Sex and Cocaine


What is Cocaine?

A person smiling at a line of white powder.

Cocaine is a powerfully addictive stimulant drug made from the leaves of the Erythroxylon coca bush. Cocaine hydrochloride is the purified chemical isolated from the plant.1 There are two main forms of cocaine:

  • Powder cocaine: Powder cocaine is commonly known as “coke” or “blow.” It is the water soluble hydrochloride salt form of cocaine.
  • Crack cocaine: Crack cocaine is commonly known as “crack” or “rock.” It is a smokeable form of cocaine that is made into crystals by processing powder cocaine with sodium bicarbonate (baking soda) and water.2

Users primarily administer cocaine intranasally, orally, intravenously, or by inhalation.1 When users snort the drug, they inhale powder cocaine through the nose where it is absorbed into the bloodstream through nasal tissue.1 The high from snorting cocaine lasts approximately 15 to 30 minutes.2 Users may also rub powder cocaine on the gums where it is absorbed into the bloodstream through the soft tissue.1 Powder cocaine can be mixed with water and injected intravenously directly into the bloodstream. When users smoke crack cocaine, they inhale the vapors into the lungs where absorption into the blood stream is almost as rapid as by injection.1 Smoking and injecting cocaine result in an almost-immediate euphoric high that lasts about 5 to 10 minutes.2

Cocaine Abuse

The immediate, intense euphoric effect is one of the main reasons crack cocaine rose in popularity in the 1980s. Cocaine use ranges from a single or occasional use to repeated or compulsive use. Any route of administration can potentially lead to absorption of toxic amounts of cocaine, causing heart attacks, strokes, seizures, or sudden death.1 According to the National Survey on Drug Use and Health (NSDUH), cocaine use has remained relatively stable since 2009. In 2014 in the United States, there were an estimated 1.5 million current (past month) cocaine users aged 12 or older, representing 0.6 percent of the population. Adults aged 18 to 25 years have a higher rate of cocaine use than any other age group, with 1.4 percent of young adults reporting past-month cocaine use.1 This data was collected in the United States and may not reflect the prevalence of cocaine use in other parts of the world.

The Effects of Cocaine

Short Term

Users feel the effects of a single dose of cocaine almost immediately. Small amounts of cocaine make the user feel euphoric, mentally alert, energetic, talkative, and hypersensitive to light, sound, and touch. Cocaine can temporarily reduce the need for food and sleep.1 Cocaine can affect different people in different ways. For example, some people report that cocaine helps them perform physical or intellectual tasks more quickly while others report the opposite.1 Users also report feelings of restlessness, anxiety, paranoia, panic, or irritability. Large amounts of cocaine may intensify the user’s high but can lead to bizarre, erratic, or violent behavior. Short term physiological effects of cocaine use include increased body temperature, heart rate, and blood pressure and dilated pupils. Users may also experience tremors, vertigo, or muscle twitches.1

Long Term

Long term, frequent cocaine use can lead to severe medical issues including gastrointestinal, cardiovascular, and neurological complications. Cocaine use can result in abdominal pain, nausea, disturbances in heart rhythm, heart attacks, seizures, strokes, and coma.1 Cocaine-related deaths are often a result of cardiac arrest or seizures. According to the NSDUH, about 913,000 Americans met the Diagnostic and Statistical Manual of Mental Disorders criteria for dependence or abuse of cocaine (in any form) during the past 12 months.1

A diagram of the number of deaths from cocaine from 2001 to 2014 and from 0 to 8000 deaths.

The bar graph above shows the total number of deaths resulting from cocaine use in the United States from 2001 to 2014.

How Does Cocaine Affect the Brain?

