Sexual Context Research Articles

Sexual excitation and sex-linked substance use predict overall cannabis use in mostly heterosexual and bisexual women

ABSTRACT Background: Bisexual and mostly heterosexual women report higher substance use than exclusively heterosexual or lesbian women. In sexual minority men, sex-linked substance use (SLSU) can increase risk for substance use problems; equivalent research in women is lacking. Objectives: To test if sexual excitation and inhibition mediate the association between sexual minority status and women’s SLSU. Methods: We surveyed a convenience sample of 595 undergraduate women who identified as exclusively heterosexual (n = 499), mostly heterosexual (n = 59), or bisexual (n = 37). Participants reported on their last month use of alcohol, cannabis, and other drugs (e.g., cocaine) in sexual and non-sexual contexts, and symptoms of alcohol and non-alcohol drug use disorders (e.g., withdrawal symptoms). Drug use symptoms were collapsed across non-alcohol substances. We used structural equation modeling to test serial mediations of women’s SLSU and overall drug and alcohol use. Results: Bisexual and mostly heterosexual women reported higher cannabis use (η2 = 0.030) and drug use disorder symptoms (η2 = 0.050) than heterosexual women. Mostly heterosexual women’s SLSU was a stronger predictor of alcohol use (η2 = 0.019) and binge drinking frequency (η2 = 0.015) than for other orientation groups. Bisexual and mostly heterosexual women’s higher sexual excitation predicted their higher SLSU, which in turn predicted higher cannabis use frequency and drug use disorder symptoms. However, sexual inhibition failed to mediate either SLSU or overall substance use. Conclusion: These findings point to SLSU as a mechanism by which sexual minority women may experience disparities in substance use related harms.

“Thinking back through our mothers”: A curriculum of organic relationality

The feminist motif “thinking back through our mothers” calls us to claim the mother’s heritage, not to identify with her, not to repudiate her, but to become ourselves in a middle ground. In this article, the thread of thinking back through our mothers for a curriculum of organic relationality crosses different times and places and includes different racial, sexual, class, linguistic, and national contexts. I weave this thread thematically along three major lines. First, I explore the role of interconnectedness and relational dynamics as central to such a curriculum. Second, I discuss creative tensionality between mothers and daughters as generative and having implications for reclaiming the classroom in a space of simultaneous un/attachment, un/burdening, and non/belonging. Third, I argue that nonviolent relations across differences is the site for building a curriculum community that welcomes the alterity of the other and grows compassionate relationships. While drawing upon diverse women writers and feminist curriculum scholars, I also weave in autobiographical stories about my mother, who is a retired teacher educator in China. While this ongoing weaving does not lead to one singular blended product, gratitude despite difficulty emerges as one path to claim the maternal legacy.

The social meanings of PrEP use - A mixed-method study of PrEP use disclosure in Antwerp and Amsterdam.

Pre-Exposure Prophylaxis (PrEP) is a novel HIV prevention tool. PrEP stigma is a frequently reported barrier, while social disclosure of PrEP use may be an important facilitator. We explored how PrEP users managed PrEP use disclosure using a symbolic interactionist approach. We interviewed 32 participants from two PrEP demonstration projects (Be-PrEP-ared, Antwerp; AMPrEP, Amsterdam). We validated qualitative findings through Be-PrEP-ared questionnaire data. A minority of participants had received negative reactions on PrEP. The way PrEP use was disclosed was highly dependent on the social situation. In a sexual context among MSM, PrEP use was associated with condomless sex. Friends endorsed PrEP use as a healthy choice, but also related it to carelessness and promiscuity. It was seldom disclosed to colleagues and family, which is mostly related to social norms dictating when it is acceptable to talk about sex. The study findings reveal that PrEP stigma experiences were not frequent in this population, and that PrEP users actively manage disclosure of their PrEP user status. Frequent disclosure and increased use may have helped PrEP becoming normalised in these MSM communities. To increase uptake, peer communication, community activism and framing PrEP as health promotion rather than a risk-reduction intervention may be crucial.

Recurrent Sexually Transmitted Infections Among a Cohort of Men Who Have Sex With Men Using Preexposure Prophylaxis in Belgium Are Highly Associated With Sexualized Drug Use.

