Management of Hyperactive Sexual Desire

All patients presenting with hypersexuality require careful assessment and evaluation, including clinical examination. We have seen hypersexuality in women as a presenting symptom of an androgen-secreting ovarian tumor, a spinal tumor, and organic brain disease. It may be present in temporal lobe epilepsy, and it can also occur in psychiatric disturbances such as mania and, very rarely, depression. Genital disorders may also cause hypersexual behavior, as a patient treated by one of the authors illustrates. This 64-year-old woman presented with a frequent and urgent need to masturbate by clitoral stimulation, a problem that started abruptly after she had been hospitalized with a fractured leg. She was found to have rock-hard pieces of smegma adhered under her clitoral prepuce. Removal of the smegma, under local anesthesia, cured her sexual problem, which had been caused by poor hygiene because her leg was in plaster.

It is helpful to dichotomize individuals with hypersexuality into those people who simply have a very high sexual drive, over which they can exert a high degree of control, and those who are insatiable and unable to control their need for extremely frequent sexual activity. Individuals in the former group frequently present to sex therapists with their partners, who have lower levels of sexual drive (i.e., discrepant sexual drive presentation). They can generally be managed with sex therapy. Vary rarely, treatment with an antiandrogen is required to suppress such individuals' sexual drive. We view the latter group as having an obsessive-compulsive disorder, which is treated as such - with psychotherapy, pharmacotherapy (e.g., selective serotonin reuptake inhibitors or clomipramine), or a combination of both. Sex therapy is generally not indicated for this group, although concomitant couples therapy may be needed in cases where the hypersexuality has led to relationship distress.

Hypersexuality is a less common problem than hypoactive sexual desire. It can manifest as antisocial or criminal sexual behavior or simply as excessively high frequency of masturbation or intercourse that interrupts the person's life activities. Because the causes of hypersexuality include both psychiatric and organic disturbances, comprehensive evaluation is required in all cases.