S/x on Dr/gs Reference
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Clinical + experiential evidence

Cocaine

Stimulant·Recreational / illicit

Effect across the cycle

DesireFacilitatory: Acute dopamine surge and disinhibition sharply raise desire.
ArousalMixed: Subjective arousal up, but vasoconstriction undercuts genital response.
PerformanceInhibitory: Vasoconstriction impairs erection; rare priapism reported.
ClimaxInhibitory: Delayed ejaculation and anorgasmia are common.
ExperienceFacilitatory: Intense acute euphoria and confidence.
MemoryMixed: Variable; heavy intoxication degrades encoding.

Mechanism

Blocks dopamine, norepinephrine and serotonin reuptake (DAT/NET/SERT). Acute dopamine surge and disinhibition raise desire, but potent alpha-adrenergic and endothelial vasoconstriction impair erection — the classic 'heightened desire, physical inability' paradox. Chronic use damages endothelium, accelerates atherosclerosis and downregulates striatal D2 receptors.

Pharmacokinetics
Rapid onset, short duration; heavy redosing typical.
Reversibility
Chronic vascular and dopaminergic damage may not fully reverse.

Sex differences & notes

Women transition to compulsive use faster; chronic dopaminergic hypoactivity drives persistent low libido and anorgasmia in both sexes.

Key sources

  • Kendirci et al. priapism model 2007
  • PMC8072657 D2 sex-effects