Men who have sex with men (MSM) experiencing recurrent sexually transmitted infections (STIs) may play a crucial role in the STI epidemic. However, there is limited understanding of what kind of behavior leads to recurrent STIs. A total of 179 MSM using preexposure prophylaxis were followed up for 18 months and were screened quarterly for chlamydia, gonorrhea, and syphilis from 2015 to 2018 in Belgium. Participants were stratified into 3 different groups (no STI, one STI episode, recurrent STI episodes during the study). Sociodemographic and sexual behavioral characteristics were compared between the 3 groups, and significant associations with recurrent STI were explored using multivariate logistic regression models. A total of 62.0% (n = 111/179) of participants experienced at least one STI during the study, and more than 1 in 3 became reinfected with an STI at another visit (n = 66/179 [36.9%]). Participants experiencing recurrent STIs reported the highest frequency of sexualized drug use (86.4%) compared with participants experiencing one (60.0%) or no STI (47.1%). Therefore, sexualized drug use was highly associated with recurrent STIs (adjusted odds ratio [aOR]. 4.35). Other factors associated with recurrent STIs were being younger than 40 years (aOR, 3.29), had a high number (>4) of nonsteady partners with whom receptive (aOR, 1.17) or insertive (aOR, 1.12) condomless anal intercourse occurred in the last 3 months. Sexualized drug use was the greatest risk factor for having recurrent STIs. Tailoring prevention and care, including specialized services tackling problematic drug use in a sexual context, may help to curb the STI epidemic among MSM.

Lack of caste discrimination by males during sexual context in a neotropical paper wasp

AbstractPotential mates often exhibit strong variation in reproductive quality, so the choice for the best sexual partner is generally adaptive. However, its adaptive value diminishes in cases where potential mates are similarly fit or when mate choice is too costly, leading mate choice to be unusual or absent. “Primitively eusocial” insects have flexible castes. Workers usually behave as “helpers,” but sometimes they mate and lay fertilized eggs. Despite worker totipotence, direct reproduction is, overall, higher in queens. Males of the temperate paper wasp Polistes dominula are able to discriminate castes, preferring gynes (= future queens) over workers, thus assuring more profitable mates. To our knowledge, no study has tested this ability in neotropical paper wasps. Here, we test the prediction that in the congeneric neotropical paper wasp Polistes versicolor, male sexual preference for gynes is unusual or absent. We perform laboratory paired mating trials in which a male was introduced to either a gyne or a worker. Caste assigned was confirmed by morphophysiological analysis. As predicted, male sexual interest was similar regardless of female caste. Conducting gas chromatography analysis, we demonstrated that queens and workers have distinct cuticular hydrocarbon profiles so caste‐related cues are available. We discuss the possibility that reduced differences in direct reproductive potential between castes and high costs of caste discrimination account for the absence of mate choice for gynes in P. versicolor males despite its occurrence in P. dominula. Thus, caste discrimination by males during sexual context is not so strict in species in which workers are able to mate and lay fertilized eggs.

Advancing Trans-Affirming Practice to Recognize, Account for, and Address the Unique Experiences and Needs of Transgender Sexual Assault Survivors.

Transgender (trans) persons are sexually assaulted at high rates and often encounter barriers to equitable services and supports. The receipt of timely and appropriate postassault care, provided increasingly by specialized forensic nurses around the world, is critical in ameliorating the harms that accompany sexual assault. In order to adequately respond to the acute health care needs of trans clients and attend to longer term psychosocial difficulties that some experience, forensic nurses not only require specialized training but must also cultivate collaborative relationships with trans-positive health and social services in their communities. To meet this need, we describe our strategy to advance trans-affirming practice in the sexual assault context. We outline the design and evaluation of a trans-affirming care curriculum for forensic nurses. We also discuss the planning, formation, and maturation of an intersectoral network through which to disseminate our curriculum, foster collaboration, and promote trans-affirming practice across health care and social services in Ontario, Canada. Our approach to advancing trans-affirming practice holds the potential to address systemic barriers experienced by trans survivors and transform the response to sexual assault across other sectors and jurisdictions.

