Maryland And Arkansas Officials Reject Petitions To Allow Medical Marijuana To Treat Female Orgasm Disorder

Two separate efforts in Maryland and Arkansas to add female orgasm disorder (FOD) as a qualifying condition for medical marijuana have been rejected by regulators in those states.

Officials in Maryland wrote in a letter late last month that advocates’ request to add the condition was “insubstantial” because research cited in the petition did not “prove that the pain, suffering, and disability of the medical condition can be reasonably expected to be relieved by medical cannabis.”

“Therefore,” said the letter from the Maryland Cannabis Administration (MCA), “FOD will not be added to the list of qualifying conditions.”

In Arkansas, meanwhile, the state Department of Health denied a similar petition on Wednesday.

“I find the current scientific evidence related to use of medical marijuana to treat female orgasmic disorder is insufficient to support the use of medical marijuana for the treatment of Female Orgasmic Disorder,” wrote Dr. Jennifer Dillaha, the department’s director. “Randomized, placebo-controlled trials with assessment of therapeutic dose are still needed to assess the risk and benefits.”

Despite Maryland regulators’ conclusion that the bulk of 14 studies submitted as part of advocates’ petition failed to adequately demonstrate that cannabis can treat FOD, their letter acknowledges two recent studies that officials admitted are promising. It also points out that people with FOD may still have a legal path to medical marijuana.

Licensed healthcare providers in the state may already “certify patients for medical cannabis in Maryland for another ‘chronic medical condition which is severe and for which other treatments have been ineffective’ in addition to the list of current approved qualifying conditions,” MCA noted.

The petition to add FOD to the state’s list of qualifying conditions was filed by Suzanne Mulvehill, a clinical sexologist and researcher who’s recently led similar efforts to get other states to allow women to use medical cannabis to treat orgasmic difficulty. Research by Mulvehill and co-author Dr. Jordan Tishler, a doctor and cannabis specialist, was one of the studies that Maryland officials tipped their hats to.

“Though MCA is not adding FOD as a qualifying condition at this time,” they wrote to Mulvehill in the October 31 letter, “we acknowledge the two cannabis-specific studies submitted, including the recent article you and Dr. Tishler published in Sexual Medicine earlier this year,” as well as a separate 2020 article, “may show a promise of effective treatment in this area with additional supporting research.”

Similarly, Arkansas officials both acknowledged that more recent studies into marijuana and FOD show potential.

“The most relevant articles in the packet [submitted with the petition] are also those most recently published,” Dillaha wrote. “They report the results of survey studies related to self-reported effects of marijuana use on Female Orgasmic Disorder as defined by the orgasm subscale of the Female Sexual Function Index.”

“Overall, the results indicate a positive association between use of marijuana and enhanced sexual arousal experience,” the official added, though she emphasized that the data was self-reported and that some other studies show “an association of higher doses of marijuana with a negative effect on female sexual function.”

Arkansas and Maryland are the latest states to make a decision on a request involving FOD. Three others—New Mexico, Connecticut and Illinois—have already voted in favor of the addition, although those actions still need further approval from state officials. Regulators in Ohio, for their part, rejected a request in May to add FOD to the state’s list of qualifying conditions.

Oregon, meanwhile, is expected to make a decision on a proposal there by December 5, Mulvehill said.

“We are committed to improving the health and lives of women affected by FOD through scientific research and public policy recognizing medical cannabis as a treatment for FOD,” she told Marijuana Moment in an email.

In a response to MCA, Mulvehill also requested information on how to file an appeal of the decision “and request a public meeting to request testimony.”

While MCA officials said in the letter that “no recommendation was submitted or found from the American College of Obstetricians and Gynecologists (ACOG) to utilize cannabis to effectively treat FOD,” Mulvehill replied that she was unaware of any analogous societies, including the American Psychological Association, that have recommended marijuana for the treatment of PTSD, which is already a qualifying condition in Maryland.

“If approval for a condition by societies was a requirement for approval by [Maryland]’s MCA,” she wrote to regulators, “PTSD would not have been approved.”

Tishler also told Marijuana Moment that he thought MCA’s “expectations of the evidence are too high and [it] may be applying a standard to FOD more stringent that other diagnoses.”

