diff --git a/pcsx2-gsrunner/Main.cpp b/pcsx2-gsrunner/Main.cpp
index cbe4f1e78c..4444e6cde3 100644
--- a/pcsx2-gsrunner/Main.cpp
+++ b/pcsx2-gsrunner/Main.cpp
@@ -107,7 +107,7 @@ bool GSRunner::InitializeConfig()
 
 	// complete as quickly as possible
 	si.SetBoolValue("EmuCore/GS", "FrameLimitEnable", false);
-	si.SetIntValue("EmuCore/GS", "VsyncEnable", static_cast<int>(VsyncMode::Off));
+	si.SetIntValue("EmuCore/GS", "VsyncEnable", false);
 
 	// ensure all input sources are disabled, we're not using them
 	si.SetBoolValue("InputSources", "SDL", false);
diff --git a/pcsx2/Config.h b/pcsx2/Config.h
index c8e1a4a333..12c4589730 100644
--- a/pcsx2/Config.h
+++ b/pcsx2/Config.h
@@ -190,13 +190,6 @@ enum class SpeedHack
 	MaxCount,
 };
 
-enum class VsyncMode
-{
-	Off,
-	On,
-	Adaptive,
-};
-
 enum class AspectRatioType : u8
 {
 	Stretch,
@@ -596,6 +589,8 @@ struct Pcsx2Config
 			struct
 			{
 				bool
+					SynchronousMTGS : 1,
+					VsyncEnable : 1,
 					PCRTCAntiBlur : 1,
 					DisableInterlaceOffset : 1,
 					PCRTCOffsets : 1,
@@ -618,9 +613,7 @@ struct Pcsx2Config
 					OsdShowIndicators : 1,
 					OsdShowSettings : 1,
 					OsdShowInputs : 1,
-					OsdShowFrameTimes : 1;
-
-				bool
+					OsdShowFrameTimes : 1,
 					HWSpinGPUForReadbacks : 1,
 					HWSpinCPUForReadbacks : 1,
 					GPUPaletteConversion : 1,
@@ -664,12 +657,6 @@ struct Pcsx2Config
 
 		int VsyncQueueSize = 2;
 
-		// forces the MTGS to execute tags/tasks in fully blocking/synchronous
-		// style. Useful for debugging potential bugs in the MTGS pipeline.
-		bool SynchronousMTGS = false;
-
-		VsyncMode VsyncEnable = VsyncMode::Off;
-
 		float FramerateNTSC = DEFAULT_FRAME_RATE_NTSC;
 		float FrameratePAL = DEFAULT_FRAME_RATE_PAL;
 
diff --git a/pcsx2/GS/GS.cpp b/pcsx2/GS/GS.cpp
index 9fa2c6f882..4b2f25e368 100644
--- a/pcsx2/GS/GS.cpp
+++ b/pcsx2/GS/GS.cpp
@@ -471,7 +471,7 @@ void GSPresentCurrentFrame()
 
 void GSThrottlePresentation()
 {
-	if (g_gs_device->GetVsyncMode() != VsyncMode::Off)
+	if (g_gs_device->IsVSyncEnabled())
 	{
 		// Let vsync take care of throttling.
 		return;
@@ -528,9 +528,9 @@ void GSUpdateDisplayWindow()
 	ImGuiManager::WindowResized();
 }
 
-void GSSetVSyncMode(VsyncMode mode)
+void GSSetVSyncEnabled(bool enabled)
 {
-	g_gs_device->SetVSync(mode);
+	g_gs_device->SetVSyncEnabled(enabled);
 }
 
 bool GSWantsExclusiveFullscreen()
diff --git a/pcsx2/GS/GS.h b/pcsx2/GS/GS.h
index 4b42cd32ef..efd1fdc03b 100644
--- a/pcsx2/GS/GS.h
+++ b/pcsx2/GS/GS.h
@@ -84,7 +84,7 @@ void GSSetDisplayAlignment(GSDisplayAlignment alignment);
 bool GSHasDisplayWindow();
 void GSResizeDisplayWindow(int width, int height, float scale);
 void GSUpdateDisplayWindow();
-void GSSetVSyncMode(VsyncMode mode);
+void GSSetVSyncEnabled(bool enabled);
 
 GSRendererType GSGetCurrentRenderer();
 bool GSIsHardwareRenderer();
@@ -127,7 +127,7 @@ namespace Host
 	void SetFullscreen(bool enabled);
 
 	/// Returns the desired vsync mode, depending on the runtime environment.
-	VsyncMode GetEffectiveVSyncMode();
+	bool IsVsyncEffectivelyEnabled();
 
 	/// Called when video capture starts or stops. Called on the MTGS thread.
 	void OnCaptureStarted(const std::string& filename);
diff --git a/pcsx2/GS/Renderers/Common/GSDevice.cpp b/pcsx2/GS/Renderers/Common/GSDevice.cpp
index d0b40b11d2..7e49535fe2 100644
--- a/pcsx2/GS/Renderers/Common/GSDevice.cpp
+++ b/pcsx2/GS/Renderers/Common/GSDevice.cpp
@@ -307,7 +307,7 @@ int GSDevice::GetMipmapLevelsForSize(int width, int height)
 
 bool GSDevice::Create()
 {
-	m_vsync_mode = Host::GetEffectiveVSyncMode();
+	m_vsync_enabled = Host::IsVsyncEffectivelyEnabled();
 	return true;
 }
 
diff --git a/pcsx2/GS/Renderers/Common/GSDevice.h b/pcsx2/GS/Renderers/Common/GSDevice.h
index c990f1683c..3003f079e2 100644
--- a/pcsx2/GS/Renderers/Common/GSDevice.h
+++ b/pcsx2/GS/Renderers/Common/GSDevice.h
@@ -803,7 +803,6 @@ protected:
 	static constexpr u32 EXPAND_BUFFER_SIZE = sizeof(u16) * 16383 * 6;
 
 	WindowInfo m_window_info;
-	VsyncMode m_vsync_mode = VsyncMode::Off;
 
 	GSTexture* m_imgui_font = nullptr;
 
