How it shows up: pornography, apps, sex work, and drugs and sex

Compulsive sexual behaviour shows up in many different ways, depending on the man and his context. These are the most common behaviours I see.

Porn, apps, drugs and sex, and more

Pornography is one. Porn use tends to take up more and more time, and it can escalate in different directions: into cam sites, and into subscription sites such as OnlyFans. Sometimes it is the porn itself that helps us escape and avoid. Sometimes it escalates into behaviours with wider impacts, financial and eventually relational.

Apps are another, and their use has exploded in recent years: finding partners, arranging hook-ups and casual sex. It isn't only the sex. It is the whole process: the time spent talking to people, posting photos, seeking partners, going through cycles of engagement and disengagement, and the investment of time, energy and emotional labour. It doesn't always lead to sex. Sometimes the process itself becomes compulsive and is the main driver. Other times the sex at the end supercharges the process.

Drugs and sex is another big category. That includes chemsex, which is disproportionately experienced by gay, bi and other men who have sex with men (MSM), though not exclusively, and the use of many other drugs in sexual contexts, such as ketamine and cocaine. Using drugs in sex can become an increasing part of someone's life and difficult to manage over time.

It can also include using sex workers and paying for sex, multiple affairs, or seeking out many different partners by more traditional means, with the pursuit and the maintenance of pseudo-relationships becoming highly compulsive and taking us away from other parts of our lives. It can include cruising and sex in public spaces, sex parties, sex-on-premises venues and saunas, for men of both sexualities. These are hypersexualised spaces that let us express ourselves in particular ways and can become deeply compelling, partly because we get a range of needs met there, which makes them really difficult to stop. And it can include risk-taking: unsafe sex, sex with the potential for physical or emotional harm, pushing boundaries so that risk is part of the experience. Everyone's threshold for risk is different, and in some circumstances risk can be healthy. At other times it causes significant harm.

No behaviour is judged

In practice, it is rarely just one behaviour. Sometimes there is a progression: porn, then other online behaviours such as cams or OnlyFans, then sex workers. Or apps, then casual partners, then more risk-taking, then drugs. More commonly, though, men dip in and out of different behaviours at different times. The overarching pattern is that sexualised behaviour helps them manage something, while the behaviours themselves vary.

What is crucially important is that no behaviour is judged. No behaviour is wrong in itself. We can be sexual in any way we want, as long as we are not causing deliberate harm to another person without their consent. Sex can take lots of forms. The questions we ask are these. Is the sex I'm having moving me away from the values I hold for myself, from who I wanted to be sexually? And is it creating more negative than positive outcomes? If the answer to both is yes, that is a good sign something is happening. That is what we see in the men we work with.

What it costs, and what it gives

The consequences show up across several areas of life, differently for different people and at different points. Physical health is one of the biggest: infections, sexually transmitted infections, physical injury where sex has been pushed to a limit, and changes in sexual function, such as erection problems, delayed or early ejaculation, changes in desire, bodies becoming less reliable, or needing different kinds of stimulation than we expected. Mental health is another. Almost everyone I work with comes because there is distress. Frankly, I don't think people come into the room unless they have felt distress about this, and if they hadn't, I would question whether there is a problem. The psychological impact can include anxiety, depression, the effects of past trauma driving the behaviour or new trauma created by it, suicidality, self-harm and acute distress, and with drugs and sex in particular, the onset of serious and enduring problems such as psychosis. Relationships are affected for almost everyone. Work is affected: behaviours seep into working hours and professional roles, or the psychological and physical impact means men can't work or have to step away from the direction they wanted. And leisure and valued activities shrink. The impact of compulsive sexual behaviour is often to shrink our world.

These behaviours are also giving something. They aren't just horrible things that take over our lives. They provide physical reward, fun, pleasure, arousal, and often connection. That is why stripping a behaviour away without understanding what it provides can do real damage.

