What Is Chemsex?

Chemsex, a contraction of ‘chemical’ and ‘sex’, is a term that refers to the consumption of psychoactive substances in specifically sexual contexts. This practice of voluntarily taking substances aims to intensify, prolong and increase both pleasure and sexual performance.

The term first appeared in the 2000s, in gay and MSM (men who have sex with men) cultures, as a way to describe preferences and practices carried out under the influence of drugs (Stuart, 2019).

Chemsex is a difficult practice to analyse. According to a 2024 report by the French Monitoring Centre for Drugs and Drug Addiction (OFDT), chemsex affected between 13 and 14% of MSM in the year 2023. In one of two successive reports on the subject, carried out as part of the 2021–2024 sexual health roadmap and submitted by Amine Benyamina, president of Addictions France, around 22% of MSM admit to having partaken in chemsex.

As chemsex garners increasing interest in the public health sphere, it’s important to remember that it is, above all, for those who practice it, a way to meet people, make connections and have fun. For a lot of gay, bisexual and MSM, it’s a space in which they can break away from social norms and injunctions. It’s a way to enjoy a sex life that is removed from inhibitions, away from the dominant scripts and stigma that weigh upon sex between men.

Sexualised drug use is a phenomenon that can be observed within the general population (most notably, the consumption of alcohol and cannabis). The use of psychotropic substances with the aim to intensify sexual pleasure, or as a way to treat erectile dysfunction, is present in all social groups throughout time (Levy et Garnier, 2006 ; Toates, 2014).

However, chemsex is part of the history and heritage proper to one sexual minority in particular: gay men, bisexual men and MSM. To gain the clearest possible understanding of chemsex, it is important to bear in mind that there are certain aspects of sex and gay culture that give rise to this practice. These aspects form part of a multi-factorial context that has significantly influenced perceptions of sex between men (Stuart, 2019).

It’s crucial to look at the legislation that has long since framed male homosexuality. Male homosexuality was made illegal in the UK during the rein of Henry VIII (Buggery act 1533), and remained illegal until the introduction of the Sexual Offences Act in 1967, which decriminalised private homosexual acts between men aged over 21. The age of consent for homosexual acts would not be made equal to that of heterosexual acts (16) until 2001. It’s also important to consider the weight of religious dogma on the way society treats homosexuals. Another crucial point is the AIDS outbreak, more precisely Human immunodeficiency virus (HIV) infections in the 1980s. It’s an extremely common viewpoint that homosexuals are responsible for ‘spreading’ AIDS (Bagmigboye & McKay, 1986). Referred to at this time as the ‘gay cancer’ or ‘homosexual plague’, the 40,000 recorded deaths left a deep scar on the LGBTQIA+ community.

Long since regarded as ‘disgusting’, ‘dirty’, ‘impure’, and ‘unnatural’, sex between men is marked by deep-seated and persistent stigmas that have endured through the ages and which persist, in particular, through the stress experienced by those belonging to minority groups. It is therefore not surprising to see the phenomenon of chemsex emerging in gay communities today, as they are still shaped by this cultural and social legacy and the associated stigmas.

This trend is accompanied by the emergence of new ways of meeting people (Websites and mobile apps with geolocation) and new drugs (new psychoactive substances— NPS) (EMCDDA, 2015).

There are two main factors that can contextualise this recent emergence in the practice of chemsex. On one hand, the arrival of dating apps that use geolocation allow people to find partners instantly and locally. Since 2010, attendance at nightlife venues is falling, and people are enjoying house parties instead (OFDT, 2024). The appearance of these apps has fundamentally changed relationships and how partners meet, particularly in the gay community: ‘Some users explain how they become members of chemsex “culture” as a response to the gradual disappearance of non-sexual communication in the era of apps, with substance use also serving to reduce social inhibitions.’ (Report « Chemsex » 2022, headed by Pr. Amine Benyamina).

On the other hand, this trend also accompanies the arrival of new psychoactive substances (NPS’s) on the drug market that benefit, initially, from a legal grey area that means it’s easy to buy them online and get them delivered to home. NPS’s reproduce the chemical structures and effects of illicit drugs thanks to lab-created synthetic molecules. According to the OFDT, more than 897 new synthetic drugs have been identified in Europe since 1997. Amongst some of these, cathinones (3-MMC, 4-MMC, 3-CMC, NEP...) and stimulants with entactogen properties (feelings of empathy, a desire for emotional and physical closeness) have been noted.

We can see a sort of three-part pattern, comprising, on the one hand, psychoactive substances, on the other, sexuality, and finally, dating apps.

As described previously, these are the most commonly used substances during chemsex. The belong to the entactogen family. Desired effects in a sexual context are multiple: increased sexual arousal, disinhibition, a feeling of euphoria and overall well-being, increased physical endurance, more intense desire and physical and emotional proximity between partners. They facilitate prolonged and multiple sexual encounters.