@@ -824,6 +823,7 @@ protected:
 		u32 start, count;
 	} m_index = {};
 	unsigned int m_frame = 0; // for ageing the pool
+	bool m_vsync_enabled = false;
 	bool m_rbswapped = false;
 	FeatureSupport m_features;
 
@@ -874,7 +874,7 @@ public:
 	__fi s32 GetWindowHeight() const { return static_cast<s32>(m_window_info.surface_height); }
 	__fi GSVector2i GetWindowSize() const { return GSVector2i(static_cast<s32>(m_window_info.surface_width), static_cast<s32>(m_window_info.surface_height)); }
 	__fi float GetWindowScale() const { return m_window_info.surface_scale; }
-	__fi VsyncMode GetVsyncMode() const { return m_vsync_mode; }
+	__fi bool IsVSyncEnabled() const { return m_vsync_enabled; }
 
 	__fi GSTexture* GetCurrent() const { return m_current; }
 
@@ -915,7 +915,7 @@ public:
 	virtual void EndPresent() = 0;
 
 	/// Changes vsync mode for this display.
-	virtual void SetVSync(VsyncMode mode) = 0;
+	virtual void SetVSyncEnabled(bool enabled) = 0;
 
 	/// Returns the effective refresh rate of this display.
 	virtual bool GetHostRefreshRate(float* refresh_rate);
diff --git a/pcsx2/GS/Renderers/DX11/GSDevice11.cpp b/pcsx2/GS/Renderers/DX11/GSDevice11.cpp
index fa55574974..d4251a714f 100644
--- a/pcsx2/GS/Renderers/DX11/GSDevice11.cpp
+++ b/pcsx2/GS/Renderers/DX11/GSDevice11.cpp
@@ -628,9 +628,9 @@ bool GSDevice11::GetHostRefreshRate(float* refresh_rate)
 	return GSDevice::GetHostRefreshRate(refresh_rate);
 }
 
-void GSDevice11::SetVSync(VsyncMode mode)
+void GSDevice11::SetVSyncEnabled(bool enabled)
 {
-	m_vsync_mode = mode;
+	m_vsync_enabled = enabled;
 }
 
 bool GSDevice11::CreateSwapChain()
@@ -928,7 +928,7 @@ GSDevice::PresentResult GSDevice11::BeginPresent(bool frame_skip)
 	// This blows our our GPU usage number considerably, so read the timestamp before the final blit
 	// in this configuration. It does reduce accuracy a little, but better than seeing 100% all of
 	// the time, when it's more like a couple of percent.
-	if (m_vsync_mode != VsyncMode::Off && m_gpu_timing_enabled)
+	if (m_vsync_enabled && m_gpu_timing_enabled)
 		PopTimestampQuery();
 
 	m_ctx->ClearRenderTargetView(m_swap_chain_rtv.get(), s_present_clear_color.data());
@@ -957,14 +957,13 @@ void GSDevice11::EndPresent()
 	RenderImGui();
 
 	// See note in BeginPresent() for why it's conditional on vsync-off.
-	const bool vsync_on = m_vsync_mode != VsyncMode::Off;
-	if (!vsync_on && m_gpu_timing_enabled)
+	if (!m_vsync_enabled && m_gpu_timing_enabled)
 		PopTimestampQuery();
 
-	if (!vsync_on && m_using_allow_tearing)
+	if (!m_vsync_enabled && m_using_allow_tearing)
 		m_swap_chain->Present(0, DXGI_PRESENT_ALLOW_TEARING);
 	else
-		m_swap_chain->Present(static_cast<UINT>(vsync_on), 0);
+		m_swap_chain->Present(static_cast<UINT>(m_vsync_enabled), 0);
 
 	if (m_gpu_timing_enabled)
 		KickTimestampQuery();
diff --git a/pcsx2/GS/Renderers/DX11/GSDevice11.h b/pcsx2/GS/Renderers/DX11/GSDevice11.h
index 8a7777a3c2..d989981972 100644
--- a/pcsx2/GS/Renderers/DX11/GSDevice11.h
+++ b/pcsx2/GS/Renderers/DX11/GSDevice11.h
@@ -273,7 +273,7 @@ public:
 
 	bool GetHostRefreshRate(float* refresh_rate) override;
 
-	void SetVSync(VsyncMode mode) override;
+	void SetVSyncEnabled(bool enabled) override;
 
 	PresentResult BeginPresent(bool frame_skip) override;
 	void EndPresent() override;
diff --git a/pcsx2/GS/Renderers/DX12/GSDevice12.cpp b/pcsx2/GS/Renderers/DX12/GSDevice12.cpp
index 9294bfb0b4..28339275aa 100644
--- a/pcsx2/GS/Renderers/DX12/GSDevice12.cpp
+++ b/pcsx2/GS/Renderers/DX12/GSDevice12.cpp
@@ -774,9 +774,9 @@ bool GSDevice12::GetHostRefreshRate(float* refresh_rate)
 	return GSDevice::GetHostRefreshRate(refresh_rate);
 }
 
-void GSDevice12::SetVSync(VsyncMode mode)
+void GSDevice12::SetVSyncEnabled(bool enabled)
 {
-	m_vsync_mode = mode;
+	m_vsync_enabled = enabled;
 }
 
 bool GSDevice12::CreateSwapChain()
@@ -1109,11 +1109,10 @@ void GSDevice12::EndPresent()
 		return;
 	}
 
-	const bool vsync = static_cast<UINT>(m_vsync_mode != VsyncMode::Off);
-	if (!vsync && m_using_allow_tearing)
+	if (!m_vsync_enabled && m_using_allow_tearing)
 		m_swap_chain->Present(0, DXGI_PRESENT_ALLOW_TEARING);
 	else
-		m_swap_chain->Present(static_cast<UINT>(vsync), 0);
+		m_swap_chain->Present(static_cast<UINT>(m_vsync_enabled), 0);
 
 	InvalidateCachedState();
 }
diff --git a/pcsx2/GS/Renderers/DX12/GSDevice12.h b/pcsx2/GS/Renderers/DX12/GSDevice12.h
index 49abdf47b0..d04e6c51ab 100644
--- a/pcsx2/GS/Renderers/DX12/GSDevice12.h
+++ b/pcsx2/GS/Renderers/DX12/GSDevice12.h
@@ -409,7 +409,7 @@ public:
 
 	bool GetHostRefreshRate(float* refresh_rate) override;
 
