MDMA and Sexual Behavior: Ecstasy Users’ Perceptions About Sexuality and Sexual Risk

This retrospective interview study (n=98) examined the sexual behavior of ecstasy users and found that the majority of male and female respondents reported that Ecstasy increased feelings of sensuality and produced strong feelings of empathy and emotional closeness, but often without the need or culmination of sexual activity. A second distinct group of users reported that ecstasy increased sexual desire and sexual fulfillment, and this subpopulation also exhibited more sexual risk-taking behaviors.

Abstract

“Introduction: This study examines the relationship between MDMA (Ecstasy), sexual behavior, and sexual risk taking.

Methods: The sample consisted of 98 current and former users of MDMA. Several strategies were utilized to recruit respondents and data were collected through in-depth interviews during 1997 and 1998. The majority of respondents had used MDMA during the 6-month period prior to the interview and a large percentage had consumed the drug on 100 occasions or more.

Results: Most respondents reported feelings of emotional closeness while consuming MDMA but without the desire for penetrative sex. Others, however, reported that MDMA increased sexual arousal and some respondents (in particular, gay and bisexual females) had used MDMA specifically for sexual enhancement. Sexual risk taking (e.g., having multiple partners, engaging in sex without a condom) was prevalent among respondents who did engage in sexual activity during MDMA episodes.

Discussion: Explanations for the findings are offered and implications for prevention/intervention are discussed.”

Author: Karen McElrath

Summary

Introduction

MDMA, a synthetic amphetamine, was patented in 1914, but recreational use did not surface until the 1970s and 1980s. The street name “Ecstasy” was coined in the early 1980s, and it is unclear whether the effects of MDMA on sexuality are affected by consumption patterns.

Some research suggests that MDMA increases the desire for sexual activity, although some users experience impaired sexual performance. However, other accounts suggest that MDMA enhances receptivity to being sexual.

Few studies have examined the relationship between MDMA and sexual risk taking. However, a study in Texas found that most MDMA users had engaged in unprotected sex during MDMA episodes, and another study in the United States found that MDMA users had higher rates of binge drinking.

MDMA use has been linked with unprotected sexual activity in men who have sex with men, and with having multiple sex partners and unprotected anal sex among gay males who attend “circuit” parties.

MDMA use has been found to be associated with unprotected anal sex among MSM, although other drugs have also been found to increase the likelihood of unplanned sexual intercourse.

A study of 100 “sexually active women” found that alcohol consumption and cigarette smoking were linked with the number of sex partners, but did not suggest that the links were causal.

Peugh and Belenko (2001) reviewed the literature on substance use, sexual arousal, and sexual function and concluded that some drugs increase sexual arousal, whereas others reduce it.

Methods

This study interviewed 98 current and former Ecstasy users in Northern Ireland. The total sample size was 106, but 8 interviews were discarded because of recording or transcribing problems.

Several methods were used to recruit respondents for interviews, including announcements in cities, towns, and villages throughout Northern Ireland, advertisements in a Northern Ireland club/music magazine, contact with local organizations, snowball sampling, and paying recruiters to refer friends and acquaintances.

Interviews were conducted with 12 respondents between October 1997 and November 1998. A research instrument was developed and piloted.

Interviews were conducted in Belfast, Northern Ireland, with respondents being assured of confidentiality and anonymity. The interviews lasted 1- to 2-hours and focused on issues related to first, last, and usual use of Ecstasy, positive and negative drug experiences, drug use rituals and norms, health issues, and other items.

Description of Respondents

98 current and former users of Ecstasy were recruited for the study, 18% through snowball sampling, 26% by one of nine gatekeepers, 29% through one of the study’s employees, and 27% through an ad that contained information about the study.

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A sample of current and former users of MDMA was interviewed. The mean age at which respondents had first used Ecstasy was 21 years, and patterns of use fluctuated greatly over time.

Ecstasy use was defined as the number of separate Ecstasy experiences over the lifetime, and 44 % of respondents had consumed Ecstasy on at least 100 different occasions.

Most respondents had tried cannabis, LSD or magic mushrooms, amphetamines, and cocaine/crack cocaine, although use of these substances was considerably lower than use of Ecstasy within the 6-month period prior to the interview.

Social Settings and Use of MDMA

Nearly all respondents had frequented a club on at least one occasion when MDMA was consumed. The types of clubs frequented varied, but most featured techno, hard-core, or house music, and many patrons consumed MDMA at after-hours parties. Some persons who had been using Ecstasy for several years preferred to consume Ecstasy in the company of close friends within their own homes or the homes of friends.

Although there was no active gay “circuit” culture in Northern Ireland at the time of the study, several smaller venues catered to members of the gay, lesbian, and bisexual communities.

Feelings of Sensuality or Emotional Closeness

Most respondents reported that Ecstasy was more associated with feelings of sensuality or deep emotions rather than sexual desire. Males in particular reported that they had little desire to engage in sexual intercourse when under the influence of Ecstasy.

