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Sexual Compulsivity and Sexual Behaviors Among Gay and Bisexual
Men and Lesbian and Bisexual Women
Brian C. Kelly
Department of Sociology and Department of Anthropology, Purdue University;
and Center for HIV Educational Studies & Training, New York
David S. Bimbi
Center for HIV Educational Studies & Training, New York; and Graduate Center,
City University of New York
Jose E. Nanin
Center for HIV Educational Studies & Training, New York; and Kingsborough Community
College, City University of New York
Hubert Izienicki
Department of Sociology, Indiana University
Jeffrey T. Parsons
Center for HIV Educational Studies & Training, New York; Graduate Center, City
University of New York; and Department of Psychology, Hunter College,
City University of New York
Within the existing body of research, the information pertaining to sexual compulsivity (SC)
among women, both homo- and heterosexual, remains rather limited in comparison to men.
The aim of this study was to assess the prevalence of SC in a community sample of gay and bisex-
ual men and lesbian and bisexual women and to identify differences in sexual practices based on
classification as sexually compulsive within gender. Supporting previous research, the findings
indicated that gay and bisexual men were significantly higher in SC when compared to lesbian
and bisexual women. Similarly, sexually compulsive gay and bisexual men were more likely to
report drug use with sex than their non-sexually compulsive peers, suggesting that ‘‘party n’ play’’
may play a larger role for men with SC. In addition, the findings demonstrated empirical support
for the proposition that lesbian and bisexual women with symptoms of SC were more likely to
engage in specialized sexual behaviors in comparison to their non-sexually compulsive peers.
These data suggest that SC manifests differently in gay, lesbian, and bisexual men and women.
Within the past decade, the literature on sexual compul-
sivity (SC) has steadily grown. This phenomenon,
also referred to as ‘‘sexual addiction’’ or ‘‘sexual impul-
sivity’’ (Barth & Kinder, 1987), has received much inter-
est from both popular and academic circles (see also
Gold & Heffner, 1998). Perhaps the most-cited defini-
tion of SC comes from Kalichman and Rompa (1995),
who defined it as ‘‘an insistent, repetitive, intrusive,
and unwanted urge to perform specific acts often in
ritualized or routinized fashions’’ (p. 587). These urges
often translate into a range of sexual behaviors experi-
enced as compelled by the individual with SC. Over
time, this definition has been elaborated to often include
specific symptoms and characteristics of SC. For
instance, Black, Kehrberg, Flumerfelt, and Schlosser
(1997) categorized SC symptoms into paraphilic and
nonparaphilic. The former category included an array
This article was submitted for publication under the Editorship of
John DeLamater.
The Sex and Love v3.0 Project was supported by the Hunter Col-
lege Center for HIV/AIDS Educational Studies and Training, under
the direction of Jeffrey T. Parsons. We acknowledge the contributions
of other members of the Sex and Love v3.0 research team: Michael R.
Adams, Anthony Bamonte, Lauren DiMaria, Catherine Holder, James
P. Kelleher, Juline Koken, Brooke Wells, and Anna Levy-Warren. We
thank Sarit Golub for helpful feedback on an early version of the
manuscript. Finally, we thank two anonymous peer reviewers whose
comments helped strengthen this manuscript.
Correspondence should be addressed to Jeffrey T. Parsons, Depart-
ment of Psychology, Hunter College, City University of New York,
695 Park Ave., New York, NY 10021. E-mail: jeffrey.parsons@
hunter.cuny.edu
JOURNAL OF SEX RESEARCH, 46(4), 301–308, 2009
Copyright #The Society for the Scientific Study of Sexuality
ISSN: 0022-4499 print=1559-8519 online
DOI: 10.1080/00224490802666225
of alternative compulsive sexual behaviors, such as
exhibitionism or voyeurism. The latter group contained
more conventional compulsive sexual behaviors that
became excessive or uncontrolled—for instance, com-
pulsive masturbation, excessive use of pornography,
sex with multiple anonymous partners, excessive use of
the Internet for sexual purposes, and disproportionate
amounts of time thinking about sex or obsessing over
a particular partner (Black, 2000; Kafka, 1994; Parsons,
Severino, Grov, Bimbi, & Morgenstern, 2007). Psycho-
logical symptoms often associated with SC include low
self-esteem, loneliness, intimacy problems, social anxi-
ety, guilt, social skills impairment, and additional
impulse control problems (Black et al., 1997; Carnes,
1991; Gold & Seifer, 2002; Kafka, 1997; Kalichman &
Rompa, 1995). In addition, people who experience SC
may report a range of adverse consequences such as
psychological distress, interpersonal problems, financial
difficulties arising from costs associated with paying for
sex or pornography, and interference in performing
employment responsibilities (Muench & Parsons, 2004;
Parsons, Kelly, Bimbi, & Morgenstern, 2008).