-	void SetVSync(VsyncMode mode) override;
+	void SetVSyncEnabled(bool enabled) override;
 
 	PresentResult BeginPresent(bool frame_skip) override;
 	void EndPresent() override;
diff --git a/pcsx2/GS/Renderers/Metal/GSDeviceMTL.h b/pcsx2/GS/Renderers/Metal/GSDeviceMTL.h
index f99cd9b7c1..53b5805cce 100644
--- a/pcsx2/GS/Renderers/Metal/GSDeviceMTL.h
+++ b/pcsx2/GS/Renderers/Metal/GSDeviceMTL.h
@@ -392,7 +392,7 @@ public:
 
 	PresentResult BeginPresent(bool frame_skip) override;
 	void EndPresent() override;
-	void SetVSync(VsyncMode mode) override;
+	void SetVSyncEnabled(bool enabled) override;
 
 	bool GetHostRefreshRate(float* refresh_rate) override;
 
diff --git a/pcsx2/GS/Renderers/Metal/GSDeviceMTL.mm b/pcsx2/GS/Renderers/Metal/GSDeviceMTL.mm
index b9240682c1..fc6d00d250 100644
--- a/pcsx2/GS/Renderers/Metal/GSDeviceMTL.mm
+++ b/pcsx2/GS/Renderers/Metal/GSDeviceMTL.mm
@@ -877,7 +877,7 @@ bool GSDeviceMTL::Create()
 		{
 			AttachSurfaceOnMainThread();
 		});
-		[m_layer setDisplaySyncEnabled:m_vsync_mode != VsyncMode::Off];
+		[m_layer setDisplaySyncEnabled:m_vsync_enabled];
 	}
 	else
 	{
@@ -1305,7 +1305,7 @@ void GSDeviceMTL::EndPresent()
 	if (m_current_drawable)
 	{
 		const bool use_present_drawable = m_use_present_drawable == UsePresentDrawable::Always ||
-			(m_use_present_drawable == UsePresentDrawable::IfVsync && m_vsync_mode != VsyncMode::Off);
+			(m_use_present_drawable == UsePresentDrawable::IfVsync && m_vsync_enabled);
 
 		if (use_present_drawable)
 			[m_current_render_cmdbuf presentDrawable:m_current_drawable];
@@ -1367,13 +1367,13 @@ void GSDeviceMTL::EndPresent()
 	}
 }}
 
-void GSDeviceMTL::SetVSync(VsyncMode mode)
+void GSDeviceMTL::SetVSyncEnabled(bool enabled)
 {
-	if (m_vsync_mode == mode)
+	if (m_vsync_enabled == enabled)
 		return;
 
-	[m_layer setDisplaySyncEnabled:mode != VsyncMode::Off];
-	m_vsync_mode = mode;
+	[m_layer setDisplaySyncEnabled:enabled];
+	m_vsync_enabled = enabled;
 }
 
 bool GSDeviceMTL::GetHostRefreshRate(float* refresh_rate)
diff --git a/pcsx2/GS/Renderers/OpenGL/GLContext.h b/pcsx2/GS/Renderers/OpenGL/GLContext.h
index cef1458e37..b75e7217d0 100644
--- a/pcsx2/GS/Renderers/OpenGL/GLContext.h
+++ b/pcsx2/GS/Renderers/OpenGL/GLContext.h
@@ -35,6 +35,7 @@ public:
 	virtual bool IsCurrent() = 0;
 	virtual bool MakeCurrent() = 0;
 	virtual bool DoneCurrent() = 0;
+	virtual bool SupportsNegativeSwapInterval() const = 0;
 	virtual bool SetSwapInterval(s32 interval) = 0;
 	virtual std::unique_ptr<GLContext> CreateSharedContext(const WindowInfo& wi, Error* error) = 0;
 
diff --git a/pcsx2/GS/Renderers/OpenGL/GLContextEGL.cpp b/pcsx2/GS/Renderers/OpenGL/GLContextEGL.cpp
index 69f5948364..b905f02856 100644
--- a/pcsx2/GS/Renderers/OpenGL/GLContextEGL.cpp
+++ b/pcsx2/GS/Renderers/OpenGL/GLContextEGL.cpp
@@ -312,6 +312,11 @@ bool GLContextEGL::DoneCurrent()
 	return eglMakeCurrent(m_display, EGL_NO_SURFACE, EGL_NO_SURFACE, EGL_NO_CONTEXT);
 }
 
+bool GLContextEGL::SupportsNegativeSwapInterval() const
+{
+	return m_supports_negative_swap_interval;
+}
+
 bool GLContextEGL::SetSwapInterval(s32 interval)
 {
 	return eglSwapInterval(m_display, interval);
@@ -492,6 +497,19 @@ bool GLContextEGL::CreateContext(const Version& version, EGLContext share_contex
 	}
 
 	Console.WriteLnFmt("Got GL version {}.{}", version.major_version, version.minor_version);
+
+	EGLint min_swap_interval, max_swap_interval;
+	m_supports_negative_swap_interval = false;
+	if (eglGetConfigAttrib(m_display, config.value(), EGL_MIN_SWAP_INTERVAL, &min_swap_interval) &&
+		eglGetConfigAttrib(m_display, config.value(), EGL_MAX_SWAP_INTERVAL, &max_swap_interval))
+	{
+		DEV_LOG("EGL_MIN_SWAP_INTERVAL = {}", min_swap_interval);
+		DEV_LOG("EGL_MAX_SWAP_INTERVAL = {}", max_swap_interval);
+		m_supports_negative_swap_interval = (min_swap_interval <= -1);
+	}
+
+	INFO_LOG("Negative swap interval/tear-control is {}supported", m_supports_negative_swap_interval ? "" : "NOT ");
+
 	m_config = config.value();
 	m_version = version;
 	return true;
diff --git a/pcsx2/GS/Renderers/OpenGL/GLContextEGL.h b/pcsx2/GS/Renderers/OpenGL/GLContextEGL.h
index 23ef99eb9c..52eeb571eb 100644
--- a/pcsx2/GS/Renderers/OpenGL/GLContextEGL.h
+++ b/pcsx2/GS/Renderers/OpenGL/GLContextEGL.h
@@ -24,6 +24,7 @@ public:
 	bool IsCurrent() override;
 	bool MakeCurrent() override;
 	bool DoneCurrent() override;
+	bool SupportsNegativeSwapInterval() const override;
 	bool SetSwapInterval(s32 interval) override;
 	virtual std::unique_ptr<GLContext> CreateSharedContext(const WindowInfo& wi, Error* error) override;
 
