Hypersexuality / hypersexual disorder

ShinyBrownEyes said:

I think it's possibly the case that I seriously misjudged/misread how sexually interested she was in me during our brief courtship. We're hardly ever intimate and it has always felt that way to me. She has recently said that this aspect of the relationship is something she could take or leave. Where as I am desperate to feel the intimacy of someone enjoying regular sexual closeness.

Isn't this a textbook case for sex therapy? A very particular kind of couples therapy where the therapist tries to help you fix your sex life. In particular to help you and your wife work through your miss-matching sexual desire in a non confrontational way. Would you consider that? Would your wife? It seems a lot less extreme that chemical castration. Miss match in sexual desire is not an uncommon problem in relationships and sex therapy is there to address exactly this sort of issue.

ShinyBrownEyes said:

That's when I came across the more recent clinical [link removed by moderation team] into hypersexuality and increased prevalence in autistic males.

Moderation team why was this link removed? Are we censoring clinical studies now? If a peer reviewed research article isn't allowed here what is? Kerri-ModRoss-Mod

Thanks Peter and abg. For context, the article I linked to was in the peer-reviewed journal Dialogues in Clinical Neuroscience and titled 'Sexuality in autism: hypersexual and paraphilic behavior in women and men with high-functioning autism spectrum disorder'. It's available to read open access on the publisher website (Taylor & Francis), published 2017.

In terms of the substance of what is going on, I'm open minded. I haven't received a formal diagnosis of Autism and ADHD but everything I'm reading has a loud ring of truth about it. If self-assessment was all that was required for a diagnosis, then I've scored very highly in a handful of different tests. I have previously been diagnosed with recurrent depressive disorder (a few years into our marriage), and subsequently traits of EUPD (during a psychiatric investigation into whether or not I was bipolar, which concluded in favour of EUPD traits). When I started exploring autism and ADHD it crossed my mind that my struggle with my sexuality might have a 'special interest' quality to it. The abovementioned research identifies hypersexual individuals through a few assessments, including the HBI-19 (Hypersexual Behaviours Inventory) questionnaire. The threshold score is 49/95 and I scored in the 80s (self-assessed). One of the key findings of the study is that males with autism are more likely to be hypersexual than females with autism and both males and females in the health control category. Also, 'ASD men reported a greater sexual desire for [frequency of] sexual intercourse than their HC counterparts', but in contrast HC males were 'reporting a higher frequency of sexual intercourse than ASD individuals.' My personal experience seems to fits these findings.

So yes, sex therapy is something I have wanted to explore throughout our marriage. However, I'm also aware there's something about me and my desire/intensity that is likely atypical, including that I take SSRI medication reported to have an effect in reducing libido, and that I take it in high doses but with negligible effect in this area. My wife and I also have to take account of numerous strains on our sexual relationship such as endometriosis, infertility, chronic pain, and the cumulative effect of my many meltdowns/explosive behaviour over the years (which we're only in recent weeks starting to contemplate may be a manifestation of autistic burnout/meltdown). I'm still pretty much as vivacious, curious/open to experimentation, intense as the day we met, despite the pain we've both experienced in all this, whereas my wife is ready to draw a line under this part of our life together.

My (self-assessed) Camouflaging Autistic Traits score was very high (quite a bit higher than the average AS woman). I'm learning that I'm not very in tune with my own emotions and needs. I think I've prbably wrongly rationalised this as 'Christian' since childhood: I promised on our wedding day to lay down my life for my wife and, being quite a black & white thinker, always have wanted to put my wife and children's needs first and seen my own wants as 'selfish' when they clash with theirs. When the pull of the 'selfish' has become unbearable, however, I've lacked the skills to communicate this effectively. All of which, I guess, a sex therapist could help with... unless it is the case that this is a bona fide disorder that even adjustments between my wife an I won't resolve (and to be fair to her, she's at the end of her wits with me and the damage may be irretrievable).

