Next Article in Journal
Impact of Pharmacist Educational Intervention on Costs of Medication with Improved Clinical Outcomes for Diabetic Patients in Various Tertiary Care Hospitals in Malaysia: A Randomized Controlled Trial
Previous Article in Journal
Predictive Analysis of Postpartum Depression Using Machine Learning
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Healthcare
Volume 13
Issue 8
10.3390/healthcare13080899
healthcare-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Systematic Review

Prevalence of Sexualized Substance Use and Chemsex in the General Population and Among Women: A Systematic Review and Meta-Analysis of Cross-Sectional Studies

by
Manshuk Ramazanova
1,
Botagoz Turdaliyeva
2,
Alfiya I. Igissenova
3,
Maiya Zhakupova
4,
Akmaral Sh. Izbassarova
5,
Mariya Seifuldinova
6,
Gulnaz Nurlybaeva
5,
Raushan Yergeshbayeva
7 and
Indira Karibayeva
8,*
1
Department of Public Health and Social Sciences, Kazakhstan Medical University “KSPH”, Almaty 050060, Kazakhstan
2
Kazakh Scientific Center of Dermatology and Infectious Diseases, Almaty 050002, Kazakhstan
3
Department of Microbiology and Virology, Asfendiyarov Kazakh National Medical University, Almaty 050012, Kazakhstan
4
Department of Public Health, Asfendiyarov Kazakh National Medical University, Almaty 050012, Kazakhstan
5
Department of Physical Medicine and Rehabilitation, Sports Medicine, Asfendiyarov Kazakh National Medical University, Almaty 050012, Kazakhstan
6
Department of General Surgery and Topographic Anatomy, Asfendiyarov Kazakh National Medical University, Almaty 050012, Kazakhstan
7
Department of Nutrition, Asfendiyarov Kazakh National Medical University, Almaty 050012, Kazakhstan
8
Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA
*
Author to whom correspondence should be addressed.
Healthcare 2025, 13(8), 899; https://doi.org/10.3390/healthcare13080899
Submission received: 9 March 2025 / Revised: 3 April 2025 / Accepted: 12 April 2025 / Published: 14 April 2025
Browse Figures
Review Reports Versions Notes

Abstract

:
Background and Objectives: Sexualized substance use (SSU) and chemsex have garnered increasing attention in public health research, particularly among men who have sex with men (MSM). However, the prevalence and implications of these behaviors in the general population and among women remain underexplored. This systematic review and meta-analysis aimed to synthesize existing evidence on the prevalence of SSU and chemsex in the general population, with a specific focus on women. Materials and Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, ProQuest, Scopus, Web of Science, Cochrane, and PsycINFO were searched for studies published before 18 February 2025. The keywords included “chemsex”, “sexualized substance use”, “prevalence”, and “women”. Studies were included if they reported prevalence data on SSU or chemsex in the general population or among women. The exclusion criteria included studies focused exclusively on MSM, adolescents, or specific drug toxicity. The pooled prevalence estimates were presented using forest plots, and the heterogeneity was assessed using I2 statistics in RStudio (version 4.3.2). Results: The findings reveal that SSU and chemsex are significant phenomena, with pooled prevalences of 19.92% in the general population and 15.61% among women. The higher prevalence of SSU (29.40%) compared with chemsex (12.66%) in the general population suggests that substance use during sex is a broader behavioral pattern. Among women, the prevalence of chemsex was notably lower (3.50%) than SSU (25.78%). Conclusions: This study underscores that SSU and chemsex are significant public health concerns extending beyond the MSM community. The findings highlight the need for inclusive public health strategies that address these behaviors across the general population. Future research should focus on standardizing definitions, exploring contextual factors, and developing targeted interventions to mitigate associated risks, such as sexually transmitted infections, substance dependency, and mental health disorders.

1. Introduction

Engaging in new sexual experiences and seeking heightened sensations can increase the likelihood of individuals participating in risky sexual behaviors, which may pose health risks [1,2]. Sexualized substance use (SSU) and chemsex—the intentional use of psychoactive substances to enhance sexual experiences—have garnered increasing attention in public health research, particularly within the context of men who have sex with men (MSM) [3].
Chemsex, a combination of the words “chemical” and “sex”, originates from the London LGBTQ+ club scene, and its definition varies in the literature [4]. Typically, chemsex refers to the consumption of specific substances, often referred to as the “four chems”—mephedrone, gamma-hydroxybutyrate (GHB), gamma-butyrolactone (GBL), and methamphetamine—with the intention of prolonging, intensifying, or removing inhibitions during sexual activity with a particular mindset [3]. This practice typically occurs in the context of extended sexual encounters involving multiple partners, lasting several hours or even days [5]. Some authors also include ketamine and cocaine in their definition of chemsex [5]. Additionally, recent studies have expanded the use of the term to include individuals with various sexual orientations.
Although there is no consensus on the definition of chemsex [6,7], evidence suggests a significant difference between SSU and chemsex users [8]. SSU is the deliberate use of one or more psychoactive substances before or during sexual activity, with objectives that may include extending duration, diversifying practices, and enhancing the experience or performance [9]. Regardless of the definition, SSU and chemsex often involve polydrug use and are associated with altered decision-making processes, which can lead to unsafe sexual behaviors such as condomless sex and the sharing of syringes and other drug paraphernalia [10]. Consequently, individuals who engage in SSU and chemsex are more susceptible to sexually transmitted infections (STIs) including HIV, abuse, and non-consensual sexual activity [11,12].
For these reasons, numerous studies emphasize the need to consider this phenomenon a public health priority. The focus on chemsex among MSM has overshadowed the broader implications of SSU and chemsex in the general population, particularly among women. This oversight is concerning given the rising use of novel psychoactive substances (NPSs), polydrug use, and the potential for SSU to contribute to adverse health outcomes, including STIs, mental health disorders, and substance dependence [12,13]. Despite the growing prevalence of SSU and chemsex, there remains a significant gap in the literature regarding its epidemiology outside the MSM community, particularly among women. This gap highlights the importance of understanding the prevalence of SSU and chemsex beyond the MSM community.
The aim of this review is to systematically examine the current literature to determine the prevalence of SSU and chemsex in the general population and, specifically, among females. By identifying the extent of SSU and chemsex in diverse populations, we can better address the associated health risks and provide comprehensive support services. For the purposes of this study, we will adhere to the definitions of SSU and chemsex as used by the authors of the published studies.

