Medical Marijuana and Intimacy

Hi, everybody. My name is Dr. Jordan Tishler, I’m from Boston, Massachusetts. I am a Harvard trained physician. I work for the VA in Emergency Room. And I’ve started my own private practice in Cannabis Therapeutics in addition to all of that. And I’ve come here today to talk to you about two subjects near and dear to my heart, one obviously is cannabis and the other is sex. In fact…yeah. Well, it’s important to everyone.

Sex and Medical Marijuana

Sex and cannabis, can it solve our intimacy problems? I’d like to say, spoiler alert, the answer here is yes, it can. Cannabis as we probably all know is a very potent aphrodisiac and as such, we in the cannabis and medical community have an obligation to use this for good. Let’s think a little bit about sexuality, and let’s jump in here and address myth number one. Myth number one: women aren’t interested. Really? Does anybody believe that anymore?

Well, apparently, lots of people do. But when you look at this across the United States, women are sexually active. In the age group from 18 to 50, approximately 70% of women are sexually active. And what warms my heart is that when you look out on the tail, at the 90-year-olds, 40% of them are still doing it. But female sexual dysfunction is a real and pervasive problem. Over the course of her lifetime, or their lifetime, women were reported roughly 40%, have some sort of an issue with sexuality, so we need to address this.

Now, let’s look at men. Male sexual dysfunction is more than just erectile dysfunction. Whether it’s because Hollywood thinks it’s funny or because the pharmaceutical industry is out there pushing the tablets that they have manufactured, erectile dysfunction gets all the play. And it turns out, when you look at this objectively, that it’s a real issue. But it affects mostly older men, and it affects roughly 20% of men.

When you look at other issues, for example, lack of desire, we don’t hear much about that in men, do we? But that again affects roughly 20% of men, and it does it across all age groups. Most common problem for men — we used to call premature ejaculation; now we, I think, more kindly call it “early finish” — affects 30% of men, so bigger than either of the other two alone. Now, let me remind you that the tablets out there for erectile dysfunction — Viagra, Levitra, Cialis — work only for erectile dysfunction and do nothing to address these other issues. And let me also remind you that they do nothing for women.

Sexual dysfunction affects people’s lives. Poor sexual function leads to depression, anxiety, mood instability, and most importantly, strife between caring partners, so we need to be able to address this. Yet, very few people seek or receive care for their sexually related problems. Women, or roughly 35% of them will seek and receive care for their sexual issues, which is better than the men. But we also know that women in general, seek care better than men do. Men, the number is less than 25%, and when you factor out those who are going and seeking care for their erectile dysfunction to get a pill, then the number is pitifully low.

And you might say, “Well, seeking or receiving care is both about seeking and receiving care, and maybe it’s that the stuffy doctors can’t deal with sex.” But this has been studied, and it turns out that less than 25% of healthcare providers rate themselves as moderately to significantly uncomfortable with dealing with and diagnosing sexual problems. So another way of looking at that is the vast majority of providers are ready, willing, and able. So we need to be able to address these issues. Let’s take a moment to understand what we know about how sexuality works. Clicker. All right, now this slide’s important, but I’m going to talk about what’s on the slide in just a minute because there’s a lot of important preamble here.

Our understanding of sexuality really began in a formal sense in the 1960s, 1966, which is also the year I was born, with a publication by Masters and Johnson of their very famous study which you probably have all heard of. They described a linear process, and this turns out to be very good. They described arousal; so man is getting an erection, woman is becoming lubricated and receptive, and then you get to this plateau stage. You can think of, okay we’re doing it, we’re doing it, we’re doing it. And then there’s the orgasm phase, which hopefully doesn’t require too much explanation. And then at the end of that, there’s something that they called “resolution”, which is kind of an oddly clinical word.

And they described this as sort of a march, from the beginning to the end. And it turns out that this description is actually very apt. It works when things are going right. But you can imagine that from that description, they really aren’t looking at all of the preamble, right? What we know is that most sexuality, most sex, happens above the neck, and none of that is addressed in the Masters and Johnson’s thing. But nonetheless, the Masters and Johnson understanding was really our understanding until about 2001, when Rosemary Basson published her paper which was looking specifically at female sexual dysfunction. And she describes a lot of the stuff that’s above the neck.

And she describes a big circle of which there’s one little part that is that Masters and Johnson’s stuff. And all this other stuff on the circle is all these other important stuff, like how does a woman feel about herself? What does society say about sex, or about women who like sex? How does she feel about her partners or her potential partner? What innate sexual drive does she have, and all of these things that kind of feed into to the process of actually getting it on?

She also describes a whole bunch of sort of crisscrossing interrelations between all of these things, which makes it sort of a beautiful theory and a visual nightmare, which is why I didn’t show you this slide. So what you have in front of us now is called the Biopsychosocial Understanding of Sexuality, and that really encompasses or repackages Basson’s ideas into sort of a more visually understandable fashion. So what we have here are sort of four key elements that are related to each other, and they all need to be happening well and healthily in order for good sexual relations to happen. So obviously, there’s the biology component of it. Man has to be able to get and maintain an erection. A woman needs to be able to lubricate and become receptive, by which I mean the vagina needs to relax and be ready for penetration.

