Dear Dr G, I am a forty-eight year-old man who has been married for twenty years.My wife and I had a very healthy sex live since we were married (In fact, even before we were married).In recent years, my wife’s libido has declined tremendously, most likely due to declining hormones. We used to have sex at least twice a week and now I consider myself lucky if I get lucky once a month.In fact, in recent months, instead of having declining sexual urges, I am getting more randy than my usual self.When I am not getting sex at home, I am masturbating very regularly and often times even contemplating “out-sourcing”In fact, my wife actually caught me watching porn and masturbating, naturally she was angry and upset.My wife thinks I have sexual addiction as she reckons such behaviour is abnormal, especially for my age.In fact, she thinks I suffer from “Michael Douglas Syndrome” and need to see a psychiatrist for rehabilitation.I would like to put Dr. G on the spot about sex addiction. What is it and how do you make the diagnosis?What is the frequency of sexual urges to be considered an addiction?Isn’t there a fine line between feeling randy and compulsive behaviour?Am I just enjoying love making or addicted to sex?I am very doubtful I have “Michael Douglas Syndrome” myself; can you help me to convince her?RegardsRandy Dan Sex addiction is clinically termed as Compulsive Sexual Behaviour (CSB). This is also synonymous with hypersexual disorder or hyper-sexuality. Like any form of addiction, CSB is characterised by excessive preoccupation for sexual urges, fantasies and behaviour that is difficult to control. The compelling desire causes distress and a negative impact on health, occupation, relationship and other quality of life. Sex addiction is manifested not just in conventional sex, but involves other forms of sexual activities including cybersex, masturbation, multiple sexual partners, and pornographic consumption and paying for sex. The World Health Organisation (WHO) included CSB in the International Classification of Diseases (ICD) and defined it as “Impulsive Disorder characterised by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour.” It’s obvious that different individuals have different degrees of desire and libido. Therefore, it is impossible to quantify the frequency or urges of sexual pleasure as a barometer of sexual addiction. The key for the diagnosis is not the frequency, but the inability to demonstrate restraint, and the lack of self-control rendering a negative impact on the self and others. A 2014 review published by the Addiction and Research Centre in France quoted a prevalence rate of sexual addiction range from 3%-6% in the general population. Some studies suggest that sex addiction predominantly affects men to the tune of 80%. The risk factor is associated with abnormal levels of sex hormones and imbalance of the neurotransmitters in the brain. Some experts implicate childhood abuse, neglect and emotional trauma that increases the risk of developing sexual addiction. In reality, like many forms of addiction, the risk factors are usually multi-factorial. Underlying mental health conditions are also recognised to trigger compulsive sexual behaviour. When the sexual obsession becomes a major focus in daily life, the uncontrollable actions may result in inappropriate behaviour disrupting career, health and other people. Michael Douglas famously admitted to sex addiction in his 2012 biography, highlighting his divorce and rocky marriage due to serial adultery. Some indications of individuals struggling with compulsive sexual behaviour include recurrent intense sexual urges that takes up significant daily life and the feeling of losing control. The transient release of the tension is followed by a sense of guilt and remorse. The sexual behaviour often persists despite serious consequences, such as break-up of relationships, contracting sexually-transmitted infections, career conflicts, financial strains and legal problems. This may result in loneliness, depression, anxiety and trouble maintaining relationships. Individuals with sexual addiction should seek medical attention when the behaviour escalates out of control and has an adverse impact on their lives or others. However, many sufferers may hide the behaviour and fear shame, embarrassment and judgment from others. The treatment options aim to reduce symptoms and manage excessive urges. Cognitive behaviour therapy is the gold standard in helping individuals to change behaviour with new positive coping skills and reducing unwanted sexual urges. Medications such as anti-androgens and Selective Serotonin Reuptake Inhibitors (SSRI) are also utilised to reduce sexual urges. It is not uncommon for couples to experience rough patches in life when faced with disparity in needs. Needless to say, bedroom matters are not immune to such differences. The urges for sex are heavily influenced by state of health and state of mind, keeping up in making out may seem like a chore when one party is disinterested. Such prolonged disparity creates dents in relationships, and accusations of having an addiction when couples cannot agree on the common ground. The American civil rights activist, Maya Angelou, once said: “There is a very fine line between loving life and being greedy for it!” When Dr. G is often put on the spot by men (or women) accused of having an excessive appetite for sex to the extent of addiction and destruction, his response is “There is also a fine line in affection for love and addiction to love making!” As long as love is in the equation, open communication will eventually turn any form of greedy addiction into loving lifelong affections! 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