Another problem is that I have struggled from relatively soon into our marriage to read her body language and facial expressions. They are not as 'stylised'/so obviously desiring me as before we were married. As a teenager I had no idea I was attractive to girls. I genuinely didn't realise when I was being flirted with, until other's spelt it out to me. It came as an utter surprise to discover in my late teens that I was considered 'conventionally' attractive among people I would have regarded as my peers and the kinds that previously rejected me. I studied women's bodies, fashions, and facial expressions though my mother's home shopping catalogues, and later TV/cinema, from a pre-pubescent age. As a teenager I was never interested in dating, really. I wanted a thriving marriage and nothing else. An all consuming relationship I could utterly devote myself to (that remains the case, but I think I've pushed her away). I couldn't quite believe my luck when I became close to my future wife. She's older than me and ticked all the boxes, and then a ton more! I prided myself on learning everything I could to please her and assumed (perhaps this was my mistake) that we would be only increasing our frequency, variety, and ultimately intimacy and mutual acceptance as every month passed. Early on in our marriage she used to tell me I should be a sex instructor, but it wasn't that long before I started constantly finding I couldn't read her either in the bedroom or outside. It's like I couldn't adapt as the relationship evolved (I hadn't lived away from my parents, either, before we married when I was 19). And I took it all as rejection from her and failure on my part.

And here's another problem: I want to adapt to her but, deep down I can't shift my desire for her, my fantasies, my compulsions. I don't want her to have to pretend to be someone she isn't. And now, over two decades on, I've put her through so much outside the bedroom. I live with constant guilt and shame about the times I've lost my (explosive and destructive) temper, or the times I've been suicidal, struggled to keep job after job, and the impact that has had on the family. It's not all to do with sexuality, but I know that experiencing sexual fulfilment with my wife is when I have most felt 'myself'/at peace in my life. It's like everything is okay in that moment, that I'm okay too, and that the peace I feel might be heavenly.

Long before I had any understanding of autism I wondered, many times, if there was a way to reduce or remove my sexuality. It affects my sleep, concentration, being in the present, mood... Now that I'm exploring a likely Autism and ADHD diagnosis I just wonder, given my high HBI-19 score, whether treatment is possible in the UK and what the methodology is for demarcating the needs of each partner in a committed marriage/relationship. I am prepared to lose this part of me, though I feel it would be a genuine loss that I would grieve for. I just don't want to lose my family, if that makes sense.

Sorry if it's all a bit rambling. I'm tired a lot at the moment and I find articulating what I feel really hard work. Thanks for the welcome to the community.

ShinyBrownEyes said:

including that I take SSRI medication reported to have an effect in reducing libido

I mean sometimes people just get lucky and don't get the side effects.

ShinyBrownEyes said:

My wife and I also have to take account of numerous strains on our sexual relationship such as endometriosis, infertility, chronic pain, and the cumulative effect of my many meltdowns/explosive behaviour over the years (which we're only in recent weeks starting to contemplate may be a manifestation of autistic burnout/meltdown).

Any one of these things your wife has experienced might reduce her sexual desire and there exactly the sort of things that a sex therapist could address.

ShinyBrownEyes said:

I live with constant guilt and shame about the times I've lost my (explosive and destructive) temper, or the times I've been suicidal, struggled to keep job after job, and the impact that has had on the family.

It's an excellent argument for couples therapy.

ShinyBrownEyes said:

And here's another problem: I want to adapt to her but, deep down I can't shift my desire for her, my fantasies, my compulsions. I don't want her to have to pretend to be someone she isn't.

I mean by your own words she used to enjoy sex with you a lot. There are external factors, ill health and tension in your relationship that would explain her loss of interest. She promised to be with you when she married you. I'm assuming at the time you both assumed that would be a sexual thing. Tell me have you ever actually asked her if she would do couples and / or sex therapy with you. Because obviously a part of it would have to be addressing the wide emotional rift between you.

Usually if there's pain or discomfort during sex we get referred to pelvic floor physiotherapy rather than sex therapy, but both are fairly common (not compulsory) parts of the treatment protocol. The surgery for diagnosing endometriosis is minor but depending on the location of the endo tissue and any other problems it's causing, surgery for removal can be tricky- a relevant example would be endo in the space between the bowel and the womb, which is both hard to remove and likely to cause pain during sex.

