Chemsex and Psychosexual Health: A Comprehensive Review from Neurobiological and Ayurvedic Perspectives

Chemsex, defined as the intentional use of psychoactive substances (PS) to facilitate or enhance sexual activity, has emerged as an important public health and psychosexual medicine concern. It has been associated with increased sexual risk-taking, substance dependence, psychiatric morbidity, and impaired psychosocial functioning. Objective: This review aims to examine chemsex through an integrative framework by synthesizing current evidence from neurobiology, psychosexual medicine, and Ayurvedic perspectives. Methods: A literature review was conducted using PubMed, Scopus, Web of Science, and Google Scholar. Relevant literature on chemsex, reward neurobiology, sexualized drug use, addiction mechanisms, and Ayurvedic concepts related to mental regulation and vitality was reviewed. Results: From a neurobiological perspective, commonly used chemsex substances such as methamphetamine, mephedrone, and gamma-hydroxybutyrate (GHB) act primarily through dopaminergic and reward-related pathways, producing heightened pleasure, disinhibition, and reinforcement. Repeated exposure may contribute to neuroadaptation, compulsive use, impaired executive control, and reduced natural reward sensitivity. From an Ayurvedic perspective, chemsex may be interpreted as dysregulation of mental qualities, impaired judgment, and depletion of restorative vitality constructs such as ojas and shukra dhatu. These interpretations are conceptual and should not be considered claims of direct biological equivalence. Conclusion: Chemsex is a multidimensional phenomenon involving neurobiological, psychological, behavioral, and social determinants. Integrative approaches combining harm reduction, addiction treatment, psychosexual care, and supportive holistic interventions may offer broader management pathways. Further empirical research is needed to validate interdisciplinary models.