Symptoms

Compulsive sexual behavior may consist of generally acceptable sexual acts taken to an extreme. These behaviors become problems when they become an obsession that's disruptive or harmful to you or others.

Other compulsive sexual behaviors are outside the bounds of commonly accepted conduct. Called paraphilias, these behaviors range from compulsive cross-dressing to having sexual desires toward children (pedophilia).

Compulsive sexual behavior symptoms vary in type and severity. Some signs that you may be struggling with compulsive sexual behavior include:

• Your sexual impulses are intense and feel as if they're beyond your control.
• Even though you feel driven to do certain sexual behaviors, you may or may not find the activity a source of pleasure or satisfaction.
• You use compulsive sexual behavior as an escape from other problems, such as loneliness, depression, anxiety or stress.
• You continue do risky sexual behaviors despite serious consequences, such as the potential for getting or giving someone else a sexually transmitted infection, the loss of important relationships, trouble at work, or legal problems.
• You have trouble establishing and maintaining emotional closeness, even if you're married or in a committed relationship.

When to see a doctor
Get help if you feel like you've lost control of your sexual behavior, especially if your behavior causes problems for you or for other people. Compulsive sexual behavior tends to become more intense and difficult to control over time, so get help when you first recognize there may be a problem. Efforts to use sheer willpower to resist sexual compulsions may not succeed because the urges can be so powerful.

Here are some questions to ask yourself as you decide whether to seek professional help:

• Can I control my sexual impulses?
• Is my sexual behavior hurting my relationships, affecting my work or resulting in negative consequences, such as getting arrested?
• Is sex constantly on my mind, even when I don't want to think about it?
• Do I try to hide my sexual behavior?

Seek treatment right away
Seek immediate treatment if:

• You think you may cause harm with uncontrolled sexual behavior
• You have bipolar disorder or other problems with impulse control, and you feel like your sexual behavior is slipping out of control
• You are suicidal

Causes

It's unclear what causes compulsive sexual behavior. Causes may include:

• An imbalance of natural brain chemicals. High levels of certain chemicals in your brain (neurotransmitters) such as serotonin, dopamine and norepinephrine may be related to compulsive sexual behavior. These brain chemicals also help regulate your mood.
• Sex hormone levels. Androgens are sex hormones that occur naturally in both men and women. Although androgens also have a vital role in sexual desire, it's not clear exactly how they're related to compulsive sexual behavior.
• Conditions that affect the brain. Certain diseases or health problems may cause damage to parts of the brain that affect sexual behavior. Multiple sclerosis, epilepsy, Huntington's disease and dementia have all been associated with compulsive sexual behavior. In addition, treatment of Parkinson's disease with some dopamine agonist medications may cause compulsive sexual behavior.
• Changes in brain pathways. Compulsive sexual behavior is an addiction that over time might actually cause changes in the brain's neural circuits — the network of nerves that allows brain cells to communicate with one another. These changes may cause pleasant reactions by engaging in sexual behavior and unpleasant reactions when the behavior is stopped.

Risk factors

Compulsive sexual behavior can occur in both men and women, though it's more common in men. It can also affect anyone regardless of sexual preference — whether heterosexual, homosexual or bisexual.

Compulsive sexual behavior often occurs in people who have:

• Alcohol or drug abuse problems
• Another psychological condition, such as a mood disorder, impulse control disorder or mental health problem, such as a gambling addiction
• A history of physical or sexual abuse

There's a broad range of sexual activities that can be warning signs of compulsive sexual behavior. Examples include:

• Having multiple sexual partners or extramarital affairs
• Having sex with anonymous partners or prostitutes
• Avoiding emotional involvement in sexual relationships
• Using commercial phone sex conversations for gratification
• Visiting sexually explicit Internet sites or services
• Engaging in excessive masturbation
• Frequently using pornographic materials
• Engaging in masochistic or sadistic sex
• Exhibitionism
• Having a fixation on an unattainable sex partner

Complications

Compulsive sexual behavior can have numerous negative consequences that affect both you and others. You may:

