Hypothesis / aims of study
The use of ketamine as a recreational drug has seen a significant rise in recent times. This trend has prompted growing attention for the potentially devastating manifestations in the urinary tract attributed to ketamine consumption: Ketamine Induced Uropathy (KIU). KIU in turn severely compromises the overall quality of life (QoL) of affected individuals. In addition to the commonly recognized symptoms such as pain and lower urinary tract symptoms (LUTS), there is an emerging concern regarding the potential influence of ketamine use on sexual function in both males and females. Therefore, the objective of this study is to investigate the prevalence, nature and impact of sexual complaints among individuals with KIU.
Study design, materials and methods
As per protocol, all patients consulting our dedicated KIU outpatient clinic complete the self-administered International Consultation on Incontinence Questionnaire: LUTS and Sexual Matters (ICIQ-M/F LUTSsex), and the ICIQ LUTS QoL module (ICIQ-LUTSqol). Male patients who had sexual intercourse in the past 4 weeks also complete either the International Index of Erectile Function 5 (IIEF-5) or its comprehensive version (IIEF-15). A database was created with the questionnaires’ outcomes and descriptive statistics were performed.
Results
A total of 52 consecutive patients who visited our clinic between October 2023 and March 2024 completed the questionnaires (Table 1). The median age of the patients was 27 years (IQR 24-32 years), and the majority were male (69%). Thirty two patients had sexual intercourse in the past month. Twenty percent of the women experienced a lot of discomfort due to reduced lubrication, and 30% reported a lot of pain during sexual intercourse (Table 2). In 33%, LUTS had a major negative impact on their sex life. Most female patients (70%) did not report urine leakage during sexual intercourse, and 30% a little to somewhat. Regarding quality of life, 46% of women who had had intercourse reported the impact of LUTS on their sex life as “a lot”.
Male patients reported various sexual dysfunctions such as reduced ejaculatory volume (44%) and pain during ejaculation (57%). (Table 3) Based on the IIEF questionnaires, we found that 12% experienced moderate to severe erectile dysfunction and 25% mild to moderate erectile dysfunction. In 23% of men, LUTS spoilt their sex life a lot, while 43% reported that LUTS had a moderate to significant negative effect on their sex life.
Interpretation of results
Our study shows a high prevalence of sexual dysfunction among the relatively young individuals consulting our clinic with KIU. The finding that almost half of the patients, who were sexually active, experienced a moderate to significant negative impact of LUTS on sexual functioning, underscores the potential profound influence of ketamine use on both physiological and psychological aspects of sexual health. This suggests that KIU may not only cause physical discomfort but also significantly impairs sexual satisfaction and overall quality of life.
The reported sexual dysfunctions among both male and female patients, including reduced lubrication, dyspareunia, urinary leakage during intercourse, reduced erectile rigidity, diminished ejaculatory volume, and discomfort during orgasm, are consistent with previous research on the adverse effects of ketamine on sexual function.1 2 In comparison to earlier studies, our study highlights the utilization of the ICIQ-M/F LUTSsex questionnaire, which explores a broader spectrum of sexual issues in both men and women, rather than solely focusing on erectile dysfunction in men. Additionally, our study does not exclusively focus on the effect of ketamine use on sexual health, but also specifically investigates the influence of ketamine-induced LUTS on sexual well-being.
Overall, these findings underscore the importance of addressing sexual health concerns next to LUTS in individuals with KIU. Communication about the adverse effects of ketamine abuse on sexual function and well-being will hopefully contribute to the motivation for sustained abstinence from ketamine. Further research is necessary to better understand the mechanisms underlying ketamine-induced sexual dysfunction and to develop targeted interventions to address these issues effectively. It remains to be investigated whether abstinence from ketamine also improves symptoms of sexual dysfunction, in a similar way as abstinence improves symptoms of KIU in a majority of patients.