Clinical evidence
Ketamine
Dissociative (NMDA antagonist)·Recreational / illicit
Effect across the cycle
DesireMixed: Reduces aversion and can facilitate in chemsex settings; not a true desire booster.
ArousalInhibitory: RCTs show diminished subjective arousal intensity.
PerformanceInhibitory: Dissociation impairs coordination and physical performance.
ClimaxInsufficient: Little direct evidence on orgasmic effect.
ExperienceMixed: Dissociation reshapes the experience; facilitates some acts, alienates others.
MemoryInhibitory: Anterograde impairment; state-dependent encoding.
Mechanism
Non-competitive NMDA-receptor antagonist that also modulates GABAergic interneurons. In chemsex it facilitates receptive acts through dissociation and analgesia, but controlled studies show it diminishes subjective sexual arousal.
Sex differences & notes
Sex-specific effects: reduced calcarine-gyrus activation in men; heightened sexual aversion in women (two RCTs, 67 volunteers).
Key sources
- PMC12901892 — two randomized ketamine/arousal trials