35J Gandhara Med Dent Sci
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FREQUENCY OF SEXUAL DYSFUNCTION AMONG PATIENTS USING CANNABIS: A CROSS -
SECTIONAL STUDY
Fazale Rabbani1, Israr ud Din2, Waleed Ahmad3, Sumaira Mehreen4
ABSTRACT
OBJECTIVES
To determine the frequency of sexual dysfunction (decreased libido and
premature ejaculation) in patients using cannabis.
METHODOLOGY
A Cross-sectional study was conducted at the Department of Psychiatry,
Medical Teaching Institute, Lady Reading Hospital, Peshawar, on 329
patients using cannabis. The mean age of the patients was 30.08 (6.41) years.
The mean duration of cannabis use was 299.24 (138.23) weeks. 'The Arizona
Sexual Experience Scale’ (ASEX, 2020) was utilized to measure the frequency
of sexual dysfunction among those users, having scores from 5-30 and higher
scores indicating more sexual dysfunction. The data were analyzed using
SPSS version 28.0.
RESULTS
The frequency of sexual dysfunction in this study was 213 (64.7%). Among
males, 206 individuals (96.7%) reported sexual dysfunction, whereas 107
individuals (92.2%) did not. In contrast, 7 females (3.3%) experienced sexual
dysfunction, while 9 females (7.8%) did not. The p-value of 0.07 was near the
threshold for significance, suggesting a possible link between gender and
sexual dysfunction, with a higher prevalence observed in males. For
individuals with less than 200 weeks of cannabis use, 67 (31.5%) reported
sexual dysfunction, while 41 (35.3%) did not. Conversely, among those with
more than 200 weeks of cannabis use, 146 individuals (68.5%) reported
dysfunction, compared to 75 individuals (64.7%) who did not.
CONCLUSION
A significant proportion of cannabis users in this study experienced sexual
dysfunction, highlighting a potential health concern associated with cannabis
use.
KEYWORDS: Cannabis Use, Sexual Dysfunction, Substance Use, Decreased
Libido, Premature Ejaculation
How to cite this article
Rabbani F, Din IU, Ahmad W,
Mehreen S. Frequency of Sexual
Dysfunction among Patients Using
Cannabis: A Cross-Sectional Study. J
Gandhara Med Dent Sci.2025;12(3):
35-39. https://doi.org/10.37762/jgmds.
Date of Submission: 04-04-2025
Date Revised: 15-05-2025
Date Acceptance: 30-05-2025
1Assistant Professor, Department of
Psychiatry, Lady Reading Hospital,
Peshawar
3Assistant Professor, Department of
Psychiatry, Lady Reading Hospital,
Peshawar
4Assistant Professor, Department of
Psychiatry, Lady Reading Hospital,
Peshawar
Correspondence
2Israr Ud Din, Assistant Professor,
Department of Psychiatry, Lady
Reading Hospital, Peshawar
+92-333-9242689
drisrar@yahoo.com
INTRODUCTION
Cannabis is the most widely used illicit drug in the
world. According to the United Nations Office on
Drugs and Crime’s annual report, the estimated global
prevalence of cannabis usage among people aged 15-64
is 4.9% (232 million).1 Medical professionals use it to
treat pain, conditions like multiple sclerosis, epilepsy,
cancer, Huntington’s disease, glaucoma, anxiety,
Alzheimer’s disease and weight loss, as well as
moderate-quality evidence for Parkinson’s disease.2
Cannabis’s psychotropic qualities restrict its use,
although it has been used therapeutically and has
several potential medical applications.3 In some
countries, cannabis is illegal (Pakistan). In other, it is
considered a "soft narcotic" (UK and USA) or legal
(mainly countries in South America, Asia, and Africa).4
Many countries restrict the use of cannabis due to the
risk of being used as substance abuse, causing health
issues in public.5 Cannabis use is associated with
adverse health issues involving various organ systems.
Its misuse can cause psychomotor dysfunction, impair
cognition and increase the risk of psychotic symptoms,
including addiction and cannabis use disorder.
Moreover, smoking cannabis can result in respiratory
impairment, from the trachea epithelium to lung
function impairment.6 Many commonly used drugs can
interfere with male sexual function either by decreasing
libido, interfering with erectile function, or causing
absent seminal emission or retrograde ejaculation.