Cocaine affects the mesolimbic dopamine system, which is the brain’s reward pathway. The mesolimbic dopamine system is stimulated by all types of rewarding stimuli such as food, sex, and many drugs, including cocaine.1 When this system is stimulated, dopamine is released by neurons into synapses (the small gaps between two neurons), where it binds to specialized proteins called dopamine receptors on the neighboring neurons. By this process, dopamine acts as a chemical messenger, carrying a signal from neuron to neuron.1 When cocaine is not present, neurons in the mesolimbic dopamine system release dopamine into synapses. Dopamine that is not absorbed into the post-synaptic neuron is broken down and taken back up into the pre-synaptic neuron.

Brain scan.

Cocaine interferes with the normal communication process by binding to the dopamine transporter and blocking the removal of dopamine from the synapse. Dopamine then accumulates in the synapse to produce an amplified signal in the receiving neurons. The accumulation of dopamine in the synapse is what causes the euphoria experienced after taking cocaine.1 The prolonged use of cocaine causes the brain to adapt to its presence. In response, the overall synthesis of dopamine by the brain is decreased. Between cocaine doses, or when the frequent use of cocaine is interrupted, the user experiences the opposite of pleasure, due to the low levels of dopamine: fatigue and depressed or altered moods.3 This experience is sometimes referred to as a “come down.”

The Effects of Cocaine on Sexual Experiences

Many users report feeling like a “sex god” while having sex while high on cocaine because of the euphoric feeling associated with the drug. As a stimulant, it can increase the user’s feelings of confidence and alertness. It is also known as an aphrodisiac because it increases the sex drive of many users. Many descriptions of sex while on cocaine include words like “animalistic” and “invincible.”4 According to Larissa Mooney, a professor of substance abuse at the University of California, Los Angeles, cocaine and other amphetamines increase the levels of dopamine and norepinephrine in the brain. Dopamine increases pleasure and norepinephrine increases stamina, so both can make users feel euphoric, energized, and focused.4

Although it produces a sense of euphoria and a surge in energy and sensory awareness, these effects often wear off quickly and can have negative consequences on both male and female sexual function. Although research is limited, studies have shown a correlation between amphetamine use and erectile dysfunction. According to a study published in the Journal of Sexual Medicine, amphetamine users were twice as likely to experience erectile dysfunction compared to the matched controls.5 The study found that duration of cocaine use had no effect on participants’ sexual function. Interestingly, participants who used most frequently were most likely to report an increase in positive sexual function. Not enough research has been conducted to determine whether or not erectile dysfunction is a long term consequence or a short term effect.

Cocaine can lead to an over emphasis on personal desires and short-term outcomes which may decrease the likeliness of users practicing safe sex. Drug intoxication and addiction can compromise judgment and decision-making and potentially lead to risky sexual behavior, including trading sex for drugs and needle sharing. This increases a cocaine user’s risk for contracting sexually transmitted infections such as HIV and other infectious diseases such as hepatitis C.1 Research has shown that cocaine impairs immune cell function, promotes replication of the HIV virus, and amplifies the damaging effects of HIV on different types of cells in the brain and spinal cord, resulting in further damage.1 Cocaine use has been attributed to accelerated HIV infections.1

Cocaine use may also influence users to make decisions they would not make sober. Over-emphasis on personal desires and impaired judgment may increase the risk for sexual assault to occur. Before any sexual encounter, it is imperative that both parties are consenting. Consent is an agreement between people before they engage in any kind of sexual activity. Both people have to say “YES!” clearly and confidently. In order to give consent, both parties must not be under the influence of any mind-altering substance, including cocaine. Any form of sexual contact that occur while one partner is under the influence of cocaine may be considered sexual assault or rape. Even a sexual act in which two intoxicated people have agreed to engage in is not considered consensual and can possibly be classified as sexual assault.

The Effects of Cocaine on Fertility and Pregnancy

A pregnant person.