Males often prefer to dance with women than to have sex with them, because dancing brings them closer to others experiencing similar feelings.

Sexual Arousal

Several respondents reported having experienced feelings of sexual arousal while consuming Ecstasy, but others reported difficulties in achieving erection or being unable to ejaculate while consuming Ecstasy. Younger males reported these difficulties more often than older males.

I think that sex on Es is brilliant, because you want to shag for Ireland all night, and you don’t care. MDMA definitely makes me feel horny, and want sex.

Males who had experienced MDMA-related sexual intercourse appeared to distinguish between two kinds of sexual activity.

Sexual encounters tended to take place in private residences, either after people had left clubs or during planned house parties.

Research conducted elsewhere found that some MDMA users reported being open to exploring new forms of sexuality.

MDMA is used for energy, the rush and the whole sort of ecstatic feeling of it. But some people have reported problems with sex and E is generally considered a good sexual aid.

Some female respondents reported that new forms of sexuality included bisexuality. They recalled that the last 10 women with whom they had engaged sexually were straight women who had been using Ecstasy.

A gay girl reported feeling more open to suggestions and going with things a lot easier when she used Ecstasy. A heterosexual female reported feeling similar feelings: “people seem to be an awful lot more attractive” (022).

Most male and female respondents reported that Ecstasy increased feelings of sensuality and empathy, but often without the need or desire for or culmination of sexual activity. Alternatively, a second group of users reported that Ecstasy increased sexual desire and contributed to sexual fulfilment.

Although several respondents had consumed alcohol during Ecstasy episodes, others avoided alcohol entirely. Heavy drinkers were just as likely as light drinkers or nondrinkers to engage in or attempt to engage in sexual activity.

Sexual Risk Behaviors

Some respondents reported having multiple sex partners, and some reported engaging in behaviors that pose risk for infectious disease. These respondents were more often younger, 18 to 25 years old.

Some respondents reported engaging in “one night stands” with strangers or distant acquaintances during Ecstasy episodes.

Some respondents voiced next-day regrets about their sexual activity during MDMA episodes.

Several respondents reported that they had unsafe sex with friends while experiencing an E episode. These respondents tended to be younger and their friends were likely to be in the same age group.

If I’ve copped off, I’ll usually go to a party, skin up, talk to everybody, and then go home, listen to music and fall asleep.

Many respondents consumed alcohol as well as MDMA during MDMA episodes, and some claimed that sexual risk taking occurred more often while consuming MDMA compared to alcohol.

A male respondent reported that Ecstasy use increased the likelihood of unprotected sex, but alcohol use was far more likely to contribute to sexual risk taking.

Ecstasy makes you more conscious of what you’re doing than alcohol.

The Role of MDMA, Other Drugs, and Sexual Behavior

The findings suggest that the perceived relationship between MDMA and sexual behavior differs among respondents. Some respondents reported that MDMA reduced the likelihood of sexual performance, while others reported that MDMA increased sexual enjoyment.

Peugh and Belenko (2001) reviewed the literature on substance use and sexual function and concluded that substances can affect both sexual arousal and sexual functioning. However, the effects appear to depend on the particular substance ingested, the dosage consumed, as well as individual perceptions of drug effects. Future research is needed to understand the effects of cannabis, alcohol, and MDMA on sexual arousal.

MDMA As a Sexual “Aid”

In the present study, respondents reported that MDMA enhanced sexual relations by reducing sexual inhibitions or boosting sexual confidence. Gay and bisexual women were more likely to use MDMA for sexual enhancement than heterosexual women, although the sample size prohibited accurate conclusions from being drawn.

MDMA and Sexual Risk

We asked respondents about risk behaviors regarding sexual activity, and found that although some tended to avoid these behaviors, others engaged in diverse sexual risk taking during MDMA episodes, e.g., having multiple sex partners, choosing sex partners who were acquaintances or strangers.

Prevention and Harm Reduction

Sexual risk behaviors fit neatly within the collective circle of Ecstasy users, including failing to use a condom, having multiple sex partners within a specified period of time, and unprotected sexual intercourse. Bellis, Hughes, and Lowe (2002) suggested that condoms should be available in club settings. However, some users prefer to consume Ecstasy in other places, e.g., private residences.

Limitations of the Study and Suggestions for Future Research

Data for this study were collected from current and former Ecstasy users between October 1997 and November 1998. It is likely that the scene has changed since that time, and it is unclear whether the findings observed in this study would apply currently.

Several respondents reported that Ecstasy use had surfaced in Northern Ireland in the early 1990s, and the current Ecstasy “scene” in the United States has an approximate time span that is similar to the Northern Ireland scene observed when this study was undertaken.

THE AUTHOR

Karen McElrath’s current research focuses on stigma and risk among injecting drug users, drug use and political conflict, and measurement issues.