Abstract Background The intersection of drug use, sexual pleasure and sexual risk behavior is rarely explored when it comes to poor women who use drugs. This paper explores the relationship between sexual behavior and methamphetamine use in a community-based sample of women, exploring not only risk, but also desire, pleasure and the challenges of overcoming trauma. Data were integrated for mixed methods analysis. Results While many participants reported sexual risk behavior unprotected vaginal or anal intercourse in the quantitative survey, sexual risk was not the central narrative pertaining to sexual behavior and methamphetamine use in qualitative findings. Rather, desire, pleasure and disinhibition arose as central themes. Findings were mixed on whether methamphetamine use increased sexual risk behavior. Conclusion The use of mixed methods afforded important insights into the sexual behavior and priorities of methamphetamine-using women.
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