2. Materials and Methods

2.1. Search Strategy, Study Selection, Data Collection, and Meta-Analysis

A systematic review of studies published before 18 February 2025, was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [14]. The review protocol was submitted to PROSPERO (ID: CRD420250653893) after confirming that no similar reviews existed.
The following databases were searched: PubMed, ProQuest, Scopus, Web of Science, Cochrane, and PsycINFO via OVID. The filters applied included publication in English, publication in scholarly journals, and document types limited to articles, research articles, and early access articles. No restrictions were placed on the year of publication.
To define the search terms, a preliminary PubMed search was conducted to identify relevant keywords from the titles and abstracts of studies focusing on the prevalence of sexualized substance use and chemsex in the general population. Based on this preliminary search, the following keywords were used in the final search strategy: “chemsex” OR “chem sex” OR “sexualized substance use” OR “sexualized drug use” AND “prevalence” AND “women”. Further details on the search strategy are provided in Table 1.
Table 2 presents the eligibility criteria used to select articles in accordance with the Population, Intervention, Comparator, Outcome, and Study Design (PICOS) framework. The population included the general adult population and studies on women, while studies exclusively on men, sexual or gender minorities, female or male sex workers, and adolescents were excluded. The intervention criteria encompassed SSU, SDU, and chemsex, whereas studies focusing solely on alcohol use or the use of specific drugs, such as gamma-hydroxybutyrate (GHB) or methamphetamine, were excluded. No comparator was applicable. The outcome of interest was the number of individuals reporting SSU, including SDU and chemsex, out of the total assessed, while studies examining the toxicity, overdose, and abuse of specific drugs, such as GHB or methamphetamine, were excluded. This review included cross-sectional and observational studies, whereas reviews, abstracts, editorials, and commentaries, as well as studies published in languages other than English, were excluded.
The eligibility assessment and data collection were conducted in accordance with the PRISMA guidelines [14]. The PRISMA checklist for systematic reviews is available in Supplementary Table S1. Two independent researchers performed a standardized search (M.R. and I.K.). After searching all databases, the results were combined in Excel, and duplicates were removed. Only unique records were screened for relevance based on the titles and abstracts. In the final stage of the eligibility assessment, full-text articles were evaluated against the inclusion criteria, and the relevant data were extracted using a standardized data collection form. The extracted information included the first author’s last name, year of publication, country, study design, setting or assessment method, mean age, the definition of SSU, total population assessed, total population reporting SSU, total women assessed, total women reporting SSU, substances used, and sexual orientation (if provided). Two datasheets were compared and combined. Discrepancies in the study selection between the researchers were resolved through discussion with the third author (B.T.), and consensus was reached for all included studies.
The meta-analysis was conducted using the RStudio software (version 4.3.2) [15]. Two R packages, meta and metafor, were used to perform the meta-analysis of proportions. The pooled mean prevalence of SSU, along with its 95% confidence interval (CI), was estimated using a random-effects model [16]. The results of the model were visually displayed using forest plots. The heterogeneity was assessed by calculating I2 [17]. Potential sources of heterogeneity were explored through meta-regression analysis. To account for the potential influence of small sample size studies—particularly relevant in random-effects models where smaller studies receive relatively higher weights—we conducted sensitivity analyses including influence analysis and leave-one-out analysis. These steps helped identify whether any single study disproportionately affected the overall estimate. Additionally, publication bias was evaluated through funnel plot visualization and Egger’s test [16]. Subgroup analysis was conducted based on the type and definition of SSU reported: SSU use and chemsex.

2.2. Risk of Bias and Certainty of Evidence Evaluation

The risk of bias (quality) assessment was conducted using an adapted version of the Newcastle–Ottawa Scale (NOS) for cross-sectional studies [18]. The modified NOS evaluates each study based on six criteria, organized into three assessment groups: selection (three criteria), comparability (one criterion), and outcome (two criteria). Each criterion can earn up to one point, and the comparability criterion can receive a maximum of two points. This results in a total score range of 0 to 7, with higher scores indicating superior study quality. The risk of bias assessments were independently carried out by two authors after they had agreed on the assessment procedures. A third author calculated the inter-rater agreement between the two assessors. In this review, studies with scores of five points or more for cross-sectional studies were deemed to be of satisfactory quality and included in the systematic review [19,20].
Adhering to the guidelines from the Cochrane Handbook for Systematic Reviews of Interventions, we assessed the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework [21]. Furthermore, this assessment followed the procedures outlined in research notes on the evaluation of GRADE in systematic reviews [22]. The certainty of evidence was calculated in RStudio, using the “GRADE” package. This framework comprises five domains: risk of bias, assessed using the NOS for the cross-sectional studies checklist mentioned earlier; inconsistency, assessed via the I2 statistic; indirectness, assessed via PICO criteria; imprecision, assessed by determining if the 95% CI of the pooled estimate crosses the threshold of interest; and publication bias, assessed using Egger’s test results.

3. Results

3.1. Characteristics of Included Studies

A total of 1527 articles were identified using the search strategy described above. After removing duplicates, 1084 titles and abstracts were screened, of which 140 articles were selected for full-text evaluation. However, the full text was unavailable for one study. Following a full-text assessment, 13 studies met the PICOS eligibility criteria and were included in the meta-analysis. Among the excluded articles, 47 focused on a specific population, including 1 study that examined only adolescents [23], 44 that lacked the required data, and 18 that were not observational cross-sectional studies. Additionally, four studies examined the toxicity of a single substance [24,25,26,27], four presented data on drug-associated deaths [28,29,30,31], and three were healthcare professionals’ assessments [32,33,34]. The PRISMA flowchart illustrating the study selection and inclusion process is presented in Figure 1 [14].
Among the included studies, twelve presented data on the prevalence of SSU in the general population, while thirteen focused on the female population. Most of these studies were conducted in Europe. The assessment settings varied, with eight studies using online questionnaires, three studies involving STI clinic participants, and others including household surveys, as well as surveys among erotic show attendees. The definitions of SSU and chemsex also varied between studies. Overall, 38,359 individuals were questioned about SSU, with 17,112 respondents confirming its use. In the thirteen studies that assessed females only, 24,484 women were asked about SSU, and 7918 confirmed its use. Further details on the study participants can be found in Table 3.

3.2. Meta-Analysis of SSU Prevalence

The mean prevalence of SSU among the general population was 19.92% (95% CI: 13.81%; 27.86%). The prevalence estimate exhibited high heterogeneity: I2 = 100%, Q (df = 11) = 2948.02, and p < 0.001. The mean SSU prevalence estimates were higher among studies that focused on SSU (29.40% (95% CI: 21.17%; 39.24%)), also with high heterogeneity (I2 = 100%, Q (df = 5) = 1259.67, and p < 0.01). Conversely, the mean prevalence estimates were considerably lower in studies that focused on exclusively chemsex (12.66% (95% CI: 7.06%; 21.65%)), also with high heterogeneity (I2 = 98%, Q (df = 5) = 254.9, and p < 0.01), as presented in Figure 2a.
The mean prevalence of SSU among the female population was 15.61% (95% CI: 11.53%; 20.80%). The prevalence estimate exhibited high heterogeneity (I2 = 99%, Q (df = 12) = 1150.79, and p < 0.01). The mean SSU prevalence estimates were higher among studies that focused on SSU (25.78% (95% CI: 19.67%; 33.00%)), also with high heterogeneity (I2 = 99%, Q (df = 6) = 725.78, and p < 0.01). As is the case with the general population, the mean prevalence estimates were considerably lower in studies that focused on exclusively chemsex (3.50% (95% CI: 1.42%; 8.35%)), also with high heterogeneity (I2 = 91%, Q (df = 5) = 53.37, and p < 0.01), as presented in Figure 2b.
The heterogeneity of the pooled estimate among the general population was initially assessed using influence analysis and leave-one-out analysis. Both assessments identified the Miltz (2021) study [39], which had the lowest prevalence estimates, as the most influential study that significantly impacted the pooled mean prevalence of SSU in the general population (Figure 3a,b).
Furthermore, two meta-regression models were constructed to assess the heterogeneity of the pooled estimate among the general population. The first model evaluated the impact of the number of LGBTQ+ individuals on the pooled mean prevalence of SSU, while the second model examined the influence of the year of publication on the pooled mean SSU prevalence. Neither model revealed significant associations at the p < 0.05 cutoff point. The results are available in Supplemental Figures S1 and S2.
Similarly, the heterogeneity of the pooled estimate among the female population was initially assessed using influence analysis and leave-one-out analysis. Both assessments identified the Miltz (2021) [39] and Gertzen (2024) [46] studies, which had the lowest prevalence estimates, as the most influential studies that significantly impacted the pooled mean prevalence of SSU in the female population (Figure 4a,b).
Furthermore, a meta-regression model was constructed to assess the heterogeneity of the pooled estimate among the female population, examining the influence of the year of publication on the pooled mean SSU prevalence. The meta-regression model did not reveal a significant association at the p < 0.05 cutoff point. The results are available in Supplemental Figure S3.
Figure 5a,b display the funnel plots used to evaluate the publication bias for the pooled SSU prevalence estimates in the general population and the female population, respectively. Both plots show noticeable asymmetry. Furthermore, the presence of publication bias was confirmed by the significant results of Egger’s test (p < 0.05).