GBL is the precursor to GHB. This chemical product, used as a solvent, is synthesised into GHB by the liver once ingested. These are central nervous system depressants with a dual action: they induce euphoria and cause amnesia. When used in small doses in a sexual context, they induce feelings of euphoria, disinhibition and deep muscle relaxation that facilitates penetrative practices such as fisting. They also increase tactile sensitivity and sexual desire. These muscle-relaxing effects and disinhibition in particular explain their popularity in chemsex circles.

A powerful stimulant, cocaine is used for its euphoric effects, increased self-confidence and energy. It helps to delay ejaculation and increases feelings of desire all whilst reducing social and sexual inhibition.

MDMA produces powerful entactogenic effects: intense feelings of love and connection with partners, increased tactile and sensorial sensitivity, and disinhibition. They are less specific to chemsex than cathinones, but are extremely present in the party scene in general.

An anaesthetic used in recreational doses for its dissociative effects and its ability to alter bodily perception. In a sexual context, it may facilitate practices that require considerable physical and mental relaxation. It may also produce modified states of consciousness that some people seek to intensify certain sensory experiences. Its use in chemsex is more marginal but gaining in popularity.

Beyond their pharmacological effects, each of these products respond to specific needs— disinhibition, endurance, emotional connection, physical relaxation— that echo psychosocial dynamics proper to MSM communities: the weight of stigma, stress within minorities, and the difficulty of exploring a fulfilling, destigmatised sex life.

The products used in chemsex environments can be consumed in different ways: orally (parachuting), intra-nasally (sniffing), intra-rectally (plugging), or intravenously (slamming). Each mode of administration influences the speed with which the substance takes effect, as well as the intensity of said effects. They also come with specific risks. Sharing a straw to sniff favours hepatitis B and C transmission, whilst sharing a syringe exposes users to the risk of HIV transmission, slamming being the most high-risk mode of administration.

It’s important to note that polysubstance use (the simultaneous or successive use of different substances) is common in chemsex circles and multiplies the risks associated with each individual substance taken.

Substance and polysubstance use can lead to sexual dysfunctions. The most frequent problems cited by those who practice chemsex concern erectile dysfunction, difficulty reaching orgasm (anorgasmia), ejaculatory issues and reduced sexual satisfaction. Many users resort to taking PDE-5 inhibitors such as Viagra and Tadalafil as a way to combat the effects of the drugs on sexual arousal and erection (Papazian et Miele, 2026).

The diversity of the products used, the way they are consumed, and how often polysubstance makes up part of chemsex situations outline specific risk profiles. It is at the intersection of risks associated with drug use and those associated with sexual practices.

Chemsex has gained notable attention in both the media and discussions about public health concerns of the last 15 years. Since 2010, health professionals in addictology and sexual health report the emergence of health issues (intoxication and overdosing, dependence, mental health issues, hepatitis-based infections etc.) amongst certain chemsexers (OFDT, 2024). Chemsex is a recent, complex phenomenon that presents a veritable public health issue. It lies at the dangerous intersection of risky sexual behaviour and the risks associated with drug use.

Direct risks linked to drug use primarily concern overdose and intoxication, and can go as far as loss of consciousness and falling into a coma. This is a particular risk with GHB/GBL use, where the dosage window is particularly narrow. The term G-hole is used to refer to acute GHB/GHL intoxication, which can provoke convulsions and a loss of consciousness. Risks are also heightened by the interaction between different drugs during polysubstance use. Alcohol can cause numerous undesirable reactions with GHB/GHL and ketamine. There also exists cardiovascular risks with the use of PDE-5 inhibitors and poppers.

On a long-term basis, repeated drug use can cause dependence, withdrawal, mental breakdowns (psychosis, paranoia, dissociative episodes), and more general mental health and psycho-social issues.

Sexual practices associated with chemsex carry specific risks in relation to sexually transmitted infections (STIs) such as HIV, hepatitis B and C, gonorrhoea, syphilis, chlamydia, mpox… The effects of the products consumed — disinhibition, altered judgement, muscular relaxation— automatically lead to a reduction in the use of protective equipment. Condom use is less consistent or absent. More intense sexual practices— especially fisting— are facilitated by the effects of the substances taken, can damage the mucous membrane, further increasing the risk of contracting STIs.

Furthermore, the effect of drugs on one’s cognitive abilities alter the capacity to give or take away free and informed consent, exposing users to situations of sexual violence. These situations aren’t always identified as such at the time, nor recognised as such after the fact. These risks cannot be viewed in isolation from the psychosocial context described above: the stress of being part of a minority group, internalised homophobia and the search for community can further undermine one’s ability to protect oneself and set boundaries.

Other than the immediate risks, repeated chemsex practices can have long-term effects on a person’s sex life. Users frequently report a gradual decrease in sexual satisfaction outside of chemsex sessions, as well as sexual dysfunctions (erectile issues, ejaculation issues, anorgasmia) that can persist even after stopping.

The effects of substances on sexual response can also persist over the long term. The excitement and plateau phases tend to get drawn out when under the influence, creating a form of conditioning that can make accessing pleasure and orgasm in substance-free sexual contexts extremely difficult.