Centrally acting medications may cause sedation,
depression and reduced libido. Moreover, there has
been emerging evidence that cannabis use may be
associated with sexual dysfunction.7 The most prevalent
sexual health problem among males is sexual
dysfunction, which is linked to a wide range of negative
mental, physical, and psychological outcomes, such as
anxiety, depression, and a decline in the quality of life
for a couple.8,9 A growing number of physiological and
psychological effects, including possible implications
on sexual health, have been linked to cannabis usage.
According to existing research, cannabis usage may
ORIGINAL ARTICLE
12-3. 614
36 J Gandhara Med Dent Sci
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affect sexual function by affecting vascular health,
hormone balance, and the central nervous system.7,9 In
addition to its many medical uses, cannabis is
frequently abused as a drug.10 According to Dr.
Bieniek. Erectile function may be adversely affected by
cannabinoid receptors in the brain and penis, which
could result in problems getting and keeping an
erection.11 Cannabis users were twice as likely to
experience ED as non-users, according to a 2019
review of four studies. Numerous other factors also
play a role, including the mode of intake (smoking,
vaping, edibles, etc.), dosage, and overall health.12 A
complex link driven by several factors, including
gender and usage habits, is revealed by the prevalence
and frequency of sexual dysfunction among cannabis
users. Cannabis usage before coupled sex significantly
increased orgasm frequency (72.8%) and satisfaction
(67%) among women who reported orgasm difficulties
in 52% of cases.13 Furthermore, daily users reported
more sexual partners and particular dysfunctions, like
the inability to achieve an orgasm, frequency and
dosage of cannabis use are important factors.14,16 Given
their role in the endocannabinoid system, THC and
CBD may both have an impact on sexual function,
while individual differences in effect may be
significant.15 Nonetheless, there is still conflicting
evidence about the relationship between cannabis usage
and sexual dysfunction; some researchers indicate a
link, while others present conflicting findings. To shed
light on the potential negative consequences of
cannabis usage on sexual well-being, this study
attempts to ascertain the frequency of sexual
dysfunction (decreased libido and premature
ejaculation) among cannabis users.
METHODOLOGY
A Cross-sectional study was conducted at the
Department of Psychiatry, Medical Teaching Institute,
Lady Reading Hospital (MTI LRH), Peshawar, from
January 11, 2024, to August 19, 2024, involving 329
patients. Both genders were included. Approval was
obtained from the hospital's ethics board (Ref:
120/LRH/MTI) on May 18 2021, and patients who
fulfilled the inclusion criteria were enrolled from the
outdoor area of the Department of Psychiatry, Medical
Teaching Institute, Lady Reading Hospital, Peshawar.
The sample size was calculated using the WHO sample
size calculator, with a 95% confidence interval, 5%
absolute precision, and a prevalence of 69.1% sexual
dysfunction in a previous study.6 The expected sample
size was 329 patients. ‗Arizona Sexual Experience
Scale’ (ASEX, 2020) was utilized to measure the
frequency of sexual dysfunction among cannabis users.
Patients were diagnosed with sexual dysfunction
(decreased libido and premature ejaculation). If the
estimated score is 18 or higher on ASEX.16, the data
were analysed using SPSS version 22.0. Mean and
standard deviation were calculated for quantitative
variables like age and duration of cannabis use.
Frequency and percentage were calculated for
categorical variables, such as gender, occupation,
education status, and sexual dysfunction. Effect
modifiers like age, gender, education, employment
status, socio-economic status and duration of cannabis
use were addressed through stratification of data. Post-
stratification chi-square was applied among categorical
variables to identify the association between the
variables.
RESULTS
The mean age of the patients in this study was 30.08
(SD = 6.41) years. The average duration of cannabis
among the participants was 299.24 (138.23) weeks.
