{
  "abstract": "Background Chemsex practice is known to alter sexual experience, but the specific impact of substances on users’ erotic fantasy life remains poorly understood. Understanding whether and how chemsex transforms sexual imagination, and whether these transformations are perceived as belonging to one’s identity or as externally imposed, has significant clinical implications for psychotherapeutic treatment.In his Three Essays on the Theory of Sexuality (1905), Freud argued that sexual fantasies are not arbitrary products of the mind but reflect the emotional history of the subject: they crystallise around a nodal point of meaning constructed in childhood to make sense of the body and of adult sexuality, which then unconsciously shapes desire throughout life. This theoretical framework gains renewed relevance in the light of contemporary research: the 2024 study Fantasy Made Flesh (Andrian, Werburg, Klopp and Schwab, Journal of Sex Research), conducted on a network analysis of 1,338 participants, demonstrated that internet pornography interacts significantly with sexual fantasies, particularly non-conventional ones such as BDSM, effectively operating as a mainstream vehicle for specific erotic scripts. Chemsex substances may act through an analogous but pharmacologically amplified mechanism: just as repeated media exposure shapes and reinforces fantasy content, the psychoactive properties of drugs, particularly MDPV, may intensify and accelerate the crystallisation of new erotic material, potentially overwriting or destabilising pre-existing desire.Material and Methods A self-administered online survey was distributed through the channels of partner associations, collecting just over 100 responses from chemsex users. The questionnaire explored: the perceived difference between sober and chemsex-induced sexual fantasies; the role of substance type, frequency of use, and years of experience in shaping fantasy transformation; the subjective evaluation of that transformation (positive, negative, or integrated); and whether new erotic content was experienced as authentic or alien to sober identity.Results Both duration and frequency of use contribute to the transformation of sexual desire, but current high-frequency use is most strongly associated with the emergence of fantasies perceived as entirely new and unrelated to sober experience. High-frequency users are more likely to evaluate this transformation negatively, while occasional users, particularly long-term veterans, show greater integration or acceptance of the change. Regular and frequent chemsex practice increases the perception that desires explored in that context are externally imposed and non-authentic to sober identity. The large majority of users, regardless of frequency, express a desire to modify or discontinue the role of chemsex in their lives.Conclusion The transformation of erotic fantasy under chemsex is significantly shaped by frequency of use and substance type, with high-frequency use most strongly associated with a sense of estrangement from one’s sober desire. Given the limited sample size, this survey should be replicated on a larger scale to broaden the content explored and achieve greater statistical significance.",
  "authors": [
    {
      "affiliations": [
        "ASA ODV Milano, Milan, Italy"
      ],
      "name": "G Fracca"
    },
    {
      "affiliations": [
        "ASA ODV Milano, Milan, Italy"
      ],
      "name": "M Manfredini"
    },
    {
      "affiliations": [
        "ASA ODV Milano, Milan, Italy"
      ],
      "name": "A Antonino"
    },
    {
      "affiliations": [
        "ASA ODV Milano, Milan, Italy"
      ],
      "name": "A Bianchi"
    },
    {
      "affiliations": [
        "ASA ODV Milano, Milan, Italy"
      ],
      "name": "M Cernuschi"
    }
  ],
  "title": "P61 Chemsex and the transformation of erotic fantasy: a survey study",
  "uid": "46214cb1-3297-547a-9316-811477a230a8"
}