It’s true. Or so says the completely unscientific but -- according to the New York Times -- expert opinion of SexHelp.com. I’m outing myself by displaying my test results on this very page. It’s small so you might not see that I’m a “10” on the sex addict scale. I was pleased to see that I beat out fellow sex addict Dr. Petra Boynton (she’s only a 9, but she’s British).

As you’ve probably read of late Petra and I are in good company. Yesterday actor David Duchovny left his sex addiction rehab program, presumably bolstered after an intense few weeks of being told to masturbate less, stop fantasizing about sex, only have sex when he feels an emotional connection with his partner, and for goodness sake, don’t use sex to make yourself feel good or express something about your identity (also no sex toys, sex outdoors, BDSM, etc… etc…).

So why am I sharing such a personal fact with so many people I barely know? Well it’s not an elaborate ploy to get more dates and feed my addiction. It’s more of a response to the sex addiction literature I’ve been reading and the absolutely shameful news coverage of the two most recent sex addiction media events (first Duchovny, then the anal-bead-heralded movie premiere of Choke).

Blogs aren’t always conducive to elaborate arguments, so if you’re interested in a reading why everything you know about sex addiction is wrong, there’s lots to sink your teeth into. Here let’s just take two examples.

First up this quote from a CNN.com story published following Duchovny’s disclosure that he was seeking counseling for his “sex addiction”:

'We're seeing it with epidemic proportions now, particularly with regards to cybersex,' said Mark Schwartz, psychologist and former director of the Masters and Johnson Institute in St. Louis, Missouri. 'There isn't a week that goes by where I don't get two calls' about sex addiction.

A St. Louis psychologist who was affiliated with a sex therapy institute receiving two calls a week is hardly an epidemic (and even according to some of the sex addiction people the numbers haven’t changed from what they claim are the 6-10% of Americans who are sex addicts). And any clinician who makes broad social statements based not even on their clinical experience but the anecdotal evidence of their phone records really needs to brush up on their ethical obligations as a mental health professional.

Next up is this gem from a peer reviewed journal article written for nurses about women and sex addiction:

Addiction in women is a growing problem in the United States and is recognized as a very serious disease. Today researchers are able to document the neurochemistry of addiction in the brain. It has been found that sexual activity can create a “high” equal to that of crack cocaine.

Sounds pretty scary. The problem is that it is an inaccurate description of the actual research and it takes that mistake and further confuses it with a leap in logic. It’s true that some studies show that brain activity (although not neurochemistry as suggested in the quote) is present in similar areas during cocaine craving and orgasm. But this in no way means that the experiences are equal.

So what have most of the major news organizations done when called to report on a concept that still hasn't been accepted into either of the bibles of world mental health professionals? Well they go right to the people who invented the term; the sex addiction and recovery industry. Turning to “sex addiction counselors” as experts on human sexuality is like turning to the Ministry of Truth for an expert opinion on where we came from. Without agreement from mental health professionals, without a solid basis of evidence-based research, and in many cases without a grasp of sexological research the sex addiction industry has established itself as a necessary body to treat an illness that only they agree exists.

This is not to say that there aren’t people who struggle with out of control sexual behaviors. People lose relationships, families, jobs, and more because they feel like they can’t control a particular behavior. The problem is not that the sex addiction industry is making up the pain, the problem is that by mixing morality and ambiguity into their theory they actually reduce their chances of helping people in pain deal with their problematic behaviors. Quick fixes are great for selling books and winning elections. But they leave most of us regular folks high and dry in the end.

And so I’ve decided to come out as a sex addict. I seem to be coping fine. I work three jobs, I volunteer my time with several organizations, and if I weren’t Jewish I’m sure I’d go to church with some regularity. I even occasionally see my family (never as much as they like, but I blame that on the addiction). Sure I need help, and I never hesitate to avail myself of mental health services when in need. But I hope I can set an example that it is possible to be labeled a sex addict by a website and still be doing okay. Maybe I should make t-shirts.

**I hesitated before giving this post the title I gave it. I think there’s a tendency among those who don’t agree with the sex addiction model to make fun of the people who get labeled or label themselves as sex addicts. These people may be in genuine crisis and instead of getting the support they need they're being led up the garden path (either by people who know better or should know better). I didn’t want to increase their pain by seeming to make fun of them. But in the end, after reviewing the “research” the terminology is so ludicrous that I felt I had no choice. Plus I bet there isn’t a group that Petra Boynton belongs to that I wouldn’t be proud to join.

Despite a wide acceptance by the media, there is no agreement among bio-medical and social science researchers regarding sex addiction. Some debate the proper definition and others believe that the very idea of an addiction to sex is misguided and not helpful to those who need help. There is general agreement that some people have problems controlling their own sexual behaviors despite many efforts and obvious negative consequences of the behaviors. These problems may be mild or seriously debilitating. While there is no debate that some people engage in out-of-control sexual behavior, there is enormous disagreement about whether or not such behavior should be called sex addiction.

The 'Popular Definition' of Sex Addiction

You may have read about sex addiction in the media, either in the context of one celebrity having a sex addiction, or in an article about how the Internet is turning us all into sex addicts. The definition of sex addiction most often used in this context developed out of a vocal movement of therapists, community organizations, and religious groups led by Patrick Carnes who first articulated his vision of “sex addiction” in his book Out of the Shadows: Understanding Sexual Addiction.

On Carnes’ website he describes sex addiction this way:

"Sexual addiction is defined as any sexually-related, compulsive behavior which interferes with normal living and causes severe stress on family, friends, loved ones and one's work environment.

Sexual addiction has been called sexual dependency and sexual compulsivity. By any name, it is a compulsive behavior that completely dominates the addict's life. Sexual addicts make sex a priority more important than family, friends and work. Sex becomes the organizing principle of the addict's lives. They are willing to sacrifice what they cherish most in order to preserve and continue their unhealthy behavior."

The main feature of Carne’s definition of sex addiction is inability to control one’s sexual behavior, which also includes thinking and fantasizing about sex too much. In this formulation sexual activity and even the desire for it creates a “high” which Carnes and his colleagues equate with a drug high. The addiction is evidenced by the fact that people will engage in risky, hurtful behaviors despite understanding the negative consequences that will result.

There are many problems with the concept of sex addiction. Most importantly, there is not enough empirical research to back up this definition and the majority of “evidence” given by those who subscribe to this definition consist of stories from therapists who, we’re told, have worked with clients and successfully treated them.

How Common Is Sex Addiction?

If you’re someone who is worried about their ability to control sexual thoughts, desires, and activities, this may be something you want to know, but unfortunately there isn’t a good answer. First, it’s impossible to know how many people share an experience (like sex addiction) if we don’t agree on what that experience is. Secondly, the unscientific estimates vary wildly from therapist to therapist and from one newspaper article to the next. Estimates from the sex addiction camp range from 6–10% to 45% of the American population having a sex addiction.

Causes of Sex Addiction

Theories as to what causes sex addiction or out-of-control sexual behaviors depend to some extent on the definition one subscribes to. Causes that have been cited (but never proven) include psychological causes (e.g. inability to control impulses, sex as a way of dealing with depression or anxiety, sex as a coping mechanism), bio-medical (faulty neurotransmitter regulation, in rare cases some neurological or psychiatric disorders) and social/relational (problems with intimacy, communication problems, discrepancies of sexual desire, increased access to sexually explicit material). Many sex addiction writers often suggest a relationship between sex addiction and childhood sexual abuse, and between sex addiction and current drug abuse.

Other Definitions of Sex Addiction

Researchers who reject the idea of an addiction model have used other terms over the years, including:

• compulsive sexual behavior
• impulse control disorder
• hypersexaulity
• nymphomania
• styriasis
• out-of-control sexual behaviors

From the perspective of an individual struggling with a behavior they feel like they can’t control, what you call it may seem less important than how to stop it. But definitions are important as they often influence treatment. For example if you define sex addiction by the amount of sex you have, treatment will be designed to reduce your frequency of sexual behavior. If you define sex addiction as an inability to experience intimacy, treatment will try to build one’s capacity for sexual intimacy.

I Don’t Care About Definitions, I Think I’m a Sex Addict

Broadly speaking, if you are struggling with out-of-control sexual behaviors and think you may be a sex addict, it is always a good idea to consult with a licensed therapist. A lucrative industry has developed around the sex addiction model and you can easily find a therapist who is "certified" to treat sex addictions. The problem is that these therapists may not have training in sex therapy and may, in fact, have no education in human sexuality. While many therapists deal with sexual issues with clients, if you're looking for someone who has specialized in sexuality you should seek out a certified sex therapist. At a minimum make sure you understand the training and credentials of whoever you work with before engaging in treatment.

Postmenopausal women who have lost interest in sex may be able to bring their libidos back to life with a testosterone patch, according to new research published Wednesday in The New England Journal of Medicine.

However, the use of the male hormone to boost sex drive in women may not be risk-free. Four women in the study who were taking testosterone developed breast cancer, but none of the women on placebo did. It’s not clear whether this was a statistical blip or a warning sign that excess testosterone could cause or spur the growth of a malignancy. Some women also reported excess hair growth, although none stopped using the hormone for this reason.

Susan R. Davis, MD, PhD, of Monash University in Australia, and colleagues in the United States, Canada, and Sweden, evaluated two different doses of testosterone delivered by Procter & Gamble Pharmaceuticals’ Intrinsa patch. In 2004, a U.S. Food and Drug Administration (FDA) panel gave Intrinsa the thumbs down and called for larger, longer studies to ensure that the medication was safe, in addition to proving that it actually helped women’s sex lives.

As the new findings show, it did. Wearing the higher-dose testosterone patch boosted a woman’s “satisfying sexual experiences” by an average of 2.1 times every four weeks, compared to an increase of just 0.7 such experiences for women taking a placebo. Both testosterone doses used in the study seemed to increase desire and decrease distress.

“Although the change in activity is modest, that’s something that is appropriate and I think most women would be more than happy with it,” says study coauthor Sheryl A. Kingsberg, PhD, chief of behavioral medicine at University Hospitals Case Medical Center in Cleveland. “They wanted to return to the level of desire they had in their premenopausal years, and that’s what they got.” Before starting treatment, the women in the study had been having satisfying sex about twice a month on average, Kingsberg points out; the higher-dose patch increased that to once a week.

“For most women and providers of health care for women, that modest benefit is clinically meaningful,” agrees North American Menopause Society president JoAnn V. Pinkerton, MD, a professor of obstetrics and gynecology at the University of Virginia, in Charlottesville, who did not participate in the study.

Some women lose interest in sex during and after menopause, due in part to the drop in estrogen that comes with the “change of life.” While taking estrogen can increase lubrication and possibly restore a woman’s sex drive, hormone replacement is now understood to up the risk of heart disease and stroke. Many physicians prescribe testosterone instead, although there is currently no testosterone product that’s FDA–approved for treating women with “hypoactive sexual desire disorder.” The European Union has approved Intrinsa, but only for women who have had their ovaries removed, a procedure also known as surgical menopause.

In the current study, 814 women who had undergone either surgical menopause or natural menopause were randomly assigned to use daily a placebo patch or an Intrinsa patch containing either 150 or 300 micrograms of testosterone. The trial lasted for a year, and a subset of women was followed for an additional year. Procter & Gamble Pharmaceuticals sponsored the study and helped design the trial as well as collect and analyze the data.

“Based on these data and other studies we’ve conducted, we are continuing our talks with [the] FDA to explore new opportunities and pathways forward,” says Procter & Gamble spokesperson, Tom Milliken.

One of the women on the 300-microgram dose was diagnosed with breast cancer three months after the study ended; three others in the testosterone groups were diagnosed with the disease between 4 and 12 months after treatment began.

“We do not know if the testosterone patch contributed to proliferation or metastasis of the breast cancer in women diagnosed in the earlier months of the study, potentially affecting their long-term survival,” says Leslie R. Schover, PhD, a behavioral scientist at the University of Texas M.D. Anderson Cancer Center, in Houston, who recently wrote an article analyzing research on testosterone for low libido. “A valid safety study needs at least a five-year follow-up period in a large, randomized trial. If women use Intrinsa without such a trial, I believe they are risking their lives to gain a very modest increase in sexual desire.”

But Dr. Davis says she is not concerned about the increased breast cancer risk seen in the study. Four breast cancer diagnoses among 814 women during a two-year period “is not unexpected,” she says, and given that twice as many study participants were taking testosterone than were on placebo, “it is probably a chance finding that they were in the two treatment groups.”

Many doctors who treat postmenopausal women—and prescribe testosterone off-label to some of them—say a treatment tailored to women is sorely needed and would probably be safe with short-term use. “We don’t have enough safety data to say it’s safe for long-term use, but I think short-term, the benefits clearly outweigh the risks,” Dr. Pinkerton says.

But some experts warn that a pill or patch isn’t always the answer to a sexual problem.

“For women there are so many other things that can contribute to sexual issues, starting from the fact that the most important sex organ is the brain,” says Marcie Richardson, MD, director of the Harvard Vanguard Menopause Survey in Boston. “I’m glad that people are trying to sort this out with good objective evidence, but I hope we don’t fall victim to the notion that this is all about medication, because it’s not.”

Navigation

• Introduction
• Risk Factors
• Lifestyle or Psychological Causes
• Physical Causes
• Prognosis
• Diagnosis
• Treatment
• Lifestyle Changes
• Medications
• Injections or Topical Treatments
• Other Treatments
• Natural Remedies

Yohimbine (Yocon, Yohimex) is derived from an herbal remedy. It appears to boost erectile function by improving blood flow. Studies have been inconclusive about its benefits, but a recent analysis of seven trials reported that between 34% and 75% of men achieved favorable results when taking 5 mg to 10 mg. The American Urologic Association does not recommend yohimbine for treating impotence, although some experts believe it is an inexpensive and reasonable option for some men. Yohimbine is available over the counter as an herbal remedy. It is not government regulated and brands vary in effectiveness and quality.

Side effects include nausea, insomnia, nervousness, and dizziness. Large doses of yohimbine can increase blood pressure and heart rate. One death has been reported from taking tablets of the standard dosage (5.4 mg). More rigorous studies are needed to confirm its effectiveness, and men suffering from anxiety or hypertension are cautioned against its use. To boost success rates, one study indicated that adding L-arginine, an amino acid, may be helpful.

Other Alternative Agents

Many alternative agents are marketed for impotence. Examples include the following:

• The Asian herbal remedies, gingko and ginseng, have been used to stimulate sexual function, although studies on these agents have been small and have had mixed results. One small study reported good results with Argin-Max, which contains a mix of vitamins and natural substances (L-arginine, ginseng, ginkgo). L- arginine, an amino acid, increases production of nitric oxide, a substance that relaxes blood vessels and promotes erections. Gingko, ginseng, and l-arginine can all have side effects, and the products containing them are not regulated.
• Many others are marketed for this condition. Very few have been studied and some can be harmful.

Warnings on Alternative Remedies Used for Erectile Dysfunction

Alternative or natural remedies are not regulated and their quality is not publicly controlled. In addition, any substance that can affect the bodys chemistry can, like any drug, produce side effects that may be harmful. There have been a number of reported cases of serious and even lethal side effects from so-called natural products.

Some so-called natural remedies have been found to contain standard prescription medication. Most reported problems occur in herbal remedies imported from Asia, with one study reporting a significant percentage of such remedies containing toxic metals. Even if studies report positive benefits, most, to date, are very small. In addition, the substances used in such studies are, in most cases, not what are being marketed to the public.

The following website is building a database of natural remedy brands that it tests and rates. Not all are yet available (www.consumerlab.com).

The Food and Drug Administration has a program called MEDWATCH for people to report adverse reactions to untested substances, such as herbal remedies and vitamins (800-332-1088).

The following are some alternative remedies used for erectile dysfunction.

Gamma-Butyrolactone (GBL). GBL is found in products marketed for improving sexual function (Verve, Jolt). This substance can convert to a chemical that can cause toxic and life-threatening effects, including seizures and even coma.

Ginseng. Ginseng has hormonal qualities and should not be used with estrogen. It has also been associated with a hypoglycemia (low blood sugar) and a higher risk for uterine bleeding. It may produce manic episodes, particularly in people on antidepressants. Of note, a great number of ginseng products have been found to contain little or no ginseng. Of particular concern are reports of pesticide and other toxic contaminants in many ginseng products. In one analysis, only nine out of 22 brands did not contain major contaminants. Among the brands that did not contain contaminants were Celestial Seasoning, Centrum, Ginsana, Walgreen's, and Root to Health American Ginseng.

Gingko. Although the risks for gingko appear to be low, there is an increased risk for bleeding at high doses and interaction with high doses of vitamin E, anti-clotting medications, aspirin, or other NSAIDs. Large doses have also been known to cause convulsion. Commercial gingko preparations have also been reported to contain colchicine, an agent that can be harmful in pregnant women and people with kidney or liver problems. It should be further noted that in a 2002 study one-third of 26 brands tested did not contain enough active ingredients to provide any effects at all.

L- arginine (also called arginine). Arginine may cause gastrointestinal problems. It can also lower blood pressure and change levels of certain chemicals and electrolytes in the body. It may increase the risk for bleeding. Some people have an allergic reaction to it, which in same cases may be severe. It may worsen asthma.

Aphrodisiacs. Aphrodisiacs are substances that are supposed to increase sexual drive, performance, or desire. Some examples include the following:

• Viramax is a well-marketed product that contains yohimbine and three herbal aphrodisiacs: catuaba, muira puama, and maca. It has not been proven to be either effective or safe, and interactions with medications are unknown.
• Spanish fly, or cantharides, which is made from dried beetles, is the most widely-touted aphrodisiac but can be particularly harmful. It irritates the urinary and genital tract and can cause infection, scarring, and burning of the mouth and throat. In some cases, it can be life threatening. No one should try any aphrodisiac without consulting a physician.

Other Alternative Products Marketed for Erectile Dysfunction. Vinarol is an over-the-counter supplement that has been recalled after reports that it contains the same ingredients as found in Viagra. Of note, herbal supplements sold as Viagro and Vaegra have no association with Viagra.

Navigation

• Introduction
• Risk Factors
• Lifestyle or Psychological Causes
• Physical Causes
• Prognosis
• Diagnosis
• Treatment
• Lifestyle Changes
• Medications
• Injections or Topical Treatments
• Other Treatments
• Natural Remedies

Vacuum devices, or external management systems, are effective, safe, and simple to use for all forms of impotence except when severe scarring has occurred from Peyronies disease. Devices include Erecaid, Catalyst, and the VED pump and are available over the counter.

Using the Device. Patients must receive thorough instructions in the proper use of such devices. They typically work as follows:

• The man places the penis inside a plastic cylinder.
• A vacuum is created, which causes blood to flow into the penis, thereby creating an erection.
• A band is tightly secured around the base of the penis, which retains the erection, and the cylinder is removed.
• It takes about three to five minutes to produce an erection.

Lack of spontaneity is this methods only major drawback. The erection involves only part of the penis shaft, and the process will certainly seem peculiar in the beginning. When these psychological obstacles are overcome, many couples find the result highly satisfactory.

Success Rates. Studies have found that success with the vacuum device is equal to other methods. Between 56% and 67% of men using it reported the device to be effective. In one study of men who had used the vacuum device for many years, almost 79% reported improvement in their relationships with their sexual partners, and 83.5% said they had intercourse whenever they chose. Nevertheless, dropout rates are high. In one 1999 study, for example, the overall drop out rate was 65%. Even in a high-success group, over half stopped using it.

