The Case for Sexual Health.

Image by Vitruvian on  Flickr .

Image by Vitruvian on Flickr.

There's no evidence to suggest that you can treat sex like a drug.

There's no scientific evidence that can prove that there's an amount of sex that will be unhealthy for a person. There's also no evidence to show that consensual sexual behavior between adults is universally sick. Despite our efforts to pathologize normal behavior, we can't seem to find a way to make illness stick.

Many have tried.

Some researchers recently tried to connect what they called "sex addiction" or "hypersexuality" to a scientific theory called Incentive Sensitization Theory (IST). IST researchers argue that repeated exposure to a drug makes it impossible for addicts to regulate their need for the drug. So they keep coming back to it. This theory, if true, explains why people crave alcohol and drugs at rates they can't control.

Imagine that I placed two glasses of water in front of you and asked you to drink both. It's crazy hot in central Texas this time of year, so you gladly accept. The first glass goes down smooth. The second glass tastes disgusting and hurts your stomach the moment of your first gulp. 

It's then that I tell you that the first glass of water was clear spring water from a local well. The other glass, however, came from a bottle of ocean water I brought back from my recent trip to the Bahamas. 

What's the point? 

Just because one thing looks like the other, doesn't mean they're the same.

Just because my brain's pleasure centers are activated when I have sex doesn't mean that sex = cocaine.

IST is based on consumption of a foreign substance entering the body. Our bodies don't naturally produce cocaine. They don't naturally produce alcohol or heroin.

Proponents of sex addiction argue that, like drug addiction, sex addicts crave more and more compulsive "dangerous" sex (whatever that means) because - they too - have become desensitized to sexual behaviors, making their brains unable to regulate their need for the pleasure they receive from sex. There's just one problem:

Sex isn't a drug.

Don't get me wrong, sex is intoxicating. Even motivating. But is it reasonable to argue that the brain can't regulate sex cravings when there's no foreign substance to impair how it works? 

There's no doubt that many many people have trouble making healthy sexual choices.

That's not the debate.

The debate is what causes people to make choices they believe are unhealthy. Why do people make poor health choices when it comes to sex? Are they actually behaving in unhealthy ways? 

Should they be shamed for sexual behavior because it makes someone else uncomfortable? If there is a problem, is it evidence of a sex addiction epidemic? Or is it something more complex? 

Addiction and illness only exist as a counterpoint.

In other words, to define something as a illness, we have to know what health looks like. We know cells cancer (that's a verb) because we know how healthy cells function.

We can measure diabetes and generalize it to large groups of people because we know how much insulin the pancreas should produce. We see bones break and know they shouldn't look like that. 

 Most proponents of sex addiction define sexual health by it's absence.

You can't have too much sex.

You can't view sexually explicit materials for too long or too often.

You can't feel conflicted or confused about your sexual behavior. 

You can't have sex to manage stress or anxiety.

The closest universally accepted definition of sexual health comes from the World Health Organization (WHO). The WHO - arguably the world's leading authority on human health - cites none of the sex addiction pathologies in their definition of sexual health. Instead, they base health on principles of consent, mutual pleasure, education and autonomy among others. 

Sexual health changes according to context in which we live.

Our institutions, countries, faith communities and our families define sexual health in abstract and diverse ways. For obvious reasons: It's difficult to know what sex is healthy given the overwhelming fear we have about sexual conversations - not just with our partners and spouses, but with our children, friends and families. 

Is pleasure good? If so, how much? 

These are the conversations we must have to define sexual health. What if you and your partner disagree about what is sexually healthy?

Most of the time, this conflict is the beginning of our fears about sex addiction. Our culture makes people who like to have a lot of sex feel like there's something wrong with them because they might be different than their partners or because their fantasies are different from ours. 

So, we tell them to keep it quiet. Or we pathologize those behaviors. It was an illness to be gay until 1973. Anal sex can land you in prison in twelve states. So no wonder people hide their sexual behaviors. What stays hidden remains feared. And what is feared is unhealthy, evil or dirty.

Our society relies on counterpoints to define problematic behavior:

Night and day. Hot and cold. Health and disease. But without a clear sexual health definition, sexual addiction is a counterpoint to nothing, which makes it very hard to disprove. 

How are we supposed to have a realistic conversation about illness when we can't even agree on health? 

What do we know about sexual health problems?

We know there's no scientific agreement on whether sexual compulsivity, sex addiction and hypersexuality exist as illnesses.

The most recent attempt to define them as such was when a group of sex addiction proponents tried to classify hypersexuality in the DSM (the bible of mental illness). It failed because there wasn't enough evidence to suggest that there is such a thing. 

There's a ton of evidence to suggest that what is sexually acceptable is greatly influenced by society. Our morals, beliefs and disgusts tend to predict what is sexually healthy.

There's also evidence that sexuality is too diverse to create a single classification. It's too wide a concept to fit within a single prescription of illness. Unlike diabetes, it's hard to generalize. Maybe impossible. 

So in other words, sexual health in the United States may be different than sexual health in Kenya. Sexual health in Texas might different than sexual health in New York. And sexual health in your family might be different than sexual health in mine.

That sounds fine, right? Live and let live. 

Not so fast. 

Sexuality educator and psychologist Dr. David Ley makes a strong argument that we don't treat sex like other pleasure-seeking activities.

If I told you that in my family, we work out 12 times a week, you might be surprised, but you probably wouldn't feel morally compelled to stop us from our love of elliptical machines.

If, however, I told you that my wife and I regularly attend BDSM parties, you might rush me to a local rehab or synagogue. And the fact that I feel compelled to clarify that my wife and I don't attend BDSM parties reflects the fear of moral judgment that is so prevalent in our society when it comes to sex.

Consider this my "coming out" as a clinician who refuses to support the existence of a disorder that is built on unclear moral arguments and pseudoscience.

Morality is important and there's a place for it in sexual health discussions. We all have morals. Because of that, we must critically examine how those morals influence our ideas about health and illness.

And if you're reading this blog as a clinician, then you must be willing to let those morals be influenced by evidence that exists as a counterpoint to what you believe about sexual health.

I strongly support helping women, men, and gender non-conforming persons ground their sexuality within a framework of sexual health that fits their worldviews.

I believe in eradicating shame and promoting congruence in both personal and relationship values.

It's time to remove pathological judgment and give people something that can actually help them align their values with their behaviors.

Running around in shame circles trying to control a high sexual libido with surgical abstinence will only make matters worse. 

Some sexual health resources:

Southwest Sexual Health Alliance

The Harvey Institute

Dr. David Ley Books 

LGBTQ Sexual Health 

Center for Disease Control Sexual Health Information

Dr. Mathis Kennington