3.3. Risk of Bias (Quality) Assessment and Certainty of Evidence

All included cross-sectional studies had an NOS score of at least six out of seven. These scores indicate that the studies were of excellent quality and exhibited a low risk of bias, as demonstrated in Table 4.
The results from the GRADE certainty assessment, as presented in Table 5, suggest that the pooled mean SSU prevalence levels in both the general population and the female population had a low level of certainty. Therefore, these findings should be viewed and acted upon with caution.

4. Discussion

This systematic review and meta-analysis provide the first comprehensive synthesis of the prevalence of SSU and chemsex in the general population, with a particular focus on women. The findings reveal that SSU and chemsex are significant phenomena, with pooled prevalences of 19.92% in the general population and 15.61% among women. These estimates underscore the need to broaden the scope of research and intervention efforts beyond the MSM community, as SSU is evidently prevalent across diverse demographic groups. The higher prevalence of SSU (29.40%) compared with chemsex (12.66%) in the general population suggests that substance use during sex is a broader behavioral pattern, while chemsex represents a more specialized subset of this behavior. Among women, the prevalence of chemsex was notably lower (3.50%), with a wide range of 18% to 0%, highlighting the need for further research to understand the contextual and cultural factors that may influence women’s engagement in chemsex.
Our findings contribute to the growing body of literature on the prevalence of SSU and chemsex. A global analysis reported a mean prevalence of intoxicating substance use before or during sex at 37% (95% CI: 28%; 47%) among adults aged 18–29 years [48], highlighting significant engagement in this risk behavior. In comparison, our findings indicate a lower prevalence of SSU in the general population across studies, estimated at 20% (95% CI: 14%; 28%). Furthermore, a recent meta-analysis reported that 16% (95% CI: 11%; 21%) of MSM in Europe have engaged in chemsex [49], while another meta-analysis found that 19% (95% CI: 15%; 23%) of MSM in Asia have participated in chemsex [50]. Our research represents the first meta-analysis to aggregate data on SSU and chemsex in the general population. The observed prevalence of chemsex in our study (12.66% in the general population and 3.50% among women) is comparatively lower; however, these figures remain concerning and reinforce the notion that chemsex extends beyond the MSM community. These findings underscore the need for inclusive public health strategies that address SSU and chemsex across diverse populations.
An additional concerning trend in this study area is the rising prevalence of SSU and chemsex among adolescents. While we excluded one study reporting an SSU prevalence of 12% to 14% among adolescents in Spain [20], the available evidence suggests that this demographic is increasingly engaging in these behaviors. For example, a study on MSM adolescents in Brazil and Spain found a notably high prevalence of chemsex, with 31% (95% CI: 27%; 35%) reporting engagement in the practice [51]. Another study examining chemsex among adolescent and young MSM highlighted the significant influence of peer networks in fostering participation in chemsex [52]. These findings suggest that social dynamics and peer acceptance play a critical role in shaping adolescent substance use behaviors during sex. Given the well-documented risks associated with chemsex—including increased vulnerability to sexually transmitted infections, substance dependency, and mental health disorders—these patterns highlight the urgent need for targeted prevention and harm reduction strategies.
The literature reveals considerable variability in the definitions of SSU and chemsex, complicating direct comparisons across studies. SSU is broadly defined as the use of a wide range of illicit substances and alcohol in the context of sexual relationships, as presented in Table 1 of our research findings. Within SSU, chemsex is identified as a subculture involving the use of specific drugs to enhance sexual experiences, with one study even including 23 psychoactive substances in its definition of chemsex [40]. This lack of standardized definitions poses challenges in assessing the true prevalence and associated risks of these behaviors. Nevertheless, chemsex is associated with prolonged sexual interactions, where polydrug use can potentiate effects, ultimately leading to increased risks of sexually transmitted diseases and a broad range of mental health issues, including suicidal ideation and overdose [53,54,55]. Moreover, there is a documented risk of abuse and violation of mutual consent when the judgment of one partner—often the more vulnerable—is impaired by the psychoactive effects of stimulants, underscoring the ethical and safety concerns associated with chemsex and SSU [56,57,58].
Marked differences in the prevalence of SSU and chemsex across the United States and European countries underscore the powerful influence of sociocultural, legal, and temporal factors on these behaviors. Notably, the only US-based study included in this review was conducted in 2010 and reported no cases of SSU among women and a low overall prevalence [35]. This early timeframe likely reflects a different risk landscape, preceding the wider recognition of chemsex and the evolving patterns of SSU seen in more recent years. In contrast, more recent data from European countries—including Germany, the Netherlands, France, Spain, and Italy—demonstrate a notably higher prevalence of SSU and chemsex, including among women and heterosexual populations [59,60,61,62,63,64]. These differences may be shaped by more permissive or decriminalized drug laws, broader acceptance of recreational drug use within sexual subcultures, and stronger harm reduction frameworks that enable open disclosure. Furthermore, European STI clinics and online surveys may provide safer, more anonymous environments for participants to report sensitive behaviors compared with household surveys. These regional and temporal disparities highlight the importance of interpreting prevalence data within the sociopolitical and cultural context in which they were collected.
Several limitations warrant consideration. The heterogeneity among the included studies, particularly concerning the definitions of SSU and chemsex, assessment methods, demographic variations, and the primarily European origin of the included studies poses challenges to the generalizability of our findings. Additionally, the presence of publication bias may have influenced the pooled prevalence estimates. In our meta-regression analysis, we accounted for the number of non-heterosexual individuals in the studies; however, no significant association with SSU prevalence was observed. This finding suggests that while SSU and chemsex have been predominantly studied within MSM communities, these behaviors are not exclusive to any particular sexual orientation. Unfortunately, due to limited data, we were unable to conduct a similar analysis focusing solely on the female population. Future research should aim to explore the nuances of SSU and chemsex across different sexual orientations and gender identities, including adolescents. Populations beyond MSM remain understudied yet may exhibit distinct patterns of SSU and chemsex shaped by intersecting psychosocial, cultural, and developmental factors. Studies examining these subpopulations can provide deeper insight into risk trajectories and inform interventions tailored to their specific needs and vulnerabilities.
The findings of this review have several practical implications. Public health initiatives should broaden their focus to include diverse populations beyond MSM, recognizing that SSU and chemsex are behaviors present across various demographics. Educational programs on safe sexual behaviors should start early and target adolescents, given the high prevalence of SSU in this group and the associated risks of early sexual initiation and unprotected sex. Healthcare providers should be trained to identify and address SSU and chemsex behaviors in their patients, facilitating early intervention and support. Effective management of harmful chemsex should be multidisciplinary, addressing psychiatric, addictive, and infectious comorbidities, while emphasizing the importance of information and education to reduce associated risks and potential harm [65]. These interventions, including harm reduction programs, which have shown efficacy in addressing chemsex-related risks [66], should be expanded to reach underserved populations in this context, including women and adolescents. Sociodemographic, psychological, and behavioral factors likely shape both the initiation and continuation of these practices, including variations in motivations, risk perception, and engagement in protective behaviors. Future research is needed to explore these nuances and inform tailored interventions that consider the lived experiences and vulnerabilities of individuals engaged in chemsex and SSU.

