Today, sex is everywhere, and it seems we are more nonchalant about sexualized content compared to previous generations, even those just twenty years ago. Look at its prevalence in advertising, music, dance, clothing, television, literature, and of course, online. But still, talking about it, especially in a personal context, can be both easy and difficult. It can be especially challenging when conversations drift into areas where people are much less comfortable: sexual dysfunction and sex addiction.

In this edition of Life Lines, we’re going to give you a sense of what researchers have been looking at when it comes to studying sexual behaviour. We'll also explore what is normal, what raises concern and look at sexual dysfunctions and sex addiction.

What is “normal”?

Admit it. You’ve probably worried about whether things are “normal” in that department. You might even say that it’s normal to feel inadequate. Most often, the questions people focus on have to do with things like physicality, frequency and duration. If you think about it, it’s kind of funny how we try to be so secretive about how we get our information. As adults, we have likely participated in subdued conversations with people we can trust to be discreet. We've heard about what may or may not be happening in people's bedrooms – be it through book clubs that focus on racy titles or even adult-themed parties. At our core, we want to feel well equipped with knowledge. Still, the problem is that all of these situations have created teachings or innuendos that can be the catalyst for physical and emotional damage if we’re not careful. Researchers are doing their best to find concrete answers and create baselines as to what healthy sexuality looks like by studying both sexual behaviour and sexualization in media and culture.

So, how often do people do it?

One of the things people in relationships often wonder is how much they “should” or “should not” be having sex. This unknown can create conflict in the relationship, especially if libidos are not synchronized. A person with a higher libido can pressure their partner with lower libido by offering comparisons about what they heard is the optimal frequency or duration of sexual activity in the relationship. These kinds of situations can manifest into more significant problems than they perhaps need to if either party is shy or uncomfortable talking about it.

Recent studies show that "science actually has an accurate idea" of how often adults have sex, how sexual gratification relates to relationship satisfaction, and how much sex different age groups are having. (1) A study published in 2017 indicated that on average, adults in their fifties are having sex 54 times a year or approximately once a week, while those under 30 clocked 112 times per year. In your thirties? You may see this decline to approximately 86 times a year. Once you hit your 40s, the norm lowers to 69 times each year. Researchers in a different study found that couples who had sex weekly were happier. However, another seemed to contradict that, as they discovered that couples who are more sexually active aren’t necessarily happier. So, what’s going on here? Perhaps it’s all in our heads. A counsellor put it this way, “The truth is that whatever is comfortable for you and your partner is your normal. You don’t need to be having sex any more or less than you’d like.” (2) There's a lot more contributing to relationships; "age, values, lifestyle, sex drive, health, and quality of the relationship", are all factors that can affect how frequently couples are sexually active. (3)

The truth is that in about the second or third year of most long-term relationships, our human nature of becoming comfortably bored starts to kick in. We reach “sexual satiation…the been there/done that element” of a relationship. (4) While this can mean that our relationships are secure, some people may overreact by thinking that all of a sudden, they are incompatible with their partner. Instead, couples should be prepared to talk about whether or not there are real issues to solve for in the relationship that may underly the change in frequency or be open to finding out if there is something else that can break the boredom. Professional counsellors can help couples avoid comparing themselves to statistics because “the goal of a relationship is happiness, not sex.” (5) Talking about “needs and fantasies” openly is vital because “couples need verbal and psychological intimacy before they can experience sexual intimacy.” (6)

Other considerations

There are many different ways that people can choose to live their lives. For example, celibacy can be a choice for personal, cultural or religious reasons. (7) People can be celibate for a certain period of time, then choose to pursue other lifestyles. The bottom line is that being in touch with your needs may result in what’s normal for you. For example, when individuals are attracted to people’s minds, referred to as sapiosexuality, the relationships are not always sexual. Someone who identifies as sapiosexual may seek, “philosophical, political, or psychological discussions because it turns them on.” (8) That’s their normal. Similarly, someone who “experiences little to no sexual attraction” may not have something medically wrong with them that needs to be fixed. The person may simply identify as asexual, where they experience a difference between sexual and romantic relationships. It’s not the same thing as celibacy or even abstinence, and “there is no underlying “cause” of asexuality, it’s just the way someone is” like homosexuality or bisexuality. (9)

What about sexual dysfunction? Are there root causes?

There are, however, several different concerns that can contribute to sexual dysfunction, such as objectification and hyper-sexualization in media and culture. It’s these influences that we need to be aware of. One recent study conducted for Unicef revealed that nearly 20% of girls have been abused or assaulted at least once by a peer by the time they are age 17. (10) As movements like #MeToo inspire and empower those who have been impacted, incidents of domestic and sexual violence and sex trafficking are being discussed more openly in today’s society.

Certain actions and events that are reasonably commonplace are having long-standing effects on people, which is resulting in more sexual dysfunction. The practice of sexting – sending sexually explicit texts or photos, is alarming.

Between 10-25% of teens surveyed had sent sexts. Approximately 15-35% of those surveyed had received sexts. Navigating these adult situations with limited knowledge can lead to issues with anxiety, appearance, eating disorders, depression, shame, trauma, feelings of low self-worth and low self-esteem and may manifest in sexual disorders. (11)

Concerned? Start with a visit to your doctor

If you have a problem that prevents you from wanting or enjoying sexual activity, then you may be experiencing sexual dysfunction.(12) It’s something that happens to men and women of all ages, though the chances do increase as you age. It’s important to distinguish that there is a difference between not being in the mood occasionally and a disorder that happens regularly and affects your sex life. There are four ways to look at different sexual dysfunctions based on whether the problem relates to desire, arousal, orgasm, or pain. Sometimes the causes are physical in nature and based on life stages. Other times, the origins are rooted in emotional or mental health.

