What Is Sexual Masochism Disorder? - Choosing Therapy

Cognitive Behavioral Therapy

Cognitive-behavioral therapy (CBT) may be beneficial for people wishing to reduce or eliminate certain sexual behaviors. CBT highlights the interconnected relationship between thoughts, feelings, and behaviors. By learning how to change unwanted or intrusive thoughts, people can feel more empowered in how they choose to respond. Over time, this can lead to profound change.

Antidepressants

Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) can help with co-occurring mood disorders, such as depression or anxiety, while simultaneously lowering sex drive. A lowered sex drive can help with the impulsivity associated with masochistic thoughts and behaviors, however it does not directly address masochistic urges.

Antiandrogens

Medroxyprogesterone acetate and cyproterone acetate are members of a class of drugs which can be used to lower testosterone levels temporarily in order to reduce sex drive and allow for more effective therapy. These drugs help reduce the levels of circulating testosterone and may lower sexual impulsivity or compulsive behavior.

*All medications carry risks for side effects. A therapist and doctor will help to assess if medication would be helpful.

How to Get Help for Sexual Masochism Disorder

If you or your partner has sexually masochistic urges, fantasies, or behaviors that cause significant distress or impairment, seeking psychological help with a knowledgeable and nonjudgmental professional is an important first step. Your treatment provider can assess what healthy outlets may be possible for these sexual interests and work with you on minimizing the negative impact these impulses have on you and/or your partner’s well-being.

The Importance of an AASECT-Certified Sex Therapist

When consulting a therapist for the psychological treatment of sexual issues, make sure that your mental health practitioner is AASECT-certified. “Sex therapist” and “sex therapy” are not protected terms, meaning anyone can call themselves a sex therapist in their marketing. Additionally, most mental health licensure requirements contain little or no instruction in human sexuality. AASECT-certified providers receive an additional 18-24 months of training and a minimum of 300 additional hours of supervision in sex specific psychological issues.

Cost of Sex Therapy

Typical rates for an AASECT-certified sex therapist are on the upper end of private pay therapy rates. Most sex therapists see individual clients for 45-60-minute sessions at rates between $120-$180. They generally see couples for 75-90 minute sessions at rates between $190-$310. These rates may vary widely based on the availability of certified sex therapists in your area and general mental health costs in your state.

Coping With Sexual Masochism Disorder

Remember that, like most mental health conditions, sexual masochism disorder is more effectively treated the sooner it is addressed. If you experience sexually masochistic urges make sure to talk honestly with your partner(s) about your sexual urges and fantasies. Partners are more likely to be supportive and understanding when your behavior isn’t secretive or dishonest.

Consult with an AASECT-certified sex therapist to explore your options for reducing compulsive behaviors, implementing safety planning, and treating co-occurring mental health conditions. You might also seek a community of people who experience masochistic urges or engage in BDSM activities and have been successful in channeling their urges, fantasies, and behaviors into a non-distressing sexual forum.

Evolution of Sexual Masochism Disorder as a Mental Health Diagnosis

Sexual masochism has been included in the DSM since its inception in 1952. Paraphilic diagnoses, particularly sexual sadism and sexual masochism, have been criticized as an attempt to control deviant behavior. In some cases, paraphilia diagnoses have been used to pathologize, stigmatize, and discriminate against those who engage in alternative sexual practices.7

Throughout subsequent editions of the DSM, discernment was made between consensual sexual practices that do not cause distress as compared to harmful urges, fantasies, or behaviors that constitute a psychological disorder requiring treatment. Due to this narrower definition of sexual masochism disorder, prevalence of this diagnosis has dropped significantly.

Sexual masochism disorder, as defined in DSM-5 published in 2013, stipulates that this disorder only be diagnosed in instances of self-report for distress or psychosocial difficulties stemming from masochistic urges.