Sex in Chemsex: Sexual Response, Motivations, and Sober Sex in a Group of Italian Men Who Have Sex With Men With Sexualized Drug Use

Sexual function and dysfunction in the LGBTQIA+ community-including before and after gender-affirming surgery: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024)

INTRODUCTION

Evidence-based clinical practice guidelines focused on sexual (dys)function for the LGBTQIA+ (ie, lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual) community, including before and after gender-affirming surgery, are still scarce.

OBJECTIVES

To provide an overview and recommendations for sexual (dys)function among individuals with diverse sexual orientations, transgender and gender-diverse individuals, and intersex individuals/individuals with differences of sexual development (DSD).

METHODS

A committee of experts conducted a comprehensive review of the literature, focusing on scientific publications since the last consultation, for the fifth International Consultation on Sexual Medicine.

RESULTS

Researches that considered populations with diverse sexual orientations were reviewed and largely focused on sexual satisfaction/pleasure, sexual functioning, and sexual difficulties. Additional topics included relationship and psychological dimensions, sexual functioning during receptive anal sex, chemsex, minority stress, asexuality, and sexuality in older adulthood. The main challenges are related to small sample sizes and mostly cross-sectional study designs that limit the generalization of findings. Research focused on sexual (dys)function among transgender and gender-diverse individuals tends to focus on a medical perspective of sexual function and is often based on cisgender models or methodology. Research has also focused attention on the relationship between medical interventions for gender-affirming care (eg, hormone therapy, surgery) and has often included cross-sectional designs or short-term follow-up. Current research also highlights the unique facets of sexual (dys)function that appear important to gender-diverse individuals, such as relational and body image factors. Fewer articles focused on individuals with intersex traits/DSD, and these included a diverse approach to the samples studied and methodology used. Much of this research focused on the impact of medical interventions (eg, hormone therapy, surgery) on sexual satisfaction and function. Across populations, there were limited validated measures of sexual (dys)function.

CONCLUSION

Overall, the main challenges in the field are related to methodological gaps, as acknowledged in this review, and a summary of the literature is provided. Diversity, equity, and inclusion, as well as ethical considerations, are addressed, and clinical recommendations for supporting the sexual well-being of individuals with diverse sexual orientations, transgender and gender-diverse individuals, and intersex individuals/individuals with DSD are presented.

A systematic review of intervention strategies aimed at chemsex users

BACKGROUND

Interventions on chemsex, namely, the intentional use of specific drugs to enhance or intensify sexual experiences by gay, bisexual, and other men who have sex with men, are diverse. Despite evidence of their impact on physical, mental, and sexual health, there is no clear agreement on the best intervention strategies and approaches. In this review, we aimed to analyze and synthesize existing research on interventions addressing chemsex among gay, bisexual, and other men who have sex with men, as well as transgender and non-binary people.

METHODS

We conducted a systematic search of the electronic databases Web of Science, Scopus, ScienceDirect, PubMed, and SciELO for articles published between April and May 2024. In total, 272 articles were identified, of which 12 were reviewed.

RESULTS

Despite the limited evidence and heterogeneity of the findings, the results suggested that the available interventions can improve various factors associated with sexual, mental, and physical health.

CONCLUSION

This systematic review provides a better understanding of the interventions aimed at addressing chemsex. However, the paucity of available treatments underscores the need to implement evidence-based intervention programs aimed at improving the health of people involved in chemsex beyond mere screening.

Chemsex, sexualized drug use and emotional vulnerability among men who have sex with men (MSM): a one-month survey in a STI/HIV center

BACKGROUND

Chemsex, characterized by the intentional use of specific drugs to enhance sexual experiences during group sessions, represents a challenge for the health of some sexually active communities, such as men who have sex with men (MSM). MSM may experience mental health issues associated with chemsex participation. This survey aims to investigate the characteristics, prevalence, and correlates of sexualized drug use (SDU) and chemsex with a focus on the emotional vulnerability associated with chemsex and SDU engagement among MSM at high risk of sexually transmitted infections (STI).