“New” drugs associated with chemsex? 2C-B in sexual context. A case report and review

IntroductionThe intentional use of drugs before or during sexual intercourse (chemsex), due to its impact on mental health, is a phenomenon of high importance in men who have sex with men.ObjectivesWe report the case of a patient with polysubstance acute intoxication, including 2C-B, in order to review the evidence about the mechanisms of action of 2C-B, its efects on sexual pleasure, toxicity, patterns of abuse and somatic and mental health related consequences it may present.MethodsCase report and narrative review.ResultsWe present the case of a patient using 2C-B as a substance in chemsex practice. As the patient presented in our emergency with psychotic symptoms, he was diagnosed with “stimulant acute intoxication” and “acute psychotic symptoms induced by stimulants”. 2C-B increases dopamine (DA) serotonin (5-HT) and norepinephrine (NE) and cause stimulating and hallucinogenic effects.ConclusionsMSM is a group vulnerable to the problematic use of drugs in a sexual context. Several mental health problems have been associated with chemsex users such as psychotic sypmptoms, suicidal ideation, encephalopaty, delirium. Polysubstance use is common in chemsex practice and it can be difficult to identify the drugs used in states of acute intoxication but psychiatrists must explore the use of differents drugs from the “classic chemsex drugs” (mephedrone, GHB and metanphetamine) including 2C-B and other substances such as cocaine, MDMA, ketamine, and other cathinones different from mephedrone.

Sexuality and Multiple Sclerosis: Patient and Doctor Perspectives

Little is known on how to address sexuality in clinical care for patients with multiple sclerosis (pwMS). To describe and contrast the perception of sexuality and associated aspects of communication in pwMS and their treating neurologists ("MSologists") and provide a standard of care. Patients were surveyed using a 13-item questionnaire investigating perception on their own sexuality and opinions on communication about sexuality in context with MS. Certified MSologists in Austria received an 18-item survey regarding their approach to taking a sexual history of their patients. We report the frequency of answers given in this survey and propose a possible standard of care how sexuality could be addressed in clinical routine. Ninety-three pwMS (mean age 39 ± 11 years, 57% female) and 75 MSologists (mean age 43 ± 9 years, 63% male) completed this survey. Seventy-six percent of patients report their own sexuality as being (very) important to them and 95% think that sexual dysfunction would influence their quality of life. 84% would like to be asked about their sexuality by their MSologist. In contrast, only 15% of MSologists reported discussing sexuality with every patient. The most common reason for not doing so was a fear of crossing personal borders (34%). There is a strong desire for further medical education on this subject (76%). Discussing sexuality is important to pwMS and MSologists should consider their patients' wishes and needs to talk about it. This is the largest survey contrasting the views of patients and their treating physicians on the topic of communication about sexuality. The use of an empirical unvalidated questionnaire may have introduced bias. Moreover, patients that are open to talk about their sexuality may be potentially overrepresented in this study. MSologists should offer their patients an open opportunity and appropriate framework to discuss their sexuality during a consultation. Altmann P, Leithner K, Leutmezer F, etal. Sexuality and Multiple Sclerosis: Patient and Doctor Perspectives. J Sex Med 2021;18:743-749.

Influence of lighting environment on social preferences in sticklebacks from two different photic habitats. I. mate preferences of wild-caught females.

Ultraviolet (UV) A signals (320–400 nm) are important in mate choice in numerous species. The sensitivity for UV signals is not only assumed to be costly, but also expected to be a function of the prevailing ecological conditions. Generally, those signals are favored by selection that efficiently reach the receiver. A decisive factor for color signaling is the lighting environment, especially in aquatic habitats, as the visibility of signals, and thus costs and benefits, are instantaneously influenced by it. Although ecological aspects of color signal evolution are relatively well-studied, there is little data on specific effects of environmental UV-light conditions on signaling at these shorter wavelengths. We studied wild-caught gravid female 3-spined sticklebacks Gasterosteus aculeatus of 2 photic habitat types (tea-stained and clear-water lakes), possessing great variation in their UV transmission. In 2 treatments, tea-stained and clear-water, preferences for males viewed under UV-present (UV+) and UV-absent (UV–) conditions were tested. A preference for males under UV+ conditions was found for females from both habitat types, thus stressing the significance of UV signals in stickleback’s mate choice decisions. However, females from both habitat types showed the most pronounced preferences for males under UV+ conditions under clear-water test conditions. Moreover, reflectance measurements revealed that the carotenoid-based orange-red breeding coloration in wild-caught males of both habitat types differed significantly in color intensity (higher in clear-water males) and hue (more red shifted in clear-water males) while no significant differences in UV coloration were found. The differential reflection patterns in longer wavelengths suggest that sticklebacks of both habitat types have adapted to the respective water conditions. Adaptations of UV signals in a sexual context to ambient light conditions in both behavior and coloration seem less evident.