5. Conclusions

This systematic review and meta-analysis revealed that SSU and chemsex are prevalent behaviors extending beyond the MSM community into the general population and among women, with a pooled prevalence of 19.92% in the general population and 15.61% among women. The high prevalence of SSU and chemsex among the general population and women underscores the need for comprehensive public health strategies and further research to understand the contextual factors influencing these behaviors. Addressing SSU and chemsex requires a multifaceted approach, incorporating education, prevention, and intervention efforts tailored to general populations to mitigate associated health risks. By broadening the scope of research and public health initiatives, we can better support individuals engaging in these behaviors and reduce the adverse outcomes linked to SSU and chemsex. However, given the methodological variability among included studies and the low certainty of evidence identified in our GRADE assessment, the findings of this meta-analysis should be interpreted and acted upon with caution.

Supplementary Materials

The following supporting information can be downloaded at https://www.mdpi.com/article/10.3390/healthcare13080899/s1. Table S1. PRISMA checklist for systematic reviews. Figure S1. Meta-regression of chemsex prevalence by sexual minority population among the general population. Figure S2. Meta-regression of chemsex prevalence by year of publication among the general population. Figure S3. Meta-regression of chemsex prevalence by year of publication among the female population.

Author Contributions

Conceptualization, M.R., B.T. and I.K.; methodology, M.R., B.T., A.I.I. and I.K.; software, A.I.I., M.Z. and I.K.; validation, M.R., B.T., A.I.I., M.Z. and A.S.I.; formal analysis, M.S., G.N., R.Y. and I.K.; investigation, M.S., G.N., R.Y. and I.K.; resources, M.R. and B.T.; data curation, M.S., G.N. and R.Y.; writing—original draft preparation, M.R., B.T., and I.K.; writing—review and editing, M.R., B.T., A.I.I., M.Z., A.S.I., M.S., G.N., R.Y. and I.K.; visualization, M.S., G.N., R.Y. and I.K.; supervision, M.R. and B.T.; project administration, M.R., B.T. and I.K.; funding acquisition, M.R. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Ethical review and approval were waived for this study as this was a systematic review of the published literature. Study protocol registration: PROSPERO ID: CRD420250653893.

Informed Consent Statement

Not applicable.

Data Availability Statement

The original contributions presented in this study are included in this article. Further inquiries can be directed to the corresponding author.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

The following abbreviations were used in this manuscript:
CIConfidence interval
GBLGamma-butyrolactone
GBHGamma-hydroxybutyrate
GRADEGrading of Recommendations Assessment, Development, and Evaluation
LGBTQ+Lesbian, gay, bisexual, transgender, queer/questioning, and others
MDMA3,4-methylenedioxymethamphetamine
MSMMen who have sex with men
NOSNewcastle–Ottawa Scale
NPSNovel psychoactive substances
PICOSPopulation, Intervention, Comparator, Outcome, and Study Design
PRISMAPreferred Reporting Items for Systematic Reviews and Meta-Analyses
SSUSexualized substance use
STISexually transmitted infections
USAUnited States of America

