Dear Dr. G,

I have a bone to pick with you. I understand you normally respond to male readers, but on this occasion, I think it is important for me to put Dr. G on the spot.

My husband and I had a very healthy sex life since we were married.

In recent months, my interest in sex has somewhat declined. We used to be having sex at least twice a week and now I recall the last time we had sex was just more than a month ago.

Needless to say, the pandemic has been tough for me. Apart from working from home, I still have to deal with teenage kids home schooling. And of course, the endless household chores are also adding further stress to my life.

I think I will be forgiven to put sex very low in my priority of life!

On the other hand, my “Sex Mad” husband kept reminding me the importance of keeping the bedroom flames burning. He thinks I may have a hormonal imbalance and should see the gynaecologist.

On several occasions, I actually caught him masturbating in the shower.

I think my husband suffers from “Michael Douglas Syndrome” and need to see a psychiatrist for sex addiction instead.

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?

How can sex addiction be treated?

How do I tell my sex mad husband to go easy, before he or myself get burnt out?

Burnout Betty

The two-time Academy Award winner Michael Douglas famously acted alongside Sharon Stone in the sexual thriller Basic Instinct. Off the silver screen, Douglas was also well-publicized for his admission to sexual addiction in his 2012 biography, blaming his divorce and rocky marriage due to serial adultery. The reason (or excuse) of such infidelity was blamed on “sex addiction”. Some experts highlighted that individuals struggling with compulsive sexual behaviour including recurrent intense sexual urges that takes up significant daily life and the feeling of losing control require medical treatment. Others dispute such unacceptable behaviour, saying that it is unfaithful adultery with no medical basis.

In a medical sense, sex addiction is clinically termed as compulsive sexual behaviour. This is also synonymous with hypersexual disorder or hypersexuality. Like any form of addiction, compulsive sexual behaviour is characterized by excessive preoccupation for sexual urges, fantasies and behaviour that is difficult to control. The compelling desire causes distress and 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.

A 2014 review published by the Addiction and Research centre in France quoted a prevalence rate of sexual addiction ranging from 3%-6% in the general population. Some studies suggest that sex addiction predominantly affects men to the tune of 80%. The pathophysiology basis of sexual addiction is generally associated with abnormal levels of sex hormones and imbalance of the neurotransmitters in the brain. Psychologically, sexual addiction in adulthood may implicate childhood abuse, neglect and emotional trauma that increase the risk of developing many forms of addiction, including sexual addiction. In reality, like many forms of addiction, the risk factors are usually multi-factor in nature and underlying mental health conditions are also recognized to trigger compulsive sexual behaviour.

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 renders negative impact on self and others. When the sexual obsession becomes a major focus in daily life, this may result in inappropriate behaviour disrupting career, health and other people. The transient release of tension is followed by a sense of guilt and remorse. The sexual behaviour often persists despite serious consequences, such as break up of a relationship, contracting a sexually-transmitted infection, career conflicts, financial strains and legal problems. This may result in loneliness, depression, anxiety and trouble maintaining a relationship.

The treatment options for sexual addiction aim to reduce symptoms and manage excessive urges. Cognitive behaviour therapy is the gold standard in helping individuals change behaviour with new positive coping skills and reduces unwanted sexual urges. Medications such as anti-androgen, Selective Serotonin Reuptake Inhibitors (SSRI) are also utilized to reduce sexual urges.

The co-founder of Huffington Post and author of fifteen books, Arianna Huffington, once reminded women that they “need to lead the way to change our culture of burnout”. It is not uncommon for couples to experience rough patches in life when faced with a disparity in needs and responsibility. Needless to say, bedroom matters are not immune to such differences. The urges for sex are heavily influenced by the state of health and state of mind, keeping up in making out may seem like a chore when one party is disinterested. Disparity in sexual interests may just be a sign of bigger problems, such as inequality in workload and burden. Such prolonged disparity creates dents in relationship and accusation of having an addiction when couples cannot agree on common ground.

When Dr. G is put on the spot by men (or women) accusing their partner of having an excessive appetite for sex to the extent of addiction, his response is: “Women need to lead the way to change the culture of many things, including highlighting their strains and stresses. Only honest and open communication enhances sharing of responsibility. Then, the ‘sex mad’ addictions can keep the passion burning without any sign of burnout!”

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