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Sexual addiction and compulsion are a problem-and comprise a touchy subject that isn't talked about. All men-gay, bi and straight alike-can suffer from this disorder, Patrick Carnes, Ph.D., has written extensively on the subject. In his landmark book, Out of the Shadows, he coined the term sexual addiction. My own working definition of addiction is any behavior or activity that interferes in one's life in some way, but which one continues, despite negative consequences. Along with behaviors are other factors and dynamics, like loss of control.

If a man's tried to stop or cut down his cruising behavior, with no success, that signals a problem. Addictive behavior often displays progressive increase in tolerance. The person needs ever-stronger "hits." This syndrome explains heroin overdoses: The previous level of the drug wasn't satisfying enough, so the frustrated addict "promotes" himself to a higher, lethal dose-beyond what his body can handle.

Similarly, the sex addict needs more and more of whatever behavior satisfied him in the past. Because this progression occurs over time, it's not always obvious. Initially, masturbation with fantasy was enough to satiate his sexual appetite. Later, he needs to view pornography while masturbating. This is then that is not enough, and he feels the need to actually meet someone. Suddenly, he realizes he's cruising at a bar or sex club, or going online more often than he wants to be.

These behaviors, in and of themselves, doesn't necessarily constitute addiction. Problems arise when they interfere with being able to be completely present with one's self and one's partner and enjoy the sexual act-in addition to the fantasy.

People with addictions continue their behavior in spite of negative consequences, which they deny or do not perceive. When the man becomes accountable for his own behavior, no longer blaming it on others, only then can treatment begin.

Most people don't know that during any addictive behavior, biological chemicals are released, making these actions even more compelling.

Natural chemicals such as endorphins and adrenaline give the addict their "high." The sex addict's behavior causes chemical changes in his brain, which promote a mood- and mind-altering experience. Then there's a natural drug in our bodies called phenylethylamine or PEA for short. It's an essential chemical for those who are addicted to inherently risky behaviors like gambling, shoplifting, bungee jumping, and sex. PEA's molecular structure parallels amphetamine, and is strongest when first released. This explains why so many people with addictions say they're always seeking the feeling they had during their first high, and want to re-experience it over and over.

A number of signs exist of sexual addiction. One is a pattern of sexual behavior that's out of control. Of course, sexual impulses are the spice of life, reminding us that we're biological beings! But in sexual addiction, these feelings become intrusive. An impulse comes, followed by a strong need to act on that urge immediately, to get relief. This pattern begins to occur with some regularity.

Another warning sign: Severe consequences due to one's sexual behavior, such as being arrested, compulsive masturbation resulting in abrasions and sores, contracting sexually transmitted diseases, or having a loving relationship end when one partner catches the other cheating.

Another warning sign: Ongoing desire or efforts to limit sexual behavior with failed attempts to stop or cut down the behavior.

Sex addicts viewing the world through a sexual filter. In an attempt to cope with stress, sexual obsession/preoccupation and fantasy become primary strategies. The sex addict will allow his thought to focus on sexual fantasies and sexualize most of his experiences, to relieve himself of the tension he is experiencing.

A sex addict will use fantasy and behavior to modify his mood state. That's the essence of any addiction: an attempt to reduce anxiety, depression and other unwanted feelings and thoughts. The psychological self-soothing hit of PEA and other internal chemicals lets the sex addict feel temporary relief. His mood will elevate. But when the sexual behavior is over, he will drop into shame, despair, depression, remorse and guilt for having engaged in his obsessions and compulsions.

"Sexual acting out" (or SAO, for short) behaviors are a way of acting out our feelings-about whoever we're with, and about ourselves. For the sex addict, the goal is to identify the difference between what behavior's healthy, and what's not. 

That's what defines these repetitive, unhealthy behaviors. A man within normal limits, -briefly, or at times of stress or crisis-might find himself driven to overindulging in sexual behavior.

Some SAO behaviors include:

• Compulsive masturbation
  There's no normative frequency. As the old joke has it, a father tells his son that if he masturbates, he'll go blind. The kid responds, "Can I do it until I need glasses?"

But seriously, the sex addict does this chronically until his penis is sore or abraded, until there is no more semen to ejaculate. Or he may masturbate in his car, or in a park or restroom with the hope of being seen. He prefers masturbation over sex with a partner.

• Indulging in pornography
  Again, using porn to assist in any kind of sex is no problem. It is, however, when photos are preferable to a flesh-and-blood partner; when it's necessary for stimulation and ejaculation; and when any other form of lovemaking isn't as satisfying.
  
  
• Exhibitionism
  Exhibitionism is the desire to show one's body or body parts to another for self-arousal. An exhibitionist's thrill depends on reactions from his onlooker. The flasher gets a high from exposing himself and shocking men and/or women-the equivalent of visual rape.
  
  
• Anonymous sex and dangerous sexual practices
  
  
• Voyeurism
  This is where one is seeking sexual thrill and pleasure from viewing others either while they know or don't know they are being watched.
  
  
• Compulsive cybersex
  Before the invention of caller ID, men would call others and engage in sexual conversation against their will. Nowadays, this happens on the Internet where someone instant-messages another and attempts sex talk. If that person says no and the instigator persists, this is a violation.

The sex addict prefers to be online over sex with a partner-or to even having a partner at all. He'll spend hours on end online, viewing Internet porn, looking at personal ads and frequenting chat rooms. A man's family or partner can be watching television, while he's in the same room, enjoying cybersex on his laptop, while the others have no idea what's going on. This doesn't have to be associated with masturbation. The chase and the hunt are more exciting than the catch.

For the sex addict, this activity can consume an entire afternoon, interrupting his life. He may even leave work early to engage in these behaviors.

Sexual addiction blocks its sufferers from having deep connecting relationships. This is why it is greatly important to have to relate to another human being on nonsexual levels. Time and again, studies show that the sexual addict who engages in individual, group, and 12-step groups-all three together-is helped most effectively. Placed in proximity to others, they're forced to examine their issues of intimacy and relational skills with others.