References

  1. Weatherburn, P.; Hickson, F.; Reid, D.; Torres-Rueda, S.; Bourne, A. Motivations and Values Associated with Combining Sex and Illicit Drugs (‘chemsex’) among Gay Men in South London: Findings from a Qualitative Study. Sex. Transm. Infect. 2017, 93, 203–206. [Google Scholar] [CrossRef]
  2. Deimel, D.; Stöver, H.; Hößelbarth, S.; Dichtl, A.; Graf, N.; Gebhardt, V. Drug Use and Health Behaviour Among German Men Who Have Sex with Men: Results of a Qualitative, Multi-Centre Study. Harm Reduct. J. 2016, 13, 36. [Google Scholar] [CrossRef] [PubMed]
  3. McCall, H.; Adams, N.; Mason, D.; Willis, J. What Is Chemsex and Why Does It Matter? BMJ 2015, 351, h5790. [Google Scholar] [CrossRef] [PubMed]
  4. Giorgetti, R.; Tagliabracci, A.; Schifano, F.; Zaami, S.; Marinelli, E.; Busardò, F.P. When “Chems” Meet Sex: A Rising Phenomenon Called “ChemSex”. Curr. Neuropharmacol. 2017, 15, 762–770. [Google Scholar] [CrossRef]
  5. Maxwell, S.; Shahmanesh, M.; Gafos, M. Chemsex Behaviours Among Men Who Have Sex with Men: A Systematic Review of the Literature. Int. J. Drug Policy 2019, 63, 74–89. [Google Scholar] [CrossRef]
  6. Santoro, P.; Rodríguez, R.; Morales, P.; Morano, A.; Morán, M. One “Chemsex” or Many? Types of Chemsex Sessions among Gay and Other Men Who Have Sex with Men in Madrid, Spain: Findings from a Qualitative Study. Int. J. Drug Policy 2020, 82, 102790. [Google Scholar] [CrossRef]
  7. Amundsen, E.; Muller, A.E.; Reierth, E.; Skogen, V.; Berg, R.C. Chemsex Among Men Who Have Sex with Men: A Systematic Scoping Review of Research Methods. J. Homosex. 2024, 71, 1392–1418. [Google Scholar] [CrossRef] [PubMed]
  8. Poulios, A.; Apostolidou, A.; Triantafyllidou, S.; Krasidis, C.; Petrou, I.V.P.; Kakota, Z.; Papadopetrakis, G.; Kyprianou, E.; Yiasemi, I.; Georgiou, C.; et al. The Distinction Between Chemsex and Sexualized Drug Use Among Men Who Have Sex with Men. Sex. Cult. 2024, 28, 1276–1288. [Google Scholar] [CrossRef]
  9. Edmundson, C.; Heinsbroek, E.; Glass, R.; Hope, V.; Mohammed, H.; White, M.; Desai, M. Sexualised Drug Use in the United Kingdom (UK): A Review of the Literature. Int. J. Drug Policy 2018, 55, 131–148. [Google Scholar] [CrossRef]
  10. Sewell, J.; Miltz, A.; Lampe, F.C.; Cambiano, V.; Speakman, A.; Phillips, A.N.; Stuart, D.; Gilson, R.; Asboe, D.; Nwokolo, N.; et al. Poly Drug Use, Chemsex Drug Use, and Associations with Sexual Risk Behaviour in HIV-Negative Men Who Have Sex with Men Attending Sexual Health Clinics. Int. J. Drug Policy 2017, 43, 33–43. [Google Scholar] [CrossRef]
  11. Capodieci, S.; Zaccarelli, M.; Stingone, C.; Giuliani, E.; Cafaro, V.; Gianserra, L.; Donà, M.G.; Latini, A.; Giuliani, M. Chemsex, Sexualized Drug Use and Emotional Vulnerability among Men Who Have Sex with Men (MSM): A One-Month Survey in a STI/HIV Center. BMC Public Health 2025, 25, 600. [Google Scholar] [CrossRef]
  12. Deshaies, T.; Lafortune, D.; Boislard, M.A. Exploring the Links between Motivations to Engage in Sexualized Drug Use and Psychosexual Well-Being: A Cross-Sectional Study. Can. J. Hum. Sex. 2024, 33, 443–453. [Google Scholar] [CrossRef]
  13. Oh, S.; Liu, C.; Kitchen, M.; Hahm, H. “Chris” Prescription Opioid Misuse, Comorbid Substance Use, and Suicidal Behaviors Among US Young Adults: Findings from 2015–2019 National Survey on Drug Use and Health. Subst. Use Misuse 2025, 60, 195–201. [Google Scholar] [CrossRef]
  14. Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E. The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews. BMJ 2021, 372, n71. [Google Scholar] [CrossRef] [PubMed]
  15. Posit Team RStudio: Integrated Development Environment for R. Available online: http://www.posit.co/ (accessed on 22 January 2024).
  16. Harrer, M.; Cuijpers, P.; Furukawa, T.A.; Ebert, D.D. Doing Meta-Analysis with R: A Hands-On Guide; Chapman & Hall/CRC Press: Boca Raton, FL, USA; London, UK, 2021; Volume Chapter 4, ISBN 978-0-367-61007-4. [Google Scholar]
  17. Migliavaca, C.B.; Stein, C.; Colpani, V.; Barker, T.H.; Ziegelmann, P.K.; Munn, Z.; Falavigna, M. Meta-Analysis of Prevalence: I2 Statistic and How to Deal with Heterogeneity. Res. Synth. Methods 2022, 13, 363–367. [Google Scholar] [CrossRef] [PubMed]
  18. Wells, G.; Shea, B.; O’Connell, D.; Peterson, J.; Welch, V.; Losos, M.; Tugwell, P. Ottawa Hospital Research Institute. Available online: https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp (accessed on 20 November 2024).
  19. Karibayeva, I.; Bilibayeva, G.; Yerzhanova, A.; Alekesheva, R.; Iglikova, A.; Maxudova, M.; Ussebayeva, N. Prevalence of Vitamin D Deficiency Among Adults in Kazakhstan: A Systematic Review and Meta-Analysis. Medicina 2024, 60, 2043. [Google Scholar] [CrossRef]
  20. Breau, G.; Ellis, U. Risk Factors Associated With Young-Onset Colorectal Adenomas and Cancer: A Systematic Review and Meta-Analysis of Observational Research. Cancer Control 2020, 27, 1073274820976670. [Google Scholar] [CrossRef]
  21. Schünemann, H.J.; Higgins, J.P.T.; Vist, G.E.; Glasziou, P.; Akl, E.A.; Skoetz, N.; Guyatt, G.H.; Cochrane GRADEing Methods Group. Assessing Certainty in the Evidence in the Context of a Systematic Review. In Cochrane Handbook for Systematic Reviews of Interventions; Cochrane: Birmingham, UK, 2022. [Google Scholar]
  22. Brennan, S.E.; Johnston, R.V. Research Note: Interpreting Findings of a Systematic Review Using GRADE Methods. J. Physiother. 2023, 69, 198–202. [Google Scholar] [CrossRef]
  23. González-Casals, H.; Espelt, A.; Bosque-Prous, M.; Rogés, J.; Robles-Muñoz, M.; Colom, J.; Casabona, J.; Belza, M.J.; Folch, C. Sex Differences in Alcohol and Other Substance Use in Sexual Contexts Among Adolescents: An Observational Study. Sex. Health 2025, 22, SH24153. [Google Scholar] [CrossRef]
  24. Freestone, J.; Ezard, N.; Bourne, A.; Brett, J.; Roberts, D.M.; Hammoud, M.; Nedanoski, A.; Prestage, G.; Siefried, K.J. Understandings, Attitudes, Practices and Responses to GHB Overdose Among GHB Consumers. Harm Reduct. J. 2023, 20, 121. [Google Scholar] [CrossRef]
  25. Siefried, K.J.; Freeman, G.; Roberts, D.M.; Lindsey, R.; Rodgers, C.; Ezard, N.; Brett, J. Inpatient GHB Withdrawal Management in an Inner-City Hospital in Sydney, Australia: A Retrospective Medical Record Review. Psychopharmacology 2023, 240, 127–135. [Google Scholar] [CrossRef] [PubMed]
  26. Harnett, J.T.; Dargan, P.I.; Dines, A.M.; Archer, J.R.H.; Greene, S.L.; Hunter, L.J.; Wood, D.M. Increasing Emergency Department Attendances in Central London with Methamphetamine Toxicity and Associated Harms. Emerg. Med. J. 2022, 39, 463–466. [Google Scholar] [CrossRef]
  27. Neu, P.; Danker-Hopfe, H.; Fisher, R.; Ehlen, F. GHB: A Life-Threatening Drug Complications and Outcome of GHB Detoxification Treatment-an Observational Clinical Study. Addict. Sci. Clin. Pract. 2023, 18, 62. [Google Scholar] [CrossRef] [PubMed]
  28. Larabi, I.A.; Ghish, A.; Kintz, P.; Marillier, M.; Fabresse, N.; Pelletier, R.; Knapp, A.; Ameline, A.; Willeman, T.; Barguil, Y.; et al. Étude Nationale Du Phénomène Du Chemsex En France: Une Collaboration Interlaboratoire Sous l’égide de La Société Française de Toxicologie Analytique (SFTA). Toxicol. Anal. Clin. 2023, 35, 175–197. [Google Scholar] [CrossRef]
  29. D’Silva, A. Beware the Possible Dangers of Chemsex—Is Illicit Drug–Related Sudden Cardiac Death Underestimated? JAMA Cardiol. 2022, 7, 1080–1081. [Google Scholar] [CrossRef]
  30. Corkery, J.M.; Copeland, C.S.; Ream, S.; Streete, P.; Schifano, F. An Update on Deaths in the United Kingdom from ‘Poppers’ (Alkyl Nitrites), with a Particular Focus on ‘Swallowing’ Fatalities. J. Clin. Med. 2025, 14, 427. [Google Scholar] [CrossRef] [PubMed]
  31. Hockenhull, J.; Murphy, K.G.; Paterson, S. An Observed Rise in γ-Hydroxybutyrate-Associated Deaths in London: Evidence to Suggest a Possible Link with Concomitant Rise in Chemsex. Forensic Sci. Int. 2017, 270, 93–97. [Google Scholar] [CrossRef]
  32. Evers, Y.J.; Levels, L.T.J.; Dukers-Muijrers, N.H.T.M.; Van Liere, G.A.F.S.; Hoebe, C.J.P.A. The Availability and Feasibility of Chemsex Services Within Sexually Transmitted Disease Clinics in the Netherlands: A Cross-Sectional Survey Among Sexually Transmitted Disease Nurses. Sex. Transm. Dis. 2020, 47, 639–644. [Google Scholar] [CrossRef]
  33. Wiggins, H.; Ogaz, D.; Mebrahtu, H.; Sullivan, A.; Bowden-Jones, O.; Field, N.; Hughes, G. Demand for and Availability of Specialist Chemsex Services in the UK: A Cross-Sectional Survey of Sexual Health Clinics. Int. J. Drug Policy 2018, 55, 155–158. [Google Scholar] [CrossRef]
