Chemsex and Psychosexual Health in a Large Italian Sample of Men Who Have Sex with Men (MSM)

Chemsex, the use of psychoactive substances during sexual activity, is prevalent among men who have sex with men (MSM) and is associated with various health risks. Despite increasing global attention, research on chemsex in Italy remains scarce. This cross-sectional study explored the prevalence and characteristics of chemsex among Italian MSM, its associations with psycho-sexual health, and it sought to identify psychological, social, and health-related factors linked to the perception of chemsex as problematic. A total of 841 participants (mean age = 35.1, SD = 9.6) completed an anonymous online questionnaire assessing chemsex practices, mental health, sexual health, and minority stress. Chemsex prevalence was found to be 18.2%, with an additional 10% expressing interest in the practice. The most used substances were inhalants (83.7%) and cocaine (45.8%). Chemsex participants had higher rates of sexually transmitted infections (STIs) (χ2(1) = 27.78, p < 0.001) but also reported greater use of preventive measures, such as PrEP (χ2(1) = 95.2, p < 0.001). No significant differences in anxiety, substance use severity, or intraminority stress were found between chemsex and non-chemsex users. Chemsex participants displayed higher levels of sexual dysfunction (t(696) = 3.37, p < 0.001), particularly in receptive and insertive anal sex and erectile function, but no differences in sexual satisfaction were observed. These findings challenge the applicability of the “identity process theory” (IPT) to the Italian MSM context, suggesting that chemsex motivations may extend beyond marginalization within the community. Participants perceiving their chemsex practice as problematic reported more negative consequences from this sexual practice (χ2(1) = 14.41, p < 0.001) and lower satisfaction with sexual life (t(69) = 2.03, p = 0.046). This subgroup also sought professional help for substance use more frequently, highlighting the need for integrated mental health and substance use interventions (χ2(2) = 6.4, p = 0.041). These findings emphasize the importance of public policies and harm reduction programs to promote the well-being of MSM engaged in chemsex, with a focus on community-based interventions and peer support.