METHODS

A self-administered anonymous questionnaire to investigate demographical data, attitudes toward substance dependence, sexual behaviors and vulnerability for common mental disorders (CMD), was offered to consecutive MSM attending the STI/HIV Unit of San Gallicano Dermatological Institute of Rome, Italy, from 1 to 30 November 2023. The Mann-Whitney and Fisher's test were used to assess differences in terms of sexual behavior, SDU, STI risk and vulnerability for CMD between MSM who don't engage in SDU, who engage only in SDU (no chemsex) and chemsex.

RESULTS

One hundred and twenty-two MSM agreed to participate. Overall, 47.3% (57/119) were people living with HIV (PLWH) on antiretroviral therapy (ART); fifty (40.9%, 95% CI: 32.7-49.9) participants reported SDU, 24 (19.7%, 95% CI: 13.6-27.6) of which reported chemsex. Participants reporting SDU or chemsex were in unstable relationships (p = < 0.01), engaged in group sex (p = < 0.01) and had more than 10 sexual partners in the previous year (p = < 0.01) compared to those who denied SDU. Chemsex participants were more likely to use condoms inconsistently (p = 0.02), have a history of STIs (p = 0.02), and have had over 10 sexual partners in the past year (p = 0.04) than those who only engaged in SDU. Chemsex participants used specific and exclusive drugs when compared to other MSM engaged in SDU. Overall, 35 (28.7%; 95% CI: 21.4-37.2) and 52 (42.6%; 95% CI: 34.2-51.5) participants showed symptoms of depression and anxiety, respectively. Chemsex involvement showed a strong association with symptoms of depression compared with no-SDU andno- chemsex (COR = 3.8; 95% CI: 1.22-11.6; p < 0.01), particularly among PLWH (p = 0.04).

CONCLUSIONS

Depression may be associated with chemsex behavior, particularly in MSM with HIV. SDU, in particular chemsex, are proxies in practitioners for increased STIs risk and severe psychological distress, both as determinants and outcomes. Healthcare professionals in STI centers need more awareness of SDU and ongoing evaluation with a larger population.

The complex social, cultural and psychological drivers of the 'chemsex' experiences of men who have sex with men: a systematic review and conceptual thematic synthesis of qualitative studies

Introduction

Chemsex' is the sexualised use of drugs among men who have sex with men (MSM). Past systematic reviews have primarily focussed on quantitative research exploring the key characteristics and health consequences of chemsex. However, a large body of qualitative literature exists, drawing on different theoretical frameworks.

Methods

A systematic review and thematic synthesis of the qualitative research on chemsex was conducted with the aim of exploring the chemsex experiences of MSM in the context of substance misuse and addictions, and to reviewing their underlying theoretical frameworks. Six databases were searched, and 43 papers were included in the review.

Results

The thematic synthesis resulted in four key themes: 'characterising chemsex', 'the context around chemsex', 'the chemsex experience', and 'harms, saying safe, and stopping chemsex'. Only nine papers explicitly drew on theoretical frameworks, which were broadly divided into two categories: those which drew on psychological theories, and those that framed chemsex as a social and cultural phenomenon.

Discussion

The results of the thematic synthesis add further understanding of the key characteristics of chemsex as well as some of the complex social and psychological drivers which may shape why people have chemsex. Finally, the review highlights the clinical implications and inherent complexities in providing clinical services for those reporting chemsex and the need for greater application of theory to advance our understanding of chemsex and continue to develop appropriate forms of therapeutic support.

Systematic review registration

https://osf.io/j6k9r/.

"A way to liberate myself": A qualitative study of perceived benefits and risks of chemsex among gay, bisexual, and other men who have sex with men in Almaty, Kazakhstan

BACKGROUND

In Kazakhstan, the HIV epidemic has a significant impact on marginalized groups such as gay, bisexual and other men who have sex with men (GBMSM), exacerbated by homophobic attitudes (in society) and (resulting) minority stress. This stress often leads to coping behaviors such as chemsex - the use of synthetic stimulants to enhance sexual experiences. Our study explores the motivations and perceived risks associated with chemsex among GBMSM in Almaty.

