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Ketamine and Sex: The Good, the Bad, and the Trippy

We asked sex therapists and harm reduction specialists to tell us everything about ketamine and sex—from the helpful, to hurtful, to downright trippy.

DoubleBlind Mag

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Updated July 1, 2024

DoubleBlind // Psychedelic Guides

When psychotherapist Dr. Cat Meyer was undergoing training in ketamine-assisted therapy, she herself underwent a session with ketamine, a dissociative substance that has traditionally been used as an anesthetic as well as a recreational drug but is increasingly employed in mental health clinics for improving mood and generating self-insight. As the effects set in, Meyer felt “energy pulsating and moving up my spine and radiating out, causing my body to shiver uncontrollably with pleasure.” After she began offering ketamine-assisted therapy, she realized ketamine could enhance many people’s sexuality.

“Ketamine relaxes the body, lifting the tension and heaviness of anxiety and depression that often causes the body to constrict,” she says. “When you pair the relaxed, open sensation of the body with practices that activate and move the energy, you can more easily access these states of energetic pleasure and orgasm.” Some people have had sex on ketamine, though this must be approached with extreme care, as the substance complicates consent. Others have used it outside the bedroom to work through issues in their sex lives. And others still find ketamine-induced states to be the opposite of sexy.

What Is Ketamine?

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Ketamine. Image Courtesy of The Drug Users Bible via Flickr.

Ketamine is an analgesic, meaning that it reduces both physical and emotional pain. “This allows for the access of pleasure that might not otherwise be accessible because of mental stress or pain,” says Meyer. At high doses, it’s an anesthetic, which is why it’s sometimes used for surgeries. “High doses act as a dissociative, making it hard to be present with the body and the direction of limbs,” says Meyer. However, at lower doses, it can have a more psychedelic effect. 

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Image Courtesy of Ayo Ogunseinde via Unsplash

Ketamine works on a number of receptors in the brain, including the opioid receptors and NMDA receptors, according to Dr. Dave Rabin, neuroscientist and psychiatrist trained in ketamine-assisted therapy. “The psychological experience for the individual is one that is actually very similar to a dream — like a lucid dream or a deep meditative state, where one is able to enter a quiet observer mindset,” Rabin explains. “It helps people recover from mental illnesses like depression and PTSD by giving them a moment of pause to consider the meaning of their own experiences.” Ketamine has been shown to have almost immediate anti-depressant effects, anti-suicidal effects, and the ability to promote cell growth in the brain, he adds.

Can Ketamine Therapy Help With Sex and Relationships?

People who undergo ketamine treatment in a safe, supervised setting — such as in a psychedelic-assisted psychotherapist’s office or a ketamine clinic — can use it to overcome sexual trauma, as well as other difficulties like body image issues, some practitioners say. During ketamine-assisted therapy, patients typically have one administration session, where they are given ketamine and left alone over the course of the experience. An administration session is often followed by talk-therapy integration sessions. The sessions do not involve touching, and ethical therapists always respect proper therapeutic boundaries, which include avoiding outside or sexual relationships with their patients.   

“Ketamine-assisted sessions with a qualified guide or sitter can help people to work through traumatic experiences from their past, as it can unlock what couldn’t be experienced in the moment,” says Jaiya, a somatic sexologist trained in ketamine-assisted therapy and author of Your Blueprint for Pleasure. She was featured on Netflix’s Love, Sex, and goop. “Being that Ketamine is a dissociative, it can help us to access things that we dissociated from in the moment and to allow those things to rise into our consciousness for healing. This can deepen our relationship to our sexuality so that we move into a more fulfilling and healthy relationship, where we can express ourselves from a more empowered place without the trauma coloring and subconsciously controlling our journey.”

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In addition, those with libido issues stemming from anxiety or depression often notice an increase in sex drive after undergoing ketamine therapy. “Ketamine-assisted therapy can help an individual identify what may be getting in the way of their libido, whether this is context or situation, trauma, suppression of emotional expression, or something related to their partner that they’ve not wanted to deal with,” says Meyer. 

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Image Courtesy of We Vibe Toys via Unsplash

Meyer offers ketamine-assisted couples therapy, which can help couples communicate about topics they’re normally too embarrassed to bring up, including sex. “At lower doses, ketamine acts as a lubricant for communication and empathogen, softening the barriers that sometimes hinder expressing vulnerability and openness,” she says. “It gently allows you to let go of defenses and embrace the receptivity of your partner’s perspective, reducing the threat that opposing viewpoints may pose. As a result, conversations around intimacy and sexuality find a safe haven. Couples can explore their deepest desires, confront their fears, and share their needs and fantasies with newfound ease.”

For some, ketamine itself provides a sexual experience. For former porn star and ecosexual sexologist Annie Sprinkle, using ketamine was “like basking in the afterglow of great sex, for an hour or two! It was relaxing and nourishing.” She describes the 3D fractal-like hallucinations she experienced as “eye-gasms.”