More globally, repeated chemsex can modify sexual scripts, otherwise put, the way in which one presents themselves and experiences their sexuality. Sex without drugs may gradually seem less intense, less desirable, even impossible, creating a form of functional dependence on chemsex, beyond the addictive dimension of the substances used. This is one of the most complex aspects of treatment, as it directly touches upon sexual identity.

Geolocation-based dating apps provide considerable access to chemsex. They make it possible to find a partner at any hour, without having to go to party venues or other public spaces. This accessibility facilitates entry into chemsex practices and can quickly lead to problematic usage.

Looking beyond chemsex sessions, for numerous MSM, these apps constitute a central social hub. Doctor Maé Ilieff, psychiatrist-addictologist, highlights the fact that apps are an important vector for socialisation (even outside the sexual context) for MSM. He points out that it is difficult to break the chemsex cycle without at least partially stepping away from apps, as they expose users to very intense stimuli that trigger cravings. This statement puts the spotlight on a paradox: digital spaces make getting out of such environments as difficult as they make it easy to enter into in the first place. In an era where apps have largely encroached upon physical meeting places, the existence of community spaces allows for social and emotional interactions outside of a sexual context. This is ever more important in order to offer concrete alternatives to exclusively digital social spaces.

Regarding risks, meeting strangers in a context where substances are being taken generates a particular level of vulnerability: altered judgement, difficulty evaluating the situation and others, potential exposure to violence, rape or sexual abuse.

The paradoxical isolation that these apps can cause — sexual hypersocialisation yet a dwindling presence of emotional, non-sexual links — equally constitutes a breeding ground for dependence on both substances and the apps themselves.

Chemsex is situated at the crossroads of three main risks: drug use, sexual practices and dating apps. These factors do not simply add up, but multiply and feed into one another. It’s precisely this intersectional dimension that makes the complexity and particularity of chemsex a public health issue. The stress of being a minority and inherited trauma – the criminalisation of homosexuality, the HIV epidemic, stigmatisation – are not merely a backdrop: they are a factor of vulnerability that cuts across all risk factors and complicates the ability to escape them. PreP (Pre-exposure prophylaxis), a major scientific advancement in HIV prevention, has, in certain contexts, lead to a reduction of other STIs. Finally, leaving chemsex behind can also mean leaving behind a space for socialising and losing a sense of community. This makes seeking care particularly complex and highlights the need for a harm-reduction approach that addresses not only substance use but also the psychosocial context in which it takes place.

When faced with the complexity of the issue and its overlapping risks, the question of seeking care is done on specific terms: recognising that the practice exceeds what one had been expecting, in a context where chemsex is also a place for socialisation, pleasure and community belonging, isn’t always evident. This is precisely where the harm reduction approach comes in – not as a call for abstinence, but as a set of practical guidelines for practising in a safer way, recognising warning signs and, where necessary, finding the right support.

Without passing judgement or advocating abstinence, here are some practical tips to reduce the risks associated with chemsex.

Take some time to reflect upon your desires and the practices you want to explore, communicate them with your partner(s) before the effects take hold. If possible, choose a familiar space and partner(s) you trust, who are capable of reacting in the event of an emergency. Avoid practicing with complete strangers, or at least inform a close friend of your plans. Getting some sleep, eating properly and hydrating are all small things you can do to ensure you’re in the best possible condition for what’s to come.

Envisage breaks. Hydrate yourself throughout. Space out your doses as much as possible and keep track of what you took and when. This is particularly important when it comes to GHB/GBL where the gap between desired effects and overdose is extremely small. Avoid polysubstance use and take into account how different substances react with one another. Never take GHB/GBL and alcohol together. Use personal, single-use equipment. Keep lube and condoms on hand.

Rest, eat and hydrate. In the event of risky sexual behaviour, PEP (HIV post exposure prophylaxis) can be prescribed up to 48 hours after the fact, in a sexual health clinic or at A&E if outside normal working hours. Get tested regularly for HIV and other STIs, and warn all partners in the event that you do contract a sexually transmitted infection.

The effects of the products consumed can gradually, and sometimes brutally, alter one’s cognitive abilities and their judgement. Consent is not applicable to the beginning of the session alone, it must be able to be given, taken away or readjusted at any point.

Before getting started, it’s important to discuss the practices that you are keen to explore and those that you don’t feel comfortable with. Expressing your desires and limits before the effects from substances taken kick in remains one of the best ways to protect oneself. Choose a stop signal (verbal or non-verbal) that all partners can use and respect.

During the session, it’s imperative you remain aware of the signs other partners may be giving. The absence of a ‘no’ does not signify a ‘yes’, particularly when under the influence.

If a situation seems to have surpassed the limits of what had been discussed and defined at the beginning, whether by you or other partners, it’s important to be able to be able to put a name to it after the fact, without minimising what happened. Sexual violence during chemsex contexts are real and recognised by law as such, even if the individuals involved aren’t stranger, or consent was given at the start.

Organisations like the Terrence Higgins Trust and Antidote offer judgement-free support that’s adapted to the realities of chemsex. Both organisations focus on not only sexual health and prevention regarding chemsex, but also mental health. They also provide inclusive support in order to accompany MSM in their treatment.