@@ -52,4 +53,5 @@ protected:
 	EGLConfig m_config = {};
 
 	bool m_use_ext_platform_base = false;
+	bool m_supports_negative_swap_interval = false;
 };
diff --git a/pcsx2/GS/Renderers/OpenGL/GLContextWGL.cpp b/pcsx2/GS/Renderers/OpenGL/GLContextWGL.cpp
index 0ba43519a4..6a75e3885c 100644
--- a/pcsx2/GS/Renderers/OpenGL/GLContextWGL.cpp
+++ b/pcsx2/GS/Renderers/OpenGL/GLContextWGL.cpp
@@ -152,6 +152,11 @@ bool GLContextWGL::DoneCurrent()
 	return wglMakeCurrent(m_dc, nullptr);
 }
 
+bool GLContextWGL::SupportsNegativeSwapInterval() const
+{
+	return GLAD_WGL_EXT_swap_control && GLAD_WGL_EXT_swap_control_tear;
+}
+
 bool GLContextWGL::SetSwapInterval(s32 interval)
 {
 	if (!GLAD_WGL_EXT_swap_control)
diff --git a/pcsx2/GS/Renderers/OpenGL/GLContextWGL.h b/pcsx2/GS/Renderers/OpenGL/GLContextWGL.h
index bea67f891b..aa19ef551b 100644
--- a/pcsx2/GS/Renderers/OpenGL/GLContextWGL.h
+++ b/pcsx2/GS/Renderers/OpenGL/GLContextWGL.h
@@ -27,6 +27,7 @@ public:
 	bool IsCurrent() override;
 	bool MakeCurrent() override;
 	bool DoneCurrent() override;
+	bool SupportsNegativeSwapInterval() const override;
 	bool SetSwapInterval(s32 interval) override;
 	std::unique_ptr<GLContext> CreateSharedContext(const WindowInfo& wi, Error* error) override;
 
diff --git a/pcsx2/GS/Renderers/OpenGL/GSDeviceOGL.cpp b/pcsx2/GS/Renderers/OpenGL/GSDeviceOGL.cpp
index 43ec942a60..a4cb000372 100644
--- a/pcsx2/GS/Renderers/OpenGL/GSDeviceOGL.cpp
+++ b/pcsx2/GS/Renderers/OpenGL/GSDeviceOGL.cpp
@@ -146,21 +146,13 @@ bool GSDeviceOGL::HasSurface() const
 	return m_window_info.type != WindowInfo::Type::Surfaceless;
 }
 
-void GSDeviceOGL::SetVSync(VsyncMode mode)
+void GSDeviceOGL::SetVSyncEnabled(bool enabled)
 {
-	if (m_vsync_mode == mode || m_gl_context->GetWindowInfo().type == WindowInfo::Type::Surfaceless)
+	if (m_vsync_enabled == enabled)
 		return;
 
-	// Window framebuffer has to be bound to call SetSwapInterval.
-	GLint current_fbo = 0;
-	glGetIntegerv(GL_DRAW_FRAMEBUFFER_BINDING, &current_fbo);
-	glBindFramebuffer(GL_DRAW_FRAMEBUFFER, 0);
-
-	if (mode != VsyncMode::Adaptive || !m_gl_context->SetSwapInterval(-1))
-		m_gl_context->SetSwapInterval(static_cast<s32>(mode != VsyncMode::Off));
-
-	glBindFramebuffer(GL_DRAW_FRAMEBUFFER, current_fbo);
-	m_vsync_mode = mode;
+	m_vsync_enabled = enabled;
+	SetSwapInterval();
 }
 
 bool GSDeviceOGL::Create()
@@ -777,8 +769,19 @@ bool GSDeviceOGL::CheckFeatures(bool& buggy_pbo)
 
 void GSDeviceOGL::SetSwapInterval()
 {
-	const int interval = ((m_vsync_mode == VsyncMode::Adaptive) ? -1 : ((m_vsync_mode == VsyncMode::On) ? 1 : 0));
-	m_gl_context->SetSwapInterval(interval);
+	if (m_window_info.type == WindowInfo::Type::Surfaceless)
+		return;
+
+	// Window framebuffer has to be bound to call SetSwapInterval.
+	const s32 interval = m_vsync_enabled ? (m_gl_context->SupportsNegativeSwapInterval() ? -1 : 1) : 0;
+	GLint current_fbo = 0;
+	glGetIntegerv(GL_DRAW_FRAMEBUFFER_BINDING, &current_fbo);
+	glBindFramebuffer(GL_DRAW_FRAMEBUFFER, 0);
+
+	if (!m_gl_context->SetSwapInterval(interval))
+		WARNING_LOG("Failed to set swap interval to {}", interval);
+
+	glBindFramebuffer(GL_DRAW_FRAMEBUFFER, current_fbo);
 }
 
 void GSDeviceOGL::DestroyResources()
@@ -868,9 +871,7 @@ bool GSDeviceOGL::UpdateWindow()
 	if (m_window_info.type != WindowInfo::Type::Surfaceless)
 	{
 		// reset vsync rate, since it (usually) gets lost
-		if (m_vsync_mode != VsyncMode::Adaptive || !m_gl_context->SetSwapInterval(-1))
-			m_gl_context->SetSwapInterval(static_cast<s32>(m_vsync_mode != VsyncMode::Off));
-
+		SetSwapInterval();
 		RenderBlankFrame();
 	}
 
diff --git a/pcsx2/GS/Renderers/OpenGL/GSDeviceOGL.h b/pcsx2/GS/Renderers/OpenGL/GSDeviceOGL.h
index f49a8b98e8..a30de2d1cf 100644
--- a/pcsx2/GS/Renderers/OpenGL/GSDeviceOGL.h
+++ b/pcsx2/GS/Renderers/OpenGL/GSDeviceOGL.h
@@ -292,7 +292,7 @@ public:
 	void DestroySurface() override;
 	std::string GetDriverInfo() const override;
 
