Alcohol and sexual performance

Moderate use of alcohol can enhance sexual activity because it relaxes and lowers inhibitions. But excessive use can impair sexual functioning and make risky sex more likely.

Heavy drinking dulls sensation and makes it more difficult for men to have an erection and women to reach orgasm. Women may be less lubricated and intercourse may be uncomfortable or painful. As Shakespeare said, “It provokes the desire, but it takes away the performance.”

Most of the research in this area has been with men who are, or were, alcoholics. Sexual effects in these studies include: difficulty getting and maintaining erections, difficulty ejaculating/delayed ejaculation, reduced sexual desire, increased sexual aggression, and infertility. Some researchers estimate that as many as 54% of alcoholic men have difficulties getting and maintaining erections, and decreased sexual desire has been found in between 31-58% of men across several studies. The impact on men who are not alcoholics, and men who are drinking low to moderate amounts of alcohol is likely much less than this. While drinking enough alcohol to become intoxicated may very well result in not being able to get an erection, if the man isn’t a chronic drinker, the erection difficulties should not persist.

Alcohol and high risk sexual behavior

Heavy drinkers are more likely to engage in high-risk sexual behaviors, such as having many sexual partners and engaging in sex without condoms.

Alcohol use and sexual behavior are both commonplace on college campuses. A majority of college students experience a socially liberal campus community in which alcohol use and permissive sexual behavior are accepted parts of that subculture. The problems associated with mixing sex and alcohol have been significantly magnified since the advent of HIV and the realization that HIV is a disease that affects all groups of people, regardless of sexual orientation, age, socioeconomic status, gender, race, or religious affiliation. Studies reveal that sexual experiences are occurring in near epidemic proportions among college students. One study found that two thirds of the participants in the study had engaged in sexual intercourse and of these subjects one third reported having more than one sexual partner in the previous 11 weeks. Furthermore, almost half of the sexually active subjects did not use a condom during their most recent sexual encounter, and only one fourth reported using condoms consistently.

Another study showed that after drinking alcohol, one in seven 16-to-24-year- olds have had unprotected sex, while one in five have had sex that they regretted. Ten percent of young people have been unable to remember if they had sex the night before.

Mixing sex with alcohol or other drugs increases the chances of unintended pregnancy, and exposure to sexually transmitted infections. There are 12 million new cases of sexually transmitted diseases each year in the US, and 2/3 of these are in people under the age of 25. One study suggests that more restrictive state alcohol policies are associated with lower gonorrhea rates among young people. Some sexually transmitted diseases can be treated and cured, but not all. Herpes, genital warts, and HIV/AIDS, for example, are incurable.

In Botswana, an estimated 24% of adults ages 15–49 years are infected with HIV. A recent population-based study in Botswana has demonstrated that alcohol use is associated with multiple risks for HIV transmission among both men and women.

A recent study in India has found that sensation seeking as a personality variable was significantly associated with sexual risk taking behavior among heavy alcohol users.

Counseling patients about the association between alcohol use and high-risk sexual behaviors may result in safer sexual practices.

Alcohol and sexual assault

The prevalence of sexual assault, both involving and not involving alcohol use, cannot be accurately determined, because it is usually unreported. Estimates suggest that at least 25 percent of American women have been sexually assaulted in adolescence or adulthood and that 18 percent have been raped. Approximately one-half of all sexual assaults are committed by men who have been drinking alcohol. Approximately one-half of all sexual assault victims report that they were drinking alcohol at the time of the assault. A woman’s alcohol consumption may place her at increased risk of sexual assault. Alcohol consumption by perpetrators and victims tends to co-occur- -that is, when one of them is drinking, the other one is generally drinking as well. Certain personality characteristics (e.g., impulsivity and antisocial behavior) may increase men’s propensity both to drink heavily and to commit sexual assault. Women who have been sexually assaulted are more likely than other women to have experienced childhood sexual abuse, to have frequent sexual relationships, and to be heavy drinkers.