users believed naires to collect information. The data were analyzed us-
that their sexual performance and pleasure were increased ing conventional content analyses according to the Grane-
by drug use, and they believed more than other partici- heim and Lundman method. The answers were analyzed
pants that sexual intercourse and meth use had a strong re- and the results were interpreted.
lationship. Cocaine users also believed that drug use made
them involved with sex in an obsessive and excessive way
3.3. Ethical Considerations
and that there was a powerful relationship between their
sexual behavior and drug use (12). We explained to the participants that their informa-
tion would remain secret, their name would not be used
in any document related to this study, and they could quit
2. Objectives the study at any time.
There has been a significant increase in metham-
phetamine use recently. Using this substance as a stimu- 4. Results
lant is prevalent in different countries especially among
younger adults (13). One of the effects of metham- We interviewed 35 methamphetamine users, 5 of their
phetamine use is increased sexual activities and high-risk family members, and 5 therapists. The users were aged
sexual behaviors. The health, economic, cultural, and from 19 to 45, with the majority of them between 25 and
social burden of methamphetamine use on society is so 35. Two-fifths of them did not earn their high school diplo-
significant that understanding the reasons for metham- mas; one-fifth had a high school diploma; and the rest
phetamine use is one of the main priorities in Iran. There had a higher academic degree. Twelve of the participants
have been many efforts to prevent and treat metham- were single, three were divorced, and ten were married.
phetamine abuse and addiction in Iran for many years. The duration of their methamphetamine use was from less
This current study’s goal is to examine the exchanges of than 1 year to 8 years; a majority had been using metham-
sexual function and methamphetamine use in male clients phetamine for 2 to 5 years. More than four-fifths of the
of the public and private clinics in Tehran. users had used opium before starting methamphetamine
use. About half of them had used illicit drugs frequently
3. Patients and Methods within the last month. Methamphetamine was the most
used substance within the last month: about one-third of
3.1. Participants and Plan them had used it. Alcohol and sedatives were the next
We used a qualitative content analysis method to most-used drugs.
examine the exchange of sexual function and metham- We examined the participants’ answers and distin-
phetamine use in male clients of the public and private guished four main categories: different attitudes toward

2 Int J High Risk Behav Addict. 2016; 5(3):e29640.

 Dolatshahi B et al.

sexual behavior, different sexual abilities, feeling a com- experienced in having sex. The quality of sex with a meth
pulsion to have sexual intercourse, and having problems user is higher. Some of them also believed that a female
with appropriate sexual behaviors. Each of these cate- meth user would prefer a male methamphetamine user as
gories was further divided into subcategories, as described a sexual partner because of his relationship skills and de-
in the following sections and in Table 1. layed ejaculation.
- A 30-year-old male user: My female partner became
4.1. Category 1, Different Attitudes Toward Sexual Behavior more eager than me when she used meth!
- A 30-year-old male user: A female user gives you such
4.1.1. Different Experience of Sexual Intercourse
a pleasure that a normal person can never do!
The vast majority of the methamphetamine users re-
ported that using methamphetamine increased their sex- 4.2. Category 2, Different Sexual Ability
ual desire significantly, and that sexual intercourse while
4.2.1. Duration of Intercourse While on Methamphetamine
on methamphetamine was very enjoyable. The first uses of
The majority of participants believed that the duration
methamphetamine resulted in more enjoyable orgasms,
of their acts of sexual intercourse increased after using
longer acts of sexual intercourse, a quantitative and qual-
methamphetamine. Delaying orgasm and making the sex-
itative increase in sexual pleasure, and feelings of having
ual relationship last longer were two of the drug’s effects
more control over the relationship. Only one participant
reported by more than half of the users. These effects were
reported that methamphetamine reduced his sexual de-
more apparent at the beginning of their use and reduced
sire. Some of the participants reported that their original
after some time.
or primary uses of methamphetamine were more effective
- A 30-year-old male user: I reached orgasm every 15
in increasing their sexual desire, but the therapists did not
minutes, but it seemed nothing had happened. My sexual
accept this statement and instead believed that metham-
desire was very high. I did not let go of her, and this made
phetamine users experience anhedonia after some time as
her very tired.
a result of the impairments to the reward circuit of their
brain, which are then wrongly attributed to the quality of
4.2.2. Sexual Intercourse Marathon
substance.
Some of participants reported that they could have sex-
-A 44-year-old male user: The experience of sexual inter-
ual intercourse for hours without feeling tired or taking a
course while on meth is so great that you feel the pleasure
rest.
with all the cells in your body!
- A 30-year-old male user: You continue having sex and
-A 28-year-old male user: You feel like it is the highest
do not reach the end. You want to go on and on. You do not
point of satisfaction, there is nothing above that!
get tired, physically or mentally.
- A 35-year-old male user: We had sex in different posi-
4.1.2. Effects of Methamphetamine Use on Emotion tions for 3 hours. We did not get tired at all!
The methamphetamine users had different experi-
ences but the majority of them believed that using 4.2.3. Quality of Sex in the First Months
methamphetamine strengthened their affection toward Almost all of the participants reported that the qual-
their sexual partner. ity of their sexual encounters was great in the first few
- A 28-year-old male user: At first, it is so enjoyable that months, but its quality changed over time. The wives of
you feel everything is enjoyable! married participants did not report any change in the qual-
- A 37-year-old male user: It tasted differently. When I ity of their sexual relationship before and after their hus-
kissed my partner lips, those tasted like fruits. bands’ use of methamphetamine.
- A 32-year-old male user: In the first 6 months, it makes
4.1.3. Preferring Sexual Intercourse with a Partner Who Uses you more sexual and horny.
Methamphetamine - A 35-year-old male user: I could never experience the
Most of the methamphetamine users said that having pleasure of my first sex while on meth.
sexual intercourse with a female user was more enjoyable,
but some of them were not interested in having sex with 4.3. Category 3, Feeling a Compulsion to Have Sexual Inter-
methamphetamine users because of men’s moral prob- course
lems. When we asked the participants whether, regardless 4.3.1. Mental Compulsion to Have Sexual Intercourse and Sex-
of their personality, having sex with a methamphetamine ual Addiction
user or a normal partner was better, all of them said, A fe- Most of the users reported that using metham-
male meth user reaches orgasm less quickly and is more phetamine forced them to have sex, and, while on

