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The Management of Hypersexuality in Men: Belinda Winder
The Management of Hypersexuality in Men: Belinda Winder
The management of
hypersexuality in men
BELINDA WINDER
disorder) linked sexual preoccupation, the thoughts, urges and behaviours that have themselves offending, and the medical
seeking of sexual outlets and an increase become problematic for an individual. practitioner will need to be encouraging,
in sexual fantasies, along with increases in empathic, mindful of any reporting
sexual behaviours.4 So, in a sense, there is a HOW MIGHT INDIVIDUALS PRESENT responsibilities as per their professional
‘turning up’ of the sexual volume across a WITH HYPERSEXUALITY? duties to report potential crimes, but also
range of dimensions. There are four principal ways in which understand that the person has come to
patients might present themselves to them for help.
Additional terms for the landscape of a GP or urology clinic. They may report
hypersexuality are sexual compulsivity physical symptoms, such as genital WHAT IS NORMAL?
and sexual addiction. Sexual compulsivity soreness from excessive masturbation; In their seminal study about human male
can be understood as a recurrent, insistent, they may present with high levels of sexual behaviour, Kinsey et al2 collected
unwanted and intrusive urge to perform anxiety and/or obsessive/compulsive data from over 5000 males about their
sexual acts, which may cause anxiety feelings underpinning their need for main sources of orgasm, the principal
or distress,5 while the term ‘sexual sex; their partner may have raised their types reported by participants being
addiction’ – which has variously been excessive sexual needs as an issue in their masturbation, nocturnal emissions, petting
used as a synonym for both hypersexuality relationship; and/or the person may wish and intercourse (heterosexual/homosexual),
and sexual compulsivity – brings in the to speak to a medical practitioner because and intercourse with animals of other
general addiction literature and is typically they are concerned that their obsession species. From their research, Kinsey et
referred to as any sexual activity or urge with sex is out of control and they are al reported that while there are some
that feels out of control. worried that they may harm someone by individuals who used one sole outlet for
committing an act of sexual abuse. all their orgasms, most people regularly
It is evident that these terms broadly depended upon two or three sources, and
overlap and that hypersexuality is a If presenting with the latter, the person will some men reported having orgasms from
convenient umbrella term for sexual have already taken a first step in stopping all six sources within a short timeframe.
The average frequency of orgasms
KEY POINTS (summed orgasms across all sexual outlets
to give a ‘total sexual outlet score’ or TSO)
• Hypersexuality can cause both physical and mental disorders; it may also was calculated as being 2.74 orgasms per
contribute to risky, even illegal, sexual behaviours week for the age group ‘adolescents to
• Medication can significantly reduce hypersexuality; patients may wish to 30 years’, and 2.34 orgasms per week
seek psychological treatment while taking medication to unravel problems across the entire range of men (from
potentially underpinning the hypersexuality adolescents to 85 years), taking into
account differences in age, social status,
• It is important that medical practitioners upskill themselves with regard to religion and rural/urban area. At the high
the use of medication to manage sexual arousal, and that they feel able and end of the distribution were men who
competent to prescribe or refer patients, as appropriate reported regularly having seven or more
• Medication does not have to be ‘forever’; constant monitoring of patients orgasms per week (7.6%).
(including side-effects of medication) is important so that patients can
reduce or stop medication as appropriate These early figures produced a baseline for
high counts of sexual activity; however,
• Patients taking medication to reduce hypersexuality report lower sexual even where someone reports having seven
arousal, greater emotional control and greater ‘headspace’ – all contributing or more orgasms per week, this does not
to a better quality of life in itself indicate abnormality. Indeed, the
• Prescribing medication to someone with hypersexuality could actually data showing frequency of orgasms shows
prevent sexual abuse (in some instances – not everyone presenting with a smooth curve, not a wasteland between
hypersexuality will go on to commit a sexual crime) ‘normal’ and ‘abnormal’ frequencies of
sexual activity. Usefully, however, Kinsey
• Practitioners should consider how they would manage a patient appointment et al ’s data gives us a cut-off figure – which
in which the patient self-reports they are concerned that their hypersexuality is three times that of the average – as a
may lead them to commit a sexual offence starting point in considering if a person is
presenting with hypersexuality.
service. However, there is still likely to be 3. Langström N, Hanson RK. High rates of sexual
About the author great variation, even between mental health behaviour in the general population: correlates
clinics, as to their confidence and readiness and predictors. Arch Sex Behav 2006:35;37–52.
