Hypersexuality is a mental disorder causing people to engage in or think about sex to a point of distress or impairment. Watch as ...

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How Much Sex is Too Much? Urologist Explains Hypersexuality vs. High Sex Drive

have you ever wondered if you or someone you know is hypersexual or do you just have a high sex drive I'm Dr Reena Malik urologist and pelvic surgeon and today we're going to talk all about hypersexuality now hypersexuality is sort of a very controversial topic there's no real agreed upon definition in the dsm5 which is essentially a categorization of a number of psychiatric conditions and so what exactly is it so we're going to talk about what it is what sort of things that might be causing it and will kind of review what you can do or what kind of help you can seek if you're struggling with hypersexuality so when you're thinking of hypersexuality there's essentially three things that need to be happening one is that you're having a preoccupation with sexual desires sexual fantasies or the AC of sex that is really difficult to control you're also having a lot of sexual behaviors and that could be masturbation that can be sex with person that can be telephone sex that can be excessive use of pornography and then lastly that it's causing distress to you or your family so the consequences can seem obvious and some are less obvious so one is certainly you can get sexually transmitted infections if you're not having safe sex you can have unplanned pregnancies and these conditions can be sometimes serious obviously this can be a huge strain on your relationships whether they're romantic or not it can cause cause a significant amount of distress in and conflict in your relationships it can cause your own personal loss of self-esteem and feeling lonely at times and lastly because you're so preoccupied with having sex it may mean that you're not doing as great of a job at work so you might have difficulty keeping a position you may be spending lots of money on using escorts lastly if you're engaging in some sex offenses then you can have legal trouble but this is not common but it ranges in the studies from anywhere from 2% all the way up to 10% of people so it is common enough that you may come across somebody who has hypersexual Tendencies now how have people defined hypersexuality like is it the number of times the amount of time you're spending so there's actually a research group that sort of decided what the amount and frequency of orgasms are which is sort of normal and above and beyond that if considered to be abnormal the way they figur this out is through surveys of tons and tons of men to identify how many times people are reaching orgasm through a variety of methods that could be through partnered sex that could be through masturbation and they found that it was extremely rare for people to have more than seven orgasms a week and they describ this as total sexual output So based on this they said any person whether it's a man or woman if they had a total sexual output of more than seven orgasms per week that was sustained for 6 months and they spent more than 1 to two hours on such sexual activities that end in orgasm that this would be considered hypersexual now this is a flawed definition right because people can have lots of sex and have lots of orgasms and it canot be detrimental to their quality of life or they could be preoccupied with sexual behavior which could be problematic but they're not actually having orgasm so it's not a perfect definition so there was a proposed definitions by a number of Psych ologist and psychiatrist to Define what hypersexuality is it had to meet at least four or five criteria over a period of 6 months the first was excessive time was preoccupied or used up by either sexual fantasy sexual urges or planning for sexual activity number two was that you were repetitively engaging in these activities in response to theoric state so whether you were anxious bored depressed this was sort of your response to those feelings and number three was the same very similar but repetitively engaging in these activities when you had stressful life events number four was that doing these activities but having really trying to control your time and obsession with sexual activities but being unable to and lastly continuing these activities despite harm to yourself or others in addition to having four or five of these things you had to be an adult you had to be bothered by the amount of sex you're having and this couldn't be due to another condition like bipolar disorder for example or be due to a substance that you're taking now a really great way to think about this is through a cycle that was described in one of the research papers I've linked down below called The Sex havior cycle of hypersexuality so the way you think about it is any sort of sex event starts with an urge so you see something hear something feel something that gives you an urge for sex you then proceed to the sexual behavior so that could be masturbation that could be sex whatever it is and you then go on to sexual satiation so this is when that initial urge starts to dissipate and you're starting to feel sort of satisfied during the moment and that urge starts to wean this is Then followed by post seexual satiation post-sexual satiation is you've completed the act and your urge is pretty much gone and you're back to your normal Baseline of non-sexual arousal so the average person can have a sexual urge and not act on it and the one the difference in hypersexual individuals is they have an urge and they really cannot suppress that urge they have to act on it otherwise they sort of feel out of control in terms of satiation normally people feel satiated for a longer period of time so they complete the ACT their urge goes away and they're back to normal state for a significant amount of time now hypersexual people can feel like they're never satiated or their satiety period is significantly smaller the other interesting thing is that when they get these sexual urges they go into this state called cogn abeyance basically all their logical thought goes to the Wayside they're no longer balancing the rewards to the risks of proceeding with whatever activity they're thinking of doing they also may get in sort of what's a cognitive trans-like state so they're just focused and completely 100% thinking about achieving that sexual urge and doing that sexual behavior to complete that urge now before I get into the theories as to what causes hypersexuality there is one argument that these people who are deemed hypersexual actually just have a high sex tribe and because of society's thoughts of what is considered normal they begin to feel shame around their desire to have sex and this becomes more of a pathology so when in actuality they just have normal sexual urges and they want to have sex and this