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 Dolatshahi B et al.

Table 1. Extracted Concepts Diagram

Domain Contents

Different attitude toward sexual behavior Different experience of sexual intercourse

Effects of methamphetamine use on emotions

Preferring sexual relationships with a partner who uses methamphetamine

Different sexual ability The quality of sexual intercourse in the first months

Duration of intercourse while on methamphetamine

Sexual intercourse marathon

Feeling compulsion to have sexual intercourse Feeling a mental compulsion to have sexual intercourse

Having sexual intercourse in inappropriate places

Feeling compulsion to watch pornographic videos

Masturbation

Forcing others to have sexual intercourse

Having problems with appropriate sexual behaviors Necessity of using helping drugs

Sexual preferences

methamphetamine, they wanted to have sex at any - A 28-year-old male user: It was the most trouble-free
cost. If they did not, they became nervous and tense. sex, without stiffness of the penis!
- A 34-year-old male user: During that time, you are ea-
ger and your eyes are closed. You just want to have sex and 4.3.4. Aggressiveness and Forcing Others to Have Sex
relive your tension. Three of the participants reported being sexually ag-
- A 35-year-old male user: I did everything to have sex, I gressive.
tried very hard and did everything to satisfy my partner. - A 22-year-old male user: When I used metham-
phetamine, I became very aggressive and forced girls to
4.3.2. Having Sex in Inappropriate Places have sex with me. I even slapped and kicked them to force
them into doing this.
Most participants had the experience of engaging in
sexual relations in inappropriate or dangerous places: in- - Wife of a 30-year-old male user: He became very cruel,
side a car, in an alley, in ruins, and on top of the buildings. and I did not like that at all. He also pulled out my hairs and
In some cases, having sex in these places resulted in serious had anal sex with me. He had too much sex with me.
problems.
- A 30-year-old male user: I was in ruins and a girl was 4.4. Category 4, Having Problems with Appropriate Sexual Be-
with me. She had escaped from her parents’ house and havior
lived in cardboard boxes. I wanted to take her to my par- 4.4.1. Necessity of Using Helping Drugs
ents’ house, but I thought my mom would call the police Most participants who had used methamphetamine
on me, so I took her to ruins, and I was very stressed out for a long time encountered erectile dysfunction and had
and scared. used drugs such as Sildenafil to treat this problem.
- A 31-year-old male user: After some months without
4.3.3. Feeling Compulsion to Watch Pornographic Videos using Viagra, I had to use it to be able to have an erection.
Most of the participants reported that metham-
phetamine made them to masturbate more. Some mastur- 4.4.2. Sexual Preferences
bated several times a day. Some of them believed that this Most participants were inclined toward voyeurism.
increase in masturbation resulted from experiencing an None of them spoke about incest, but three of them
increase in sexual desire and having erectile dysfunction reported that they had thought about it. Only one of
in the same time. the users reported having homosexual desires after using
- A 35-year-old male user: I masturbated 7 times in 24 methamphetamine, but some of the therapists believed
hours. that homosexual behaviors are more prevalent among

