Chemsex and compulsive sexual behavior among sexual minority men.

Introduction: Chemsex, or the use of specific psychoactive substances to enhance or prolong sexual encounters, is increasingly prevalent among sexual minority men and is linked to adverse health outcomes.

Aim: This study examines the co-occurrence of chemsex and compulsive sexual behavior disorder (CSBD) among sexual minority men and whether this co-occurrence is connected to mental and sexual health concerns.

Methods: A sample of 289 sexual minority men (223 gay men and 66 bisexual men), recruited primarily through the dating/hookup application Grindr, completed measures of chemsex participation, CSBD, substance use disorder symptoms, and health outcomes. CSBD was measured with the Compulsive Sexual Behavior Disorder Scale-7 (CSBD-7), which uses a psychometrically validated cut-off for identifying individuals who are at high risk of experiencing CSBD.

Results: Chemsex participation (15.2%) and falling above the CSBD-7 cut-off (34.3%) were prevalent, with 9.3% of participants endorsing both. Chemsex, compared to alcohol and marijuana use during sex, was more strongly associated with sexual and mental health outcomes. Individuals reporting chemsex and/or falling above the CSBD-7 cut-off, experienced greater depression and anxiety compared to those without these concerns. However, only individuals reporting the co-occurrence of chemsex and CSBD endorsed greater sexual health concerns, such as condomless anal sex and HIV infection. Participants only endorsing chemsex were not included in the analyses due to low frequency.

Discussion: This study suggests that chemsex and CSBD co-occur and are connected to negative health outcomes, such as depression and condomless anal sex. Notably, differences in sexual health concerns (i.e., condomless anal sex, HIV infection, and the use of poppers and erectile dysfunction medications during sex) were only identified when participants endorsing chemsex were included in analyses, suggesting that CSBD's connection to sexual risk may arise from a subset of individuals struggling with chemsex. Lastly, chemsex, popper use, and erectile dysfunction medication use during sex appear more strongly connected to CSBD than marijuana or alcohol use during sex. Future research is needed using larger samples, longitudinal approaches, and more refined measures of chemsex.