Ketamine is a common date rape drug due to its ability to erode boundaries and, at high doses, incapacitate victims. “When we are in altered states of consciousness, it can be difficult to discern what our limits are,” says Meyer. “The threshold of what we would allow may increase from what our sober state of being would allow, thus creating more opportunity for harm or violating our own boundaries. Someone may have a difficult time being able to feel in their bodies what does or doesn’t feel good. Further, depending on the dosage, someone may struggle with being able to verbalize their needs, saying no, or negotiating something different.”

“Without having clear communication beforehand, a person’s ability to consent cannot be assumed, as ketamine deeply impacts one’s ability to access choice and voice.”

For these reasons, consent on ketamine is very tricky. If two people are planning to take the risk of having sex on ketamine, they should talk first, while sober, and decide what they’ll do in advance. “It is really important to check in before altering one’s consciousness as to each person’s intentions and boundaries for this shared experience,” says somatic sex educator Britta Love. “Without having clear communication beforehand, a person’s ability to consent cannot be assumed, as ketamine deeply impacts one’s ability to access choice and voice.” 

Jaiya recommends spending at least an hour discussing both people’s desires and goals for the experience, their limits and boundaries, and what will help them feel safe. “If someone is unwilling to have a consent conversation with you, that is a red flag, and I wouldn’t advise continuing with any experience with them, especially with ketamine,” she says.

Once you’ve entered a sexual experience under the influence of a substance, it’s always OK to “down-negotiate” — do less than planned — but one should not “up-negotiate,” or do more than they planned when sober, which risks “traumatization when we land back to sober reality and find boundaries were crossed,” says Love. As Jaiya puts it, “a yes can become a no at any time, but a no cannot become a yes. So, if you agree that you won’t be having intercourse but everything else is OK, then you need to hold that boundary firm.” 

Image Depicting Infographic of Consent

As your inhibitions lower, you may feel the desire to go further than you planned. Jaiya suggests discussing in advance how you’ll avoid acting on this desire. You might, for instance, take a break to cool off, or choose a safe word — a random word unrelated to sex, like “cacao” — that someone can say to pause all sexual activity. Ketamine can sometimes bring repressed fear or trauma to the surface — another situation that may call for a safe word. To avoid psychological discomfort on ketamine, keep the dose low and use it in a setting where you’re comfortable. Sex and relationship coach Ashley Manta also recommends checking in with your partner repeatedly throughout the experience to make sure they’re enjoying themselves and everything is OK. 

“Ask them during sex how they are doing, if they are alright, and if they want you to stop,” advises Andrès Lekanger, chairman of the board of the harm reduction organization Chemfriendly. “Avoid questions that automatically can be answered with ‘yes’ and ‘no,’ and use questions that force the others to think before they answer. That way, you can assess whether or not they are able to consent.”

Lastly, nobody who is sober should engage in sexual contact with someone who is on ketamine, unless this was planned and discussed thoroughly in advance. “It is a huge power imbalance negotiating sex when one person is dissociated from their body or in an otherwise expanded state and the other person isn’t,” says Love. 

Every person’s body responds differently to ketamine; one person may fall into a  K-hole — a state of immobility where one is not able to respond to their surroundings — from a much lower dose than another. For this reason, it’s important to be aware and attentive of your partner’s physical state. If you recognize that your partner’s ability to move appears hindered, save sex for a different time. Even if a partner seems conscious, they may be more impaired than you realize. “On certain drugs, you can have your eyes open and make sexualized movements and still not be conscious,” says Lekanger. “A lack of a ‘no’ is not the same as someone consenting to having sex with you. And it is not enough to have gotten a ‘yes.’ You have to make sure that the person that is consenting is able to consent. That means that they know what they are actually saying ‘yes’ to.”

How Ketamine Can Affect Sex Drive

Experiences with sex on ketamine vary widely. “Some people find themselves less interested in sex because, particularly at higher doses, ketamine reduces awareness of bodily sensation or at least the more subtle aspects of touch,” says Love. Ketamine is a medical anesthetic used in surgery, so the drug can disconnect you from your body. “On the other hand, I’ve known people who struggle to connect to their sexuality sober who find the psychological aspects of ketamine [make them] more attuned to their body and desires.” Ketamine might increase sensitivity at lower doses but “take someone into more of an out-of-body experience” at higher doses, says Jaiya, which could either decrease desire for sex or lead to an “energetic type of sexual experience” where someone finds themselves “making love in the cosmos, merging bodies into oneness, or remembering apparent past lifetimes.”

