Sex Addiction: Signs and Symptoms in Men

Previous blogs have addressed the universal signs and symptoms of sexual addiction, as well as the female gender-specific signs of sexual addiction. As a brief reminder, the universal signs and symptoms of sexual addiction in both males and females are:

• Preoccupation: obsessing about sex, making the fantasy and pursuit of it the number one priority in life
• Loss of Control: inability to limit or curtail sexual fantasies and behaviors, despite promises to self and/or others to do so
• Adverse Consequences: failed relationships, trouble at work or in school, financial issues, declining physical and emotional health, loss of interest in previously enjoyable activities, legal woes, etc.

The presence of tolerance, escalation, emotional and psychological withdrawal, and denial are also common among all sex addicts, though they are not necessary to make a diagnosis of sexual addiction.

When Men Act Out With Sex

Beyond the above universal signs and symptoms are multiple gender-specific issues that counselors should consider as part of their assessment process whenever sexual acting out and relationship addiction appear to be present. For instance, while female sex addicts tend to view their desires and behaviors in terms of a connection to their partners, men are much more likely to report overt sexual experiences such as compulsively viewing and masturbating to pornography, hiring escorts and prostitutes, getting “sensual” massages, and engaging in anonymous sex and other forms of non-intimate partner sex. Whereas women typically report romance oriented symptoms (in part to avoid the inescapable cultural shaming of women who are highly sexual), male sex addicts typically view themselves as “Don Juan” types, reveling in rather than denying their problematic, repetitive sexual exploits. Typical male sex addict behaviors include:

• Compulsively using pornography, online or otherwise
• Compulsively masturbating, with or without pornography
• Establishing inappropriate boundaries (making sexual advances toward subordinates, co-workers, bosses, clients, married women, etc.)
• Using sex to avoid feelings of loneliness or unhappiness
• Engaging in prostitution (hiring or providing) and/or sensual massage
• Compulsively sexting potential partners
• Engaging in anonymous sex
• Engaging in unsafe sexual practices
• Engaging in exhibitionism and/or voyeurism
• Having sex in high risk locations or situations
• Engaging in multiple online or extramarital affairs

Psychosexual Histories

Counselors who learn of these patterns when getting to know a male client are required to explore that individual’s sexual behavior further (in a non-graphic manner), as sex addiction may be a core issue for that client. (This is especially important when dealing with substance abusers who repeatedly relapse on drugs and alcohol related to their pursuit of sex and romance.) This exploratory process means asking difficult, uncomfortable questions about pornography, masturbation, and partner sex. Therapists should be able to use this history-taking as a way to help confront the profound denial of most male sex addicts. Therapists should also be aware that instead of seeing sexual addiction for what it is – a pathological relationship to the mood-altering experience of sex – sex addicted male clients will sometimes argue that men are biologically wired to seek and have as much sex as possible. They will tell their therapists (and themselves), in all sincerity, that all men behave in exactly the same fashion – even when they’ve been arrested, have contracted an STD, or are masturbating so much that they’ve caused physical injury to their penis. These men also believe, as do most addicts, that “as long as no one knows, I’m not hurting anyone,” effectively ignoring the jobs lost, money spent, relationship turmoil, and other negative consequences directly related to their repetitive patterns of sexual acting out.

Addiction treatment specialists should also be cognizant of the fact that many (perhaps most) male sex addicts have a cross- or co-occurring addiction. In one early study of male sex addicts, 87 percent of respondents reported that, in addition to being compulsively sexual, they regularly abused either addictive substances or another addictive behavior like gambling or spending. Today male sex addicts will often abuse meth or cocaine, sometimes with Viagra, Cialis, Levitra, or other erection-enhancing drugs along for the ride. For men with concurrent sex and drug addiction, both issues must be treated simultaneously, as continuing to use with one addiction nearly always means continuing to use (or relapsing) with the other. In other words, if you don’t treat both issues at the same time, the client may not heal from either.

Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. A licensed UCLA MSW graduate and personal trainee of Dr. Patrick Carnes, he founded The Sexual Recovery Institute in Los Angeles in 1995. He has developed clinical programs for The Ranch in Nunnelly, Tennessee, Promises Treatment Centers in Malibu, and the aforementioned Sexual Recovery Institute in Los Angeles.He has also provided clinical multi-addiction training and behavioral health program development for the US military and numerous other treatment centers throughout the United States, Europe, and Asia.