Some evidence suggests that SC may manifest
itself differently among men and women. Missildine,
Feldstein, Punzalan, and Parsons (2005) reported that
SC among gays and lesbians is highly correlated with
romantic obsession. Reflecting the gendered nature of
heterosexual patterns, gay men scored higher on SC
than lesbians. In addition, their romantic obsession
scores were also higher than those of lesbians.
It is estimated that between 3% and 6% of the popula-
tion experiences SC (Black, 2000; Coleman, 1992). Men
have been found to have higher SC rates in comparison
with women (Dodge, Reece, Cole, & Sandfort, 2004).
This difference was also found when comparing gay
and bisexual men to lesbian and bisexual women
(Missildine et al., 2005). Relatively little is known about
women who report SC or the reasons why SC is less
common among women. Black and colleagues (1997)
offered one rather broad explanation to address this
apparent gap by suggesting that sexuality in the United
States is generally constructed from the male perspec-
tive, thus allowing male sexuality to be more visible
and dominant. This dominance of the male sexual
perspective leads to higher rates of SC among men.
Similarly, Kasl (2002) listed therapists’ reluctance
to ask questions about lesbians’ sexuality or sexual
addictions because of fear of appearing homophobic,
critical, or biased as a reason for under-diagnoses of
SC in lesbians.
Potentially connected to the issue of SC is that of sub-
stance abuse. In comparison to the overall population,
gay, lesbian, and bisexual (GLB) individuals report
higher rates of alcohol and substance use (Bux, 1996;
Cochran et al., 2004; Skinner & Otis, 1996). In a sample
of urban gay and bisexual men across the United States,
a majority (52%) reported illicit drug use in the past 6
months (Stall et al., 2001). Similarly, Koh (2000) found
high rates of substance use among lesbians and bisexual
women in comparison to heterosexual counterparts. In
addition, women with same-gender sexual experiences
were more likely to report dysfunctional drug use com-
pared to other women (Cochran, Ackerman, Mays, &
Ross, 2004; Parsons, Kelly, & Wells, 2006). Some have
argued that lesbians are atgreater risk for substance abuse
than their gay male counterparts (Rosario, Hunter, &
Gwadz, 1997). Further, it has been reported that sub-
stance abuse and lack of community support for sexual
limit-setting may be reasons why SC may go unnoticed
among lesbians in a counseling setting (Kasl, 2002).
The use of drugs with sex is of direct pertinence to the
issue of SC. ‘‘Party ‘n play’’ (PnP), the use of drugs with
sex, has been reported among particular sectors of the gay
male community, especially those who frequent bars and
dance clubs (Nanin & Parsons, 2006). Among gay and
bisexual men, SC has been also correlated with substance
use before sex (Kalichman & Rompa, 1995; Quadland,
1985m. ). A similar behavior was also prevalent in a
subgroup of HIV-positive men and women who, despite
their seropositive status, engaged in sexually risky beha-
vior that was accompanied by drug use (Benotsch,
Kalichman, & Kelly, 1999; Benotsch, Kalichman, &
Pinkerton, 2001). Thus, SC and drug use may interact
in the course of sexual encounters, particularly for gay
men, given that PnP has become a salient cultural phe-
nomenon within the gay and bisexual male community.