People experience a wide variety of physiological responses, too. “There are anecdotal reports of men and women experiencing transient increases in libido,” says Dr. David Mahjoubi, founder of the Ketamine Healing Clinic of Los Angeles. Because ketamine relaxes the muscles, it also might increase comfort for those who experience pain during sex, says Manta. However, some find it hard to orgasm on ketamine, she adds. In addition, ketamine can cause erectile dysfunction, as it blocks the brain’s NMDA receptors, which are involved in erection and arousal, says Mahjoubi.

Even if ketamine can enhance sexual experiences, this doesn’t mean it’s a cure-all or should be relied on to have great sex. “The key is to be mindful of staying in a healthy relationship with the substance and recognizing if you are using it to override something that needs to be worked with,” says Jaiya. “For example, if you are using ketamine to overcome shame, then you may want to work with why the shame is there and what you can do outside of your experiences with ketamine to heal that shame.”

“… if you are using ketamine to overcome shame, then you may want to work with why the shame is there and what you can do outside of your experiences with ketamine to heal that shame.”

What It’s Like to Have Sex on Ketamine

Daniel Saynt, founder of the New Society for Wellness, a pleasure and plant medicine community, describes sex on ketamine as “an out-of-body experience which can feel like minutes but last for hours. Every stroke and touch feels heightened, but it can also take your mind into tangent thinking, in which you want to express feelings about the universe and your place in it.” It can “open up powerful orgasms which radiate across your body,” but “you may at times get lost in thought [or] find yourself visiting past love making experiences.” You might also end up confessing your feelings for a partner, as you’ll have less of a filter, he adds.

Michael, a 35-year-old life coach in New York City, tends to feel disconnected from his body on ketamine. With high doses, he feels nauseous or enters a K-hole. He remembers one instance where a woman offered him two bumps of ketamine at a concert. “Our bodies began writhing, still clothed, like a pair of mating leopard slugs twisted in an ever-spinning spiral,” he recalls. “Per usual, all the gyrations did a number on my inner ear, and within a half hour, I found myself numb-leggedly dashing for the exit with an urgent need to vomit. Alas, maybe sex on ketamine isn’t in the cards for me.”

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Even though ketamine may impede some of the physical aspects of sex, some enjoy sex on ketamine due to the emotional effects. “Some of my most powerful erotic experiences on ketamine have been with my clothes on — less to do with performing explicitly sexual acts and more to do with feeling fully connected and physically intertwined with my partner,” says Love.

READ: I Love You—Let’s Trip Together 

Because ketamine may inhibit sexual arousal or functioning, it may be useful to think of sex in a more expansive manner on ketamine. “Don’t expect it to be like the traditional penetrative, friction-oriented type of sex that you’re used to,” Meyer advises. “While erections can happen, it may not be as easy to function with. Think of sex on ketamine as more of an exploration into sensual and energetic sex that’s guided by your pleasure as the compass. Fall into the rhythm of what feels good, rather than a goal to achieve.”

Harm Reduction With Ketamine and Sex

The most common side effects of ketamine are dizziness, nausea, vomiting, and sometimes increased blood pressure and heart rate, says Rabin. Ketamine can also cause “sleepiness and an increased sense of different sensations like sound,” he says. “As ketamine does lower the seizure threshold, we generally do not recommend that people use ketamine when they have seizure disorders.” The biggest risk of ketamine, however, is that it’s a sedative and can put you in a K-hole. “It prevents or decreases the ability to quickly move around, and it decreases balance and physical coordination,” says Rabin. That’s why it’s important to be supervised by someone trusted and sober.

Underground ketamine can also be laced with dangerous substances like fentanyl, so if you’re going to get your own ketamine, Meyer urges testing it. In addition, ketamine should not be used daily or even multiple times a week for an extended period of time, as prolonged use can damage the kidneys and bladder. Exercise caution around combining ketamine with other substances: “The most risks are associated with mixing drugs, and drug users should read up on the effects and risk associated with mixing drugs,” says Lekanger. Avoid ketamine in the hot tub or bath, since this can cause dehydration and even lead someone to pass out, Meyer adds. Rabin urges avoiding any body of water, even a shallow one, and not operating heavy machinery. 

Ketamine is best used under the guidance of a professional like a psychotherapist who understands how the substance works and can not only prevent and address side effects but also help you process the insights, says Meyer. “I would also recommend ketamine for lower doses, rather than higher doses, to support one being with their body.”

If you’re going to have sex on ketamine, Meyer urges avoiding BDSM impact play, such as spanking or flogging, as ketamine “increases the chance for harm due to the lack of ability to discern the body’s threshold,” she says. Since your perception of pain is altered, it’s also advisable to avoid rough sex and to use lube to prevent potential tearing, which can increase the risk of STI transmission, says sex educator Isabelle Uren. “Agree on safer sex precautions before taking ketamine, and keep your supplies out where you can see them so you are more likely to use them,” she adds. “Make sure you are around people you trust and feel safe with.”

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