• Struggle with feelings of guilt, shame and low self-esteem
• Develop other mental health conditions, such as depression, extreme stress and anxiety
• Neglect or lie to your partner and family, taxing or destroying meaningful relationships
• Accumulate financial debts purchasing pornography and sexual services
• Contract HIV, hepatitis or another sexually transmitted infection,or pass a sexually transmitted infection to someone else
• Engage in unhealthy substance use, such as drug or alcohol abuse
• Be arrested for sexual offenses
• Lose your focus or engage in sexual activity at work, risking your job
• Face an unwanted pregnancy and its consequences

Preparing for your appointment

You can seek help for compulsive sexual behavior in a number of ways. To begin, you may:

• Talk to your family doctor. Your doctor will be able to do a thorough physical examination to look for any health problems linked to your sexual behavior. Your doctor may refer you to a psychiatrist, psychologist or other mental health provider for a more in-depth examination and treatment. Your doctor may also be able to provide you with information about local providers, support groups, websites or other resources.
• Make an appointment with a mental health provider. Look online or in the phone book or check with a local medical center to find a psychiatrist, psychologist or other mental health provider with experience in sexual behavior issues. Government websites and local government agencies such as the Department of Health and Human Services or the Department of Veterans Affairs may be able to help you find a mental health provider.
• Look into online or local support groups. Examples include Sexaholics Anonymous and Sex Addicts Anonymous. These groups may be able to refer you to an appropriate mental health provider for diagnosis and treatment as well as provide other recommendations and support online or in person.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor or mental health provider.

What you can do
Here are a few steps that can help you get ready for your appointment.

• Take some notes about your behavior, including when and how often it occurs and what seems to trigger it or make it worse.
• List any legal, employment or relationship problems caused by your behavior.
• Note any other mental health issues you have, whether diagnosed or not, such as depression or anxiety. Other mental health conditions often occur along with compulsive sexual behavior and may need treatment as well.
• Take an honest look at your substance use. Alcohol and drug abuse are common in people with compulsive sexual behavior and may need to be treated for compulsive sexual behavior to improve.
• Write down key personal information, including any recent or past traumatic events, current stresses and recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. List your questions from most important to least important in case time runs out.

Some questions you might want to ask your doctor include:

• Why am I doing these things even when it makes me feel bad?
• What treatments are available to me?
• Which do you recommend?
• Would a support group or a 12-step program be helpful for me?

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin noticing harmful sexual behavior or desires?
• Have your behaviors caused legal, relationship or employment problems, or significant distress in your day-to-day life?
• Does your behavior feel like it's getting more extreme or more out of control?
• Have you ever caused or been the victim of physical, emotional, psychological or sexual abuse?
• Has your behavior hurt you or others in the past, and are you afraid it may hurt you or others in the future?
• What other mental health conditions do you have?
• Do you drink alcohol or use illegal drugs?
• How intense are your sexual urges? When do you lose control?
• What, if anything, seems to lessen your sexual urges?
• What, if anything, appears to increase your sexual urges?

Tests and diagnosis

Your doctor, psychiatrist or other mental health provider will do a psychological evaluation, which may involve answering a number of questions about:

• Your physical and mental health as well as your overall emotional well-being
• Your sexual thoughts, behaviors and compulsions
• Your use of drugs and alcohol
• Your family, relationships and social situation

Your mental health provider may also request input from family and friends.

How compulsive sexual behavior is diagnosed
There's an ongoing debate in the psychiatric community about exactly how to define compulsive sexual behavior, because it's not always easy to determine when normal sexual behavior crosses the line into problem sexual behavior. Currently, mental health providers use the Diagnostic and Statistical Manual of Mental Disorders (DSM) — a manual published by the American Psychiatric Association — as a guide for diagnosing mental health problems.

Because compulsive sexual behavior doesn't have its own diagnostic category in the DSM, it's often diagnosed as a subcategory of another mental health condition. In many cases, compulsive sexual behaviors are generally accepted sexual activities taken to an extreme. These may be diagnosed as a subcategory of another mental health condition, such as an impulse control disorder or an obsessive-compulsive disorder.

