The following is a summary of the “Influence of opioid blockage on the sexual response cycle: A randomized placebo-controlled experiment with relevance for the treatment of Compulsive Sexual Behavior Disorder (CSBD),” published in the January 2023 issue of Psychoneuroendocrinology by Incoronato, et al.

Opioid antagonists are discussed as a viable and well-tolerated option for treating compulsive sexual behavior disorder (CSBD). However, the effects of the opioid blockade on the sexual response cycle (SRC), specifically on arousal, pain perception, and disgust sensitivity, are poorly understood. Therefore, 64 healthy participants (32 females) were invited to the lab twice, 4 weeks apart, using a double-blind, randomized cross-over design. Each participant was randomly assigned to either an SRC condition (which included an erotic audio play and masturbation to orgasm) or a control condition. 

Naltrexone (50 mg, n = 32) or a placebo was given to participants at both sessions. Physiological and self-reported measures of arousal were taken at various points along the SRC, as were pain perception, odor, disgust sensitivity, and prolactin levels. Naltrexone elevated prolactin and attenuated the surge in prolactin that occurs during orgasm. Naltrexone decreased self-reported sexual arousal across the sexual response cycle, and the respiratory rate was decreased during masturbation. 

Other indicators of physiological arousals, such as pressure pain ratings and odor disgust sensitivity, were unaffected by naltrexone. These results are consistent with the hypothesis that naltrexone has an immediate, deleterious effect on sexual arousal. Given that prolactin levels mediate sexual satiation, we postulate that a prolactin-induced increase in sexual satiation may account for the beneficial effects reported for naltrexone in treating CSBD.