Belinda Winder is a
to prescribe medication to manage sexual 4. Kafka MP. Hypersexual disorder: a proposed
professor of forensic
arousal, especially it seems where there is the diagnosis for DSM-V. Arch Sex Behav
psychology and heads up the
possibility of sexual offending. 2010;39:377–400.
Sexual Offences, Crime and
5. Kalichman SC, Rompa D. Sexual sensation
Misconduct Research Unit
While the National Offender Management seeking and compulsivity scales: reliability,
(SOCAMRU) at the School
Service facilitates this provision for prisoners validity, and predicting HIV risk behavior.
of Social Sciences, Nottingham Trent University.
in the system, it is down to community J Pers Assess 1995;65:586–601.
She is also co-founder and trustee of the Safer
healthcare professionals to manage 6. Grubbs JB, Volk F, Exline JJ, Pargament KI.
Living Foundation charity, set up to prevent
individuals presenting with hypersexuality Internet pornography use: perceived addiction,
further victims of sexual crime. Professor
in the community. It is not clear how well psychological distress, and the validation
Winder has been responsible for leading
those working in the community are able of a brief measure. J Sex Marital Ther
the mixed method evaluation programme
to deal with hypersexuality and the issues 2015;41:83–106.
of medication to manage sexual arousal at
it raises. Where effective management is 7. Vega V, Malamuth NM. Predicting sexual
Whatton, a category C prison for adult male
lacking we are leaving both the patient and aggression: the role of pornography in the
sex offenders, near Bingham, Nottinghamshire.
the rest of the community open to risk. context of general and specific risk factors.
She also initiated the first prison-based
Aggress Behav 2007;33:104–17.
service user research and evaluation group
Declaration of interests 8. Winder B, Gough B. “I never touched anybody—
for individuals who have committed sexual
Belinda Winder is leading the national evaluation that’s my defence”: a qualitative analysis of
offences. Current projects include research
of medication to manage sexual arousal in internet sex offender accounts. J Sex Aggress
about dementia, autism, internet sexual
individuals convicted of a sexual offence. This 2010;16:125–41.
offending, prevention, the role of religion and
evaluation is funded by the National Offender 9. Winder B, Lievesley R, Kaul A, et al. Preliminary
spirituality in desistance, and research with
Management Service, HM Prison Service, NHS evaluation of the use of pharmacological
transgender prisoners who have committed
England and Nottingham Trent University. treatment with convicted sexual offenders
sexual offences.
experiencing high levels of sexual
REFERENCES preoccupation, hypersexuality and/or sexual
If the presenting symptom is genital soreness, 1. Mann RE, Hanson RK, Thornton D. Assessing compulsivity. J Forens Psychiatry Psychol
for example, GPs may feel confident and risk for sexual recidivism: some proposals on 2014;25:176–94.
competent to prescribe medication to the nature of psychologically meaningful risk 10. Krueger RB, Kaplan MS. Depot-leuprolide
manage sexual arousal. For mental health factors. Sex Abuse 2010;22:191–217. acetate for treatment of paraphilias: a report of
issues, such as obsessive–compulsive thinking 2. Kinsey AC, Pomeroy WM, Martin CE. Sexual twelve cases. Arch Sex Behav 2001;30:409–22.
about sex, GPs may prefer to refer the behaviour in the human male. Philadelphia: WB 11. Bancroft J. Human sexuality and its problems.
patient to a psychiatrist or mental health Saunders Company, 1948. Edinburgh: Churchill Livingstone, 1989.