How escalation works

Escalation takes many forms and is very rarely linear or obvious. Imagine a baseline: a sense of what we want to do sexually, and what feels out of reach. We start using sex more to manage distress and discomfort. At first it feels good and helps us escape, but the stress or threat persists, and over time the original behaviours don't bring the same relief. They are still fun, but they aren't enough, so we scan for something that might add to it or take it further. A lot of this is culturally promoted. For gay men, wanting to prolong or enhance sex is held up as an aspiration, so you might try poppers or low-level recreational drugs, or explore a kink scene. I'm not here to judge that, and I can see why it is right for some men when it comes from genuine curiosity about their sexuality. The problem is when it is being done to escape difficult feelings for longer. Then we are expanding a toolbox of things that help us escape and avoid, without thinking about how each one sits with our values. Every so often we find a tool that does it all at once: the first time with G, the first sex worker, the first one-to-one on OnlyFans. High acceleration, total escape, high reward. Then the baseline shifts up, and the cycle repeats from there. We stop things, re-engage, and find the next tool. That is what escalation looks like. It is often hidden because there are gaps in between: periods of abstinence, relationships, moves, a lot of life that masks the progression, while the culture around us normalises it.

For some, it can look different. Having lots of partners was celebrated, and then peers settle down and a long-term relationship feels difficult, so they revert to sex as the fix. Often the behaviour hasn't changed. The context has. It is important to take the shame out of escalation: it isn't always a treadmill going up and up. Sometimes life changes and the way we have been sexual no longer fits.

No brakes: technology and generations

Technology enables all of this. Apps, websites, subscription services and chat services are designed with two things in mind. One is to monetise: pay for extra features, extra visibility, extra searches, with the sense that we are missing out if we don't. The other is that the algorithms encourage us to engage with sexual material in very short, high-reward bursts. We see something, get turned on, swipe, move on. We are very rarely encouraged to sit with anything, or for it to be enough. The message is that there is always something better. For men already vulnerable to this pattern, that supercharges it. Compulsive behaviour existed before, and people have always used sex to regulate. But there used to be brakes, a natural off-ramp: you could only access so much, the tape ended, the cruising ground was empty. Now it is continually accessible, any time, in your pocket. There is always somewhere to repeat the pattern, which creates a trap that is heartbreaking for many men because it is so hard to get out of.

There are generational differences, but both groups are affected. Many younger men have grown up only knowing this. Being socialised into pornography from the age of eleven or twelve is having an impact on how many men connect to sex, especially its emotional side, and brings pressures around body, performance and expectation. Most of the men in their twenties I meet are highly intelligent and can critically appraise it. But early exposure skews the perception of sex, and I think it takes away from the lower-stakes, gentler exploration we would hope adolescents could have with their own bodies and others' in consensual ways, leaving gaps in knowing how to navigate intimacy and physical connection. For many young men, apps are also the main way to date. With fewer social spaces than there used to be, the way you present yourself, the rejection, and navigating needs through an app is much more complicated, and many of the men I see fall into compulsive patterns partly because that route is simpler. For older men who have struggled to maintain sexual relationships, an online world can feel like a viable solution and genuinely gives access to sexuality they would otherwise feel cut off from. On the surface that can be positive, but for men who use sex to regulate emotion, it draws them in. For older gay, bi and other MSM especially, ageing brings a sense of being less wanted, and I see many introduced to drugs through apps for the first time in their fifties. The technology opens pathways that weren't there before. That isn't all bad, but done in an unscaffolded way it can carry significant risk.

Attention deficit hyperactivity disorder (ADHD) and neurodivergence

Although I am not an expert in neurodivergence specifically, after working alongside men struggling with compulsive sexual behaviour for many years it also feels important to acknowledge the relationship that many men describe between their sexual behaviour and their lived experience of ADHD in particular. This is not a research finding (there remains a lot of work to be done to look at the relationship between compulsive sexual behaviour and neurodivergence), but many men who are diagnosed with ADHD describe a particular relationship with sex which can further fuel cycles of feeling out of control. Being sexual can help some people with ADHD reduce internal noise, and many men talk anecdotally about a quietening effect, a stillness. When arousal is working well, it can feel calming, and for an ADHD mind it can be the one time it isn't jumping around or straining under a heavy cognitive load. That gets supercharged with stimulant drugs in sex, and in chemsex culture I see a strong overlap between ADHD and methamphetamine use. For autism, I think the picture is much more mixed, and I'm not aware of a single relationship. But certain sexual spaces can feel more inclusive, and for people who experience difference in everyday relationships, feeling part of something can be really compelling.