  34. Marik, B.; Mahajan, N.; Sarkar, R.; Mitra, R.; Dua, R.; Aggarwal, S. A Qualitative Assessment among Personnel Working in Community-Led Development Program Settings Regarding Sexualized Substance Use. Brain Sci. 2022, 12, 1590. [Google Scholar] [CrossRef]
  35. Bauer, G.R.; Jairam, J.A.; Baidoobonso, S.M. Sexual Health, Risk Behaviors, and Substance Use in Heterosexual-Identified Women with Female Sex Partners: 2002 US National Survey of Family Growth. Sex. Transm. Dis. 2010, 37, 531–537. [Google Scholar] [CrossRef] [PubMed]
  36. Lawn, W.; Aldridge, A.; Xia, R.; Winstock, A.R. Substance-Linked Sex in Heterosexual, Homosexual, and Bisexual Men and Women: An Online, Cross-Sectional “Global Drug Survey” Report. J. Sex. Med. 2019, 16, 721–732. [Google Scholar] [CrossRef] [PubMed]
  37. Evers, Y.J.; Op Den Camp, K.P.L.; Lenaers, M.; Dukers-Muijrers, N.H.T.M.; Hoebe, C.J.P.A. Alcohol and Drug Use During Sex and Its Association with Sexually Transmitted Infections: A Retrospective Cohort Study among Young People Aged under 25 Years Visiting Dutch STI Clinics. Sex. Transm. Infect. 2023, 99, 97–103. [Google Scholar] [CrossRef]
  38. Malandain, L.; Mosser, S.; Mouchabac, S.; Blanc, J.V.; Alexandre, C.; Thibaut, F. Chemical Sex (Chemsex) in a Population of French University Students. Dialogues Clin. Neurosci. 2021, 23, 39–43. [Google Scholar] [CrossRef]
  39. Miltz, A.R.; Rodger, A.J.; Sewell, J.; Gilson, R.; Allan, S.; Scott, C.; Sadiq, T.; Farazmand, P.; McDonnell, J.; Speakman, A.; et al. Recreational Drug Use and Use of Drugs Associated with Chemsex among HIV-Negative and HIV-Positive Heterosexual Men and Women Attending Sexual Health and HIV Clinics in England. Int. J. Drug Policy 2021, 91, 103101. [Google Scholar] [CrossRef] [PubMed]
  40. Rosenberger, C.; Gertzen, M.; Strasburger, M.; Schwarz, J.; Gernun, S.; Rabenstein, A.; Lermer, E.; Rüther, T. We Have a Lot to Do: Lack of Sexual Protection and Information—Results of the German-Language Online Survey “Let’s Talk About Chemsex”. Front. Psychiatry 2021, 12, 690242. [Google Scholar] [CrossRef]
  41. Chollier, M.; Bonierbale, M.; Polesel, J.M.; Clergue, F.; Maquigneau, A.; Micaelli, P.; Korchia, T.; Jarillot, E.; Jourdan, L.; Pillas, N.; et al. Exploring Sexualized Substance Use, Sexual Behaviors and HIV-Screening Practices in People Attending Erotic Industry Shows. AIDS Care 2023, 35, 876–882. [Google Scholar] [CrossRef]
  42. Íncera-Fernández, D.; Román, F.J.; Gámez-Guadix, M. Risky Sexual Practices, Sexually Transmitted Infections, Motivations, and Mental Health Among Heterosexual Women and Men Who Practice Sexualized Drug Use in Spain. Int. J. Env. Res. Public Health 2022, 19, 6387. [Google Scholar] [CrossRef] [PubMed]
  43. Rosas Cancio-Suárez, M.; Ron, R.; Díaz-Álvarez, J.; Martínez-Sanz, J.; Serrano-Villar, S.; Moreno, S.; Sánchez-Conde, M. Prevalence, Characteristics, and Associated Risk Factors of Drug Consumption and Chemsex Use Among Individuals Attending an STI Clinic (EpITs STUDY). Front. Public Health 2023, 11, 1285057. [Google Scholar] [CrossRef]
  44. Giacalone, S.; Barberi, F.; Ramoni, S.; Casazza, G.; Cusini, M.; Marzano, A.V. Sexualised Drug Use and Chemsex in Italy: A Questionnaire Study Based on a Cohort of Clients Attending a STI Outpatient Service in Milan. Int. J. STD AIDS 2023, 34, 1034–1041. [Google Scholar] [CrossRef]
  45. Bellomi, F.; Manenti, L.; Gheda, L.; Bergamini, A.; Guarneri, L.; Rosa, J.; Savoldi, M.; Vita, A. Prevalence and Characteristics of Chemsex: A Cross-Sectional Observational Study. Eur. Addict. Res. 2024, 30, 43–51. [Google Scholar] [CrossRef] [PubMed]
  46. Gertzen, M.; Karcher, S.; Schwarz, J.; Rosenberger, C.; Strasburger, M.; Rabenstein, A.; Strasser, A.M.; Palm, U.; Rüther, T. “I Can’t Get No Satisfaction”—Psychosocial Aspects and Awareness of Negative Impacts in Chemsex Users: Results from an Anonymous Online Survey. Brain Sci. 2024, 14, 666. [Google Scholar] [CrossRef] [PubMed]
  47. Jepsen, D.; Healy, K.V.; Bernard, M.; Markert, J.; Brzank, P.J. Patterns of Sexual Risk Behaviors and Sexuality-Related Risk Factors among Young Adults in Germany: Implications for Prevention and Therapy. Arch. Sex. Behav. 2024, 53, 2671–2688. [Google Scholar] [CrossRef]
  48. Gómez-Núñez, M.I.; Molla-Esparza, C.; Gandia Carbonell, N.; Badenes Ribera, L. Prevalence of Intoxicating Substance Use Before or During Sex Among Young Adults: A Systematic Review and Meta-Analysis. Arch. Sex. Behav. 2023, 52, 2503–2526. [Google Scholar] [CrossRef]
  49. Coronado-Muñoz, M.; García-Cabrera, E.; Quintero-Flórez, A.; Román, E.; Vilches-Arenas, Á. Sexualized Drug Use and Chemsex Among Men Who Have Sex with Men in Europe: A Systematic Review and Meta-Analysis. J. Clin. Med. 2024, 13, 1812. [Google Scholar] [CrossRef]
  50. Wang, H.; Jonas, K.J.; Guadamuz, T.E. Chemsex and Chemsex Associated Substance Use among Men Who Have Sex with Men in Asia: A Systematic Review and Meta-Analysis. Drug Alcohol Depend. 2023, 243, 109741. [Google Scholar] [CrossRef] [PubMed]
  51. Teixeira, J.R.B.; Lima, S.V.M.A.; de Sousa, A.R.; Queiroz, A.A.F.L.N.; Barreto, N.M.P.V.; Mendes, I.A.C.; Fronteira, I.; de Sousa, Á.F.L. Determinants of Sexual Exposure to HIV in Portuguese and Brazilian Adolescents: A Path Analysis. Rev. Lat. Am. Enferm. 2022, 30, e3714. [Google Scholar] [CrossRef]
  52. Irfan, S.D.; Sarwar, G.; Emran, J.; Khan, S.I. An Uncharted Territory of Sexualized Drug Use: Exploring the Dynamics of Chemsex among Young and Adolescent MSM Including Self-Identified Gay Men in Urban Dhaka, Bangladesh. Front. Psychol. 2023, 14, 1124971. [Google Scholar] [CrossRef]
  53. Evers, Y.J.; Dukers-Muijrers, N.H.; Kampman, C.J.G.; van Liere, G.A.; Hautvast, J.L.A.; Koedijk, F.D.; Hoebe, C.J. Prevalence of Drug Use during Sex among Swingers and Perceived Benefits and Risks–a Cross-Sectional Internet Survey in The Netherlands. Sex. Transm. Infect. 2025, 96, 40–46. [Google Scholar] [CrossRef]
  54. Hampel, B.; Kusejko, K.; Kouyos, R.D.; Böni, J.; Flepp, M.; Stöckle, M.; Conen, A.; Béguelin, C.; Künzler-Heule, P.; Nicca, D.; et al. Chemsex Drugs on the Rise: A Longitudinal Analysis of the Swiss HIV Cohort Study from 2007 to 2017. In HIV Medicine; Wiley Online Library: Hoboken, NJ, USA, 2020; Volume 21, pp. 228–239. [Google Scholar] [CrossRef]
  55. Pakianathan, M.; Whittaker, W.; Lee, M.J.; Avery, J.; Green, S.; Nathan, B.; Hegazi, A. Chemsex and New HIV Diagnosis in Gay, Bisexual and Other Men Who Have Sex with Men Attending Sexual Health Clinics. In HIV Medicine; Wiley Online Library: Hoboken, NJ, USA, 2018; Volume 19, pp. 485–490. [Google Scholar] [CrossRef]
  56. Connolly, D.J.; Coduri-Fulford, S.; Macdonald, K.; Gilchrist, G.; Muschialli, L. Consent and Violence amongst Men in the Context of Sexualised Drug Use: A Systematic Scoping Review. Int. J. Drug Policy 2025, 136, 104706. [Google Scholar] [CrossRef]
  57. Lee, H.; Labhardt, D.; Willmott, D. GHB, Chemsex and Chemical Submission: Investigating the Role of Sexuality on Victim Empathy and Blame Attribution in Drug-Facilitated Sexual Assault Against Men. Behav. Sci. 2024, 14, 913. [Google Scholar] [CrossRef] [PubMed]
  58. Javaid, A. The Interconnectedness of Chemsex, Drugs, Sexual Promiscuity and Sexual Violence. Ir. J. Sociol. 2018, 26, 183–207. [Google Scholar] [CrossRef]
  59. Møller, K.; Hakim, J. Critical Chemsex Studies: Interrogating Cultures of Sexualized Drug Use beyond the Risk Paradigm. Sexualities 2023, 26, 547–555. [Google Scholar] [CrossRef]
  60. Huang, P.; Du, S.C.; Ku, S.W.W.; Li, C.W.; Bourne, A.; Strong, C. An Object-Oriented Analysis of Social Apps, Syringes and ARTs Within Gay Taiwanese Men’s Chemsex Practices. Cult. Health Sex. 2024, 26, 497–512. [Google Scholar] [CrossRef] [PubMed]
  61. Nevendorff, L.; Schroeder, S.E.; Pedrana, A.; Bourne, A.; Stoové, M. Prevalence of Sexualized Drug Use and Risk of HIV Among Sexually Active MSM in East and South Asian Countries: Systematic Review and Meta-Analysis. J. Int. AIDS Soc. 2023, 26, e26054. [Google Scholar] [CrossRef]
  62. Lunchenkov, N.; Cherchenko, N.; Altynbekov, K.; Terlikbayeva, A.; Primbetova, S.; Gryazev, D.; German, E.; Batyrgaliev, U.; Steinert, J.I. “A Way to Liberate Myself”: A Qualitative Study of Perceived Benefits and Risks of Chemsex Among Gay, Bisexual, and Other Men Who Have Sex with Men in Almaty, Kazakhstan. Drug Alcohol Depend. 2024, 264, 112464–112474. [Google Scholar] [CrossRef]
  63. Jalil, E.M.; Torres, T.S.; de A Pereira, C.C.; Farias, A.; Brito, J.D.U.; Lacerda, M.; da Silva, D.A.R.; Wallys, N.; Ribeiro, G.; Gomes, J.; et al. High Rates of Sexualized Drug Use or Chemsex among Brazilian Transgender Women and Young Sexual and Gender Minorities. Int. J. Env. Res. Public Health 2022, 19, 1704. [Google Scholar] [CrossRef]
