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Many drugs, both legal and illegal, have side effects which impact on the user's sexual functions. For example, the side effect of many legal antidepressants and antipsychotic drugs is the reduction of sexual desire.
Perhaps the most common drug used is alcohol. At low concentrations of blood alcohol, social inhibitions are reduced, though in higher concentrations it can also inhibit performance. Many other drugs also inhibit sexual performance.
Because drug and alcohol use is commonly presented as an excuse for unacceptable behaviour, it is necessary to treat the idea of a direct causal relation between drug use and unsafe sex with caution. Drugs may provide a socially acceptable excuse for engaging in sexual behaviours in which people may want to engage but perhaps know that they should not.
Since the partial cause of the refractory period is the inhibition of dopamine by an orgasm-induced secretion of prolactin, such potent dopamine receptor agonists as cabergoline may help achieve multiple orgasms as well as the retention of sexual arousal for longer periods. In theory, it can also help to preserve erection after orgasm.
A few drugs can actually increase sexual performance when used to treat erectile dysfunction. These include sildenafil (marketed as Viagra) and tadalafil. Bremelanotide appears to affect sexual desire directly, making it the first scientifically recognized aphrodisiac. This is also true of Melanotan II, upon which bremelanotide is based. Additionally, the alkyl nitrites (poppers) have a long history of use as a sexual enhancement aid, going back about fifty years. According to the text "ISOBUTYL NITRITE and Related Compounds", many researchers agree that the alkyl nitrites may be a true aphrodisiac in the sense of promoting and enhancing sexual response.