Table 1: Descriptive Statistics of Demographic Variables
Variables Frequency %age
Age groups 30.08 (6.41)
20 to 30 170 51.7 %
31 to 40 159 48.3 %
Gender
Male 313 95.1 %
Female 16 4.9 %
Education status
Primary 82 24.9 %
Middle 88 26.7 %
Intermediate 74 22.5 %
Higher education 85 25.8 %
Employment status
Job 122 37.1 %
Business 107 32.5 %
Unemployed 100 30.4 %
Socioeconomic status
Lower 104 31.6 %
Middle 116 35.3 %
Higher 109 33.1 %
Duration Cannabis 288.24 (138.23)
Table 2: Frequency of Sexual Dysfunction
Sexual Dysfunction
Yes
No
Total
Frequency %age
213 64.7
116 35.3
329 100.0
Frequency of Sexual Dysfunction among Patients using Cannabis
37J Gandhara Med Dent Sci
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Table 3: Stratification of Sexual Dysfunction with Demographic
variables
Variables Sexual Dysfunction P-
value Yes No
Age
Distribution
20 to 30 104 66 0.16
48.8% 56.9%
31 to 40 109 50
51.2% 43.1%
Gender Male 206 107 0.07
96.7% 92.2%
Female 07 09
3.3% 7.8%
Duration of
Cannabis
Distribution
<200 weeks 67 41 0.47
31.5% 35.3%
>200 weeks 146 75
68.5% 64.7%
Education
Status
Primary 55 27 0.39
25.8% 23.3%
Middle 51 37
23.9% 31.9%
Intermediate
52 22
24.4% 19.0%
Higher
education
55 30
25.8% 25.9%
Employment
Status
Job 80 42
0.37 37.6% 36.2%
Business 64 43
30.0% 37.1%
Unemployed
69 31
32.4% 26.7%
Socioeconomic
Status
Lower 67 37 0.97
31.5% 31.9%
Middle 76 40
35.7% 34.5%
Higher 70 39
32.9% 33.6%
DISCUSSION
The association between cannabis usage is a
complicated and multidimensional topic, and
behavioural, psychological, and physiological factors
impact the prevalence of sexual dysfunction. The
purpose of this study was to investigate the effects of
cannabis usage on sexual function and whether long-
term use increases a patient’s chance of developing
sexual dysfunction. This study found a possible link
between gender and sexual dysfunction, with a higher
frequency observed in males. Cannabis usage and
sexual dysfunction have a complicated relationship,
with research pointing to both subtle and detrimental
impacts. According to research, cannabis use is linked
to poorer measures of sexual function, especially in
men, where problems, including erectile dysfunction,
diminished sexual desire, and general dissatisfaction,
are common. Sexual dysfunction symptoms can be
made worse by several factors, including the frequency
and amount of use. Research indicates that cannabis
users have problems with penile function and sexual
satisfaction, as seen by their significantly lower ratings
on the International Index of penile Function (IIEF)
when compared to non-users.17 Men who consume
cannabis regularly are more likely to experience sexual
sadness and erectile problems.18 Further evidence of a
negative impact on sexual health comes from the
negative correlation between the duration and quantity
of cannabis use and sexual esteem and
preoccupation.17,19,20 The frequency and duration of
cannabis use are another important component affecting
these results. However, the results of our study indicate
that there is no significant relationship between the
duration of cannabis use and sexual dysfunction. The
participant reported using cannabis daily (7 days/week)
for approximately 200 weeks, averaging 1.5 grams per
day, which means that the patient has been consuming
cannabis for 4 years regularly, which is nominated as
200 weeks. In our study, of individuals with less than
200 weeks of cannabis use, 67 (31.5%) reported sexual
dysfunction, while 41 (35.3%) did not. Conversely,
among those with more than 200 weeks of cannabis
use, 146 individuals (68.5%) reported dysfunction,
compared to 75 individuals (64.7%) who did not.
