Over the counter kratom use and its implications on ejaculatory dysfunction

Abstract Introduction The United States opioid epidemic remains responsible for 75,673 overdose deaths in 2021. Self-medication with kratom, a Southeastern Asian plant containing the mu opioid receptor agonists mitragynine and 7-hydroxymitragynine, is becoming increasingly prevalent. Kratom is legally available in most states with purported benefits in the self-treatment of opiate withdrawal and mood disorders. Anecdotal data linking kratom to male sexual health enhancement have not been formally investigated. Objective To objectively investigate the potential effect of kratom use on men's sexual health including ejaculatory and erectile function. Methods Under IRB approval, Twitter and Reddit (r/Kratom) were accessed to disseminate our survey featuring validated instruments (IIEF and the premature ejaculation diagnostic tool, PEDT). Sexual health prior to and after four weeks of kratom use were assessed. Descriptive statistics were used to ascertain differences between ejaculatory and erectile function with kratom use. Results Most males surveyed (n =165) were 18-40 years old (84.9%) and were white (86.7%). When examining kratom use, 82.4% (n= 136) of males used kratom for 1 or more years, with 95.8% using it at least weekly. Reasons for using kratom included an illicit drug dependency (17.6%), a prescription medicine dependency (14.5%), acute or chronic pain (39.4%), a mental health condition (63.6%), and issues with sexual health (4.8%). Of the 156 sexual health responses, 37.7% (n=59) and 20.5% (n=32) reported kratom having a positive and negative impact on their sexual health, respectively. Kratom use lead to increased time to ejaculation in 104 (66.6%) patients which was perceived as positive by 62 (59.6%). A subset of patients (n=78) answered questions about premature ejaculation prior to and after 4 weeks of kratom use. The mean pre and post kratom premature ejaculation diagnostic tool (PEDT) scores were 13.0 +/− 0.6 and 8.3 +/− 0.4 respectively (p < 0.001). Ejaculation prior to 5 minutes was improved after kratom use (n=40; 51.3% vs. n=10; 12.8%) (p < 0.0001). Post kratom use, more patients reported lack of frustration with ejaculation prior to desire (n=17; 21.8 % vs. n=48; 61.5%) (p < 0.001). Kratom users were unlikely to report concerns regarding fertility (n=1, 6.1%), testosterone levels (n=25, 15.2%), libido (n=38, 23.0%), or erectile dysfunction (ED) (n=30, 18.2%). The mean International Index of Erectile Function score was decreased with kratom use (26.6 +/− 0.6 vs. 25.9 +/− 0.5) (p < 0.05). Users rarely stopped kratom due to concerns regarding delayed ejaculation (n=5, 10%), low libido (n=8, 7.5 %), or ED (n=6, 7.9%). Conclusions Kratom users report delayed ejaculation, overall benefits to their sexual health, and a statistically significant impact on erectile function with kratom use. Clinicians treating male sexual health should be aware of kratom and its potential effect on ejaculatory and erectile function. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.