-	void SetVSync(VsyncMode mode) override;
+	void SetVSyncEnabled(bool enabled) override;
 
 	PresentResult BeginPresent(bool frame_skip) override;
 	void EndPresent() override;
diff --git a/pcsx2/GS/Renderers/Vulkan/GSDeviceVK.cpp b/pcsx2/GS/Renderers/Vulkan/GSDeviceVK.cpp
index 2f523fc189..676fabb06f 100644
--- a/pcsx2/GS/Renderers/Vulkan/GSDeviceVK.cpp
+++ b/pcsx2/GS/Renderers/Vulkan/GSDeviceVK.cpp
@@ -2222,7 +2222,7 @@ bool GSDeviceVK::UpdateWindow()
 		return false;
 	}
 
-	m_swap_chain = VKSwapChain::Create(m_window_info, surface, m_vsync_mode,
+	m_swap_chain = VKSwapChain::Create(m_window_info, surface, m_vsync_enabled,
 		Pcsx2Config::GSOptions::TriStateToOptionalBoolean(GSConfig.ExclusiveFullscreenControl));
 	if (!m_swap_chain)
 	{
@@ -2297,24 +2297,27 @@ std::string GSDeviceVK::GetDriverInfo() const
 	return ret;
 }
 
-void GSDeviceVK::SetVSync(VsyncMode mode)
+void GSDeviceVK::SetVSyncEnabled(bool enabled)
 {
-	if (!m_swap_chain || m_vsync_mode == mode)
+	if (!m_swap_chain || m_vsync_enabled == enabled)
+	{
+		m_vsync_enabled = enabled;
 		return;
+	}
 
 	// This swap chain should not be used by the current buffer, thus safe to destroy.
 	WaitForGPUIdle();
-	if (!m_swap_chain->SetVSync(mode))
+	if (!m_swap_chain->SetVSyncEnabled(enabled))
 	{
 		// Try switching back to the old mode..
-		if (!m_swap_chain->SetVSync(m_vsync_mode))
+		if (!m_swap_chain->SetVSyncEnabled(m_vsync_enabled))
 		{
 			pxFailRel("Failed to reset old vsync mode after failure");
 			m_swap_chain.reset();
 		}
 	}
 
-	m_vsync_mode = mode;
+	m_vsync_enabled = enabled;
 }
 
 GSDevice::PresentResult GSDeviceVK::BeginPresent(bool frame_skip)
@@ -2613,7 +2616,7 @@ bool GSDeviceVK::CreateDeviceAndSwapChain()
 
 	if (surface != VK_NULL_HANDLE)
 	{
-		m_swap_chain = VKSwapChain::Create(m_window_info, surface, m_vsync_mode,
+		m_swap_chain = VKSwapChain::Create(m_window_info, surface, m_vsync_enabled,
 			Pcsx2Config::GSOptions::TriStateToOptionalBoolean(GSConfig.ExclusiveFullscreenControl));
 		if (!m_swap_chain)
 		{
diff --git a/pcsx2/GS/Renderers/Vulkan/GSDeviceVK.h b/pcsx2/GS/Renderers/Vulkan/GSDeviceVK.h
index 6fff081482..94f82157bd 100644
--- a/pcsx2/GS/Renderers/Vulkan/GSDeviceVK.h
+++ b/pcsx2/GS/Renderers/Vulkan/GSDeviceVK.h
@@ -524,7 +524,7 @@ public:
 	void DestroySurface() override;
 	std::string GetDriverInfo() const override;
 
-	void SetVSync(VsyncMode mode) override;
+	void SetVSyncEnabled(bool enabled) override;
 
 	PresentResult BeginPresent(bool frame_skip) override;
 	void EndPresent() override;
diff --git a/pcsx2/GS/Renderers/Vulkan/VKSwapChain.cpp b/pcsx2/GS/Renderers/Vulkan/VKSwapChain.cpp
index f0f3f05426..fc296ba20b 100644
--- a/pcsx2/GS/Renderers/Vulkan/VKSwapChain.cpp
+++ b/pcsx2/GS/Renderers/Vulkan/VKSwapChain.cpp
@@ -18,11 +18,11 @@
 #endif
 
 VKSwapChain::VKSwapChain(
-	const WindowInfo& wi, VkSurfaceKHR surface, VsyncMode vsync, std::optional<bool> exclusive_fullscreen_control)
+	const WindowInfo& wi, VkSurfaceKHR surface, bool vsync, std::optional<bool> exclusive_fullscreen_control)
 	: m_window_info(wi)
 	, m_surface(surface)
-	, m_vsync_mode(vsync)
 	, m_exclusive_fullscreen_control(exclusive_fullscreen_control)
+	, m_vsync_enabled(vsync)
 {
 }
 
@@ -135,7 +135,7 @@ void VKSwapChain::DestroyVulkanSurface(VkInstance instance, WindowInfo* wi, VkSu
 }
 
 std::unique_ptr<VKSwapChain> VKSwapChain::Create(
-	const WindowInfo& wi, VkSurfaceKHR surface, VsyncMode vsync, std::optional<bool> exclusive_fullscreen_control)
+	const WindowInfo& wi, VkSurfaceKHR surface, bool vsync, std::optional<bool> exclusive_fullscreen_control)
 {
 	std::unique_ptr<VKSwapChain> swap_chain =
 		std::unique_ptr<VKSwapChain>(new VKSwapChain(wi, surface, vsync, exclusive_fullscreen_control));
@@ -226,17 +226,7 @@ static const char* PresentModeToString(VkPresentModeKHR mode)
 	}
 }
 