It is difficult to study the effects of cocaine use on human fertility because of ethical restrictions. Consequently, the effects of cocaine on fertility have mostly been evaluated in animal trials. Cocaine use in males is believed to lower the sperm count, reduce motility and increase the number of abnormal forms. In vitro studies have shown that high concentrations of cocaine decreased the percentage of motile sperm and reduced cervical mucus penetration.6  In one trial cited in a 2012 review, human males who had used cocaine for at least five years were twice as likely to have low sperm motility as non-users. The authors concluded that the use of cocaine and other illicit drugs had negative effects on the fertility of males.7

Prolonged cocaine use negatively impacts female fertility as well. According to Dr. Gillian Lockwood, the medical director of the Midland Fertility Clinic in England,  cocaine use can suppress ovulation altogether by interfering with the subtle feedback loops that control the menstrual cycle.8 Dr. Ricardo Yazigi, a fertility doctor at Shady Grove Fertility Center in Maryland, added that cocaine can also increase the hormone prolactin, which disrupts the hormonal balance and the menstrual cycle. Additionally, studies have shown that damage to the fallopian tubes increases with cocaine use.8 Many studies show that cocaine use negatively affects fertility, although the mechanisms for this damage are not clear.

Use During Pregnancy

Dr. Dimitrios Mastrogiannis, director of maternal-fetal medicine at the University of Illinois in Chicago, reported that cocaine use during pregnancy can cause premature delivery.8 Other sources report that cocaine use during pregnancy is associated with maternal migraines and seizures, premature membrane rupture, and placental abruption (separation of the placental lining from the uterus prior to delivery).1 Pregnancy causes normal cardiovascular changes that cocaine use exacerbates, sometimes leading to serious problems such as high blood pressure (hypertensive crises), spontaneous miscarriage, preterm labor, and difficult delivery.1 Babies born to mothers who use cocaine during pregnancy are often prematurely delivered, have low birth weights and smaller head circumferences, and are shorter in length than babies born to mothers who do not use cocaine.1 More recent studies have found that exposure to cocaine during fetal development may lead to subtle yet significant deficits in some children as they grow up. These include behavior problems and deficits in some aspects of cognitive performance, information processing, and sustained attention to tasks. Some deficits persist into the later years, with prenatally exposed adolescents showing increased risk for minor problems with language and memory.1

To increase the possibility of a healthy pregnancy, it is recommended that pregnant women abstain from all alcohol and drug use.

Concluding Remarks

It is important to understand the adverse effects illicit drugs have on your physical, sexual, and emotional health. All of us here at SexInfo encourage you to make informed decisions and to prioritize your health, sexual and otherwise.


1. “Cocaine.” National Institute on Drug Abuse. May 2016. Web. 15 Jan. 2017.

2. “Cocaine and Crack Facts.” Drug Policy Alliance. n.d. Web. 22 Jan. 2017.

3. Cardoso, Silvia Helena, André Luis Malavazzi, and Renato M. E. Sabbatini. “The Effects of Cocaine in the Brain.” Brain and Mind: Electronic Magazine on Neuroscience. Jan./March 1999. Web. 22 Jan. 2017.

4. Hay, Mark. “This Is Your Sex on Drugs.” Vice Media. 8 May 2015. Web. 23 Jan. 2017.

5. Venosa, Ali. “Amphetamines And Sex: Illicit Drug Use May Cause Erectile Dysfunction And Reduced Sexual Satisfaction In Men.” Medical Daily. 7 July 2015. Web. 23 Jan. 2017.

6. George, Valal K., Haikun Li, Claudio Teloken, David J. Grignon, W. Dwayne Lawrence, and C.B. Dhabuwala. “Effects of Long-Term Cocaine Exposure on Spermatogenesis and Fertility in Peripubertal Male Rats.” The Journal of Urology. 155.1 (1995): Web. 23 Jan. 2017.

7. Fronczak, Carolyn M., Edward D. Kim, Al B. Barqawi. “The Insults of Illicit Drug Use on Male Fertility.” Journal of Andrology. 33.4 (2012): Web. 23 Jan. 2017.

8. Pardes, Arielle. “How Do Illegal Drugs Affect Women’s Fertility?” Vice Media. 3 Nov. 2014. Web. 23 Jan. 2017.

Last Updated: 7 February 2017