Substance Use and Decision Making FAQs SUBSTANCE USE AND SEXUALITY Subject: Drug Use and Menstrual Cycle Q: I was just wondering if heavy drug use can effect the period. Or could it be I'm pregnant? A: The use of street drugs, smoking or alcohol can sometimes change a person’s usual menstrual cycle. The chance of becoming pregnant or getting a sexually transmitted infection (STI) is also increased with drug and/or alcohol use as substances interfere with a person’s decision making ability and their ability to remember to use birth control and STI protection. Drug and alcohol use is a serious medical issue in pregnancy – putting mother and baby at risk for health problems. With a missed a period, there is the chance of pregnancy. If you have concerns about a missed or late period, you can visit a health care provider such as a physician, walk-in clinic or a sexual & reproductive health clinic for advice and/or a free pregnancy test. To learn more about Sexual & Reproductive Health Clinics, see: Subject: Alcohol and the Pill Q: hi. I was just wondering if alcohol affects the pill? A: Alcohol does not decrease the actual effectiveness of the pill, however, when you’ve been drinking or using street drugs, you may not think as clearly as when you’re sober and your ability to make decisions is affected. If you have been taking the birth control pill properly, then you are protected from pregnancy. If you are missing pills and having sexual intercourse, you are in danger of getting pregnant. To learn more about birth control, see: Subject: Marijuana and Sperm Production Q: Does smoking pot decrease sperm production? A: Certain things have been proven to lower sperm count, including smoking cigarettes and marijuana, heavy alcohol consumption, using steroids and poor nutrition. Exposure to high heat, such as that of a hot tub, can affect your fertility by lowering sperm production due to excess heat in the scrotal area. In addition, men whose jobs require long hours of sitting or who wear tight underclothes may also experience decreased sperm production for this reason. However, none of these activities reduce sperm count to the point they can be considered to be effective birth control.
Subject: Alcohol, Drugs and Erectile Dysfunction Q: Almost overnight, I went from having regular arousal levels to having an almost complete failure to get an erection. I smoke marijuana once or twice a week and drink occasionally on weekends. I try to work out regularly and eat well. It seems like what used to "get me in the mood" doesn't work anymore, and it's embarrassing beyond belief to now lose an erection during sexual activity. A: Many men experience difficulties achieving or keeping an erection (erectile dysfunction or ED). Many factors can cause erectile dysfunction including stress, depression, fatigue, medication, illness, alcohol, drugs, or relationship difficulties. Cutting back or eliminating drug and alcohol use is often decreases instances of ED in many men. An occasional problem with achieving or maintaining an erection can lead to anxiety which leads to further erectile difficulties. This can become a frustrating cycle of erectile dysfunction. Open communication with your partner about your feelings and concerns can provide support, and may help to lessen anxiety. Sharing concerns and questions with a health professional, such as your family physician can rule out any medical reasons that could be causing erectile difficulties, and provide resources to help. Reviewing any medications and potential for sexual side effects with a pharmacist or physician may lead to resolution as well. Subject: Alcohol and Drugs: Steroids Q: I am an 18-year-old guy who started lifting weights in a private gym. Another guy says that he can hook me up with some steroids to help me grow muscle faster. I have heard that ‘roids make your testicles shrink. Is this true? A: It is true - testicles can shrink with steroid use. Muscles get bigger; but gonads (i.e., testes) get smaller on steroids. Performance-enhancing steroids are synthetic forms of natural testosterone. When you flood your system with them, the body tries to compensate by shutting down its own hormone production, including gonadotropin, a hormone responsible for maintaining testicle size. If you take steroids, you may find yourself with persistent erections even in the absence of sexual stimulation, or you may instead find that you have erectile dysfunction. Aside from this, anabolic steroids can cause the end of your leg and arm bones to seal up prematurely, permanently stunting your growth. Steroids can lead to acne, liver damage, aggressiveness, sleep problems, depression, and can increase blood pressure and the chance of heart attack. That's why they are illegal unless used by prescription from a health professional. To learn more about substance use and sexuality, see: To learn more about male sexual health, see: To learn more about male sexual response, see:
To learn more about female sexual health, see: Subject: Alcohol and Drugs: Sexually Transmitted Infections (STI)/HIV Q: Can using alcohol and drugs increase the risk of getting an STI? A: Using alcohol and/or drugs can change your thought processes and may have an affect on whatever you are doing at the time. Your risk of getting an STI including HIV (the virus that causes AIDS) while using alcohol and/or drugs could increase because you may not be thinking of the importance of safer sex. If you are not thinking clearly, you may not choose to use a condom or you may use it incorrectly. You may also do things that you wouldn't ordinarily do. If you are sexually active, condoms are the best way to protect yourself from STI/HIV. In order to practice safer oral, vaginal or anal sex, you need to think clearly and act responsibly. Using alcohol and/or drugs may prevent you from staying safe. To learn more about safe, safer and unsafe sexual practices, see: To learn more about STI, see: To learn more about substance use and decision making, see: Subject: Alcohol use during pregnancy Q: If you take drugs or alcohol while being pregnant, could the baby become addicted to dugs or alcohol? A: There is no safe time to use drugs or alcohol when pregnant. Drinking alcohol, using drugs (including some prescription and over the counter medications) and smoking can all affect a baby leading to problems. Some effects will be seen at birth and others may not appear until later in life. The affects will depend upon how much and the type that was used by the pregnant woman. If a woman uses drugs during pregnancy there is a chance that her baby will be born with a drug dependency problem and will need special medical care. There are community resources available for mothers who want to get pregnant/are pregnant to help with advice and resources. To learn more about alcohol and pregnancy, see:
Subject: Sexual Functioning and Response: Viagra Q: My doctor prescribed Viagra for me but it only lasts for a little while. Is this common with Viagra? What else can I try? Also, my doctor seems as uncomfortable talking about it as I am. I keep hinting that maybe I should see a specialist but he keeps giving me Viagra and saying relax. What and where can I go to get the help I need? Thanks. A: Viagra is used to treat erectile dysfunction (impotence) in men. It helps a man to get or keep an erection only when he is sexually stimulated. Viagra generally begins to work within 30 minutes and may last for up to 4 hours. Viagra is available in different dosages and your physician may need to adjust your starting dose if it does not generate the desired results. Not all men successfully respond to Viagra; Viagra has been show to be effective in only approximately 70% of men. Some medications can change the way Viagra works. Discuss the possibility of drug interactions with your pharmacist or physician. If Viagra is not producing the results you were hoping for, it is a good idea to speak with a physician about your concerns.
CURRENT DRUG THERAPY EDUCATIONAL OBJECTIVE: Readers will prescribe antidepressant drugs more confidently on the basis CREDIT of the characteristics of the patient and the various drugs Department of Psychiatry and Psychology, Chair, Department of Psychiatry and Psychology, Cleveland Clinic; Clinical Instructor, Cleveland Cleveland Clinic; Professor, Cleveland Clinic Lerner Clinic Le
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