  64. Rafful, C.; Orozco, R.; Peralta, D.; Jiménez-Rivagorza, L.; Medina-Mora, M.E.; Gutiérrez, N.; Morales-Gutierrez, M. Feasibility, Acceptability, and Perceived Usefulness of a Community-Evidence-Based Harm Reduction Intervention for Sexualized Stimulant Use Among Mexican Gay, Bisexual, and Other Men Who Have Sex with Men. Harm Reduct. J. 2024, 21, 1–13. [Google Scholar] [CrossRef]
  65. Malandain, L.; Thibaut, F. Chemsex: Review of the Current Literature and Treatment Guidelines. Curr. Addict. Rep. 2023, 10, 563–571. [Google Scholar] [CrossRef]
  66. Del Pozo-Herce, P.; Martínez-Sabater, A.; Sanchez-Palomares, P.; Garcia-Boaventura, P.C.; Chover-Sierra, E.; Martínez-Pascual, R.; Gea-Caballero, V.; Saus-Ortega, C.; Ballestar-Tarín, M.L.; Karniej, P.; et al. Effectiveness of Harm Reduction Interventions in Chemsex: A Systematic Review. Healthcare 2024, 12, 1411. [Google Scholar] [CrossRef]
Healthcare 13 00899 g001
Figure 1. PRISMA flowchart of study inclusion.
Figure 1. PRISMA flowchart of study inclusion.
Healthcare 13 00899 g001
Healthcare 13 00899 g002aHealthcare 13 00899 g002b
Figure 2. Forest plot of the pooled mean SSU prevalence: (a) general population; (b) female population [35,36,37,38,39,40,41,42,43,44,45,46,47].
Figure 2. Forest plot of the pooled mean SSU prevalence: (a) general population; (b) female population [35,36,37,38,39,40,41,42,43,44,45,46,47].
Healthcare 13 00899 g002aHealthcare 13 00899 g002b
Healthcare 13 00899 g003
Figure 3. Heterogeneity assessment of the pooled mean SSU prevalence among the general population: (a) influence analysis; (b) leave-one-out analysis [36,37,38,39,40,41,42,43,44,45,46,47].
Figure 3. Heterogeneity assessment of the pooled mean SSU prevalence among the general population: (a) influence analysis; (b) leave-one-out analysis [36,37,38,39,40,41,42,43,44,45,46,47].
Healthcare 13 00899 g003
Healthcare 13 00899 g004
Figure 4. Heterogeneity assessment of the pooled mean SSU prevalence among the female population: (a) influence analysis; (b) leave-one-out analysis [35,36,37,38,39,40,41,42,43,44,45,46,47].
Figure 4. Heterogeneity assessment of the pooled mean SSU prevalence among the female population: (a) influence analysis; (b) leave-one-out analysis [35,36,37,38,39,40,41,42,43,44,45,46,47].
Healthcare 13 00899 g004
Healthcare 13 00899 g005
Figure 5. Funnel plots: (a) general population; (b) female population.
Figure 5. Funnel plots: (a) general population; (b) female population.
Healthcare 13 00899 g005
Table 1. The search strategy used for the systematic review.
Table 1. The search strategy used for the systematic review.
DatabaseSearch FieldsFilters
PubMedTitle, Abstract, and KeywordsLanguage: English
ProQuestTitle, Abstract, and KeywordsLanguage: English
Source type: Scholarly journals
ScopusTitle, Abstract, and KeywordsLanguage: English
Document type: Articles
Web of ScienceTitle, Abstract, and KeywordsLanguage: English
Document type: Articles and early access
CochraneTitle, Abstract, and KeywordsNo filter
PsychINFO via OVIDSources: Journals, YourJournals, and Ovid EmcareNo filter
Table 2. Inclusion and exclusion criteria of study selection based on the PICOS framework.
Table 2. Inclusion and exclusion criteria of study selection based on the PICOS framework.
PICOS FrameworkInclusion CriteriaExclusion Criteria
PopulationGeneral adult population; studies on womenStudies only on men, sexual or gender minorities, female or male sex workers, and adolescents
InterventionSexualized substance use, sexualized drug use, and chemsexAlcohol or specific drug (GHB or methamphetamine) use only
ComparatorNot applicableNot applicable
OutcomeNumber of people reporting sexualized substance use, including sexualized substance use, sexualized drug use, and chemsex out of total assessedStudies assessing the specific drug (GHB or methamphetamine) toxicity, overdose, and abuse
Study designCross-sectional, observational studiesReviews, abstracts, editorials, and commentaries; also excluded studies published in languages other than English
Table 3. Sexualized substance use study descriptions.
Table 3. Sexualized substance use study descriptions.
Last Name, YearDesignCountryGroupAssessment SettingSSU and Chemsex DefinitionAgeTotal/
Women		Cases/
Women		LGBTQ+ Total
Bauer, 2010 [35]Cross-sectionalUSASSUHousehold surveySSU: sex with male partner while under the influence of substances28.70/58010/1737625
Lawn, 2019 [36]Cross-sectionalInternational SSUInternational online surveySSU: most frequently used substances before or during sexual activity, including alcohol, cocaine, cannabis, GHB/GBL, ketamine, MDMA, mephedrone, methamphetamine, poppers, and sildenafil citrate (past 12 months)31.417,940/641910,065/
2117		3033
Evers, 2021 [37]Cross-sectionalThe NetherlandsSSUSurveillance data analysis of STI clinic adults under 25SSU: substance use, including alcohol and drugs, during sexual activityUnder 2511,714/
7761		5744/3580N/A
Malandain, 2021 [38]Cross-sectionalFranceSSUOnline survey of university studentsSSU: substance use during sexual activity 680/512153/111146
Miltz, 2021 [39]Cross-sectionalEnglandChemsexQuestionnaire of the heterosexual men and womenChemsex: use of mephedrone, methamphetamine, or GHB/GBL (past 3 months)Different age groups1146/6766/10
Rosenberger, 2021 [40]Cross-sectionalGermany and German-speaking countriesChemsexOnline survey in German-speaking countriesChemsex: use of 23 psychotropic substances during sexual activity35429/150123/9257
Chollier, 2022 [41]Cross-sectionalFranceSSUPaper survey of the erotic show attendeesSSU: use of alcohol, acids, cannabis, cocaine, crystal, ecstasy, and speed during sexual activity34773/320201/77106
Íncera-Fernández, 2022 [42]Cross-sectionalSpainSSUOnline survey of heterosexualsSSU: drugs or substances before or during sexual activityVarious1177/795146/930
Cancio-Suarez, 2023 [43]Cross-sectionalSpainChemsexOnline survey STI clinic patientsChemsex: use of methamphetamine, GHB/GBL, mephedrone, cocaine, ketamine, poppers, speed, and other substances during sexual activity36 (25–47)145/3149/087
Giacalone, 2023 [44]Cross-sectionalItalyChemsexPaper questionnaire at the STI clinicChemsex: use of methamphetamine, GHB/GBL, mephedrone, cocaine, ketamine, cannabis, poppers, sildenafil, and other substances during sexual activity29534/135132/25291
Bellomi, 2024 [45]Cross-sectionalItalyChemsexOnline survey of country residentsChemsex: use of specific psychoactive substances during sexual activity 1828/1124248/89186
Gertzen, 2024 [46]Cross-sectionalGermanyChemsexOnline surveyChemsex: use of methamphetamine, GHB/GBL, mephedrone/cathinone, and ketamine during sexual activity 1392/395114/2899
Jepsen, 2024 [47]Cross-sectionalGermanySSUOnline survey of young adultsSSU: sex under the influence of illegal drugs18–27601/365131/77148
Abbreviations: GHB/GBL—gamma-hydroxybutyrate/gamma-butyrolactone; LGBTQ+—lesbian, gay, bisexual, transgender, queer/questioning, and others; MDMA—3,4-methylenedioxymethamphetamine; SSU—sexualized substance use; STI—sexually transmitted infections; USA—United States of America.
Table 4. Risk of bias (quality) assessment according to the Newcastle–Ottawa Scale.
Table 4. Risk of bias (quality) assessment according to the Newcastle–Ottawa Scale.
StudySelectionComparabilityExposureTotal
Bauer, 2010 [35]4127
Lawn, 2019 [36]3126
Evers, 2021 [37]4127
Malandain, 2021 [38]2126
Miltz, 2021 [39]3126
Rosenberger, 2021 [40]4127
Chollier, 2022 [41]4127
Íncera-Fernández, 2022 [42]3126
Cancio-Suarez, 2023 [43]4127
Giacalone, 2023 [44]4127
Bellomi, 2024 [45]3126
Gertzen, 2024 [46]3126
Jepsen, 2024 [47]3126
Table 5. Evaluation of the certainty of evidence using GRADE framework.
Table 5. Evaluation of the certainty of evidence using GRADE framework.
OutcomeStudy DesignRisk of BiasInconsistencyIndirectnessImprecisionPublication BiasCertainty of Evidence
Pooled mean SSU prevalence in the general populationMeta-analysis of cross-sectional studiesLowSeriousNot seriousNot seriousPossibleLow
Pooled mean SSU prevalence in the female populationMeta-analysis of cross-sectional studiesLowSeriousNot seriousNot seriousPossibleLow
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Ramazanova, M.; Turdaliyeva, B.; Igissenova, A.I.; Zhakupova, M.; Izbassarova, A.S.; Seifuldinova, M.; Nurlybaeva, G.; Yergeshbayeva, R.; Karibayeva, I. Prevalence of Sexualized Substance Use and Chemsex in the General Population and Among Women: A Systematic Review and Meta-Analysis of Cross-Sectional Studies. Healthcare 2025, 13, 899. https://doi.org/10.3390/healthcare13080899