Submitted studies relied on self-reported data, he acknowledged, but noted that “most people do not seek medical care for orgasm-related difficulty.” It would thus “be nearly impossible to find a sample of ICD-10 coded subjects,” he said, referring to the 10th edition of the International Classification of Diseases, a World Health Organization list of codes for various health conditions and other issues.

“Since orgasm is a purely subjective experience, there is no basis for diagnosis other than patient experience, so ICD-10 diagnosis is no more ‘accurate’ than self-reporting,” Tishler said.

As for the lack of randomized controlled trials (RCTs) around FOD, Tishler pointed out that the trials are expensive and, regardless of condition, are still relatively uncommon in the cannabis space. He and Mulvehill have been working toward a randomized controlled trial of cannabis for FOD, he said, but so far are “not finding a supportive regulatory environment, nor any funding.”

“RCTs are difficult and expensive and particularly so given the legal and regulatory frameworks in this country,” he wrote. “Perhaps MCA would like to create and fund a pathway for this research?”

In subsequent comments about Arkansas officials’ rejection of the FOD petition, Tishler said he was “not entirely surprised” by the decision, pointing out that the state’s medical program is still relatively new. Products there only began being sold legally in 2019.

“Overall, however, I’m concerned that questions about the amount/quality of the data on FOD (when compared to other conditions that have been approved) are really a smokescreen for systemic misogyny.”

As more states consider the addition, the two researchers have expanded their advocacy and education efforts. Mulvehill told Marijuana Moment last month that she’s developing training programs to help therapists better incorporate cannabis as medicine and also plans to launch a podcast, called The Orgasm Hour, sometime later this year.

Mulvehill and Tishler also have a forthcoming journal article that’s currently in the review process, she said.

Among other research into marijuana and sexual health, a study last year in the Journal of Cannabis Research found that more than 70 percent of surveyed adults said cannabis before sex increased desire and improved orgasms, while 62.5 percent said cannabis enhanced pleasure while masturbating.

Because past findings indicated women who have sex with men are typically less likely to orgasm than their partners, authors of that study said cannabis “can potentially close the orgasm in equality gap.”

A 2020 study in the journal Sexual Medicine, meanwhile, also found that women who used cannabis more often had better sex.

Numerous online surveys have also reported positive associations between marijuana and sex. One study even found a connection between the passage of marijuana laws and increased sexual activity.

Yet another study, however, cautions that more marijuana doesn’t necessarily make for better sex. A literature review published in 2019 found that cannabis’s impact on libido may depend on dosage, with lower amounts of THC correlating with the highest levels of arousal and satisfaction. Most studies showed that marijuana has a positive effect on women’s sexual function, the study found, but too much THC can actually backfire.

“Several studies have evaluated the effects of marijuana on libido, and it seems that changes in desire may be dose dependent,” the review’s authors wrote. “Studies support that lower doses improve desire but higher doses either lower desire or do not affect desire at all.”

Part of what cannabis appears to do to improve orgasms is interact with and disrupt the brain’s default mode network, Tishler told Marijuana Moment in an interview earlier this year. “For many of these women, who cannot or do not have an orgasm, there’s some complex interplay between the frontal lobe—which is kind of the ‘should have, would have, could have [part of the brain]’—and then the limbic system, which is the ’emotional, fear, bad memories, anger,’ those sorts of things.”

“That’s all moderated through the default mode network,” he said.

Modulating the default mode network is also central to many psychedelic-assisted therapies. And some research has indicated that those substances, too, may improve sexual pleasure and function.

Earlier this year, for example, a paper in the journal Nature Scientific Reports that purported to be the the first scientific study to formally explore the effects of psychedelics on sexual functioning found that drugs such as psilocybin mushrooms and LSD could have beneficial effects on sexual functioning even months after use.

“On the surface, this type of research may seem ‘quirky,’” one of the authors of that study said, “but the psychological aspects of sexual function—including how we think about our own bodies, our attraction to our partners, and our ability to connect to people intimately—are all important to psychological wellbeing in sexually active adults.”

Read the full Maryland Cannabis Administration letter below:

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Photo courtesy of Mike Latimer.