Introduction Adolescence is one of the periods in which the risk of initial use of drugs is high. Among the reasons leading to first drug use (FDU), sexual disorders have so far been poorly investigated. Aim To evaluate the prevalence of premature ejaculation, erectile dysfunction, and low sexual desire in former drug addicts in the period prior to FDU; whether or not the former drug addicts claimed that sexual dysfunctions influenced their decision to start illicit drug taking, and whether or not the subjects had sought and used drugs aiming to improve sexual drive. Methods Eighty-six male former drug addicts (18–35 years old) were investigated using a questionnaire. Main Outcome Measures Fisher and Armitage tests. Results Before FDU, 61 (71%) subjects reported having one or more sexual dysfunctions. Only 25 (29%) had no sexual dysfunction prior to FDU. Among those with normal sexual function, only three (3.49%) stated that sexual dysfunctions had influenced their decision, whereas in the sexual dysfunction group, 27 (31.4%) confirmed this experience. This difference is statistically significant, Fisher test, P =0.0033. The more severe the sexual dysfunction, the higher the percentage of those who stated that sexual dysfunction influenced their decision to start taking drugs. This trend is statistically significant, P <0.0025. About 50% of the entire sample admitted they had used drugs to improve sexual performance. Conclusions Users of illicit drugs report a high prevalence of sexual disorders prior to FDU. A large percentage claimed that sexual dysfunction influenced their decision to start taking drugs. The higher the severity of the sexual disorders, the higher the percentage of those claiming that sexual dysfunction had influenced their decision. In our opinion, these data highlight a possible new strategy in the primary prevention of substance abuse in which sexual education and early treatment of sexual disorders, among adolescents, may prevent them from FDU.

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