In addition to drug-influenced sexual behaviors, SC
may also relate to kink or fetish-oriented sexual beha-
viors (e.g., bondage & discipline [BD], sadomasochism
[SM], exhibitionism, and ‘‘water sports’’ [sex with
urine]). Nanin and colleagues (Nanin, Bimbi, Brown,
Severino, & Parsons, 2005; Nanin, Bimbi, & Parsons,
2006) coined the term specialized sexual behaviors (SSBs)
to highlight the safe nature of these types of behaviors
when practiced without unprotected anal or vaginal
intercourse (i.e., reduced HIV and sexually transmitted
infection transmission). Non-empirical reports have sug-
gested that lesbians with SC become involved in SM
activities (Kasl, 2002). With minor exceptions, the exist-
ing literature on SSBs tends to primarily explore them as
their own phenomenon (see Marshall, Payne, Barbaree,
& Eccles, 1991; Weinberg, 1987, 1994, 2006). Moreover,
most of the studies are conducted with clinical partici-
pants or offenders (Ernulf & Innala, 1995; Wiederman,
2003). Little attention is given to SSB as simply a form
of uncommon, yet healthy, sexual practice.
Among all SSBs, BD and SM have received the most
attention (Alison, Santtila, Sandnabba, & Nordling,
2001; Breslow, Evans, & Langley, 1985; Donnelly &
Fraser, 1998; Ernulf & Innala, 1995; Lewis & Adler,
1994; Matthews, 2005; Moser, 1988; Nordling,
Sandnabba, Santtila, & Alison, 2006; Spengler, 1977;
Weinberg, Williams, & Moser, 1984). However, as
Tomassilli, Golub, Bimbi, and Parsons (in press)
KELLY, BIMBI, NANIN, IZIENICKI, AND PARSONS
302
pointed out, these studies pose a number of limitations
when heavily relying on participants who openly iden-
tify with SM and are mostly men (heterosexual,
homosexual, bisexual). Thus, their results are not gener-
alizable to a larger population, and often exclude
women, especially lesbian or bisexual women.
The case of exhibitionism is perhaps an adequate
representation of the peculiar place women have occupied
within the SSB research. Once considered an exclusively
male phenomenon, for a long time exhibitionism was not
studied among women (Hollender, Brown, & Roback,
1977). Today, we know that women also expose them-
selves, yet the explanations for doing so are often ques-
tionable. For instance, when discussing exhibitionism,
Hollender et al. completely neglected women’s sexual
pleasure as reasons for exposing themselves. Instead,
they suggested that women turn to exhibitionism because
they seek attention. In contrast, some researchers have
suggested that exhibitionism is a female sign of transgres-
sion against the discourses of sexual passivity and a
chance to explore their own sexualities (Hugh-Jones,
Gough, & Littlewood, 2005). Although ‘‘male sexual
drive’’ is often taken for granted, women continue to bat-
tle against the assumptions that their sexuality is strictly
tied to reproduction or for others’ benefit.
Although the body of literature concerning SC
among men is rapidly growing, the information pertain-
ing to SC among women and SSBs among both men and
women, both homo- and heterosexual, remains rather
limited. Simultaneously, the available, yet scant, litera-
ture on sexually compulsive women suggests a variety
of characteristics unique to this portion of the popula-
tion, which subsequently warrants further exploration.
Thus, the goal of our study is threefold. We aim to
assess and contrast SC in a community sample of gay
and bisexual men and lesbian and bisexual women.
We aim to examine sexual behavior differences between
gay and bisexual men and lesbian and bisexual women.
We aim to identify the differences in sexual behaviors
(i.e., alcohol and drug use before sex and SSBs) between
those who are sexually compulsive and those who are
not, both globally and within gender. To guide our
efforts, we put forth five hypotheses:
H1: Gay and bisexual men will be more likely to exhi-
bit SC then lesbian and bisexual women.
H2: Gay and bisexual men with SC will report greater
use of drugs and alcohol with sex compared to
lesbian and bisexual women with SC.
H3: Lesbians with SC will report more engagement in
SSBs.
H4: Persons with SC will report more use of sub-
stances before engaging in sex than non-
sexually compulsive persons.
H5: Persons with SC will report greater engagement in
SSBs than non-sexually compulsive individuals.
