<p>Background: Substance use disorders and risky sexual behavior coexist for some women. Explanatory models of women&#39;s sexuality in the context of substance use are under study. This study aimed to explore how women&rsquo;s sexual behavior can become risky in the context of substance use.<br /> Methods: In this ethnographic inquiry, 25 women with substance use disorders (SUDs) were included at two Drop-In-Centers (DICs) in South Tehran. Observation, semi-structured interviews and field notes were used to collect data. Qualitative content analysis was used to attain the explanatory model of women&rsquo;s sexual behaviors in the context of substance use.<br /> Results: Three major themes emerged from the data analysis regarding their lives in the context of substance use; 1) life in the context of drug abuse, 2) negative self-perception, and 3) strive to survive. Subthemes were identified as loss of contact with family, social stigma, self-forgetfulness, worthlessness, low self-efficacy, and unsafe sexual context.<br /> Conclusion: Findings suggest that women with SUDs are highly interwoven with women&rsquo;s sexual health, facilitating a shift towards risky behaviors. Integration of safe sexual skills building programs with substance use treatment is needed.</p>