Diagnosis of sexual behavior as a paraphilia
There are, however, diagnostic criteria for clearly unhealthy sexual behaviors called paraphilias. Paraphilias are behaviors that are generally considered harmful or socially unacceptable or are illegal. Diagnostic categories for paraphilias include:

• Exhibitionism, sexually arousing fantasies, sexual urges or behaviors involving the exposure of your genitals to an unsuspecting stranger.
• Fetishism, sexually arousing fantasies, sexual urges or behaviors involving the use of objects of some kind, such as women's underwear.
• Frotteurism, sexual urges or behaviors involving touching and rubbing against a nonconsenting person.
• Pedophilia, sexually arousing fantasies, sexual urges or behaviors involving sexual activity with a child or children.
• Sexual masochism, sexually arousing fantasies, urges or behaviors involving being humiliated, beaten, bound or otherwise made to suffer.
• Sexual sadism, sexually arousing fantasies, sexual urges or behaviors involving acts in which the psychological or physical suffering, including humiliation, of the victim is sexually exciting.
• Transvestic fetishism, sexually arousing fantasies, sexual urges or behaviors involving cross-dressing in a heterosexual male. A person diagnosed with transvestic fetishism may also have gender dysphoria — discomfort with gender role or identity.
• Voyeurism, sexually arousing fantasies, sexual urges or behaviors involving the act of observing unsuspecting persons who are naked, in the process of disrobing or engaging in sexual activity.
• Paraphilia not otherwise specified, sexually arousing fantasies that don't meet the criteria for any of the specific categories. Examples include sexual behaviors involving obscene phone calls (telephone scatologia), obsession with dead bodies (necrophilia), exclusive focus on a body part (partialism), animals (zoophilia), feces (coprophilia), enemas (klismaphilia) and urine (urophilia).

Whatever the nature of your compulsive sexual behavior, push past your fear, shame or embarrassment and seek a professional evaluation. Getting the right diagnosis can be a relief and can guide treatment that will get your life back on track and save you and the people you care about a lot of anguish.

Treatment and drugs

Treatment for compulsive sexual behavior typically involves psychotherapy, medications and self-help groups. A primary goal of treatment is to help you manage urges and reduce excessive behaviors while maintaining healthy sexual activities.

People with other addictions, severe mental health problems or who pose a danger to others may benefit from inpatient treatment initially. Whether inpatient or outpatient, treatment may be intense at first. And you may find periodic, ongoing treatment through the years helpful to prevent relapses.

Finding the right kind of help
If you have compulsive sexual behavior, you may also need treatment for another mental health condition as well. People with compulsive sexual behavior often have alcohol or drug abuse problems or other mental health problems that need treatment — especially obsessive-compulsive behaviors, anxiety or a mood disorder such as depression.

Seeking help for a sexual behavior can be difficult because it's such a deeply personal matter. Try to set aside any shame or embarrassment and focus on the benefits of getting treatment. Remember that you're not alone — many people struggle with sexual urges that are extremely powerful and difficult to manage. Mental health providers understand this and are trained to be understanding, discreet and helpful. Keep in mind, what you say to a doctor or mental health counselor is kept confidential except in cases where you admit to planning or committing a crime or harming yourself or someone else.

Psychotherapy
Several forms of psychotherapy may help compulsive sexual behavior. These include:

• Psychodynamic psychotherapy. This form of psychotherapy focuses on increasing your awareness of unconscious thoughts and behaviors, developing new insights into your motivations, and resolving conflicts.
• Cognitive behavioral therapy. This form of therapy helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones.
• Group therapy. You meet regularly with a group, under guidance of a mental health professional, to explore emotions and relationships.
• Family therapy or marriage counseling. Compulsive sexual behavior affects the entire family, so it's often helpful to involve your partner or children in joint therapy sessions.

Medications
Certain medications may be helpful because they act on brain chemicals linked to obsessive thoughts and behaviors and reduce the chemical "rewards" these behaviors provide when you act on them. Which medication or medications are best for you depends on your overall situation and other mental health conditions or addictions you may have.

