Psychedelic research and sexuality: opportunities and pitfalls

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.