Chemsex as a diagnostic challenge: Toward recognition in ICD-12 and integrated treatment approaches - A narrative review (2025)

Chemsex is a phenomenon involving the intentional use of psychoactive substances before or during sexual activity, especially among men who have sex with men (MSM). It is associated with various health risks, including substance dependence, risky sexual behaviors, and both mental and somatic disorders. Despite its growing prevalence and public health relevance, chemsex lacks a clear definition and is not recognized as a distinct diagnostic entity. This narrative review synthesizes clinical, epidemiological, and technological evidence on chemsex; argues for its classification as a form of mixed addiction; and preliminarily proposes diagnostic criteria for a potential entity in the International Classification of Diseases, 12th Revision (ICD-12). This paper highlights key psychotropic substances used in chemsex, patterns of use, and their neurobiological, psychological, and behavioral consequences. It explores the relationship between chemsex and compulsive sexual behavior disorder (CSBD), current diagnostic frameworks (ICD-10 and ICD-11), and challenges in clinical practice. Therapeutic strategies discussed include cognitive behavioral therapy (CBT), digital interventions, and emerging applications of artificial intelligence (AI) in prevention and treatment. Attention is also given to epidemiological trends, sociocultural influences, and barriers to seeking help. This review concludes by identifying research gaps and advocating for a more integrated, multidimensional approach to classifying and treating chemsex-related syndromes. [Author's abstract]