Understanding the Reasons Behind Healthcare Providers' Conscientious Objection to Voluntary Assisted Dying in Victoria, Australia.

During the debates about the legalization of Voluntary Assisted Dying (VAD) in Victoria, Australia, the presence of anti-VAD health professionals in the medical community and reported high rates of conscientious objection (CO) to VAD suggested access may be limited. Most empirical research on CO has been conducted in the sexual and reproductive health context. However, given the fundamental differences in the nature of such procedures and the legislation governing it, these findings may not be directly transferable to VAD. Accordingly, we sought to understand how CO operates in the context of VAD. Prior to the implementation of the VAD legislation in June 2019, we conducted semi-structured interviews with seventeen health professionals with a self-declared CO to VAD, to explore what motivated their CO. Participants identified multiple motivations, which can be broadly categorized as: concerns for oneself; concerns for patients; concerns about the current Victorian legislation; and concerns for the medical profession. Participants' moral commitments included personal, professional, and political commitments. In some cases, one's CO was specific to Victoria's current legislation rather than VAD more broadly. Our findings suggest CO motivations extend beyond those traditionally cited and suggest a need to better understand and manage CO in the healthcare context.

Chemical sex (chemsex) in a population of French university students.

IntroductionChemsex is defined by the use of psychoactive substances to facilitate or improve sexual relations. Our objectives were to assess the prevalence of the practice of ‘chemsex’ in a population of French university students and to identify socio-demographic and clinical factors associated with this practice.Material and methodsWe have used an anonymous online questionnaire comprising 15 questions on socio-demographic characteristics, chemsex use, sexual satisfaction, the type of substances used in this sexual context and their route of administration.ResultsA total of 680 people were included in our study. Among them, 22.5% reported chemsex behaviour in the past year. Using a multivariate analysis, factors associated with chemsex were dating application use (p = 0.049) and pornography use [viewing more than once per month (p = 0.002)]. Having a sexual partner involved in chemsex (p < 0.0001), celibacy (p = 0.007), sexual orientations other than heterosexual (p = 0.0013) and especially bisexuality (p = 0.0002) were also significantly associated with chemsex.ConclusionThis is the first study reporting a high prevalence of chemsex in a university student population. Further larger studies should be conducted to confirm these results showing a high prevalence of this at-risk behaviour.

Is Homosexuality in the Priesthood Diminishing? Evidence from Sexual Attitudes, Behaviors, and Contexts of Catholic Clergy in the United States

This study explores the results of the 2021 Survey of American Catholic Priests, an effort to replicate the 2002 Los Angeles Times survey of priests, in evaluating stability and change in the sexual beliefs, dispositions, and behaviors of Catholic priests in the United States. Reinforcing widespread perceptions, we find that younger priests hold more conservative sexual attitudes than their older counterparts. We also find them to be less likely to report homosexual attraction, and we perform a very basic projection of the future sexual orientation composition of the US clergy using baseline assumptions and a cohort replacement model. We find that orientation and orthodoxy are intertwined, with heterosexual priests reporting higher celibacy adherence and belief that behaviors identified by the Church as sins are in fact sins. Our analyses further suggest that the present lower clergy supply is largely explicable by a decline in progressive priests.

