Findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) have revealed that a substantial minority of people in Britain have used medication recreationally to enhance sexual performance.

Natsal-3 is a cross-sectional survey of 6,293 men and 8,869 women aged 16-74 years, resident in Britain. The survey asked all those who reported ever having at least one sexual partner about their use of medications to assist sexual performance (medicated sex).

Among the weighted sample of 6,863 men and 7,067 women, men were more likely to report ever use of medication compared with women 12.9% (95% CI: 11.9-13.9%) vs 1.9% (95% CI: 1.7-2.3%). Medicated sex was more prevalent in older men and younger women. Odds ratio (OR) for the 55-74 age group compared with the 16-34 age group was 2.31 (95% CI: 1.87-2.84) for men and 0.38 (95% CI: 0.23-0.63) for women; P = 0.001.

After adjusting for age, medicated sex was significantly associated with being in a steady relationship (but not living together) or previously in a live-in relationship among men. Among women, after adjusting for age, medicated sex was less likely among single women, compared with those living with a partner.

Medicated sex was associated with smoking, alcohol consumption of more than 6-8 units a week and ever use of recreational drugs. It was also associated with those reporting a higher number of lifetime partners and unsafe sex. The association for unsafe sex was stronger for men than women: OR 3.73 (95% CI: 2.87-4.85) for men and 1.71 (95% CI: 1.12-2.63) for women; P = 0.001.

Men with erectile dysfunction (ED) were more likely to report medicated sex in the past year compared with those without (28.4% vs 4.1%).

As prevalence of reported ED in the sample was only 13%, this means approximately half of medicated sex occurs among those without diagnosed ED. Among men with ED, use of medication was strongly associated with severity of symptoms.

Among all sexually active men, medication use was associated with: higher levels of sexual activity, particularly in those reporting three or more partners in the past year; eight or more episodes of sex in the past four weeks; using the internet to find a partner in the past year; paying for sex; unsafe sex (two or more partners and no reported condom use in the past year); and STI diagnosis in the past five years. The associations remained significant even after controlling for same-sex behaviour.

A substantial minority of people in Britain reported medicated sex.

The association between medicated sex and risky sexual behaviour is not confined to high-risk groups such as men who have sex with men.

In general practice, we often prescribe phosphodiesterase type 5 inhibitors such as sildenafil for men who present with ED. However, we may not be aware that other patients might also be using them and accessing them from elsewhere.

The use of drugs recreationally to enhance sexual performance without established medical diagnoses raises several concerns; these include the association with unsafe sexual behaviour, potentially harmful drug interactions with other medications such as antiretrovirals, and the missed opportunities for discussion regarding the perceived need for the drugs and the implications for the patient’s partner(s).

Up till now, studies regarding prevalence of drugs to enhance sexual performance have been limited to certain population groups and almost exclusively in men who have sex with men.

This study suggests that 13% and 2% of the sexually active male and female populations respectively have used medications to enhance sexual performance in the previous year. Moreover, 4% of patients will be using medications for reasons other than ED, while 14% with ED who do not seek help will be using medications.

The patients who do present to us requesting drugs for ED might offer opportunities for discussion about medication use, safer sex advice and STI/HIV testing.

Dr Richard Ma

Mitchell KR, Prah P, Mercer CH. Medicated sex in Britain: evidence from the third National Survey of Sexual Attitudes and Lifestyles. Sex Transm Infect 2016;92:32-38