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JOHN COTTERILL
Sex Addiction ?
7 July 2009: 10 Messages
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I am currently working with a male, 35, who has trouble ejaculating intra-vaginally. He has, in fact, managed to do this only on 3 occasions in the last 5 years with his wife. He has, as he
describes it, a low sex drive and has always masturbated exclusively to images of men masturbating alone (internet). He has never had or wants to have a gay relationship and never fantasizes. Currently looking at this problem as potentially an
addiction. All contributions welcome.
John Cotterill (jsbc@TALKTALK.NET)
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2
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I assume you mean sexual addiction. If so, I do not understand what aspects of this case suggest sexual addiction. This appears to be a case of inhibited male orgasm (otherwise known as retarded ejaculation) with a
possibility of hypogonadism. I suggest a medical evaluation to rule out other diagnoses or contributory diagnoses.
Charles Moser (docx2@IX.NETCOM.COM)
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3
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I am guessing that many of us have had ‘similar’ patients over the years. I would not rule out ‘sex addiction’. I might frame it differently in that it seems the patient has become habituated
to these images for his sexual arousal. In these situations, we have to go back and re-program the patient's brain to different stimulation. I have had a number of men who got ‘conditioned’ to get aroused with a specific masturbation position,
stimuli, etc., so it is like the old Pavlovian condition-response that we have to re-program in the brain. I typically find that having them taper off the original stimuli and bring back new stimuli (i.e. with their wife/partner) is the best and
most successful process.
Linda Banner (llbanner@EARTHLINK.NET)
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I have encountered this problem a few times and have tried the following which have yielded results in most patients:
1. Put him on a vibrator trial with oral sildenafil to augment erections along with visual stimulation with his wife by the side to stimulate and help him masturbate. The wife also learns to understand the
husband’s ejaculatory problem, which is situational.
2. Ask him to have intercourse with his wife with the clipping that stimulates him most played during the act for augmented visual stimulation (internet clips of men masturbating), since he cannot fantasize. The same
ejaculation will be achieved if what he says is true. However this is not possible with all couples. The wife has to be counseled and told it is perfectly normal for some men to behave this way.
3. Use of Buproprion 150mg SR, increased to 300mg SR. This drug, used as an anti-smoking drug has premature ejaculation as its side effect. Therefore it has a role in anejaculators or delayed ejaculators.
Please try out these suggestions and let us know what you have chosen to do for your patient.
T R MURALI (golde2003@GMAIL.COM)
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Am I the only one struck by the fact that this allegedly heterosexual man masturbates exclusively to images of men? There are a great many men who find it difficult to acknowledge to themselves that they are gay, and
engage in heterosexual relationships. However it is easy to understand why someone like this may have reduced interest in a female partner!
Abraham Morgentaler (amorgent@YAHOO.COM)
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I want to comment on the impact that the internet has had on sexuality. During the sexual revolution of the 60s and 70s, people experimented widely with their sexuality. Herpes and AIDS put a damper on much of this
activity in the subsequent decades, but now the internet has provided an outlet to explore sexual fantasies safely and anonymously. This has resulted in an explosion of sexual expression via webcams among people all over the world. If you haven't
checked out such sites, you really should. Men who purport to be ‘straight’ will interact with other men both verbally and on camera without hesitation. While in and of itself this would seem to be harmless and very safe from a disease standpoint,
I wonder what impact all of this has on sexual relationships within marriages. I suspect that many men and women find more excitement on the internet than they do in their own bedrooms!
Stephen (stephen.smith19@COMCAST.NET)
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I totally agree with Dr. Abe Morgentaler.
Johnny Roy (DocRoy@AOL.COM)
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I wonder about the concept of being able to explore and have everything without boundaries or cost. And I agree with Stephen that we need to understand the impact this 'freedom' has on people who are emotionally not
robust. We can't put the internet genie back into its bottle but maybe sensible information needs to be put out there about the effects of focusing one's sexuality predominantly on to non-intimate, hugely varied and totally non-demanding cyber
people. Add confusion about one's sexual competence, sexual orientation or connection with a legally committed partner into the mix and we get patients.
Margaret Redelman (redels@MEDEMAIL.COM.AU)
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The advise I give men with retarded ejaculation is to stop masturbating. Why? They usually develop a certain way to masturbate, that cannot be replicated by their wives or partners. Besides, by
masturbating, they lower their desire. One should also find out (i) whether this problem is lifelong or acquired (ii) the circumstances of the FIRST sexual relationship/s (iii) guilt about sex. The sex therapy technique is basically to replace
his hand with her hand. She should be able to make him ejaculate; then, penetration can be allowed, where she will stimulate him first, and before he ejaculates he can penetrate her. A vibrator could be used too.
Pierre Assalian (pierreassalian@3WEB.NET)
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Dr. Murali, I have never heard of Bupropion causing premature ejaculation, and I use Buproprion a lot for depression.
Pierre Assalian (pierreassalian@3WEB.NET)
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