4 Int J High Risk Behav Addict. 2016; 5(3):e29640.

 Dolatshahi B et al.

male methamphetamine users. Three of participants re- leads to aggression after frustration. Our results, consis-
ported an inclination toward sexual aggression. tent with previous studies, showed relationships between
- A 28-year-old male meth user: After starting meth use, amphetamine-type stimulants use and sexual aggression;
I became a sodomite! it was found in this study, like other studies (20), that using
- A 30-year-old male meth user: Some thoughts about amphetamine-type stimulants leads to sexual aggression.
incest came to my mind, but I wiped them out immediately One of the findings of this study was the widespread
like cleaning a blackboard! use of Sildenafil by methamphetamine users as a self-
treatment method for their erectile dysfunction. Other re-
searchers have also found that methamphetamine users
5. Discussion who experience sexual intercourse marathons are more
likely to self-treat with medications such as Sildenafil (15).
This report includes the results of a qualitative study Having sexual intercourse marathons (sexual intercourses
to understand the sexual problems in male metham- which last for several hours) is very prevalent among
phetamine abusers and their dependents and to exam- methamphetamine users. There is an extreme shortage
ine the relationship between these problems and the first of specific researches on sexual intercourse marathons es-
use of this substance. The clinical effects of metham- pecially among methamphetamine users. It seems that
phetamine on sexual performance are not similar in all methamphetamine facilitates this condition by increasing
users, and most people have different experiences in using sexual desire, reducing behavioral inhibition, increasing
this drug (7). This difference has been shown in this study. the duration of erections, and reducing the refractory pe-
It seems that the expectation and amount of knowledge riod (11).
that a user has about the effects of this substance are im- In this study, the participants stated that, after begin-
portant in the effects they get from it. ning to use methamphetamine, they started sexual rela-
It is also clear that methamphetamine affects the sex- tionships with multiple partners. Other studies have also
ual desire of users differently. Many participants reported shown this association. Tayyebi et al. (6) (2013) found that
that they experienced a significant increase in their sexual methamphetamine users are more likely to change their
desire at the beginning of their use of this drug, but other sexual partners.
participants did not report increases in their sexual de- An important trait said about methamphetamine is
sire. Some studies have shown that using stimulant drugs that using it can gradually change the user’s sexual profile;
like methamphetamine increase sexual desire at the begin- it has been seen that many people who had always lived
ning of use (14). in a heterosexual relationship and had never shown any
The users emphasized that the main advantage of us- conscious desire toward people of the same sex felt homo-
ing methamphetamine was the strengthening of the sex- sexual desires and started to have homosexual intercourse
ual relationship with their partner. Some users attributed after using methamphetamine. Most of our participants
the different quality of their sexual relationship to this feel- did not acknowledge experiencing these desires, but that
ing of intimacy. Semple et al. (15) (2002) show in their could be explained by both our small sample and because
study that homosexual people have a different experience homosexuality is a powerful stigma in Iranian society. All
in all phases of sexual intercourse. One the effects of us- therapists involved in this study reported seeing these de-
ing methamphetamine in men is delaying the ejaculation sires in their clients.
time (16). In our study, some methamphetamine users re- According to these points, using methamphetamine
ported this effect. can lead to quantitative and qualitative changes in what
During focused group discussions, some metham- a person perceives as his/her role in sexual performance
phetamine users described the nature of their sexual be- and can bring about physiological changes in sexual per-
havior after using methamphetamine as compulsive, and formance. Some of these behaviors result from metham-
some used the phrase sex addiction for these relation- phetamine intoxication and some are caused by changes
ships. Other studies have also shown the association be- made by the long-term use of this substance. Policies re-
tween methamphetamine use and compulsive sexual be- lated to sexual issues that arise from the long-term us-
haviors (17). Methamphetamine use leads to an impair- ing of methamphetamine need more quantitative and ac-
ment of the user’s ability to make decisions (18) and re- curate studies. There is a fear that the changes in per-
duces their control over their sexual behaviors (19). As a re- formance, emotions, and sexual attitudes in metham-
sult, a methamphetamine user does not inhibit the desires phetamine users transmit to other people and affect the
and behaviors that are socially and morally inappropriate. culture of Iranian society, specially the younger popula-
This lack of control increases the unusual behaviors and tion.

Int J High Risk Behav Addict. 2016; 5(3):e29640. 5

 Dolatshahi B et al.

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