Compulsive sexual behaviour (CSB) and problematic porn use
If you’re reading this, there’s a good chance part of you is worried that your sexual behaviour or porn viewing means there is something wrong with you.
Maybe you feel “bad”, “disgusting”, or “broken”, and you’re trying to work out if you have a “porn addiction” or “sex addiction”.
As therapists, we tend to use the term compulsive sexual behaviour, but whatever words you’re using, what matters to me is that you are concerned that sex and porn are getting in the way of the life you want.
Does any of this sound familiar?
People often contact me when they notice some of the following:
- They are viewing porn, purchasing sex, or using apps to manage difficult feelings (stress, loneliness, anxiety, shame), often on autopilot.
- Repeating behaviours they’ve promised themselves they’ll stop, and then feeling stuck in a cycle of “never again” followed by “I’ve done it again”.
- Feeling increasingly isolated and choosing porn or other sexual experiences instead of being with others or sleeping.
- Making excuses to create opportunities to engage in sexual experiences (time alone, trips away, secrecy).
- Feeling like a “bad” or “wrong” person because of what they’ve watched, what they are into, or how often they masturbate.
You do not have to meet a specific diagnosis of compulsive sexual behaviour disorder (CSBD) to benefit from therapy. If it feels out of control or is impacting your life, getting support is appropriate.
Shame, “being bad”, and avoiding intimacy
Many people who look for porn addiction help believe the main problem is porn itself, when underneath, there is a deep fear of not being “enough”.
If you carry a shame story like “I’m not attractive”, “I’m not good enough”, “I’m too much”, or “If someone really sees me, they’ll leave”, partnered sex can feel risky and exposing.
Porn then becomes a safer option because:
- A screen cannot reject or criticise you.
- You have control over what happens and when it ends.
- You can avoid the feared humiliation of “failing” with a real person (for example, losing an erection, not orgasming, or not performing “well enough”).
Over time, this can look and feel like porn addiction or sex addiction, when in reality, porn is working hard as a strategy to contain shame and to avoid the terror of “not being good enough” with another person.
In my work with Shame Containment Theory, we treat shame as a protective response, not proof that you are bad or broken.
Therapy offers a confidential space to explore how shame has led you to withdraw, hide, or use sexual behaviour to cope, and to begin building a kinder, more grounded relationship with yourself and your sexuality.
Porn-induced erectile dysfunction (PIED) and anxiety
There is a lot of frightening information online about porn induced erectile dysfunction (PIED), with claims that porn “rewires your brain” or causes permanent damage to erections.
Current evidence does not support the idea that porn viewing causes a specific medical condition called PIED.
What research and clinical experience does show is that:
- Anxiety, performance pressure, and fear of “not being enough” are very common reasons men lose erections during partnered sex.
- If you feel safer with porn than with a partner, your body may respond differently in each situation, not because porn has broken you, but because the emotional stakes and anxiety levels are completely different.
In therapy, we will look together at:
- What you expect will happen in partnered sex (for example, “I’ll go soft”, “They’ll laugh”, “They’ll leave”).
- How shame and anxiety build in your body and mind during intimacy.
- Ways to reduce pressure, slow things down, and create safer, more connected experiences where your body has a better chance to respond.
If you’re worrying that porn has “ruined” your erections, we will focus on understanding anxiety, shame, and safety, rather than pathologising your body.
Chemsex
Sex therapy can help if drug use during sex has become risky or out of control, leaving you anxious, ashamed, or disconnected from yourself and important relationships. I take a harm reduction approach, prioritising safety, choice, and realistic change over abstinence.
Signs chemsex might be an issue
- Relying on drugs (like mephedrone, GHB/GBL, crystal meth) to lower inhibitions, have sex longer, or manage shame around desire.
- Blackouts, unsafe sex, or injuries you can’t fully recall.
- Feeling compelled to repeat despite health scares, relationship damage, or exhaustion.
- Using alone or escalating doses to chase the same high.
Therapy focuses on understanding triggers (like loneliness or performance fears), building safer strategies, and addressing underlying shame without judgment.
How I work with CSB or perceived "porn addiction"
My approach is sex-positive and non-judgmental:
I am not here to police your sexuality, erase consensual interests, tell you what kind of sex you should be having, or what should or should not turn you on.
Instead, we will:
- Understand what your behaviour is doing for you: regulating feelings, escaping, self-soothing, self-punishing, or avoiding intimacy.
- Explore how shame and early experiences have shaped the way you see yourself and your sexuality (Shame Containment Theory).
- Change “I am bad” to “I did something I don’t feel good about”, so shame is less overwhelming and less likely to drive further compulsive behaviour.
- Build a realistic relationship around porn, apps, or other behaviours that fit your values and life, not someone else’s rulebook.
- If you’re in a relationship, support you to talk honestly, rebuild trust, and move away from secrecy.
What therapy can help you move toward
Over time, people I work with often report:
- Less compulsive, secret, or panic-driven behaviour.
- A more confident and authentic view of themselves, rather than feeling fundamentally bad or broken.
- More confidence facing intimacy, with a clearer sense of what they want and what feels safe.
- A relationship with porn and sexual activity that feels more like choice and less like compulsion.
You do not have to do this alone
Taking the next step
If you recognise yourself in any of this, we can use the first session to begin to:
- Explore and understand what’s been happening.
- Understand how shame and fear of “not being enough” might be shaping your sexual behaviour.
- Think together about what a more comfortable, authentic sexual life would look like for you.
You can contact me to arrange an appointment, or send a brief message if you’re unsure and want to check whether this is the right space for you.
I offer specialist psychosexual therapy for compulsive sexual behaviour, sex and porn addiction concerns, and shame-based struggles around sex and relationships, in London, Newcastle and North East, and online across the UK. I offer both in-person sex therapy in Tynemouth, NE England, and online sessions, so you can access support wherever you are in the world.
Understanding compulsive sexual behaviour (CSB)
You might be wondering if what you’re experiencing “counts” as compulsive sexual behaviour, sex addiction, or porn addiction.
The clinical reality:
The World Health Organisation uses the term compulsive sexual behaviour disorder (CSBD) for persistent, distressing patterns of sexual behaviour that get in the way of your life, despite your efforts to change.
What it’s NOT:
Research shows little evidence that sex or porn work like substance addictions (no physical withdrawal, tolerance, or brain changes specific to sex). This is why I don’t use “sex addiction” or “porn addiction” language in my practice.
What it IS:
CSBD describes when sexual behaviour becomes compulsive, secretive, and distressing, not because sex/porn are addictive, but because they serve powerful emotional functions (escape, soothing, shame avoidance, performance anxiety relief).
You don’t need a diagnosis to get help.
Very few people meet every single WHO criterion for CSBD. If your sexual behaviour, porn viewing, or relationship with sex causes shame, isolation, relationship problems, or stops you living the life you want, therapy can still help.
Read the full WHO CSBD criteria here
https://icd.who.int/browse/2024-01/mms/en#1630268048
To read more on CSB, go to my blog or click the link in the header