then spirals into a feeling like there's something wrong with them because of societal Norms so there are a few theories as to why people become hypersexual and two of these that sort of seem very opposite but are on sort of a spectrum are sexual compulsivity and sexual impulsivity now sexual compulsivity is essentially like people who have OCD so for example when someone has a compulsion they get a thought that is so difficult to ignore and the only way for that thought to go away for them is to do the action so very similarly it's thought that people who have hypersexuality get these obsessive thoughts that they they need to then proceed to complete the thought in this case the sexual behavior and so these sexual behaviors may be a way that they seek to self soothe themselves when they're having significant anxiety depression or mood conditions on the other hand impulsivity is essentially the inability to resist the urge to have sex it's sort of similar but in this case though when you have the ACT you get pleasure right and that pleasure then reinforces the desire to go be impulsive again and try and Achieve that pleasure and so very often what these people will feel is they'll feel this strong sense of tension which then during the ACT they feel this immense relief and gratification and then after the ACT they feel guilty but the cycle then repeats itself and so the way to think about this is compulsivity is using the ACT to get away from negative feelings like anxiety stress depression whereas impulsivity is using the ACT to get pleasure or get a positive reward and so they're sort of again like on a spectrum someone can be using it can kind of fall into what either of those categories another theory is that hypersexuality is a trauma and sex disorder what that means is that people experience trauma and stress during their childhood and this trauma then leads to them having difficulty regulating their body's normal systems of desire and arousal and so then they go on to have difficulty forming intimate relationships with normal levels of sexual desire and arousal the other thought is that this is a sex addiction now addiction by definition has a few characteristics one is that you need increasing amounts of whatever thing you are addicted to to achieve that same level of pleasure so in this case sexual behavior the second thing is that you begin to have a dependence on the substance or thing that you're addicted to and then also that you have withdrawal symptoms when it's taken away you need more and more of the same substance to achieve the same kind of satiation that you did previously so in order to kind of fulfill the addiction you no longer need sex once a day you need sex twice a day three times a day so on and so forth with it there's a desire and a realization that you're out of control and you've tried you've either wanted to or tried to control the addiction while being unsuccessful in addition you'll spend a lot of time engaged in the activity that you're addicted to and lastly you'll continue doing the activity despite knowing that it has negative consequences to your psychological Health your relationships or your physical health when they've looked at brains of people who have hypersexuality disorder or what they've thought to be hypersexuality disorder they've seen increased activity in certain parts of the brain that are involved in Pathways of motivation and reward as well as memory and so these areas get highly activated so that when people have sexual urg is their motivation for them is higher and they also their reward response is higher also they may have disregulation in some of the frontal cortical parts of their brain which then cause difficulty in making good decisions essentially impairing their judgment and enhancing their impulsivity for sexual behavior now when you think about sexual excitation or inhibition we know that certain parts of our neurotransmitters and hormones are responsible for increasing excitation and that can include things like dopamine and testosterone so we see that in certain medical conditions or certain medications that you take for certain medical conditions that there can be more hypersexuality for example people who have Parkinson's disease often take medications that increase dopamine and so when you increase dopamine they tend to have more hypersexual Behavior similarly we can see it in people taking medications for seizures people who've had brain injuries to those areas or who have dementia now what can you do for hypersexuality so certainly you need to see a psychiatrist or a psychologist to discuss the issues at hand and there are a number of medical and psychological treatments available let's start with medical you can take anti-depressants or selective serotonin reuptake Inhibitors now these medications increase serotonin and serotonin actually causes inhibition of sexual thoughts so these can be very effective in improving hypersexuality similarly medications like anti-androgens reduce testosterone which is also involved in sexual desire or excitation other medications similarly can work to act on the hypothalamic pituitary axis to then reduce the production of LH and FSH which are hormones that then cause testosterone production other medications that have shown some benefit include nxone mood stabilizers antis psychotics and even anti-anxiety medications in terms of psychotherapy using things like cognitive behavioral therapy which allows you to sort of change your thoughts around those sexual urges and replace them with more positive things using acceptance and commitment therapy which allows couples to work together to change their relationships with thoughts rather than the actions themselves or motivational interviewing where they go through with the person where the psychologist or psychiatrist will go through and see what your goals and values are to help you elucidate where you're struggling and help you find Solutions hypersexuality can be a really serious problem so if you're watching this video I encourage you strongly to get help from a psychologist from a psychiatrist who can help you work through these issues this is going to take time and effort and energy but you will get through it and it is really important to get help by the way I have to let you guys know about my new podcast which is already up up on Apple and Spotify sharing some of the older interviews that I've had on this channel but starting December 8th you will see brand new interviews both here on YouTube and on Spotify apple or wherever you consume your podcast from the Reena Malik MD podcast I've already started interviewing some of the Most Fascinating People and I'm continuing to find so many cool and interesting people to join me on the podcast every single week and as always you to take care of yourself because you're worth it

Dr.

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