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Talking to Patients About Marijuana Use

It’s not uncommon for healthcare providers to discuss sensitive subjects with their patients.  But handling two or more sensitive subjects at once, like sexual health and marijuana use, can be a challenge.  Both topics are entwined with a patient’s  overall well-being along with cultural norms and expectations. 

Discussing them together can be delicate.  You don’t want to alienate your patient, but you do want to make sure he or she gets proper care.

Many practitioners do not want to pry into a patient’s drug use or sexual health, but since drug use can have a huge impact on sexual health, it’s important to know how to talk about them.

The pointers below refer to marijuana use, but can be adapted to other drugs. 

Understand Marijuana

According to 2009 statistics from the National Institute on Drug Abuse, over 28 million Americans over the age of 12 said they had abused marijuana in the previous year.  About 4.3 million were deemed addicted using DSM-IV criteria.  Almost 1 out of 11 people who try marijuana become addicted.  And for people who use marijuana daily, the addiction rate is 25% to 50%.

How does marijuana affect the brain?  Its primary active ingredient is called tetrahydrocannabinol, or THC.  When THC enters the human body, it attaches itself to proteins called cannabinoid receptors.  In the brain, these receptors are prominent in areas that affect pleasure, memory, and pain, among other functions.

Understand How Marijuana Affects Sexual Health

Some patients may tell you that marijuana enhances their sexual experience.  But marijuana use can have serious consequences for sexual health, including:

  • High-risk behaviors.  Marijuana affects judgment and decision-making.  People under its influence may be more likely to engage in unsafe sex, increasing the risk of getting or passing along sexually-transmitted infections (STIs).  Unintended pregnancies are also a concern, as are unwanted emotional issues, either during the act or after.
  • Orgasm issues.  Research has suggested that men who use marijuana daily are more likely to have problems reaching orgasm than non-users.  They are also more likely to experience premature ejaculation.
  • Erectile dysfunction.  A recent study in the Journal of Sexual Medicine reported that cannabinoid receptors are found in penile tissue.  The authors suggest that when THC attaches to these particular receptors, erectile dysfunction can result.
  • Testicular cancer.  Research has shown that men with testicular cancer were 70% more likely to be marijuana users.  This may be because cannabinoid receptors are also found in the testes.
  • Fertility.  Sperm cells exposed to THC are more likely to tire themselves out as they swim to an egg cell.  Some do not reach the egg at all. And if they do, they are less likely to fertilize it, since THC hinders the release of enzymes needed to penetrate the egg wall.

Women who use marijuana can also have fertility issues.  THC can travel to the uterus, cervix, vagina, and vaginal fluids, giving the sperm cells more opportunities for THC exposure.

Reserve Your Judgment

Even in the best of circumstances, it can be difficult for patients to open up about drug use or their sexual lives.  If they are worried about being judged, they may not want to give you their whole story.  Any details they omit could be critical to their care.

Remember that your goal is better health for your patient.  If you discuss these issues in an open, non-judgmental way, your patient may be more likely to be honest with you.  Make them feel comfortable about asking you questions as well. 

Be Aware of Resources

Sometimes, the severity of a patient’s drug use falls outside your expertise.  Know what resources are available in your local area and make referrals when necessary. 

Educate Yourself

Drug use and sexual health permeate many aspects of healthcare. Find out what issues are especially important for the population you serve.  Participate in workshops and trainings and stay on top of different trends.  If you are unsure which resources are most reliable, check with a colleague.

Keep the Lines of Communication Open

Let your patients know that you and your colleagues are always available to help.  If they are not ready to open up with you at first, they may do so later.