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Try out PMC Labs and tell us what you think. Learn More. Classic and contemporary approaches to the assessment of female sexuality are discussed.


Asking the right questions may uncover serious problems Jennifer P. Addiction to sexual activities can be just as destructive as addiction to chemical substances. Addicts may jeopardize their marriage and family relationships, allow their job performance to deteriorate, and endanger themselves and their partner through multiple sexual exposures. Even though they realize the consequences, they cannot control their compulsions without appropriate treatment. The author explains how to spot addicts and coaddicts among your patients.

For most people, sex enhances the quality of life. Through their addiction, they may injure themselves physically, experience psychological distress, lose their livelihood, and ruin meaningful relationships. Sexual addiction often coexists with chemical dependency, and untreated sexual addiction contributes to relapse to chemical use. These patients not only endanger themselves but also put their loved ones at risk Adult searching orgasm Washington AIDS and other sexually transmitted diseases.

Physicians can help by learning about this phenomenon, which is gaining increasing attention in behavioral medicine, and then educating these patients and their families. The concept of sexual addiction was introduced less than 10 years ago 2.

It not only provides an explanation for otherwise irrational behavior but also suggests effective treatment for patients who have not been helped by more traditional therapy. The presence of three establishes the diagnosis. Most of the criteria concern behavior: Two indicate decreased control, one. These criteria can be used to diagnose other addictions as well.

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Goodman 4 proposed a set of diagnostic criteria for addictive disorder that may be modified and applied to sexual behavior table2. Any behavior that is used to produce gratification and escape internal discomfort can be engaged in compulsively and can constitute an addictive disorder. Compulsive gambling 5spending, and overeating meet these criteria as well.

Characteristic findings of any addictive disorder are the following: Compulsivity, that is, loss of the ability to choose freely whether to stop or to continue. Continuation of the behavior despite adverse consequences, such as loss of health, job, marriage, or freedom. Obsession with the activity.

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All of the patients in the following illustrative case reports exhibited these findings. This activity consumed several hours a day. His primary outlet was sex with multiple anonymous partners. When he learned that the majority of gay men in his city had tested positive for the human immunodeficiency virus HIVhe began to worry constantly about his risk of contracting AIDS.

Still, he was unable to change his unsafe sexual practices despite repeated promises to himself to do so.

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CASE 2 : A year-old married minister had a year history of sexual involvement with female parishioners who came to him for counseling. Overcome by remorse and guilt, he promised to break off with the women. However, he was unable to avoid new involvements. After several women came forward with their stories, the minister was fired, evicted from his church-owned house, and publicly humiliated.

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He and his wife moved to another state, where she supported them with her teaching income. CASE 3 : A year-old woman from a rigidly religious family married an alcoholic. After 2 years of marriage, she became involved in what was to be the first of many extramarital affairs. To prevent detection by her husband, she withdrew from him emotionally and neglected the marital relationship. She recognized that she was not spending Adult searching orgasm Washington time with her children. Despite feelings of guilt, she did not seek help until she cheated on her new lover.

CASE 4 : A year-old married business executive neglected sales calls when out of town and visited massage parlors and prostitutes, despite knowledge that he was risking HIV infection. He was once an effective salesman, but his work performance suffered because of his sexual pursuits.

He took alternative routes on trips in an effort to avoid massage parlors, but he was unable to control his urge to visit these establishments. His wife learned about his sexual activities when he was arrested for soliciting sex from an undercover policewoman posing as a prostitute. At that point, his marriage was in jeopardy, his children and friends shocked, and his job future uncertain.

At least three criteria must be met for diagnosis, and some symptoms of the disturbance must have persisted for at least 1 month or have occurred repeatedly over a longer period. Adapted from American Psychiatric Association 3. When sexual behavior is compulsive and continued despite serious adverse consequences, it is addiction. Sex addicts tend to sexualize other people and situations, finding sexual connotations in the most ordinary incident or remark.

