Psychedelic research and sexuality: opportunities and pitfalls.

Psychedelic-assisted therapy (PAT) may influence sexuality through its effects on emotion, perception, and embodiment, but current evidence is limited and heterogeneous. Most studies report sexual outcomes only as secondary or incidental findings, which restricts interpretability and causal inference. The article reviews neurobiological, psychological, clinical, and ethical dimensions of PAT and outlines implications for sexuality, aiming to highlight future research directions. Esketamine has been approved for depression in the US and EU, while psilocybin and MDMA have Breakthrough Therapy Designation in the US for depression and PTSD, respectively.

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Abstract

Psychedelic-assisted therapy (PAT) is increasingly investigated as a treatment for depression, post-traumatic stress disorder (PTSD), and substance use disorder. In the United States (US) and European Union, esketamine has been approved for the treatment of depression, while psilocybin and 3,4-methylenedioxymethamphetamine (MDMA) have received Breakthrough Therapy Designation in the US for depression and PTSD, respectively. Despite growing interest, the effects of PAT on sexuality and intimacy remain underexplored. This opinion article reviews the neurobiological, psychological, clinical, and ethical dimensions of PAT and outlines implications for sexuality, with the aim of highlighting future research directions. Sexuality arises from a complex interplay of biological, psychological, social, and relational factors. Psychedelics act on systems involved in emotion, perception, and embodiment, suggesting potential effects on sexual motivation, arousal, interaction, and satisfaction. However, current evidence is limited and heterogenous, with few controlled trials. In most studies, sexual outcomes are secondary or incidental findings, limiting interpretability and causal inference.