There’s a psychological component to it. What past experiences does this person have? How does that influence their self-esteem, and their feelings about sex, and their self-worth, and all of those factors? There’s the sociocultural stuff. What does society impose upon us in terms of views that color our thinking, about sex, or people who want to have sex, or people who like to have sex, or this kind of sex? It goes on and on. And then of course there’s the interpersonal stuff. What does somebody think about this potential partner? Or how are they feeling about their long-term partner? They just pissed me off, and it ain’t happening tonight.

Sexual Dysfunction in Men and Women

So that sort of stuff, it all has to factor in here. One of the things that I would like to point out is that, in general, as much as there is much made about the differences between men and women, I think that there are more analogies than dissimilarities. And if we look at sort of categories of sexual dysfunction among men and women as you can see on this slide, there are a lot of similarities. Clearly, we’ve talked about desire, which can be a problem not commonly discussed in men and more commonly discussed in women. Issues with arousal clearly exist for men whether they have difficulty getting and maintaining and erection, or for women who are having difficulty with the lubrication and relaxation to be receptive.

And then there are issues of orgasm in men. We talked a little about the early finish, but there are also men who have difficulty achieving orgasm which is particularly common actually in both men and women who are using certain medications like SSRIs. And then obviously we heard much about women who either have difficulty climaxing or they’re not getting the kind of intensity or frequency of climax that’s necessary to derive the satisfaction that she’s looking for. So here we get to the point, Cannabis can help with these sexual problems.

Let us look at women. Cannabis has been shown to clearly benefit all four phases. Now, the four phases let me reiterate. We’re talking about desire, arousal, orgasm, and what we now call satisfaction, all right? Cannabis is an aphrodisiac, it helps women be interested. It’s both helpful in terms of receptive. That’s somebody says, “Hey, baby. Let’s do it,” and she says, “Yeah, let’s do it.” And then there’s also what the literature calls proceptive, which I think is kind of a not very useful word, but basically this means she’s interested. She’s the one saying, “Hey, baby. Let’s do it,” or female initiated. Cannabis helps with all of those sorts of things.

Cannabis has been shown to help with arousal and lubrication as well. Some of this is because Cannabis is potent at directing blood flow to the female genitalia. It’s also good for de-stressing, relaxing, and focusing on the here and now. I would like to stop for a moment and tell you a little anecdote about how some of this research has gotten done, because I think it says a lot about both their intrepid researchers and their willing subjects.

So a study that I was reading some time ago, specifically about cannabis and arousal in women, these researchers designed a device, and this device looked a whole lot like a dildo. It was designed however to measure vaginal contractions and lubrication. So these researchers went out, and they found women who were willing to participate in this study in which they insert this device into the woman’s vagina. And then they show these women some CNN. And as you can imagine, it didn’t do much for them. Then they showed these women some pornography, and by and large the response there was kind of “meh”. Some women responded a little bit, other women not so much, but there it was. Then they gave the women some cannabis, and in fact in this case it was an infused THC.

And then they showed them the CNN, and not surprisingly, still didn’t do anything for them. But when they got to the pornography, the response was quite brisk suddenly. So what this tells me is that Cannabis makes dull pornography really interesting. Anyway, you kind of get the point. Cannabis has been shown in women to help intensify through increased tactile perception as well as all the de-stressing stuff to increase intensity and frequency of climax, and lead to greater feelings of satisfaction and intimacy. And as an interesting scientific correlate, it’s been shown that when you measure circulating levels of the hormone Oxytocin, which is felt to be the bonding hormone, they are elevated in women who are having sex while using cannabis.

Let’s talk again about men. Men are very similar to women in this regard, but it gets a little bit trickier for men. So when we’re talking about desire, it’s very similar. Cannabis is a potent aphrodisiac and gets men interested. Yay. When we start talking about arousal and climax, that’s where things get a little sticky. No one’s going to laugh at that? Come on.

All right, so the bottom line is, for getting and maintaining an erection and having an orgasm, a little goes a long way. So a small amount of Cannabis use, and by that I kind of think buzzed, a little bit, can be helpful. Again, it de-stresses, it relaxes, it helps you focus, it potentiates blood flow to the genitalia, all of those good things. It helps men focus so that they don’t have the early finish, it also increases tactile sensation so that men who are having difficulty having orgasm can achieve orgasm, and generally speaking that’s all a good thing. The problem is too much is too much, all right? The way I look at this is it’s really difficult to focus on the here and now, and maintain that erection, and orgasm, when your mind is out there orbiting Jupiter.

Medical Marijuana Helping with our Intimacy and Sexuality Issues

So a little, good; a lot, maybe not so good. Cannabis has been shown again, in men as in women, to really promote that sense of satisfaction, and men also have elevated Oxytocin levels when measured. So regardless of gender, cannabis promotes desire, arousal, orgasm, and satisfaction. Overall, intimacy is enhanced. In men, lower doses, better than higher doses. But to the question that we started with, can Cannabis help with our intimacy problems, the answer is, why, yes, cannabis does help with our sexuality and intimacy. So go out there and use cannabis for good, and thank you all.

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