-static VkPresentModeKHR GetPreferredPresentModeForVsyncMode(VsyncMode mode)
-{
-	if (mode == VsyncMode::On)
-		return VK_PRESENT_MODE_FIFO_KHR;
-	else if (mode == VsyncMode::Adaptive)
-		return VK_PRESENT_MODE_FIFO_RELAXED_KHR;
-	else
-		return VK_PRESENT_MODE_IMMEDIATE_KHR;
-}
-
-std::optional<VkPresentModeKHR> VKSwapChain::SelectPresentMode(VkSurfaceKHR surface, VsyncMode vsync)
+std::optional<VkPresentModeKHR> VKSwapChain::SelectPresentMode(VkSurfaceKHR surface, VkPresentModeKHR requested_mode)
 {
 	VkResult res;
 	u32 mode_count;
@@ -260,31 +250,30 @@ std::optional<VkPresentModeKHR> VKSwapChain::SelectPresentMode(VkSurfaceKHR surf
 		return it != present_modes.end();
 	};
 
-	// Use preferred mode if available.
-	const VkPresentModeKHR preferred_mode = GetPreferredPresentModeForVsyncMode(vsync);
-	VkPresentModeKHR selected_mode;
-	if (CheckForMode(preferred_mode))
-	{
-		selected_mode = preferred_mode;
-	}
-	else if (vsync != VsyncMode::On && CheckForMode(VK_PRESENT_MODE_MAILBOX_KHR))
-	{
-		// Prefer mailbox over fifo for adaptive vsync/no-vsync.
-		selected_mode = VK_PRESENT_MODE_MAILBOX_KHR;
-	}
-	else if (vsync != VsyncMode::Off && CheckForMode(VK_PRESENT_MODE_FIFO_KHR))
-	{
-		// Fallback to FIFO if we're using any kind of vsync.
-		// This should never fail, FIFO is mandated.
-		selected_mode = VK_PRESENT_MODE_FIFO_KHR;
-	}
-	else
-	{
-		// Fall back to whatever is available.
-		selected_mode = present_modes[0];
-	}
+  // Use preferred mode if available.
+  VkPresentModeKHR selected_mode;
+  if (CheckForMode(requested_mode))
+  {
+    selected_mode = requested_mode;
+  }
+  else if (requested_mode != VK_PRESENT_MODE_FIFO_KHR && CheckForMode(VK_PRESENT_MODE_MAILBOX_KHR))
+  {
+    // Prefer mailbox over fifo for adaptive vsync/no-vsync. This way it'll only delay one frame.
+    selected_mode = VK_PRESENT_MODE_MAILBOX_KHR;
+  }
+  else if (requested_mode == VK_PRESENT_MODE_FIFO_RELAXED_KHR && CheckForMode(VK_PRESENT_MODE_FIFO_KHR))
+  {
+    // Fallback to FIFO if we're using any kind of vsync.
+    // This should never fail, FIFO is mandated.
+    selected_mode = VK_PRESENT_MODE_FIFO_KHR;
+  }
+  else
+  {
+    // Fall back to whatever is available.
+    selected_mode = present_modes[0];
+  }
 
-	DevCon.WriteLn("(SwapChain) Preferred present mode: %s, selected: %s", PresentModeToString(preferred_mode),
+	DevCon.WriteLn("(SwapChain) Preferred present mode: %s, selected: %s", PresentModeToString(requested_mode),
 		PresentModeToString(selected_mode));
 
 	return selected_mode;
@@ -294,7 +283,11 @@ bool VKSwapChain::CreateSwapChain()
 {
 	// Select swap chain format and present mode
 	std::optional<VkSurfaceFormatKHR> surface_format = SelectSurfaceFormat(m_surface);
-	std::optional<VkPresentModeKHR> present_mode = SelectPresentMode(m_surface, m_vsync_mode);
+
+	// Prefer relaxed vsync if available, stalling is bad.
+	const VkPresentModeKHR requested_mode =
+		m_vsync_enabled ? VK_PRESENT_MODE_FIFO_RELAXED_KHR : VK_PRESENT_MODE_IMMEDIATE_KHR;
+	std::optional<VkPresentModeKHR> present_mode = SelectPresentMode(m_surface, requested_mode);
 	if (!surface_format.has_value() || !present_mode.has_value())
 		return false;
 
@@ -414,6 +407,7 @@ bool VKSwapChain::CreateSwapChain()
 
 	m_window_info.surface_width = std::max(1u, size.width);
 	m_window_info.surface_height = std::max(1u, size.height);
+	m_actual_present_mode = present_mode.value();
 
 	// Get and create images.
 	pxAssert(m_images.empty());
@@ -558,12 +552,12 @@ bool VKSwapChain::ResizeSwapChain(u32 new_width, u32 new_height, float new_scale
 	return true;
 }
 
-bool VKSwapChain::SetVSync(VsyncMode mode)
+bool VKSwapChain::SetVSyncEnabled(bool enabled)
 {
-	if (m_vsync_mode == mode)
+	if (m_vsync_enabled == enabled)
 		return true;
 
-	m_vsync_mode = mode;
+	m_vsync_enabled = enabled;
 
 	// Recreate the swap chain with the new present mode.
 	DevCon.WriteLn("Recreating swap chain to change present mode.");
diff --git a/pcsx2/GS/Renderers/Vulkan/VKSwapChain.h b/pcsx2/GS/Renderers/Vulkan/VKSwapChain.h
index b359e879cb..5a1fdfbe5d 100644
--- a/pcsx2/GS/Renderers/Vulkan/VKSwapChain.h
+++ b/pcsx2/GS/Renderers/Vulkan/VKSwapChain.h
@@ -25,7 +25,7 @@ public:
 
 	// Create a new swap chain from a pre-existing surface.
 	static std::unique_ptr<VKSwapChain> Create(
-		const WindowInfo& wi, VkSurfaceKHR surface, VsyncMode vsync, std::optional<bool> exclusive_fullscreen_control);
+		const WindowInfo& wi, VkSurfaceKHR surface, bool vsync, std::optional<bool> exclusive_fullscreen_control);
 
