In my experience, excessive sexual desire is so rare as to constitute a clinical curiosity when it is a primary symptom. An abnormally intense sexual appetite in females has been termed "nymphomania" and the corresponding condition in the male is "Don Juanism."

Primary hyperactive sexual desire must be differentiated from those high levels of sexual activity that are components of manic and hypomanic states. I have seen two patients who were genuinely distressed by excessive sexual desire. They constantly felt sexually hungry and tense even shortly after orgasm. Both were hypomanic, and both responded to lithium therapy with a more comfortable level of sexual desire as well as with a general calming.

One such patient presented with a complaint of impotence. The examination revealed that he masturbated to orgasm six to ten times during the day, interrupting his work as a telephone repairman in order to do this. He then attempted intercourse every night with his wife. Not surprisingly, his erections were less than complete at those times. This increased his anxiety still further and was the reason he sought consultation. When he tried to stop masturbating, the anxiety mobilized by this attempt to refrain was massive and intolerable.

Another patient who was obsessed with fears about his sexual performance tried to employ a compulsive pattern of sexual expression in order to reassure himself. Naturally, this had the opposite effect since he failed to function perfectly with the many partners (sometimes three different women in one night) which were part of his compulsive pattern, he sought therapy for his "impotence."

This patient managed to persuade a urologist to perform penile implant surgery which did, indeed, give him the perfectly reliable erection he had sought so obsessively. And surgery did him no harm. Afterwards he did, in fact, cease his sexual over-activity, but as obsessives usually will, he found another and related obsession he became obsessed instead with a fear that he would always be rejected by women whom he valued, no matter what he did. The obsessive's expressed concern is not the true reason he is anxious. In fact, the obsessive concern may be a smoke screen, a distraction from the real and unconscious vulnerability.

Sex therapy is inappropriate for obsessive patients, regardless of whether or not the content of their obsessive preoccupation is sexual. Such patients require specific kinds of treatment, usually long term. The description of this topic is beyond the scope of our discussion here.