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Original research
Prevalence of drug use during sex among swingers and perceived benefits and risks – a cross-sectional internet survey in the Netherlands
  1. Ymke J Evers1,2,
  2. Nicole H T M Dukers-Muijrers1,2,
  3. Carolina J G Kampman3,
  4. Geneviève A F S van Liere1,2,
  5. Jeannine L A Hautvast4,
  6. Femke D H Koedijk3,
  7. Christian J P A Hoebe1,2
  1. 1 Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, The Netherlands
  2. 2 Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
  3. 3 Department of Sexual Health, Twente Public Health Service, Enschede, The Netherlands
  4. 4 Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
  1. Correspondence to Ymke J Evers, Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen 6400 AA, Netherlands; ymke.evers{at}


Objectives Drug use during sex has been associated with sexually transmitted infections (STI). While a growing body of research has investigated drug use during sex among men who have sex with men, data in swingers is limited. Swingers are heterosexual couples who have sex with others and singles who have sex with these couples. Our study assessed the prevalence of drug use during sex and perceived benefits and risks among swingers.

Methods In 2018, 1005 swingers completed an online questionnaire that was advertised at Dutch swinger-websites. We assessed the associations between drug use during sex <6 months (any drug use excluding alcohol and erection medicines) and sociodemographic characteristics, alcohol use and condomless sex using backward multivariable logistic regression analysis. We compared drug use, motives, beliefs and experienced effects between heterosexual male, bisexual male and female drug-using swingers using χ2-tests.

Results Drug use during sex was reported by 44% (443/1005): 51% in women, 44% in bisexual men and 39% in heterosexual men (P<0.01). Condomless vaginal (46%) and anal sex (22%) was higher in drug-using swingers (vs 34% and 13% in non-drug-using swingers, P<0.001). Among drug-using swingers, XTC (92%), GHB (76%) and laughing gas (69%) were mostly used. Prolonging sex (68%) and increasing arousal (66%) were the most reported motives. Most reported positive effects were feeling happy (78%) and increasing energy (78%). Ninety-four per cent considered drug use to be pleasurable. The most reported negative effect was feeling tired (53%), 7% reported that they might become addicted or felt uncomfortable having sex without drugs.

Conclusion This study among a large group of swingers shows that drug use during sex is highly prevalent. STI clinics should discuss drug use during sex among swingers and provide information on safer sex and drug use, while acknowledging the perceived benefits, such as the increased quality of sex.

  • drug use during sex
  • swingers
  • beliefs
  • experienced effects
  • intention to quit

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  • Handling editor Joseph D Tucker

  • Contributors All authors were involved in the conception and design of the study. CK and FK produced the database, YE analyzed the data and wrote the first draft of the manuscript. CH, ND and GVL contributed to writing the paper. All authors were involved in the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was provided by the medical ethical committee of the Radboud University Medical Centre (study nr: 2018-4217). Data were registered in a fully anonymised and de-identified manner. To join the awarding of a dinner voucher of 50 euros, participants were directed to a separate survey where they could fill in their email address only for the use of sending the incentive.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.