 	__fi VkSurfaceKHR GetSurface() const { return m_surface; }
 	__fi VkSwapchainKHR GetSwapChain() const { return m_swap_chain; }
@@ -57,7 +57,11 @@ public:
 	}
 
 	// Returns true if the current present mode is synchronizing (adaptive or hard).
-	__fi bool IsPresentModeSynchronizing() const { return (m_vsync_mode != VsyncMode::Off); }
+	__fi bool IsPresentModeSynchronizing() const
+	{
+		return (m_actual_present_mode == VK_PRESENT_MODE_FIFO_KHR ||
+				m_actual_present_mode == VK_PRESENT_MODE_FIFO_RELAXED_KHR);
+	}
 
 	VkFormat GetTextureFormat() const;
 	VkResult AcquireNextImage();
@@ -67,14 +71,14 @@ public:
 	bool ResizeSwapChain(u32 new_width = 0, u32 new_height = 0, float new_scale = 1.0f);
 
 	// Change vsync enabled state. This may fail as it causes a swapchain recreation.
-	bool SetVSync(VsyncMode mode);
+	bool SetVSyncEnabled(bool enabled);
 
 private:
 	VKSwapChain(
-		const WindowInfo& wi, VkSurfaceKHR surface, VsyncMode vsync, std::optional<bool> exclusive_fullscreen_control);
+		const WindowInfo& wi, VkSurfaceKHR surface, bool vsync, std::optional<bool> exclusive_fullscreen_control);
 
 	static std::optional<VkSurfaceFormatKHR> SelectSurfaceFormat(VkSurfaceKHR surface);
-	static std::optional<VkPresentModeKHR> SelectPresentMode(VkSurfaceKHR surface, VsyncMode vsync);
+	static std::optional<VkPresentModeKHR> SelectPresentMode(VkSurfaceKHR surface, VkPresentModeKHR requested_mode);
 
 	bool CreateSwapChain();
 	void DestroySwapChain();
@@ -98,10 +102,11 @@ private:
 	std::vector<std::unique_ptr<GSTextureVK>> m_images;
 	std::vector<ImageSemaphores> m_semaphores;
 
-	VsyncMode m_vsync_mode = VsyncMode::Off;
+	VkPresentModeKHR m_actual_present_mode = VK_PRESENT_MODE_IMMEDIATE_KHR;
 	u32 m_current_image = 0;
 	u32 m_current_semaphore = 0;
 
 	std::optional<VkResult> m_image_acquire_result;
 	std::optional<bool> m_exclusive_fullscreen_control;
+	bool m_vsync_enabled = false;
 };
diff --git a/pcsx2/Host.h b/pcsx2/Host.h
index 847cb9548e..0eb469d54d 100644
--- a/pcsx2/Host.h
+++ b/pcsx2/Host.h
@@ -16,8 +16,6 @@
 #include <string_view>
 #include <vector>
 
-enum class VsyncMode;
-
 class SettingsInterface;
 
 namespace Host
diff --git a/pcsx2/ImGui/FullscreenUI.cpp b/pcsx2/ImGui/FullscreenUI.cpp
index f876ed2b64..a03367aad9 100644
--- a/pcsx2/ImGui/FullscreenUI.cpp
+++ b/pcsx2/ImGui/FullscreenUI.cpp
@@ -3482,11 +3482,6 @@ void FullscreenUI::DrawGraphicsSettingsPage(SettingsInterface* bsi, bool show_ad
 		"13", //GSRendererType::SW,
 		"11", //GSRendererType::Null
 	};
-	static constexpr const char* s_vsync_values[] = {
-		FSUI_NSTR("Off"),
-		FSUI_NSTR("On"),
-		FSUI_NSTR("Adaptive"),
-	};
 	static constexpr const char* s_bilinear_present_options[] = {
 		FSUI_NSTR("Off"),
 		FSUI_NSTR("Bilinear (Smooth)"),
@@ -3621,8 +3616,8 @@ void FullscreenUI::DrawGraphicsSettingsPage(SettingsInterface* bsi, bool show_ad
 	MenuHeading(FSUI_CSTR("Renderer"));
 	DrawStringListSetting(bsi, FSUI_CSTR("Renderer"), FSUI_CSTR("Selects the API used to render the emulated GS."), "EmuCore/GS",
 		"Renderer", "-1", s_renderer_names, s_renderer_values, std::size(s_renderer_names), true);
-	DrawIntListSetting(bsi, FSUI_CSTR("Sync To Host Refresh (VSync)"), FSUI_CSTR("Synchronizes frame presentation with host refresh."),
-		"EmuCore/GS", "VsyncEnable", static_cast<int>(VsyncMode::Off), s_vsync_values, std::size(s_vsync_values), true);
+	DrawToggleSetting(bsi, FSUI_CSTR("Sync To Host Refresh (VSync)"), FSUI_CSTR("Synchronizes frame presentation with host refresh."),
+		"EmuCore/GS", "VsyncEnable", false);
 
 	MenuHeading(FSUI_CSTR("Display"));
 	DrawStringListSetting(bsi, FSUI_CSTR("Aspect Ratio"), FSUI_CSTR("Selects the aspect ratio to display the game content at."),
@@ -7410,8 +7405,6 @@ TRANSLATE_NOOP("FullscreenUI", "Metal");
 TRANSLATE_NOOP("FullscreenUI", "Software");
 TRANSLATE_NOOP("FullscreenUI", "Null");
 TRANSLATE_NOOP("FullscreenUI", "Off");
-TRANSLATE_NOOP("FullscreenUI", "On");
-TRANSLATE_NOOP("FullscreenUI", "Adaptive");
 TRANSLATE_NOOP("FullscreenUI", "Bilinear (Smooth)");
 TRANSLATE_NOOP("FullscreenUI", "Bilinear (Sharp)");
 TRANSLATE_NOOP("FullscreenUI", "No Deinterlacing");
diff --git a/pcsx2/MTGS.cpp b/pcsx2/MTGS.cpp
index 757025af86..b7579b9e86 100644
--- a/pcsx2/MTGS.cpp
+++ b/pcsx2/MTGS.cpp
@@ -931,7 +931,7 @@ void MTGS::ApplySettings()
 
