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Individuals with CSB (compulsive sexual behavior) may face a variety of medical complications, including unwanted pregnancies; sexually transmitted infections, including HIV/AIDS; and physical injuries due to repetitive sexual activities (for example, anal and vaginal trauma).
Sexually transmitted infections, such as HIV/AIDS, are a major health risk for those with CSB. Higher levels of sexual compulsivity appear to be related to more unprotected sexual acts, a higher total number of sexual partners, and being diagnosed with multiple sexually transmitted infections. A study of HIV-positive individuals found that compared with those who were not sexually compulsive, people with CSB were significantly more likely to report engaging in unprotected vaginal or anal intercourse, having more total sexual partners, and engaging in sexual behaviors that could lead to HIV transmission. In addition, four times as many new HIV infections can be expected in the HIV-negative partners of sexually compulsive individuals.
Individuals with CSB report significant marital, occupational, and financial difficulties as consequences of their sexual urges and behaviors. They also report that significant distress is caused by the amount of time spent consumed by their urges, thoughts, behaviors, out-of-control feelings, and post-behavior guilt. Mental health consequences, such as anxiety and depression, are common in people with CSB.
Although studies have documented the connection between substance use and sexual behaviors, few have specifically examined the connection between CSB and substance use. Substances can alter the experience of sexual behaviors. Methamphetamine increases sexual desire and sensations while decreasing sexual inhibition, and cocaine leads to feelings of well-being, self-confidence, and alertness. Research has shown that substance abuse is common in individuals with CSB, but it is not always clear which problem came first. Did the person become addicted to drugs because she was initially looking for sex and drugs came along with the sexual activity, or did the sexual activity get out of control because of the drug addiction?
The substance abuse–sex connection may be stronger among gay men due to the higher rates of certain drugs of abuse in the gay community (e.g., crystal methamphetamine) and the arguably easier access to sexual outlets. In addition, substance users typically feel more confident and desirable, and they have an easier time cruising for sex and making contact with another person, resulting in greater success in finding a partner. One study examining drug use in African American men who have sex with other men found that drug use increased their feelings of hyper-sexuality or sexual compulsion, increased their comfort with approaching other men, and allowed them to cope with feelings of homophobia.
Jon E. Grant, JD, MD, MPH, Brian L. Odlaug, PhD, MPH, and Samuel R. Chamberlain, MD, PhD are the co-authors of "Why Can't I Stop?: Reclaiming Your Life from a Behavioral Addiction"
