Patient Characteristics by Type of Hypersexuality Referral: A Quantitative Chart Review of 115 Consecutive Male Cases (2015)

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Journal of Sex and Marital TherapyCOMMENTS: A study on men (average age 41.5) with hypersexuality disorders, such as paraphilias and chronic masturbation or adultery. 27 were classified as "avoidant masturbators," meaning they masturbated (typically with porn use) one or more hours per day or more than 7 hours per week. 71% of these porn addicts reported sexual functioning problems, with 33% reporting delayed ejaculation.  What sexual dysfunction do 38% of the remaining men have? The study doesn't say, and the authors have ignored requests for details. The two other primary choices for male sexual dysfunction are ED and low libido.

LINK - J Sex Marital Ther.

2015 Nov-Dec;41(6):563-80. doi: 10.1080/0092623X.2014.935539.


Hypersexuality remains an increasingly common but poorly understood patient complaint. Despite diversity in clinical presentations of patients referred for hypersexuality, the literature has maintained treatment approaches that are assumed to apply to the entire phenomenon. This approach has proven ineffective, despite its application over several decades. The present study used quantitative methods to examine demographic, mental health, and sexological correlates of common clinical subtypes of hypersexuality referrals. Findings support the existence of subtypes, each with distinct clusters of features. Paraphilic hypersexuals reported greater numbers of sexual partners, more substance abuse, initiation to sexual activity at an earlier age, and novelty as a driving force behind their sexual behavior. Avoidant masturbators reported greater levels of anxiety, delayed ejaculation, and use of sex as an avoidance strategy. Chronic adulterers reported premature ejaculation and later onset of puberty. Designated patients were less likely to report substance abuse, employment, or finance problems. Although quantitative, this article nonetheless presents a descriptive study in which the underlying typology emerged from features most salient in routine sexological assessment. Future studies might apply purely empirical statistical techniques, such as cluster analyses, to ascertain to what extent similar typologies emerge when examined prospectively.

Excerpt From The Study:

In the excerpt below note the extensive spin about erectile dysfunction (ED), despite the fact that one third of the problem porn users already report delayed ejaculation (DE), a common precursor to ED with partners. What's missing from this paper:

  1. 71% reported sexual functioning problems with 33% known to have delayed ejaculation. What sexual dysfunction do 38% of the remaining men have? The study doesn't say, and the authors have ignored requests for details. The two other primary choices for male sexual dysfunction are ED and low libido.
  2. The men were not asked about their erectile functioning without porn. If all their sexual activity involved masturbating to porn, and not sex with a partner, they may never realize they had porn-induced ED.
  3. The authors cite Ley et. al., 2014 as falsifying porn induced ED. It did not, and has been thoroughly dismantled here.

Avoidant Masturbators

When those in the avoidant masturbator subtype (n = 27) were compared with all other cases (n = 88), there was a trend toward members of this group more frequently volunteering that they used sex as an avoidance strategy (100% vs. 41%), χ 2 (1, n = 34) = 3.81, p = .051, φ = 0.33. With respect to the mental health and sexological variables, the avoidant masturbator subtype was significantly more likely to report a history of anxiety problems (74% vs. 23%), χ (1, n = 101) = 20.27, p < .001, φ = 0.45, and of sexual functioning problems (71% vs. 31%), χ (1, n = 88) = 10.63, p = .001, φ = 0.35, with delayed ejaculation being the most commonly reported sexual functioning problem (33% vs. 7%), χ 2 (1, n = 88) = 9.09, p = .003, φ = 0.32. Those in the avoidant masturbator subtype had a trend toward being less likely than the rest of the sample to have ever been in a serious romantic relationship (70% vs. 86%), χ 2
(1, n = 102) = 3.34, p = .068, φ = 0.18. Of those who reported romantic relationships, there was a trend toward higher likelihood of the relationship having ended (28% vs. 9%) or been strained as a result of their hypersexuality problems (56% vs. 50%), χ 2 (3, n = 82) = 5.91, p = .052, φ = 0.27.

As previously noted, the avoidant masturbator subtype was operationalized as engaging in more than 1 hr per day, on average, of pornography use/masturbation. As predicted, this subtype had a trend toward a greater likelihood of reporting their sexual behaviors as being part of an avoidance strategy. Although substance abuse is also a common avoidance behavior, this subtype was less likely to report abusing substances, perhaps because of having already found an effective avoidance strategy in the pornography use, although this finding is in contrast with research on so called behavioral addictions (including hypersexuality), in which co-occurrence with substance use disorders has been found (as summarized in Grant, Potenza, Weinstein, & Gorelick, 2010). It would be useful for future research to assess whether the men in this subtype have problems with still other behaviors characteristic of avoidance, such as gaming (i.e., videogames) or more general Internet use problems. It is worth speculating whether most so-called behavioral addictions are related to procrastination or avoidance and might respond to similar treatment approaches. It is our hypothesis that the addiction is related to avoidance and procrastination.

Consistent with individuals who might be high in avoidance or procrastination (e.g., Beswick, Rothblum, &Mann, 1988; Flett, Stainton, Hewitt, Sherry, &Lay, 2012), the  avoidant masturbators were significantly more likely to report anxiety problems. Potentially consistent with higher anxiety is the finding that these individuals had a trend toward being less likely to have ever been in a romantic relationship; perhaps they are less likely to feel comfortable engaging in face-to-face sexual and relationship interactions. It could also be that the time they are investing in pornography use and masturbation limits the time for pursuing relationships. Avoidant masturbators who were in relationships had a trend toward reporting more relationship strain. This may be due to their problem being more difficult to hide from a partner (e.g., many partners of the chronic adulterers and paraphilic hypersexuals may not know about the interests or activities of the patient). It could also be that they are masturbating because of problems in their relationship that began before the sexual behavior problems; however, this could be said for all of the subtypes, as we did not assess causality in this study. Last, and perhaps also related to relationship problems, is that the avoidant masturbators are more likely to report sexual functioning problems than are the other subtypes, specifically, delayed ejaculation. It is very important to note that it is unclear whether these problems predated the pornography or masturbation problems and thus, might be related to anxiety and relationship problems, or whether it is the result of prolonged and frequent masturbation resulting in desensitization with respect to physiological sexual functioning. The finding of delayed ejaculation, rather than erectile dysfunction as the primary reported complaint is also interesting in the context of the popular media hype that pornography viewing is linked with erectile dysfunction. Although there are clinical accounts and emotionally charged media and self-help sites propagating this belief (e.g., The Doctor Oz Show, January 31, 2013; James & O’Shea, March 30, 2014;, there are no data to support the notion that pornography viewing causes erectile dysfunction (Ley, Prause, & Finn, 2014). While the claims of these media sources may contain some validity, the problem is that they propose hypotheses that require scientific testing, which has not yet occurred. The findings from this study are, to our knowledge, the first to examine the relation between the masturbation/pornography subtype of hypersexuality and sexual functioning.