Ketamine abuse also affects sexual health

Recreational ketamine use is rapidly increasing, and ketamine-induced uropathy (KIU) is gaining recognition for its severe impact on quality of life (QoL), including pain, hematuria, lower urinary tract symptoms (LUTS), and potential negative effects on sexual function. This study investigates the prevalence of sexual dysfunction among men with KIU.

Male patients with KIU completed the International Index of Erectile Function (IIEF-5 and/or IIEF-15). Erectile dysfunction (ED) was defined as a score of ≤21 on IIEF-5 or ≤ 25 on domain A of IIEF-15. Patients who had not been sexually active in the previous four weeks (a score of 0 on IIEF-5 or within any domain of IIEF-15) were excluded. The impact of LUTS on sexual life and its perceived severity were assessed using items 10a and 10b of the International Consultation on Incontinence Questionnaire LUTS Quality of Life module (ICIQ-LUTSqol). A score > 5 on item 10b was considered indicative of a (major) problem.

A total of 123 men with KIU, mean age 28 years (range: 18-50 years), completed the questionnaire(s): 81 (66%) completed IIEF-5, and 88 (72%) IIEF-15. Only 42% (N = 37) had been sexually active in the preceding four weeks. Mean IIEF-5 score in these patients was 18 (SD 5.7), with 63% meeting the criteria for ED. Mean IIEF-15 domain A score was 50 (SD 16.3), with 51% classified as having ED. Beyond ED, 39% reported reduced or absent ejaculation volume, and 52% reported mild to severe pain during ejaculation. Overall, 58-75% reported that LUTS had at least some negative impact on their sexual life, and 64% perceived this impact as a (major) problem.

Less than half of men with KIU were sexually active in the past four weeks, with the majority reporting sexual health issues, including frequent erectile dysfunction and ejaculatory dysfunction, which were often perceived as significant problems. Awareness is needed among current and potential recreational ketamine users, as well as their healthcare providers, regarding the detrimental effects of ketamine not only on bladder function but also on sexual health.