RESHAPING THE HOMOSEXUAL IDENTITY OF MIDDLE-AGED GAY MEN IN AMERICA: A SOCIOLOGICAL STUDY OF IDENTITY PROCESS ON ANDREW SEAN GREER’S LESS

The detrimental effects caused by the LGBT victimization in America are directly felt by middle-aged homosexuals nowadays and is internalized into their identity, creating problems that continuously affect them even after LGBT acceptance in the United States. The shift of homosexual identity in middle-aged American homosexuals is thus inevitable in order to regain their identity balance. Andrew Sean Greer’s Less depicts this issue through the internal conflicts of Arthur Less —a character struggling to accept his identity as an aging homosexual man. Arthur’s process in assimilating new experiences around him and accommodating his conceptionabout his homosexual identity become the highlights of this study. The writer utilizes Susan Krauss Whitbourne’s Identity Process Theory that deals with identity assimilation, identity accommodation, and identity balance. The result shows that past LGBT victimization has caused (1) HIV/AIDS trauma, (2) hyper-sexualized image, (3) cynicism towards marriage, and (4) internalized homonegativity, all of which creating the balance disruption on identity. When identity assimilation fails and identity accommodation occurs, middle-aged American homosexuals are encouraged to acknowledge that (1) homosexual identity exists beyond stereotyped sexual context, (2) there are no standardized attitudes that they must adopt, and (3) they are allowed to desire the same sense of comfort and intimacy through committed relationship or marriage, like their heterosexual counterparts.

Up-regulating Sexual Arousal and Down-regulating Disgust while Watching Pornography: Effects on Sexual Arousal and Disgust

ABSTRACT Sexual response occurs when sexual excitatory factors outweigh inhibitory factors. Problems with sexual arousal may occur when sexual excitation is too low and/or inhibitory influences such as feelings of disgust are too strong. To explore interventions that may help overcome decreased sexual responding, we examined if sexual responding could be amplified by instructions to up-regulate sexual arousal and/or down-regulate disgust. Women with no sexual difficulties (N = 255; µage = 20.55; SD = 2.23) were randomly assigned to a sexual arousal up-regulation, disgust down-regulation, or passive control condition. Participants were instructed to use the assigned regulation strategy while viewing pornography. To prevent floor effects due to low disgust responsivity in a non-clinical sample, half of the participants were presented with a prime that was designed to make the contaminating properties of sex more salient. Instruction to up-regulate sexual arousal successfully enhanced feelings of sexual arousal in the unprimed group, yet the increase in sexual arousal was not paralleled by reductions in feelings of disgust. Instruction to down-regulate disgust successfully decreased disgust; however, this decrease was not paralleled by increases in sexual arousal. Overall, findings indicate that emotion regulation techniques could facilitate affective control in sexual contexts.

Feminine Power in Proclus's Commentary on Plato's Timaeus

AbstractNotorious for advancing a strict dichotomy between the masculine “demiurgic father” and the feminine “nurse/receptacle of becoming” as the “natural” origin of the cosmos, Plato's Timaeus has become a site for feminist interrogation. Most critics easily deem the text a masculine fantasy that projects feminine impotence and obligatory heterosexuality, reinforcing patriarchal power structures that are blindly reproduced in their historical reception. Consequently, this article analyzes the Neoplatonic replication of this framework, but with special attention given to Proclus's challenges to this gendered and sexual context. In this late, sometimes forgotten figure, we find, rather surprisingly, a Platonist who neither sequesters the feminine to the domain of the passive receptacle nor charges her simply with being a bastard image of the masculine. Rather, for Proclus, the feminine becomes the site of lived, erotic power that produces and sustains the value of authentic otherness. Furthermore, Proclus offers a challenge to the naturalness of the sex binary, suggesting a radical queerness as the basis of all identity. Overall, we shall see how classical patriarchal thinkers may, despite themselves, offer subversive models that might present readers with possibilities for troubling the sexual prejudices of ancient metaphysical schemas.

Social learning by mate‐choice copying increases dispersal and reduces local adaptation

