Neurobiological mechanisms underpinning chemsex: a scoping review of human neuroimaging and neurophysiological studies
Abstract
<p>Background: Chemsex is a subculture of sexualised drug use commonly observed in men who have sex with men. The existing literature largely covers motivations for engagement, harm profiles, and service needs. There is a distinct lack of robust neurobiological evidence. <h4>Aims:</h4> We mapped direct neuroimaging and neurophysiological evidence on chemsex. We also defined adjacent evidence that could inform reciprocal reinforcement between drug effects and sexual reward. <h4>Methods:</h4> We searched PubMed for adult human studies published from January 2000 to February 2026. One eligibility framework admitted direct chemsex evidence and drug–sexual convergence within one design. A third route admitted studies of pre-specified chemsex-component processes. <h4>Results:</h4> We included 26 studies: one direct study, six drug–sexual convergence studies and 19 chemsex component studies. Five concerned GHB/GBL, four concerned methamphetamine and two concerned ketamine. Eleven addressed sexual reward, CSBD or problematic pornography use. Three linked neural measures to sexual risk or control in MSM. The direct chemsex study used EEG. Acute GHB work linked GHB with altered erotic appraisal and nucleus accumbens–ventromedial prefrontal coupling. Methamphetamine and ketamine studies produced task-specific findings without modelling sexualised drug use. Adjacent studies implicated anticipation and conditioning. Other findings concerned insula-linked salience or cognitive control, but several results were null or anatomically narrow. <h4>Conclusions:</h4> There is a distinct lack of neurobiology-driven chemsex research. This review identifies plausible biological regions of interest and brain networks that may be altered in chemsex as possible targets for future neuroimaging and neurophysiological studies. <h4>Keywords:</h4> chemsex; sexualised drug use; neuroimaging; EEG; gamma-hydroxybutyrate; methamphetamine; ketamine; compulsive sexual behaviour</p>
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