AMA Style

Ramazanova M, Turdaliyeva B, Igissenova AI, Zhakupova M, Izbassarova AS, Seifuldinova M, Nurlybaeva G, Yergeshbayeva R, Karibayeva I. Prevalence of Sexualized Substance Use and Chemsex in the General Population and Among Women: A Systematic Review and Meta-Analysis of Cross-Sectional Studies. Healthcare. 2025; 13(8):899. https://doi.org/10.3390/healthcare13080899

Chicago/Turabian Style

Ramazanova, Manshuk, Botagoz Turdaliyeva, Alfiya I. Igissenova, Maiya Zhakupova, Akmaral Sh. Izbassarova, Mariya Seifuldinova, Gulnaz Nurlybaeva, Raushan Yergeshbayeva, and Indira Karibayeva. 2025. "Prevalence of Sexualized Substance Use and Chemsex in the General Population and Among Women: A Systematic Review and Meta-Analysis of Cross-Sectional Studies" Healthcare 13, no. 8: 899. https://doi.org/10.3390/healthcare13080899

APA Style

Ramazanova, M., Turdaliyeva, B., Igissenova, A. I., Zhakupova, M., Izbassarova, A. S., Seifuldinova, M., Nurlybaeva, G., Yergeshbayeva, R., & Karibayeva, I. (2025). Prevalence of Sexualized Substance Use and Chemsex in the General Population and Among Women: A Systematic Review and Meta-Analysis of Cross-Sectional Studies. Healthcare, 13(8), 899. https://doi.org/10.3390/healthcare13080899

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop