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Gay men and Sex Addiciton
Feb 19, 2009

Hello Doctor,

I see gay men around (I am one!) and I see th ebehaviors, what they talk about, what they focus mostly on, and sexual behaviors and I been thinking most of them are addicted to sex. I was looking and gay and hiv/aids organizations and I couldnt find much information about sex addiciton among gay males or sex addiction in general. Don't you think there is a there is a big denial among gay men about our responsibility over our acts and that is about time to educate gay men (and men in general!) about SA? Thank you!

Response from Dr. Frascino

Hi,

I do not believe that most gay men with healthy sexual appetites are addicted to sex. Rather, I would guess more of the general public is sex-phobic.

I do agree we need more effective STD/HIV awareness and prevention campaigns targeted at risk groups like gay men. Dubya cut funding to many effective HIV-prevention programs, because they dared to mention gay sex and/or condoms. So we've got some catching up to do. President Obama is presently working on a National HIV/AIDS Strategy and Plan. That should help considerably. I'll post some information about sexual compulsivity below. There is also additional information about sex addiction and treatment in the archives. Have a look!

Dr. Bob

"Sexual Compulsivity"(An excerpt from Men Like Us, pages 178-182)

by Daniel Wolfe 2000

The night Terry's mother called me to tell me that he had died, I spent the rest of the night having sex in the basement of a porn theater. I never cried, but I went back every night for three weeks. I was a mess. I was in parks until all hours of the night. I almost got arrested in the bathroom at the local university. I narrowly escaped. I went back and the guard recognized me -- it turned out I was trying to go in when it was spring break. I went in again. The last straw was when I had been in the park until the middle of the night. The next day I was sick, dragged myself to work late, and on the way home stopped in the park again. When I started always being late for work, or getting to the Greenmarket too late to buy the pretzels I love, those were real warning signs for me.

People have always used sex as a way to escape their solitude, forge connections, and gain a sense of power or pleasure. Gay men in particular have found that exploration of sex together -- lots of it -- is a means of healing homophobia, an affirmation of gay pride, a way to feel a sense of God, or just plain good. Well, most of the time.

Sometimes, having lots of sex -- or looking to have it -- doesn't feel so good. "Sexual compulsivity" is a term used to describe patterns where sex feels powerful without being pleasant, something you repeat over and over with less and less reward or sense of control. Examples of this can range from repeated attempts to act out sexually with people who have not consented -- flashing your genitals, say, or fondling strangers on the mall escalator -- to the more common and murkier pattern of unsatisfying sex sought out when you want to numb some other intense emotion. Feeling as if you're losing your ability to choose when and how to be sexual, having lots of sex with people whom you find abusive or unattractive, or seeing your sexual partners as objects to be used rather than people to connect with are all cited as symptoms of sexual compulsivity. Describing a common cycle -- feeling driven to use sex to try to reach some magical altered state, and then experiencing a deeply depressing letdown afterward -- some men talk about the problem with a different phrase: "sexual addiction."

Addiction and compulsion are controversial terms when it comes to sex, with battles over the implications of each. Addiction makes sex sound too much like a poison better given up, like alcohol, say some, when in fact there is no physiologically addictive component to sex, and having it is a sign of health. Others counter that compulsion ignores the incredible powerful social role of sex and reduces sexual behavior to another symptom, like washing your hands too much or not stepping on cracks. Some students of gay history worry about both approaches, remembering the way that diagnoses of disease have long been used to cast a cloud of shame over any sex that does not fit the majority's idea of "normal." Some critics of gay society worry in the opposite direction, alarmed that the call for sexual freedom is silencing discussion of how many men have lots of sex without nearly so much satisfaction.

In practice, though, the differences between the terms addiction and compulsion (used interchangeably in the rest of this section) seem less important than the common themes expressed by men who find them meaningful. "I don't know whether I was addicted or compulsive, but I know that I would sit on my bed and cry if I didn't pick up someone every night after work," says Sam, age thirty-five. "One time I picked up three people on my block one right after the other, and arrived late for an extremely important appointment." Other common stories include seeking sex immediately after important emotional events like the death of a parent or a friend; alternating sexual binges with periods of depression and total aversion to sex; and risking illness, arrest, or financial ruin in the pursuit of unsatisfying sex. A general feeling of numbness or dissociation during sex (the word trance comes up a lot) is also common to people struggling with these issues. Some of the men who describe themselves as sexual addicts report a childhood history of physical or sexual abuse, or emotional neglect. Many more report another addiction or behavior disorder -- alcoholism, eating disorders, gambling, and the like.

If complaints about numbing or overpowering sex sound suspiciously like an effort to tidy messy realities into some unthreatening fifties fantasy of what sex "should be," talk of sexual compulsivity can carry that danger. People throughout history have certainly gambled, and lost a great deal, in the pursuit of sexual excitement, including excitement whose charge comes precisely because it's naughty or illegal or inappropriate or objectifying. Virtually everyone has had the experience of sex for reasons -- mastery, a sense of power, an escape from worry -- that may be more about changing a feeling inside ourselves than about experiencing one with someone else. And of course gay people feel shame about sex -- straight people teach us to. Deciding where that shame comes from or what it means is a tricky business.

All of that makes it essential for gay men to cut themselves some slack during assessment of sexual "addiction," but not to rule out the exercise entirely. "The goal is be able to integrate your sex life with other things you want -- feelings of freedom, self-esteem, intimacy, whatever -- in such a way that you can be at relative peace with the sexual part of yourself," says New York City therapist Stephen McFadden. "What that means has to be an individual definition."

"Treating" Sexual Compulsivity Step 1: Awareness If you're not risking your life, courting arrest, or violating the rights of others through compulsive behavior, struggling with sexual compulsion usually begins with the same medicine prescribed for those seeking better sex or safer sex: mindfulness. The same exercise that works for sex in general -- asking yourself about what you do and how you feel, before, during, and after sex -- can help you to grow conscious about your feelings of compulsion. Don't limit your thinking to direct contact with others; include phone sex, masturbation, and online cruising if you do them. People grappling with sexual compulsion -- as with eating disorders, alcoholism, or other powerful forms of behavior -- talk of "triggers," the people, places, or things that activate intense cravings or behavior that feels out of control. For alcoholics, that trigger might be a bar where they used to drink; for someone who feels sexually compulsive, it could be a beach, a college bathroom, or an adult bookstore. Emotional "spots" you're in can also trigger compulsive behavior, as is captured in the oft-quoted acronym HALR -- meaning feeling vulnerable when you're hungry, angry, lonely, or tired. Is it that you're horny or that you're alone on Saturday night and can't stand being in your apartment? Do you want sex or some way to escape the fact that you just got home from a difficult visit with your family? "I tell people, forget doubt, monogamous, nonmonogamous, you have sex this way, you don't have sex that way," says therapist Michael Shernoff. "If you say you're on the way to the university bathroom to have sex, ask yourself: Is sex what you want, or just something you know how to get? I've spent months with people trying to help them figure out what it means to be horny, as opposed to anxious or bored or depressed or tired."

Other triggers for compulsive sex are found in the intersection of addictions, such as when you start drinking after a period of being sober, or start binge eating after not doing so for month. "Shame in general is a big trigger," says Joe Amico, M.Div., executive director of Minnesota's gay and lesbian chemical addiction center, the Pride Institute, "particularly when folks feel like what they're doing now stirs up bad memories of past experiences. For someone with a history of sexual abuse, for example, sex can trigger intrusive feelings of guilt about who you are and what happened to you. It feeds itself: More sex is a way of escaping the pain."

Step 2: Talk About It with Someone Not everyone needs ongoing therapy or to go to group meetings to deal with sexual addiction. A few counseling sessions or conversations with a close friend or pastoral counselor can be enough for some people to begin to feel aware. And unlike physical addictions to substances such as alcohol or heroin, sexual compulsivity is often not a lifelong struggle. "For the first two years I was in Sexual Compulsives Anonymous, I cried and whined and screamed, and people rolled their eyes at me and had compassion for me and got me through," says Charles, a thirty-seven-year-old public relations executive from Pennsylvania. "Now I can trick occasionally and go to the local porn theater for forty-five minutes, and not for five hours, and not for five hours every day for three weeks." Amico says that many people "go to meetings and treatment for a couple of years and then drop out of the scene." For others, issues are so strong it may mean a lifetime of investigation.

Step 3: Make a Plan If you do seek therapy or peer support, don't have it be all talk and no action. Try to implement a plan, a way of finding what McFadden calls "a combination of understanding what contributes to the problem and a strategy about how to change it." That may just be returning to step one, above, or writing out a "contract" of the kind made by members of Sexual Compulsives Anonymous.

Diagnosing Sexual Addiction Sex, like food, is something that everyone needs -- the question is how nourishing you're finding it. Rather than rushing to judgment, or treatment, of your sexual practices, take a look at them. "Most of us don't understand our sexual life -- we have rules or methods for how we get off, but we don't necessarily sort out those rules or the mystery about them," says GMHC's Richard Elovich. "There is such a thing as sexual compulsion, but there's also natural confusion that may fit the diagnosis." Dr. Sealy agrees. "If you answer yes to fifteen out of twenty questions on an assessment test, that may or may not indicate addiction," he says. "The real question is whether you're selling out your integrity and tromping on your sense of spirituality and self. Can you sustain a sense of sexual satisfaction, or is there only dread?" With those warnings in mind, below are some of the questions designed to try to gauge sexual compulsivity. They're a tool for inquiry, not an acid test.

Do you think of yourself as overly preoccupied or obsessed with sex?

Do you feel driven to have sex in response to the effects of stress, anxiety, depression, or other intense emotions?