Abstract In heterogeneous environments, dispersal may be hampered not only by direct costs, but also because immigrants may be locally maladapted. While maladaptation affects both sexes, this cost may be modulated in females if they express mate preferences that are either adaptive or maladaptive in the new local population. Dispersal costs under local adaptation may be mitigated if it is possible to switch to expressing traits of locally adapted residents. In a sexual selection context, immigrant females may learn to mate with locally favoured males. Mate‐choice copying is a type of social learning, where individuals, usually females, update their mating preferences after observing others mate. If it allows immigrant females to switch from maladapted to locally adapted preferences, their dispersal costs are mitigated as mate choice helps them create locally adapted offspring. To study if copying can promote the evolution of dispersal, we created an individual‐based model to simulate the coevolution of four traits: copying, dispersal, a trait relevant for local adaptation, and female preference. We contrast two scenarios with copying—either unconditional or conditional such that only dispersers copy—with a control scenario that lacks any copying. We show copying to lead to higher dispersal, especially if copying is conditionally expressed. This leads to an increase in gene flow between patches and, consequently, a decrease in local adaptation and trait‐preference correlations. While our study is phrased with female preference as the learned trait, one may generally expect social learning to mitigate dispersal costs, with consequent feedback effects on the spatial dynamics of adaptation. A free Plain Language Summary can be found within the Supporting Information of this article.

"Next Time" Means "No": Sexual Consent and the Structure of Refusals

This paper emphasizes a need to recognize sexual refusals both in public discourse and in the context of particular interactions. I draw on sociolinguistic work on the structure of refusals to illuminate a much-discussed case of alleged sexual violence as well as to inform how we ought to think and talk about sexual consent and refusal more generally. I argue on empirical and ideological grounds that we ought to impute the same significance to refusals uttered in sexual contexts as we do to those uttered in nonsexual contexts. Finally, I propose an amendment to the definition of affirmative consent that would put it in line with the conclusions drawn in the rest of the paper.

Primed to vocalize: Wild-derived male house mice increase vocalization rate and diversity after a previous encounter with a female.

Males in a wide variety of taxa, including insects, birds and mammals, produce vocalizations to attract females. Male house mice emit ultrasonic vocalizations (USVs), especially during courtship and mating, which are surprising complex. It is often suggested that male mice vocalize at higher rates after interacting with a female, but the evidence is mixed depending upon the strain of mice. We conducted a study with wild-derived house mice (Mus musculus musculus) to test whether male courtship vocalizations (i.e., vocalizations emitted in a sexual context) are influenced by a prior direct interaction with a female, and if so, determine how long the effect lasts. We allowed sexually naïve males to directly interact with a female for five minutes (sexual priming), and then we recorded males’vocalizations either 1, 10, 20, or 30 days later when presented with an unfamiliar female (separated by a perforated partition) and female scent. We automatically detected USVs and processed recordings using the Automatic Mouse Ultrasound Detector (A-MUD version 3.2), and we describe our improved version of this tool and tests of its performance. We measured vocalization rate and spectro-temporal features and we manually classified USVs into 15 types to investigate priming effects on vocal repertoire diversity and composition. After sexual priming, males emitted nearly three times as many USVs, they had a larger repertoire diversity, and their vocalizations had different spectro-temporal features (USV length, slope and variability in USV frequency) compared to unprimed controls. Unprimed control males had the most distinctive repertoire composition compared to the primed groups. Most of the effects were found when comparing unprimed to all primed males (treatment models), irrespective of the time since priming. Timepoint models showed that USV length increased 1 day after priming, that repertoire diversity increased 1 and 20 days after priming, and that the variability of USV frequencies was lower 20 and 30 days after priming. Our results show that wild-derived male mice increased the number and diversity of courtship vocalizations if they previously interacted with a female. Thus, the USVs of house mice are not only context-dependent, they depend upon previous social experience and perhaps the contexts of these experiences. The effect of sexual priming on male courtship vocalizations is likely mediated by neuro-endocrine-mechanisms, which may function to advertise males’ sexual arousal and facilitate social recognition.

