ChemSex

"'Chemsex' has been defined as a voluntary intake of certain psychoactive and non-psychoactive drugs in the context of sex parties and sexual intercourse with the intention of enhancing, prolonging, and sustaining sexual experiences, hence facilitating the sexual encounter [1]. These sessions are mostly among men who have sex with men [2,3,4,5,6,7,8,9,10,11,12,13,14]. Conversely, one could argue that the use of drugs whilst being involved in intimate, sexual behavior may relate to a vast range of populations. From this point of view, similar concepts have been proposed, including perisexual drug use [15], sexualized drug behavior [16], 'Sex on Chems' (Wilson and Williamson, 2024) [17], 'Party-n-Play' [18], wired sex [19], and 'Pampalibog' (in the Filipino language; [20]). Chemsex practices are becoming increasingly popular. Data from 55, 446 MSM subjects living in 44 urban centers were made available by Schmidt et al. [21]. In the European region, the past 4 weeks’ chemsex involvement was highest in Brighton (16.3%), Manchester (15.5%), London (13.2%), Amsterdam (11.2%), and Barcelona (7.9%). In 2018, 785 MSM were recruited at nine Dutch clinics, and 511 (65%) completed the online questionnaire. Chemsex, which was defined as using cocaine, crystal meth, designer drugs, gamma-hydroxybutyric acid/gamma-butyrolactone (GHB/GBL), ketamine, 'speed' and/or 3,4-methylenedioxymethamphetamine (XTC; MDMA), was reported by 41% of interviewees during the previous 6 months [22].

"At times, to enhance libido, potency, and sexual pleasure, a range of aphrodisiacs, which are often naturally occurring and traditionally used, are self-administered [23]; moreover, aphrodisiacs’ intake is frequently rooted in cultural beliefs and superstitions. The U.S. Food and Drug Administration (FDA) defines an aphrodisiac drug product as 'any product that bears labeling claims that it will arouse or increase sexual desire, or that it will improve sexual performance'. Conversely, the European Medicines Agency (EMA) does not have specific definitions for aphrodisiac products but regulates drugs for sexual dysfunction [24]. As a result, a range of over-the-counter (OTC) herbal products and approved prescription drugs (for example, for erectile dysfunction) are legally available. From an anthropological perspective, chemsex cultures are multifaceted and shaped by a wide range of social and psychological factors [25], for example, geographical location, the use of apps and online platforms, and the availability of specific substances. Indeed, there is a lack of research as well on how sexual experience affects drug reward in animals [26]. Mating is clearly regarded as a basic reward activity. In fact, conventional reinforcers (e.g., food, sex) stimulate dopamine (DA) transmission in the nucleus accumbens shell [27]. Addictive drugs share with conventional reinforcers the property of stimulating DA transmission in the nucleus accumbens shell. This response, however, undergoes one-trial habituation in the case of conventional reinforcers. Resistance to habituation allows drugs to repetitively activate DA transmission in the shell upon repeated self-administration [27]. In sober sex, a clear post-ejaculation refractory time (PERT), e.g., the period after a single ejaculation when further erections and ejaculations are inhibited, has been documented [28]. Conversely, Schreck et al. [29] documented a 40-hour-long chemsex session. Further, a recent UK-based, mixed methods study surveyed some 123 subjects; 86% of respondents engaged in riskier sex during sessions and 35% no longer enjoyed sober sex [17]. Hence, one could argue that chemsex may respond to the perceived need to use a range of drugs to overcome resistance to habituation, synergistically increase sex-derived physiological pleasure, and facilitate voluntary self-exposure to idiosyncratic practices. To experience a more intense rush and longer sex, some drugs are being injected so that much higher bioavailability levels are being attained [30,31]."