Canadian Health: The influence of alcohol while taking recreational medications
Canadian Health: The influence of alcohol while taking recreational medications
The effects of alcohol on reproductive function can be divided into those that result from acute alcohol consumption by otherwise healthy individuals (social drinking) and those secondary to chronic alcoholism. The latter effects are not just caused by the pharmacological effects of ethanol but are compounded by secondary systemic disturbances induced by alcohol, including liver disease, malnutrition and domestic disharmony. 
Furthermore, a significant proportion of female alcoholics in one study had a history of sexual dysfunction before becoming alcoholics. This demonstrates the difficulty in trying to establish cause and effect in this situation.
The effects of alcohol consumption were well known to Shakespeare, who commented in Macbeth that alcohol ‘provokes the desire but takes away the performance’ Shakespeare’s observations were based on anecdotal evidence but have been confirmed in the more rigorous laboratory setting.
In one study, 60% of male and 65% of female alcohol abusers found their sexual function improved by alcohol. Studies have been performed in which alcohol is administered to men and women who are exposed to visual or auditory erotic material. Penile erection and vaginal vasocongestion were measured. Alcohol increased the subjective impression of sexual arousal but reduced the objectively measured signs.
Alcohol also causes orgasmic delay in women. Alcohol depresses testosterone concentrations in men following acute ingestion. The low testosterone is associated with a subsequent rise in LH concentration, suggesting a direct toxic effect on the testis. Testosterone rises again as the blood alcohol level falls. In contrast, in women, acute alcohol intoxication has no effect on LH or oestrogen levels although menstrual disturbances and anovulatory cycles have been reported. 
A large national survey in the USA in 1981 correlated drinking behaviour and reproductive function in a representative sample of 917 women. Dysmenorrhoea, menorrhagia and premenstrual pain were related to the alcohol consumption and were strongly associated with drinking more than six drinks a day at least once per week. Also women consuming six drinks per day at least five times a week had higher levels of infertility. The survey does not exclude the possibility that the women drank alcohol because of their gynaecological disorder.
Testosterone concentrations are supressed in chronic alcoholics both in the presence and in the absence of liver disease. Alcohol-induced liver disease alters metabolic processes so that androgens are metabolised to oestrogens. This may lead to gynaecomastia. The combination of low testosterone and high oestrogen is also associated with other signs of feminisation and impotence seen in alcoholics. In one study, 7% of impotent men attending an outpatient clinic were alcoholic.
Similarly in a study of 17 000 alcoholic patients, 8% were impotent. Low testosterone levels are also associated with
decreased spermatogenesis leading to oligozoospermia. In chronic alcoholics, the sexual dysfunction is related to the quantity, frequency and duration of drinking. One study showed that 59% of men attending an alcoholism programme experienced problems with erection and 48% difficulties with ejaculation during bouts of heavy drinking. Chronic alcoholism may result in permanent impotence even after the complete cessation of drinking for many years.
An assessment of men from infertile couples showed that a group of heavy alcohol consumers had an increase in the number of inflammatory cells in semen. The authors suggested that the presence of pyospermia may indicate an inflammatory response resulting from testicular damage. Another recent study in 225 infertile men found that regular alcohol consumption was associated with poor results at postcoital testing where sperm numbers and movement are assessed in the females cervical mucus following sexual intercourse.