What is healthy sexual behavior for many people may be unhealthy for others, just as the use of alcohol causes no adverse consequences for most people but severe problems for some. Sex addicts describe a euphoria with sex similar to that described by drug addicts with drug use.

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This may be an effect of endorphins and other endogenous brain chemicals, whereas the drug-induced state is externally produced. Milkman and Sunderwirth 6 have classified sexual addiction as an arousal addiction because its effects on the brain are similar to the effects of cocaine, amphetamines, compulsive gambling, and risk-taking behaviors. In contrast, addiction to alcohol, sedatives or hypnotics, and food are considered satiation addictions. Like alcoholics and other drug addicts, sex addicts behavior engage in distorted thinking, rationalizing, and defending and justifying their behavior while blaming others for resulting problems.

They deny having a problem and make excuses for their behavior.

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On the basis of a survey of about self-identified sex addicts, Carnes 1 categorized addictive sex into 11 patterns table 3. Sex addicts usually participate compulsively in more than one type of sexual behavior.

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For example, they may masturbate compulsively in addition toviewing pornography and patronizing prostitutes. Although some sex addicts are hypersexual, seeking sexual intercourse or orgasm several times daily, most are not. Many sex addicts report progression of their addiction; that is, they have to take increasing risks or try new sexual behaviors to maintain the same euphoric effect.

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Sex addicts, like alcoholics and other addicts, often come from a dysfunctional family in which parents were chemically dependent, sexually addicted, abusive, or otherwise emotionally unavailable. Sexual difficulties are common in families of sex addicts. In some families, there was no overt incest, but a heightened sense of sexuality was present.

Privacy in the bathroom and bedroom may have been lacking. Children who are sexually abused may grow up fearing sex, confusing sex with love, or believing that the only way to relate to others is sexually. More than half of sex addicts surveyed come from a rigid, emotionally disengaged family.

As a result, children grow up lacking accurate information about sex and believing that sex is powerful and dangerous. Like chemical dependency, sexual addiction is a family disease. They may believe that they are not worthwhile, that no one could love them for themselves, that they can control and are responsible for others, and that sex is the most important of love.

Spouses of sex addicts were often sexually abused in childhood and thus have fear or confusion about sex. They tend to be attracted to individuals who are needy, which describes most addicts. Coaddicts usually fear abandonment, often cannot imagine life without their partner, and are willing to accept Adult searching orgasm Washington that healthier persons may find unacceptable.

These included viewing pornography, swapping sexual partners, and having sex in public places. Many coaddicts fear refusing sex; others use sex to control and manipulate. Those whose sexually addicted partner prefers other sexual outlets eg, compulsive masturbation, hiring of prostitutes may go for years with out conjugal relations, often at great cost to their emotional well-being.

All too often, couples who seek marriage counseling because of sexual problems are advised to add variety to their sexual repertoire or to do more to please each other sexually. Some marriage counselors may not understand that the sexual problems are an addictive pattern, not a marital issue.

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Often, the coaddict takes responsibility for the marital discord and fruitlessly works at finding a solution, as illustrated in the following case. Case 5 : A year-old woman, the mother of three small children, was raised by a rageful alcoholic father and a dependent mother.

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She married a man who also had an alcoholic parent. Over the course of their marriage, he had multiple affairs.

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He denied the most blatant evidence of his philandering until she at times doubted her own sanity. Although she knew he was having sex with other women, she did not dare deny him sex for fear he would leave.

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Frightened of confronting her husband and expressing her anger, she had bouts of depression and periods of overeating. During her second pregnancy, she contracted gonorrhea from her husband. She expressed intense shame when she disclosed her home situation to her physician. Despite her recognition of how hurtful this behavior was to her children, she was unable to stop. Eventually she sought counseling, ed a self-help group for spouses of sex addicts, and later divorced her husband.

Sexual addiction is of en accompanied by other addictions. Compared with the safe-sex group, men who engaged in riskier sexual activities had more partners, used more drugs, and felt they had less control over their sexual activities. Further changes in sexual behavior are not likely to occur unless the compulsive nature of their sexual behavior and polydrug use are dealt with more directly.

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