 	RunOnGSThread([opts = EmuConfig.GS]() {
 		GSUpdateConfig(opts);
-		GSSetVSyncMode(Host::GetEffectiveVSyncMode());
+		GSSetVSyncEnabled(Host::IsVsyncEffectivelyEnabled());
 	});
 
 	// We need to synchronize the thread when changing any settings when the download mode
@@ -970,19 +970,19 @@ void MTGS::UpdateDisplayWindow()
 	});
 }
 
-void MTGS::SetVSyncMode(VsyncMode mode)
+void MTGS::SetVSyncEnabled(bool enabled)
 {
 	pxAssertRel(IsOpen(), "MTGS is running");
 
-	RunOnGSThread([mode]() {
-		Console.WriteLn("Vsync is %s", mode == VsyncMode::Off ? "OFF" : (mode == VsyncMode::Adaptive ? "ADAPTIVE" : "ON"));
-		GSSetVSyncMode(mode);
+	RunOnGSThread([enabled]() {
+		INFO_LOG("Vsync is {}", enabled ? "ON" : "OFF");
+		GSSetVSyncEnabled(enabled);
 	});
 }
 
-void MTGS::UpdateVSyncMode()
+void MTGS::UpdateVSyncEnabled()
 {
-	SetVSyncMode(Host::GetEffectiveVSyncMode());
+	SetVSyncEnabled(Host::IsVsyncEffectivelyEnabled());
 }
 
 void MTGS::SetSoftwareRendering(bool software, GSInterlaceMode interlace, bool display_message /* = true */)
diff --git a/pcsx2/MTGS.h b/pcsx2/MTGS.h
index 6f2cb77773..0921f8e310 100644
--- a/pcsx2/MTGS.h
+++ b/pcsx2/MTGS.h
@@ -70,8 +70,8 @@ namespace MTGS
 	void ApplySettings();
 	void ResizeDisplayWindow(int width, int height, float scale);
 	void UpdateDisplayWindow();
-	void SetVSyncMode(VsyncMode mode);
-	void UpdateVSyncMode();
+	void SetVSyncEnabled(bool enabled);
+	void UpdateVSyncEnabled();
 	void SetSoftwareRendering(bool software, GSInterlaceMode interlace, bool display_message = true);
 	void ToggleSoftwareRendering();
 	bool SaveMemorySnapshot(u32 window_width, u32 window_height, bool apply_aspect, bool crop_borders,
diff --git a/pcsx2/Pcsx2Config.cpp b/pcsx2/Pcsx2Config.cpp
index 5a89e24009..86b6ae3a1c 100644
--- a/pcsx2/Pcsx2Config.cpp
+++ b/pcsx2/Pcsx2Config.cpp
@@ -793,11 +793,12 @@ void Pcsx2Config::GSOptions::LoadSave(SettingsWrapper& wrap)
 	SettingsWrapSection("EmuCore/GS");
 
 #ifdef PCSX2_DEVBUILD
-	SettingsWrapEntry(SynchronousMTGS);
+	SettingsWrapBitBool(SynchronousMTGS);
 #endif
-	SettingsWrapEntry(VsyncQueueSize);
 
-	wrap.EnumEntry(CURRENT_SETTINGS_SECTION, "VsyncEnable", VsyncEnable, NULL, VsyncEnable);
+	SettingsWrapBitBool(VsyncEnable);
+
+	SettingsWrapEntry(VsyncQueueSize);
 
 	SettingsWrapEntry(FramerateNTSC);
 	SettingsWrapEntry(FrameratePAL);
diff --git a/pcsx2/VMManager.cpp b/pcsx2/VMManager.cpp
index e3bde50353..88c8550121 100644
--- a/pcsx2/VMManager.cpp
+++ b/pcsx2/VMManager.cpp
@@ -2004,7 +2004,7 @@ double VMManager::AdjustToHostRefreshRate(float frame_rate, float target_speed)
 	const float ratio = host_refresh_rate / frame_rate;
 	const bool syncing_to_host = (ratio >= 0.95f && ratio <= 1.05f);
 	s_target_speed_synced_to_host = syncing_to_host;
-	s_use_vsync_for_timing = (syncing_to_host && !EmuConfig.GS.SkipDuplicateFrames && EmuConfig.GS.VsyncEnable != VsyncMode::Off);
+	s_use_vsync_for_timing = (syncing_to_host && !EmuConfig.GS.SkipDuplicateFrames && EmuConfig.GS.VsyncEnable);
 	Console.WriteLn("Refresh rate: Host=%fhz Guest=%fhz Ratio=%f - %s %s", host_refresh_rate, frame_rate, ratio,
 		syncing_to_host ? "can sync" : "can't sync", s_use_vsync_for_timing ? "and using vsync for pacing" : "and using sleep for pacing");
 
@@ -2051,7 +2051,7 @@ void VMManager::UpdateTargetSpeed()
 	{
 		s_target_speed = target_speed;
 
-		MTGS::UpdateVSyncMode();
+		MTGS::UpdateVSyncEnabled();
 		SPU2::OnTargetSpeedChanged();
 		ResetFrameLimiter();
 	}
@@ -2546,13 +2546,13 @@ void VMManager::SetPaused(bool paused)
 	SetState(paused ? VMState::Paused : VMState::Running);
 }
 
-VsyncMode Host::GetEffectiveVSyncMode()
+bool Host::IsVsyncEffectivelyEnabled()
 {
 	const bool has_vm = VMManager::GetState() != VMState::Shutdown;
 
 	// Force vsync off when not running at 100% speed.
 	if (has_vm && (s_target_speed != 1.0f && !s_use_vsync_for_timing))
-		return VsyncMode::Off;
+		return false;
 
 	// Otherwise use the config setting.
 	return EmuConfig.GS.VsyncEnable;
@@ -2739,6 +2739,7 @@ void VMManager::CheckForGSConfigChanges(const Pcsx2Config& old_config)
 	{
 		// Still need to update target speed, because of sync-to-host-refresh.
 		UpdateTargetSpeed();
+		MTGS::UpdateVSyncEnabled();
 	}
 
 	MTGS::ApplySettings();