Have serious problems developed as a result of your sexual behavior (for example, injuries, illnesses, or loss of a job, or fiscal stability)?

Do you find yourself constantly cruising or scanning the environment for a potential sexual partner, even when you don't feel it's appropriate?

Do you often find yourself preoccupied by the idea of making sexual contact with a particular man you've seen or heard about, even if you don't know him?

Have you repeatedly tried to stop or reduce certain sexual behaviors and been unable to do so?

Have you missed important events in the lives of your family, friends, or life partner because of the time you spend pursuing sex?

Do you feel yourself violating your own ethical standards or principles in sex?

Do you worry about turning HIV positive, yet regularly have risky sex anyway? And here are a few questions that need to be balanced against the realities of being gay in a largely straight world, but are still worth thinking about.

Do you keep the extent or nature of your sexual activities hidden form friends and/or partners?

Do your sexual encounters place you in danger of arrest for lewd conduct or public indecency?

Do you often have sex with men because you're feeling aroused and later regret it?

Has your involvement with pornography, phone sex, or online sex kept you from other kinds of intimate contact with romantic partners?

When you have sex, do you feel depressed, guilty, or ashamed afterward?

Has the money you have spent on sex-related activities seriously strained your financial resources?

Turning a Gay Gaze on Sexual Addiction Shame on Whom? Shame about sex, and keeping it secret, are red flags for sexual addiction in much of the psychological and addiction literature. But having grown up experiencing your desire for other men as something not valued or appreciated -- something to be acted out apart from your family and friends -- it's natural that many gay men would keep their sexual lives secret or split off. Coming out doesn't magically heal that split, or the shame and ambivalence it helps create. Trying to separate out the confusion about sex that society instills in us from the guilt and shame that fuel a psychological compulsion is a delicate proposition at best. "I've had men come in to me and say, 'You have to help me, I'm addicted, I masturbate every day,'" says New York City therapist Michael Shernoff, MSW. "And I have to ask, 'Well, why do you think that's sexually compulsive?' If you leave important meetings and go do it in the middle of the men's room, that's one thing. If you do it by yourself, in a stall, that's another. If you're doing it at home because you can't get to sleep unless you have an orgasm, that's yet another. There's no such thing as a pure motive in sex. It all has to be differentiated."

Straight Talking Gay culture -- partly because we don't usually meet sex partners at work or through family, and partly because of the belief that there are models other than the monogamous child-rearing couple -- has created some ways of being sexual that don't show up on the ordinary radar screens of the straight world. Some of those things -- such as anonymous sex, cruising for sex, or having "fuck buddies" -- may well show up on your local therapist's sexual addiction assessment, however. One of the original self-help groups for sex addicts, Sexaholics Anonymous, goes as far as targeting "sex outside of heterosexual marriage" as a warning sign. Clearly, we're all diagnosable.

Stranger Things Have Happened Consider gay realities as well as straight ones. "Just because you have sex with a stranger doesn't make you a sex addict, or mean you're not one," says John Sealy, M.D., director of a treatment center for sexual disorders at Del Amo Hospital in California and a board member of the National Association of Sexual Addiction and Compulsivity. "It's not what you're eating, it's what's eating you." Similarly, it's tempting to want to split your sexual self into parts: the "bad" part, which feels drawn to the dangerous thrill of sex in the park, say, and the "good" part, which is monogamous and loving, brings home flowers, and gives your boyfriend soulful looks that would make Betty Crocker proud. "The reality of sexual life is more complex," says therapist Stephen McFadden. "Evaluating those complexities means looking at what you're getting or not getting from various kinds of sex, not just wishing lust away or dismissing gay culture."

Are We Alone? Most discussion of addiction -- whether a physical addiction, such as alcoholism, or a compulsion, such as an eating disorder -- uses a disease model, looking at the problem as something that an individual works to heal within himself. "That gets complicated," warns GMHC director of HIV prevention, Richard Elovich, "because most sex happens between two people, not just you. It's not something you 'have a case of.'" Treating sexual compulsivity as your problem alone can reinforce the isolation many gay men feel about their sexuality in the first place.

Beware Abstinence Absolutism Many men who feel there's some compulsive element to their sex jump at an "I'll-never-do-that-again" approach. While abstinence, freely chosen, can be helpful, says Jack Morin, Ph.D., author of The Erotic Mind, going to battle against sexual behavior can sometimes be the worst thing to do. "Struggle fuels compulsion," says Morin. "The solution is not for one side to win, but to integrate the warring selves by looking at what you are actually feeling while you're being compulsive. Conscious self-examination can disrupt some of the intensity, and much of the confusion."

Excerpted from Men Like Us: The GMHC Complete Guide to Gay Men's Sexual, Physical, and Emotional Well-Being by Daniel Wolfe. Copyright © 2000 by Daniel Wolfe. Excerpted by permission of Del Rey, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.



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