You may have to try several medications, or a combination of medications, to find what works best for you with the fewest side effects. Medications used to treat compulsive sexual behavior are often used primarily for other conditions. They include:

• Antidepressants. Those most commonly used to treat compulsive sexual behavior are selective serotonin reuptake inhibitors (SSRIs). These include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and others.
• Mood stabilizers. Examples include lithium (Lithobid).These medications are generally used to treat bipolar disorder (manic depression), but may reduce uncontrolled sexual urges.
• Naltrexone (ReVia). This medication is generally used to treat alcoholism and blocks the part of your brain that feels pleasure with certain addictive behaviors.
• Anti-androgens. These medications reduce the biological effects of sex hormones (androgens) in men. One example is medroxyprogesterone (mud-rok-see-pro-JES-tur-own). Because they reduce sexual urges, anti-androgens are often used in men whose compulsive sexual behavior is dangerous to others, such as pedophilia.
• Luteinizing hormone-releasing hormone (LHRH). This medication may reduce obsessive sexual thoughts by reducing the production of testosterone.

Self-help groups
Self-help and support groups can be effective for sexual addiction and dealing with all of the issues it can cause. Most are modeled after the 12-step program of Alcoholics Anonymous (AA). In addition to helping you make changes directly, these groups can help you learn about your disorder, find support and understanding in your condition, and identify additional treatment options and resources. These groups may be Internet based or have local in-person meetings or both. If you're interested in a self-help group, look for one with a good reputation and that makes you feel comfortable. Such groups don't suit everyone's taste, so ask your mental health provider about alternatives.

• COSA
• Sex Addicts Anonymous
• Sex and Love Addicts Anonymous
• S-Anon International Family Groups
• Sexaholics Anonymous
• Sexual Compulsives Anonymous
• Sexual Recovery Anonymous

Coping and support

Although it may be difficult to overcome compulsive sexual behavior on your own, you can take steps to care for yourself with healthy coping skills while getting professional treatment.

• Stick to your treatment plan. Take medications as directed and attend scheduled therapy sessions. Remember that it can be hard work and that you may have occasional setbacks.
• Educate yourself. Learn about compulsive sexual behavior so that you can better understand its causes and your treatment.
• Discover what drives you. Identify situations, thoughts and feelings that may trigger sexual compulsions so that you can take steps to manage them.
• Avoid risky situations. Don't jeopardize your health or that of others by putting yourself into situations where you'll be tempted to engage in risky sexual practices.
• Get treatment for substance abuse or other mental health problems. Your addictions, depression, anxiety and stress can feed off each other, leading to a cycle of unhealthy behavior.
• Find healthy outlets. Explore healthy ways to rechannel your sexual compulsions through exercise and recreational activities.
• Practice relaxation and stress management. Try such stress-reduction techniques as meditation, yoga or tai chi.
• Stay focused on your goal. Recovery from compulsive sexual behavior can take time. Keep motivated by keeping your recovery goals in mind and reminding yourself that you can repair damaged relationships, friendships and financial problems.

Prevention

Because the cause of compulsive sexual behavior isn't known, it's not clear how it might be prevented, but a few things may help keep this type of behavior in check:

• Get help early for problems with sexual behavior. Identifying and treating early symptoms may help prevent compulsive sexual behavior from getting worse over time, or escalating into a downward spiral of shame, self-esteem problems and harmful acts.
• Seek treatment early for mental health disorders. Compulsive sexual behavior may be worsened by depression, anxiety or obsessive-compulsive behavior.
• Identify and seek help for alcohol and drug abuse problems. As with mental health disorders, substance abuse can cause a loss of control and unhappiness that can lead to poor judgment and may push you toward unhealthy sexual behaviors.
• Seek treatment for childhood sexual abuse. Many people with compulsive sexual behavior were sexually abused as children. Appropriate professional treatment may help heal those emotional scars.
• Avoid risky behaviors. Stay away from strip clubs, bars or other areas where it might be tempting to look for a new sexual partner. Likewise, it's a good idea to stay off the computer, or install software that blocks pornographic websites.