Pharmacosex: Reimagining sex, drugs and enhancement

BackgroundThe use of drugs in sexual contexts is receiving closer attention in the media, public health bodies and communities than ever before. However, research to date is most often concerned with the sex-related drug use of lesbian, gay, bisexual, transgender and queer (LGBTQ) populations, and particularly men who have sex with men (MSM) engaging in ‘chemsex’. Against a backdrop dominated by public health and medical science perspectives, this article seeks to move beyond prevailing sex on drug discourses characterised by risk and harm, or pleasure. Drawing on an expansive notion of enhancement, we explore intersections between drug consumption and sex via the concept of ‘pharmacosex’: the ways in which wider populations experiment with a range of illicit drugs that modify and enhance their sex lives in the context of broader processes of the pharmaceuticalisation of sexuality. MethodsDrawing on two empirical studies comprising a virtual ethnography and 45 interviews with participants across a range of gender and sexual identities who regularly combine sex and drugs, this article contributes to the growing body of research that attends to the materiality of drug consumption practices in relation to the historical and social contexts from which they emerge. ResultsOur participants reported variegated and complex modes of enhancement in relation to a wide range of psychoactive substances. Participants described enhanced emotional connectedness, bodily sensations, disinhibition and desire, but they also discussed how sex enhances drug experiences. As important but currently neglected in research literature were the therapeutic dimensions of drug-taking reported, which cannot be neatly distinguished from purely hedonic motivations. While enhancement was also experienced by participants in more challenging ways in relation to shame, regret, risk and/or harm, these experiences simultaneously afforded space for the emergence of innovative practices of risk-management, safety and care. ConclusionThis study exposes the diversity of practices and meanings sex-related drug use hold for participants, but also demonstrates the paucity of biomedical conceptions of sexual enhancement limited to stamina, function and libido, and the need for a more expansive approach. The study also raises questions about the extent to which contemporary discourses of self-improvement have come to ‘inhabit’ sexuality in the twenty-first century, and the role drugs might play in this context. By shifting the gaze from pathology to enhancement and exploring the plurality of practice, we can better understand the motivations for engaging in sex-related drug use, thereby circumventing knee-jerk counterproductive enforcement and policy responses.

Chemsex and Mental Health of Men Who Have Sex With Men in Germany.

Background: Chemsex is defined as using certain substances immediately before or during sexual activities to facilitate, prolong and/or intensify sexual experience, mainly by some communities of men who have sex with men (MSM). Four substances are typically associated with chemsex: methamphetamine, mephedrone, GHB/GBL, and ketamine. While there is a lot of evidence for increased prevalence of HIV, sexually transmitted infections and other sexual health measures among MSM, who engage in chemsex, there has been little research on mental health aspects. This study aims to describe aspects of mental health among a sample of German men who have sex with men (MSM) who engage in chemsex and to describe potentially adverse consequences of chemsex behavior.Method: This paper refers to a subset of participants from the German Chemsex Survey, an MSM-community recruited, self-completed online survey with a self-selected convenience sample. The survey comprised 420 different items considering recreational substance use, substance use in sexual settings, mental health, sexual transmitted infections, adverse consequences of chemsex behavior, and experiences of non-consensual sex acts. A group of participants who used methamphetamine, mephedrone, GHB/GBL, and/or ketamine in a sexual setting in the last 12 months (n = 280, chemsex group) was analyzed regarding symptoms of depression (PHQ-9), general anxiety disorder (GAD-7), somatization (PHQ-15), and PTSD (Primary Care PTSD Screen). Group comparisons were conducted between the chemsex group and men who did not use substances in a sexual context (n = 177, non-chemsex group). Mean scores of mental health measures were compared, as well as scores above a cut-off that indicates clinically relevant symptoms. Logistical regression was utilized to determine whether mental health measures can predict adverse consequences of engagement in chemsex behaviors.Results: A total of 1,583 men started the survey; 1,050 participants provided information on substance use. Twenty-seven percent of participants (n = 280) reported that they used methamphetamine, mephedrone, GHB/GBL and/or ketamine in a sexual setting in the last 12 months. The chemsex group showed significantly higher mean scores for depression, anxiety, and somatization than the non-chemsex group, but effect sizes were low. Even though mean scores were heightened, they were still far below the cut-off for clinically relevant symptoms. The chemsex group reported significantly higher incidences of non-consensual sex acts compared with the non-chemsex group. Some men in the chemsex-group experienced potentially adverse consequences, such as loss of control regarding time and money spent for chemsex activities or amount of substances used at one occasion (49.6%), negative impacts on social functioning (33.6%), psychotic symptoms (13.2%), and physically aggressive behavior toward others (2.9%). Clinically relevant symptoms did not predict a higher likelihood for adverse consequences.Discussion: Mean scores for depression, anxiety, and somatization were significantly higher in the chemsex-group, but effect sizes were low. Both groups reported poorer mental health compared to men in the German general population. Mental health measures did not contribute to predict potentially adverse consequences of chemsex behavior.