METHODS

We conducted semi-structured in-depth interviews with 21 chemsex participants self-identified as GBMSM in Almaty, Kazakhstan. Participants were recruited through community-based organizations to ensure a diverse sample in terms of age and ethnicity. Thematic analysis was used to identify key themes related to motivations and risks.

RESULTS

Participants practiced chemsex to seek liberation from societal norms and personal inhibitions, increase sexual pleasure, and escape daily stressors. Chemsex sessions provided intensified sexual experiences, emotional comfort, and social connections, challenging constraints on sexual behavior. Participants recognized significant risks, including mental and physical health issues, social stigma, and violence victimisation. Despite these risks, the desire for the perceived benefits of chemsex, particularly feelings of freedom and happiness, underscored its appeal.

CONCLUSIONS

The study reveals a complex dynamic in which chemsex serves as a coping mechanism for minority stress, a source of sexual liberation, and a social connector for GBMSM in Kazakhstan, while also posing significant health risks. These findings emphasize the need for targeted harm reduction strategies, mental health support, and community-building efforts that are responsive to the experiences and needs of GBMSM who engage in chemsex.

Exploring the Role of Social Support and Sexual Functioning: A Study of Chemsex and Sober Sex in Men Who Have Sex with Men

Research on chemsex, the intentional use of certain drugs in sexual contexts by gay men and other men who have sex with men (MSM), has been growing in recent years although, even today, much of it focuses on drug use and its consequences, rather than on the sexual and social experiences of users. This study aimed to explore the influence of social support and sexual functioning on the frequency of chemsex and sober sex. A sample of 160 MSM WAS recruited through social media and NGOs. Through regression analysis, it was found that lower perceived social support and greater number of routes of drug administration predicted a higher frequency of chemsex practice. On the other hand, higher perceived social support, higher levels of desire and arousal, and fewer routes of drug administration predicted a higher frequency of engaging in sober sex. This study provides empirical evidence that both social support and sexual functioning are key elements in chemsex and have an impact on both the frequency of chemsex and sober sex. Given the importance of these elements, we suggest that interventions should be framed holistically. Nevertheless, not all chemsex is problematic and it is a free choice in sexuality.

Sexualized drug use and chemsex: A bibliometric and content analysis of published literature

Sexualized drug use (SDU) describes drug-facilitated sexual enhancement, and chemsex is an SDU subculture involving the use of specific drugs by men who have sex with men (MSM). This study aimed to identify research trends, foci, and themes within the SDU and chemsex-specific literature. The Web of Science Core Collection was searched with a list of SDU synonyms. All SDU-related articles were analyzed using the R package, bibliometrix. Full text review identified chemsex-specific records, and text was extracted verbatim for content analysis in Leximancer. The search returned 1,866 unique records. A total of 521 addressed SDU, and 301 papers specifically addressed chemsex. The small but growing SDU literature primarily addressed consensual encounters between MSM, and drug-facilitated assault experienced by women, in Western settings. Little attention was given to transgender communities or consensual SDU in cisgender heterosexual individuals. The literature primarily viewed SDU through a public health lens, specifically focusing on the risk conferred to sexual health.The SDU and chemsex-specific literature are potentially limited in scope and may inadequately capture the geographical, demographic, and cultural diversity of these phenomena. Future research should address the myriad social and health implications of SDU and chemsex participation across all relevant communities and settings.

Getting Inside the Mind of Gay and Bisexual Men Who Have Sex with Men with Sexualized Drug Use - A Systematic Review

Objectives

Sexualized Drug Use (SDU) consists of using any drug purposely before or during sex with the intent of modifying sex experiences. SDU is especially practiced among Gay and Bisexual Men who have Sex with Men (GBMSM). This study aims to review the relevant literature to identify and summarize the reasons reported by GBMSM to engage in SDU.

Methods

A systematic review of the literature using PubMed/Medline, Scopus, Google Scholar, and PsycINFO, comprising qualitative and quantitative papers published between 2010 and 2022, was conducted with a narrative synthesis of the findings. PRISMA guidelines were followed.

Results

Our search identified 1400 publications, of which 23 were included. Reasons to engage in SDU were aggregated as follows: (1) Enhancing sexual sensations and performance, (2) Achieving hedonic mental and emotional states, (3) Tackling negative thoughts and feelings, and (4) Social motivations. Different sample methods and ways of asking for motivations may limit the internal validity of these conclusions.

Conclusion

Both individual and social factors are involved in the decision to engage in SDU. SDU practices should not be medicalized, however therapeutic support if needed should provide multidisciplinary, pleasure-centered, harm-reducing care interventions, specifically designed for these minorities of GBMSM.

Prevalence, characteristics, and associated risk factors of drug consumption and chemsex use among individuals attending an STI clinic (EpITs STUDY)

Sex-related drug consumption and its health-related consequences have gained relevance in the assessment of patients with sexually transmitted infections (STIs), which pose a significant challenge to public health. We aim to assess the prevalence and characteristics of drug consumption and chemsex practices, describe the associated risk factors among general individuals attending an STI clinic, and evaluate the psychological impact associated with these behaviors. We conducted an online anonymous survey offered to patients with a diagnosis of STI in a tertiary hospital in Spain. Data included sociodemographic characteristics, sexual preferences and behavior, and assessment of drug use, chemsex, and psychological and mental health symptoms. Data from 145 subjects was collected, with a higher proportion of cis-gender men (71%), and a median age of 32 years. 64 participants (44%) reported drug use in the last year, with an observed 33.8% prevalence of chemsex consumption. Drug use and chemsex were more frequent among cis-gender men, Men who have Sex with Men (MSM), people living with HIV (PLHIV), and those reporting previous group sex. Poppers and cannabis were the most frequently reported drugs, with a prevalence close to 20% for cocaine, mephedrone, extasis, and GHB. Consequences related to drug use included unpleasant physical sensations, sexual dysfunction, and impaired sexual experience after reduction or drug discontinuation. The prevalence of drug use and chemsex practices are high among patients evaluated for STIs, especially between men, MSM, and subjects practicing group sex. The study highlights the urgent need for targeted interventions on prevention and reduction of their impact on health and social well-being.

Substance Use in Sexual Relationships: Association with Sexual Assertiveness and Sexual Satisfaction

BACKGROUND

The main objective was to examine sexual assertiveness and sexual satisfaction in people who have sex under the influence of alcohol and drugs, considering the type of substance consumed, the frequency of consumption, gender, and sexual orientation.

METHODS

The sample consisted of 274 adults who had sexual relationships consuming substances. A questionnaire composed of sociodemographic, sexual history and substance use items, the Sexual Assertiveness Scale and the Global Measure of Sexual Satisfaction were administered.

RESULTS

Gender differences were found in sexual assertiveness and in the frequency of substance use. Women reported greater sexual assertiveness and greater alcohol consumption. Men reported greater consumption of different types of substances. Furthermore, bisexual participants showed greater assertiveness and STI prevention. Homosexual participants reported a higher frequency of the consumption of poppers, mephedrone, and GBL/GHB. Sexual assertiveness was associated with sexual satisfaction. Greater consumption of some types of substances was related to sexual assertiveness, STI prevention, and sexual satisfaction.

CONCLUSIONS

The association found between sexual assertiveness and sexual satisfaction in a specific context of substance use in sexual relationships corroborates the important role that these psychosexual variables have in sexual health, in view of the frequency and type of drug consumed, gender, and sexual orientation.

Factores determinantes de la exposición sexual al VIH en adolescentes luso-brasileños: un análisis de rutas