Physical causes can include:

• Alcohol and drug use
• Chronic illness
• Diabetes
• Fatigue
• Heart disease
• High blood pressure
• Hormone imbalances
• Medical conditions related to vascular and nervous systems
• Medications
• Sexual trauma
• Urinary or bowel issues
• Genito-urinary health concerns

Mental health causes may be linked to:

• Body image or dysmorphia issues, where a person spends a lot of time worrying about flaws in their appearance
• Fear of pregnancy
• Inhibitions
• Psychological conditions such as anxiety or depression
• Relationship problems
• Sexual trauma
• Stress

In women specifically, sexual dysfunction can be related to events and changes related to pregnancy, breastfeeding, and menopause. While both sexes can experience low libido, some of the most common concerns in men are related to erections and ejaculation. For women, it's often associated with pain and physical discomfort during sex, and difficulty orgasming, which may link back to significant life stages and life events.

As we’ve seen earlier, nothing related to sexuality is straightforward. For some people, what they are experiencing may not be considered a dysfunction to them: it might be normal and healthy. The key to deciding whether to explore treatment is when the concern creates chronic stress and possible anxiety or depression, and they want to stop a behaviour or address a problem, then it becomes a sexual disorder.(13)

Other symptoms show the potential to evolve into disorders because they cause significant distress. These include behaviours such as (14):

• Exhibitionism – where over a period of several months, someone has had the urge or acted to expose their genitals to a stranger
• Fetishes – where inanimate objects or body parts are eroticized and used sexually
• Sadomasochism – where intense sexual fantasies, urges or behaviours are acted upon to induce humiliation or submission, or other psychological or physical suffering, including being bound or beaten
• Voyeurism – where someone has urges to observe an unsuspecting person who is naked or engaging in sexual activity

But just as easily, sexual dysfunctions include more commonplace symptoms such as erectile disorders (ED), premature ejaculation, and vaginismus, where women experience involuntary contraction of muscles making sexual intercourse painful or impossible. Physicians and psychologists can treat sexual dysfunction through psychotherapy, sex-therapy, and prescription medication. Professional counsellors, cognitive behavioural therapy (CBT), drugs like Viagra, and estrogen or hormone replacement therapy can all be helpful.

What about sex addiction?

Sex addiction starts as an intimacy disorder and progresses to a compulsion of sexual thoughts and acts. It can affect both the addict and people close to them (friends and family) negatively over time. The addict has to increase and intensify their sexual behaviour to achieve the desired results. It becomes an obsession and changes the brain’s reward centers.(15) Most sex addiction does not progress beyond masturbation, pornography, phone or computer sex services.

Pornography is easily accessible through the Internet. It's the digital format that makes it so attractive and addictive. The viewer can observe behaviours that are sexually exciting without physical consequences, like pregnancy or sexually transmitted diseases. What’s alarming about pornography is that it can be introduced at a young age through accidental exposure and creates compulsive sexual thoughts and acts. The addiction can develop and generate difficulty through adolescence as the addict starts dating. Their expectations of what is normal in relationships becomes misaligned and may be problematic as they date and form intimate relationships. Pornography addiction may initially begin with "soft-porn," where content does not involve intercourse. The addict may reach arousal with repeated exposure. But over time, they may find that they need to gradually increase their activity and seek out more graphic material or sex toys to achieve orgasm. It can cause relationship, physical, and psychological issues for the addict and people in their lives.(16)

Sexual addiction can be related to low self-esteem, depression and anxiety. It may be the addict needs to validate that they are attractive. They seek multiple or unattainable partners or compare themselves to a celebrity they wish to emulate.

It can also manifest in the increasingly popular experience of sugar dating where both parties seek arrangements to meet. “Older adults (sugar daddies or mommas) and younger women or men (sugar babies) find the babies provide time, companionship and sex in exchange for hard cash, gifts, and experiences.” (17) They use arrangements to legitimize relationships. Sugar babies fear stigma and disclosure and can experience extreme stress, but they don’t embrace the identity of sex workers. Sugar adults focus on the commodities they are providing, altering the definitions of legitimate sexual relationships. (18)

Sometimes addicts can get involved in illegal activities including but not limited to; exhibitionism, voyeurism, obscene calls, harassment, molestation and rape. That does not mean that sex addicts will become sex offenders. About 55% of convicted sex offenders are considered sex addicts. In these cases, the motivations are often deeper seeded: anger, power, control, revenge.

What kinds of supports exist to develop healthy conversations about sexual health and healthy behaviours?

The best thing you can do is consult with your doctor to discuss any concerns you may have about your sex life. They will likely conduct a physical exam to ensure there aren’t underlying medical issues that need to be addressed. They may recommend remedies that seem unrelated: exercise, proper nutrition, and sleep. They could also prescribe medications that may help.

Consider working with a psychologist or counsellor who specializes in sexuality and sexual health. It’s been said that the brain is the biggest sex organ in the body. Discussing issues and insecurities can help develop positive mental health that, in turn, promotes improved sexual health.

Learning how to talk about sex is essential. It's a necessary aspect of our lives. Once you gain confidence, you can make change, finding a path to greater fulfillment and a healthier, balanced and more gratifying approach to life.