How Sex Addiction Became A Diagnosis

Last month, former congressman Anthony Weiner pleaded guilty to charges related to sexing with a 15-year-old, declaring, “I have a sickness, but I do not have an excuse.”

Weiner’s seeming inability to stop sending sexts to a minor, despite all the personal and political consequences he knew he could face, has touched off a debate around the dubious science of sex addiction . Weiner’s actions put him in a long line of famous men — from Tiger Woods to David Duchovney to Josh Duggar — who argue that their sexual behavior reflects an addiction.

For the most part, modern medical professionals are skeptical about the science of sex addiction . But there’s a long tradition of using medical language to explain socially unacceptable sexual appetites.

Sex addiction as we currently understand it became part of the public discussion around 1980, as Barry Reay, Nina Attwood and Claire Gooder of the University of Aukland explained in a 2012 paper .

After the country had experimented with two decades of free love, disco clubs and shifting gender and sex roles, there was a serious pushback to sexual promiscuity, particularly coming from conservative Christians and certain strains of feminism. Rising concern about addictions to drugs, alcohol and gambling provided an easy way to talk about destructive sexual behavior. The term “sexual addiction” was broad enough to encompass any sort of sexual thought or action that made people feel guilty or ashamed.

“Its success as a concept lay with its medicalization, both as a self-help movement in terms of self-diagnosis, and as a rapidly growing industry of therapists on hand to deal with the new disease,” Reay and his colleagues wrote.

Today, when we talk about sexual addiction, we’re often talking about the danger of people retreating from “real life.” Framing it as addiction helps us understand why men like Weiner and Woods would wreck their marriages and careers for fleeting encounters. Checklists of sexual addiction symptoms include items like “thinking of sex to the detriment of other activities” and “neglecting obligations such as work, school or family in pursuit of sex.”

A long history of pathologizing sex

For thousands of years, doctors have worried that excessive or inappropriate sexual behavior would harm men’s ability to function in productive, socially appropriate ways. In the days of early Christianity, cultural studies scholar Elizabeth Stephens explains , medical texts warned that “excessive” ejaculation depleted masculinity.

She quotes historian Peter Brown’s description of the belief among Roman doctors that “no normal man might actually become a woman, but each man trembled forever on the brink of becoming ‘womanish.’ His flickering heat was an uncertain force.”

If the link between ejaculation and weakness was a longstanding concern, it took on a sudden new urgency in the 19th century, Stephens wrote. In the 1830s, French physician Claude-François Lallemand “discovered” spermatorrhea, a malady roughly comparable to sex addiction. Noting the asymmetrical testes of a man who had died of a cerebral hemorrhage, he concluded that the unfortunate man’s troubles began with the excessive discharge of semen.

Suddenly doctors were seeing spermatorrhea everywhere. Doctors compiled long lists of the purported disease’s symptoms, including decreased sexual desire, “erections and emissions upon slightest excitement,” nervous asthma, cowardice, poor memory and insanity.

Doctors believed the most significant cause of spermatorrhea was masturbation, Stephens wrote. The treatments ranged from exercise and cold bathing to injections of acetate of lead, blistering of the penis, and occasionally, castration .

Stephens argued that “many of the concerns about non-reproductive male sexual practices in the nineteenth century derive from an unease about modern indulgences making men soft, weak, incontinent, and undisciplined.”

Race, class and sexual panic

In the 19th-century U.S., this medical panic had a lot to do with a rapidly changing society. Middle-class young men were leaving rural areas and seeking upward mobility in the growing cities. Historian Kevin J. Mumford explained that this new freedom demanded individual self-control. Reformers warned that men who succumbed to urban vice “were likely to be found wanting in virtually all manly endeavors, especially in the pursuit of profit,” he wrote.

If spermatorrhea was a great threat, being susceptible to it was also seen as a mark of civilization and racial superiority. Nineteenth-century racial “science” held that black men were utterly lacking in self-control and prone to becoming rapists, yet they were in no danger of the physical and mental damage that sexual licentiousness caused white men. That meant, Mumford wrote, that by exercising sexual self-restraint, men “not only avoided sexual disorders but also distinguished themselves as white.”

Medical attitudes toward women’s sexuality also took a sharp turn in the 19th century. Before then, according to historian Carol Groneman, Western doctors generally believed women were as lewd and lascivious as men, and that female orgasm was necessary for pregnancy. But as men left their farms and home workshops for jobs in the industrializing economy, cultural belief in the differences between men and women’s sexual desires grew. Now, middle-class white women were seen as naturally nurturing and civilizing, and excessive female sexual desire was a threat to social order.

Groneman described an 1856 account by a gynecologist of a married 24-year-old woman who came to him complaining about her lascivious dreams about men other than her husband. The doctor instructed her to reduce her intake of meat, take cold enemas and swab her vagina with a borax solution. “If she continued in her present habits of indulgence, it would probably become necessary to send her to an asylum,” he wrote.

In other cases, gynecologists treated what they now termed nymphomania —defined rather ambiguously as “excessive” female sexual desire — with surgery, removing women’s ovaries and clitorises.

By the turn of the 20th century, Groneman writes, nymphomania was closely tied to all kinds of “dangerous” female behavior, including lesbianism, prostitution and agitating for economic and political rights.

Changing norms

For both women and men, the concept of sexual disorders in the past was broad enough to encompass all manner of social and economic upheaval. That’s still true today. As the cases of Weiner and other prominent men suggest, we can use “sex addiction” to mean being bad at monogamy, committing actual sexual crimes, or simply lacking the self-control to put long-term goals ahead of momentary pleasure.

The truth is, psychiatrists now generally don’t consider sexual addiction to be a real disorder. The American Psychiatric Association left it out of the latest edition of the Diagnostic and Statistical Manual of Mental Disorders after studies found little evidence to support the “addiction” label. For example, people who exhibit the behaviors we call sexual addiction don’t show the same patterns in brain activity as those who are addicted to drugs. “Sexual addiction” may actually be a loose collection of traits like high sex drive and lack of impulse control.

But history suggests that the way we think about sexual disorders isn’t just about medical evidence. It’s about our understanding of self-control, and the expectations we have for how men and women are “normally” supposed to behave.