Furthermore, the risks of sexual dysfunction may be
increased by the combination of cannabis with other
lifestyle choices like drinking alcohol, smoking, and
having mental health issues like anxiety and despair. A
study has shown a negative correlation between sexual
intercourse and prolonged duration of cannabis use.19
According to a few small studies conducted on female
patients, cannabis mostly raises sexual excitation and
desire. However, this impact may diminish as cannabis
use increases, leading to a decrease in sexual
excitement and desire.20 Regardless of dosage, cannabis
has been shown to have both enhancing and inhibiting
effects on males, ranging from erectile dysfunction to
an increase in sexual desire.20 However, for several
reasons, it has been more challenging to define the
relationship between cannabis use and sexual
dysfunction. Studies that measure sexual function are
frequently based on patient self-reporting, which makes
them biased. Additionally, a comprehensive picture of
sexual function is made up of many different
components, including libido, erectile function, and the
capacity for orgasm, all of which may be impacted
differently by cannabis use.21 Our results are
comparable to a study that showed a prevalence of
69.1% sexual dysfunction in patients using cannabis.4
Studies have shown that frequent cannabis smokers
have reported sexual dysfunction such as inhibited
orgasm, premature ejaculation, and dyspareunia.22,14
While men are at higher risk of experiencing sexual
dysfunction, Women might gain from cannabis use,
indicating improvements in conditions including
dyspareunia and general sexual satisfaction.18
According to Harris et al. (2024), the endocannabinoid
system’s role in sexual function implies that although
Frequency of Sexual Dysfunction among Patients using Cannabis
38 J Gandhara Med Dent Sci
July - September 2025
cannabis may improve some elements of women’s
sexual health, it poses hazards to men’s sexual health.17
In contrast, some studies suggest that moderate
cannabis use might not have a substantial negative
impact on sexual function and, in some situations,
might even be associated with improved vascular
responses.15 Longitudinal designs should be used in
future studies to monitor cannabis usage and sexual
functioning throughout time. This would assist in
establishing causal linkages and determining if
continued usage exacerbates sexual dysfunction or if
abstinence improves it. It would be clear from
comparative research with non-addicted people or
infrequent cannabis users if sexual dysfunction is a
direct result of cannabis addiction or a symptom of a
larger trend. The reliability and relevance of results
would be enhanced by larger and more varied samples
encompassing a range of age groups, genders, sexual
orientations, and socioeconomic backgrounds. Future
research should look at how cannabis usage interacts
with lifestyle characteristics, relationship quality, and
mental health status to affect sexual performance.
LIMITATIONS
Despite these results, several limitations need to be
noted: First, because sexual function assessments are
self-reported, there is a chance of recall bias and
subjective variability; Second, outcomes may vary
depending on cannabis strains, THC/CBD ratios, and
modes of consumption (smoking, edibles, vaping),
which were not fully taken into consideration in this
study; and Third, although our research shows a
correlation, causality is still unclear, requiring
additional longitudinal and experimental research to
elucidate the direct effects of cannabis on sexual health
and highlighting the need for further research to clarify
the nuanced impact of cannabis on sexual health across
genders.
CONCLUSIONS
The conclusion was established based on findings that
the majority of the participants were having sexual
dysfunction in the form of decreased sexual dysfunction
and lower sexual satisfaction. Long-term and excessive
cannabis use seems to impair sexual function through
neurophysiological and hormonal disturbances, despite
some research suggesting that low-dose cannabis may
improve sexual encounters by lowering anxiety and
raising excitement. To provide users with more detailed
advice, future research should also examine potential
mitigating factors, such as dosage management,
frequency of usage, and individual physiological
characteristics.
CONFLICT OF INTEREST: None
FUNDING SOURCES: None
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LICENSE: JGMDS publishes its articles under a Creative Commons Attribution Non-Commercial Share-Alike license (CC-BY-NC-SA 4.0).
COPYRIGHTS: Authors retain the rights without any restrictions to freely download, print, share and disseminate the article for any lawful purpose.
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Frequency of Sexual Dysfunction among Patients using Cannabis
Fazale Rabbani - Concept & Design; Data Aquisition;
Drafting Manuscript; Critical Revision; Supervision; Final
Israr Ud Din - Concept & Design; Data Acquisition; Drafting
Manuscript, Critical Revision; Final Approval
Waleed Ahmad - Concept & Design; Data Acquisition;
Drafting Manuscript; Critical Revision; Final Approval
Sumaira Mehreen - Concept & Design; Data Acquisition;
Data Analysis/Interpretation; Drafting Manuscript; Final
Approval
Approval
AUTHORS CONTRIBUTION
The authors accept responsibility for all aspects of the work
and will ensure that any concerns regarding the accuracy or
integrity of any part are properly investigated and resolved.