Resumen Objetivo: analizar los efectos directos e indirectos de los factores determinantes de la exposición sexual al virus de la inmunodeficiencia humana entre adolescentes hombres que tienen relaciones sexuales con hombres y las implicaciones para el cuidado en enfermería. Método: estudio transversal, realizado con 578 adolescentes luso-brasileños de 18 a 19 años. Se evaluaron las interrelaciones del estado civil, uso de aplicaciones de relación, práctica de chemsex, desinformación, credibilidad de la pareja, prácticas sexuales desafiantes y medidas de protección ineficaces sobre la exposición sexual al virus de la inmunodeficiencia humana, a través de la técnica del Análisis de Rutas. Resultados: presentó un efecto directo significativo para la exposición sexual al virus de la inmunodeficiencia humana: estado civil (β=-0,16), uso de aplicaciones (β=-0,30), prácticas sexuales desafiantes (β=0,48) y medidas de protección ineficaces (β=0,35). En las rutas indirectas: la credibilidad de la pareja influyó en medidas de protección ineficaces (β=0,77); tener una relación fija/poliamorosa influyó en el uso de aplicaciones de relación (β=-0,46); el chemsex, mediado por prácticas sexuales desafiantes (β=0,67), determinó una mayor exposición sexual. Conclusión: se deben tener en cuenta las conductas sexuales de adolescentes y las configuraciones de una relación amorosa/sexual en la planificación de la asistencia de enfermería para reducir la exposición sexual al virus de la inmunodeficiencia humana.

Fatores determinantes da exposição sexual ao HIV em adolescentes luso-brasileiros: uma análise de caminhos*

Resumo Objetivo: analisar os efeitos diretos e indiretos de fatores determinantes da exposição sexual ao vírus da imunodeficiência humana entre adolescentes homens que fazem sexo com homens e as implicações para o cuidado em enfermagem. Método: estudo transversal, realizado com 578 adolescentes de 18 a 19 anos luso-brasileiros. Avaliaram-se inter-relações de situação conjugal, uso de aplicativos de relacionamento, prática de chemsex, desinformação, credibilidade do parceiro, práticas sexuais desafiadoras e medidas protetivas pouco eficazes sobre a exposição sexual ao vírus da imunodeficiência humana, com a técnica de Análise de Caminhos. Resultados: apresentou efeito direto significante para exposição sexual ao vírus da imunodeficiência humana: situação conjugal (β=-0,16), uso de aplicativos (β=-0,30), práticas sexuais desafiadoras (β=0,48) e medidas protetivas pouco eficazes (β=0,35). Nos caminhos indiretos: credibilidade do parceiro influenciou medidas protetivas pouco eficazes (β=0,77); ter relacionamento fixo/poliamoroso influenciou o uso de aplicativos de relacionamento (β=-0,46); chemsex, mediado por práticas sexuais desafiadoras (β=0,67), determinou maior exposição sexual. Conclusão: comportamentos sexuais dos adolescentes e configurações do relacionamento amoroso/sexual precisam ser considerados no planejamento da assistência em enfermagem para diminuir a exposição sexual ao vírus da imunodeficiência humana.

Determinants of sexual exposure to HIV in Portuguese and Brazilian adolescents: a path analysis

OBJECTIVE

to analyze the direct and indirect effects of determinants of sexual exposure to the human immunodeficiency virus among male adolescents who have sex with men and the implications for nursing care.

METHOD

cross-sectional study carried out with 578 Portuguese and Brazilian adolescents aged 18 and 19. Interrelationships of conjugal status, use of dating apps, practice of chemsex, unawareness, partner credibility, challenging sexual practices and ineffective forms of protection against sexual exposure to the human immunodeficiency virus were evaluated using the Path Analysis technique.

RESULTS

significant direct effect on sexual exposure to the human immunodeficiency virus: conjugal status (β=-0.16), use of apps (β=-0.30), challenging sexual practices (β=0.48) and ineffective forms of protection (β=0.35). Indirect paths: partner credibility influenced ineffective forms of protection (β=0.77); having a steady/polyamorous relationship influenced the use of dating apps (β=-0.46); chemsex, mediated by challenging sexual practices (β=0.67), determined greater sexual exposure.

CONCLUSION

adolescent sexual behaviors and forms of amorous/sexual relationship must be considered in nursing care planning to reduce sexual exposure to the human immunodeficiency virus.

(1) Adolescents present high prevalence (81.0%) of sexual exposure to HIV. (2) Specificities of sexual practices are determinant factors of sexual exposure. (3) The higher the credibility given to a partner, the higher the sexual exposure to HIV. (4) Challenging sexual practices (such as fisting) determine sexual exposure. (5) Nursing care must focus on lowering exposure to HIV.