Chemsex et usages de substances en contexte sexuel : les problématiques sexuelles spécifiques (2026)

FRANÇAIS :
Contexte : Le chemsex, usage intentionnel de psychoactifs dans le cadre d’une activité sexuelle, concerne majoritairement des hommes ayant des rapports sexuels avec des hommes (HSH). Cette pratique s’accompagne fréquemment de problématiques sexuelles spécifiques : modification des scripts sexuels, court-circuitage du désir, plateau excitatoire prolongé, dysfonctions en dehors des sessions (dysfonction érectile et/ou éjaculatoire), baisse de satisfaction et réduction progressive du répertoire érotique. Un signal d’alerte clinique est la « sexualité 100 % sous produits », lorsque la sexualité devient difficile à envisager sans consommation.
Méthode : Nous proposons une revue narrative de la littérature portant sur les dimensions sexologiques du chemsex et discutons les implications cliniques d’une prise en soin multidisciplinaire.
Résultats : La pratique du chemsex s’inscrit dans un contexte de déterminants sociaux et communautaires (stigmatisation, stress minoritaire, normes de milieu) mais aussi de possibles vulnérabilités préexistantes (construction de la sexualité, difficultés sexuelles antérieures, traumatismes), pouvant être responsables d’une fragilisation du consentement. Sur le plan clinique, la répétition de sessions centrées sur l’endurance et la performance peut conduire certains patients à interroger un comportement sexuel compulsif, en interaction avec les effets des substances. La prévention et réduction des risques (toxicologiques, infectieux mais aussi sexologiques) est indispensable mais doit s’inscrire dans des parcours coordonnés, non jugeants et informés des réalités communautaires HSH.
Conclusion : Nous plaidons pour une prise en soin intégrée, articulant sexologie, addictologie, santé mentale et santé sexuelle, selon un modèle à deux axes : sécuriser les sessions et développer une sexualité sans consommation en accord avec ses désirs, diversifiée et orientée vers le plaisir. [Résumé d'auteur]
ENGLISH:
Background: Chemsex (the intentional use of psychoactive substances in the context of sexual activity) mainly concerns men who have sex with men (MSM). It is commonly described as planned session that may last several hours to several days, sometimes in group settings, and often organised through geolocated dating apps and community networks; substances frequently mentioned include cathinones, methamphetamine and/or gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL), with occasional polysubstance patterns. This practice is frequently associated with specific sexological difficulties, including changes in sexual scripts, a “short-circuiting” of desire, a prolonged arousal plateau, and sexual dysfunction outside sessions (erectile and/or ejaculatory dysfunction), as well as reduced sexual satisfaction and a progressive narrowing of the erotic repertoire. A clinically relevant warning sign is 100% under-substances sexuality, when sexual activity becomes difficult to imagine without drug use. This warning sign is particularly relevant when sexual learning has occurred predominantly in chemsex settings, as it may limit access to alternative, pleasure-based sexual scripts.
Method: We conducted a narrative review focusing on the sexological dimensions of chemsex and discuss the clinical implications of multidisciplinary care. The review was organised around core sexological domains (desire, arousal, orgasm/ejaculation and satisfaction) and complemented by work addressing sexual consent and sexual violence, minority stress and stigma, and service models integrating sexology, addiction medicine, mental health and sexual health. Searches were primarily performed in PubMed/MEDLINE and complemented with French-language sources, using combinations of terms related to chemsex/sexualized drug use, MSM/HSH, sexology/sexual function, consent, and interventions.
Results: The practice of chemsex occurs in a context of social and community determinants (stigmatization, minority stress, community norms) but also of possible pre-existing vulnerabilities (sexuality development, previous sexual difficulties, trauma), which may be responsible for weakening consent. Clinically, the repetition of sessions centred on endurance and performance may lead some patients to question the presence of compulsive sexual behaviour, in interaction with substance-related effects. Minority stress frameworks help interpret how stigma and discrimination can shape affect regulation, self-esteem, relationship patterns and a need for belonging, potentially reinforcing substance use as a coping strategy for sexual and social anxiety. From a sexological standpoint, patients may describe a shift toward performance-driven scripts (endurance, intensity, multiplicity of partners) alongside later difficulties in “non-chem” contexts, including reduced desire, erectile difficulties, delayed ejaculation/anorgasmia, and dissatisfaction. In clinical assessment, distinguishing compulsive sexual behaviour from substance-driven repetition is essential: persistence of loss-of-control symptoms outside intoxication and across contexts may suggest a compulsive component, whereas fluctuations linked to session-related intoxication may point to substance effects and learned scripts. Consent-related vulnerabilities may be amplified by prolonged sessions, group dynamics, power imbalances, and drug-induced amnesia or fluctuating capacity to consent. Prevention and harm reduction, addressing toxicological and infectious risks, as well as sexological issues, are essential, but must be embedded within coordinated care pathways that are non-judgmental and informed by MSM community realities. These measures are more likely to be acceptable when delivered within culturally competent services that recognise community norms without moralising, and that collaborate with community-based organisations and peer resources.
Conclusion: We argue for an integrated care approach combining sexology, addiction medicine, mental health and sexual health, based on a two-track model: improving session safety while fostering the development of a drug-free sexuality aligned with one's desires, diverse and pleasure-oriented. This dual-track framing avoids conditioning care on immediate abstinence while still setting explicit sexological targets (desire, arousal, orgasm and sustainable satisfaction) and supporting the (re)development of non-chem erotic skills and scripts. A dedicated, non-judgmental space for discussion of practices and substance use, grounded in an accurate understanding of MSM community realities, appears crucial for engagement and for clinically meaningful change. [Author's abstract]