Also is that the standard treatment protocol for stubborn endometriosis that  can’t be treated with other means surgery? Maybe I’m wrong but I thought that was a fairly minor surgical procedure and very successful? I would imagine at some point if the endometriosis is bad his wife will need surgery anyway for her own comfort.

Yes- the sex therapy itself isn't the issue. I've been doing physical therapy which covers a lot of the same ground. But what I meant is that there ARE doctors who think that sex therapy is there to convince us we're not really in pain, and that type of bad experience can put us off going for treatment that might actually be very helpful.

ok but with endometriosis part of the point of sex therapy is helping women find pleasurable ways to have sex that aren't painful. That might involve special positions, outercourse or incorporating sex toys etc. just because some one is sent for sex therapy for painful sex it doesn't mean the doctor thinks the pain is in their head.

Like your wife, I have endometriosis, and at one point I was sent to sex therapy by a GP because he didn't believe my symptoms were physical. Is it possible that your wife has had that type of experience, or that she's heard from people who have? I know that I'm wary of sex therapy now myself given the connection to this type of medical condition, even though it's very helpful for other people.

I don't think that's something you realistically can do. Nor should you be expected to. It sounds like you two need some sort of counciling. If she won't consider sex therapy then maybe just couples counciling in general?

Yes, she's not interested in sex therapy. She says people change and, essentially, it's my problem. I know that sounds heartless, but really she's been through a huge amount (I haven't even listed all the health complications). And while it may turn out I am diagnosed with autism and ADHD, and this may help her see my struggles with more understanding, the reality is I don't think she's got any headspace for working on this with me. For me there is still plenty about our marriage and family that mean I want to keep it together. So, given that this is where we are I've felt all I can do is look at how to reduce my libido and imagination.

Yes, she's not interested in sex therapy. She says people change and, essentially, it's my problem. I know that sounds heartless, but really she's been through a huge amount (I haven't even listed all the health complications). And while it may turn out I am diagnosed with autism and ADHD, and this may help her see my struggles with more understanding, the reality is I don't think she's got any headspace for working on this with me. For me there is still plenty about our marriage and family that mean I want to keep it together. So, given that this is where we are I've felt all I can do is look at how to reduce my libido and imagination.

Usually if there's pain or discomfort during sex we get referred to pelvic floor physiotherapy rather than sex therapy, but both are fairly common (not compulsory) parts of the treatment protocol. The surgery for diagnosing endometriosis is minor but depending on the location of the endo tissue and any other problems it's causing, surgery for removal can be tricky- a relevant example would be endo in the space between the bowel and the womb, which is both hard to remove and likely to cause pain during sex.

Also is that the standard treatment protocol for stubborn endometriosis that  can’t be treated with other means surgery? Maybe I’m wrong but I thought that was a fairly minor surgical procedure and very successful? I would imagine at some point if the endometriosis is bad his wife will need surgery anyway for her own comfort.

Yes- the sex therapy itself isn't the issue. I've been doing physical therapy which covers a lot of the same ground. But what I meant is that there ARE doctors who think that sex therapy is there to convince us we're not really in pain, and that type of bad experience can put us off going for treatment that might actually be very helpful.

ok but with endometriosis part of the point of sex therapy is helping women find pleasurable ways to have sex that aren't painful. That might involve special positions, outercourse or incorporating sex toys etc. just because some one is sent for sex therapy for painful sex it doesn't mean the doctor thinks the pain is in their head.

Like your wife, I have endometriosis, and at one point I was sent to sex therapy by a GP because he didn't believe my symptoms were physical. Is it possible that your wife has had that type of experience, or that she's heard from people who have? I know that I'm wary of sex therapy now myself given the connection to this type of medical condition, even though it's very helpful for other people.

I don't think that's something you realistically can do. Nor should you be expected to. It sounds like you two need some sort of counciling. If she won't consider sex therapy then maybe just couples counciling in general?