Side Effects. Side effects include blocked ejaculation and some discomfort during pumping and from use of the band. Minor bruising may occur, although infrequently. It is very important to use a medically approved pump. There have been reports of injury from vacuum devices bought through catalogues that do not have a pressure-release valve or other safety elements.

Venous Flow Controllers

Vacuum-less devices that trap blood within the penis are also available. They are called venous flow controllers or simple constricting devices. These devices are typically rubber or silicone rings or tubes (e.g., Actis) that are placed at the base of the erect penis to trap the erection. They can be used by men who can achieve erections but lose them easily. These devices should not be used for longer than 30 minutes or lack of oxygen can damage the penis, and they should not be used by patients who have bleeding problems or are taking anticoagulants (blood thinners).

Penile Implants

Penile implants are available for men who fail less invasive treatments. More than 200,000 implant procedures were performed between 1982 and 1989, and men have reported high rates of satisfaction. Nevertheless, this is now the least popular therapy for erectile dysfunction.

Three types of surgical implants are currently being used for the treatment of erectile dysfunction:

• A hydraulic implant consists of two cylinders placed within the erection chambers of the penis and a pump. The pump releases a saline solution into the chambers to cause an erection, and removes the solution to deflate the erection.
• A penile prosthesis is composed of two semi-rigid but bendable rods that are placed inside the erection chambers of the penis. The penis can then be manipulated to an erect or non-erect position.
• A third implant uses interlocking soft plastic blocks that can be inflated or deflated using a cable that passes through them.

There appear to be no long-term immune problems related to the silicon or other materials in the devices.

Limitations. Erectile tissue is permanently damaged when these devices are implanted and procedures are irreversible. Although uncommon, mechanical breakdown can occur, or the device can slip or bulge, especially if the patient coughs or vomits vigorously after the operation. In addition, a less than optimal quality of erection may result. (Using the MUSE system may restore or improve the function of a penile prosthesis in patients with a failed device.)

Complications. Infection is the major concern with these devices. Redness and fever often accompany a full-blown infection. Any intermittent pain that continues to occur after an implant may be an indicator of a low-grade infection. If the infection can be caught early enough, implant failure can be prevented. Most infections are treated with antibiotics for at least 10 to 12 weeks. If antibiotics fail, a surgical exchange, in which the infected implant is simultaneously replaced with a new one, should be considered. This is a complex procedure, but some surgeons have reported a 90% success rate. Coatings with specific antibiotics are being investigated and studies are reporting very low infection rates. Long-term effects are unknown.

Vascular Surgery

For men whose impotence is caused by damage to the arteries or blood vessels, vascular surgery might be an option. Two types of operations are available: revascularization (or bypass) surgery, and venous ligation. The American Urologic Association stresses that vascular surgery is still investigative.

Revascularization. The revascularization procedure usually involves taking an artery from a leg and then surgically connecting it to the arteries at the back of the penis, bypassing the blockages and restoring blood flow. In a related procedure called deep dorsal vein arterialization, a penile vein is used for the bypass. Young men with local sites of arterial blockage or those with pelvic injuries generally achieve the best results. In studies of selected patients there was improvement in erectile dysfunction in 50% to 75% of men after five years.

Venous Ligation. Venous ligation is performed when the penis is unable to store a sufficient amount of blood to maintain an erection. This operation ties off or removes veins that are causing an excessive amount of blood to drain from the erection chambers. The success rate is estimated at between 40% and 50% initially, but drops to 15% over the long term. It is important to find a surgeon experienced in this surgery. In a variation of this technique called venous ablation, ethanol is injected into the deep dorsal vein, the main vein that drains blood from the penis. The ethanol causes scarring that closes off smaller veins and prevents blood leakage, thereby bolstering erectile function. In a small trial in 10 men with severe impotence, half maintained erectile function two to three years after the procedure.