Method
Participants and Procedures
A cross-sectional, street-intercept survey method
(Miller, Wilder, Stillman, & Becker, 1997) was used to
survey 1,629 members of the GLB community at two large
GLB community events in New York City in the Fall of
2004 through the Sex and Love Project v3.0 (see Nanin
et al., 2006; see also Grov, Parsons, & Bimbi, 2008), which
was approved by the institutional review board of the
corresponding author (Jeffrey T. Parsons). This approach
to collecting data has been used in numerous studies
(Carey, Braaten, Jaworski, Durant, & Forsyth, 1999;
Chen, Kodagoda, Lawrence, & Kerndt, 2002), including
those focused on GLB persons (Benotsch, Kalichman, &
Cage, 2002; Kalichman & Rompa, 2001), and has been
shown to provide data that are comparable to those
obtained from other more methodologically complex
approaches (Halkitis & Parsons, 2002).
The brief paper-and-pencil survey took approxi-
mately 10 to 15 min to complete. Entrance to the event
required paid admission; however, discount passes were
widely available, and free admission passes were pro-
vided to gay, lesbian, and HIV-related community orga-
nizations. Individuals attending the event were
approached and invited to complete the Sex and Love
Survey by a member of the research team. Those who
agreed to participate were given a survey on a clipboard
and a pencil, and were encouraged to move to nearby
seating areas for privacy. The first page of the survey
served as the assent form. The response rate was high,
with approximately 82.9% of individuals approached
consenting to participate. A movie pass was given as
an incentive for completing the survey.
Measures
Demographics. Research staff recorded the partici-
pants’ self-report of gender and age on the survey before
handing it to the participants for completion. Other demo-
graphic data, such as racial and ethnic identity and sexual
identity, were self-reported by the participants on the
survey. For racial and ethnic identity, participants were
asked to ‘‘check ALL that apply’’ from a list that included
African American, European and White, Middle Eastern
and Arab, Asian, South Asian, Pacific Islander and
Hawaiian, Hispanic and Latino, Native American, and
‘‘other’’; and if they checked more than one to ‘‘please
circle the one you MOST IDENTIFY WITH.’’
SC. The Kalichman Sexual Compulsivity Scale
(KSCS) was used to assess SC among the participants
(Kalichman & Rompa, 1995). Individuals with a score
of 24 or above on the KSCS were identified as sexually
compulsive. A score of 24 indicated high levels of
symptoms for SC; this cut-off score was used to identify
SEXUAL COMPULSIVITY AND BEHAVIORS
303
high SC individuals, as it was the 80th percentile in
previous studies (Benotsch et al., 1999). The scale was
originally developed for use with a GLB population,
and has demonstrated reliability and validity.
Substance use. Participants were presented with a
list of substances (alcohol, crystal methamphetamine,
ketamine, cocaine or crack, nitrate inhalants, gamma
hydroxybutyrate [GHB], ecstasy, and marijuana), and
asked to indicate a ‘‘yes’’ or ‘‘no’’ response for the follow-
ing question: ‘‘Have you ever used this substance?’’ If yes,
participants were asked to report if they used this drug in
the past 3 months. Persons who reported not ever using
substances were automatically coded as ‘‘no’’ for the
recent use question.
Sexually related substance use. Sexual activity while
using substances was measured with a yes or no response
for the following question: ‘‘Have you used this substance
while having sex in the last 3 months?’’ The substances
were individually assessed and included alcohol, crystal
methamphetamine, ketamine, cocaine or crack, amyl
nitrates (‘‘poppers’’), GHB, ecstasy, and marijuana.
Sexual behaviors. SSBs and other atypical sexual
behaviors were measured with a yes or no response to
the following question: ‘‘Withany (female=male) sex part-
ner have you engaged in (behavior)?’’ These questions
were asked for both lifetime engagement in SSBs or atypi-
cal behaviors and recent (past 3 months) engagement in
particular SSBs or atypical behaviors. These behaviors
were individually assessed and included SSBs (i.e., water
sports or golden showers, fisting or handballing, ‘‘ass
play,’’ BD, SM, exhibitionism, and ‘‘breath play’’ or
asphyxiation) and atypical behaviors (i.e., snowballing,
felching, and group sex). Snowballing entails the oral
exchange of semen between two or more individuals,
and felching involves the ingestion of semen out of a per-
son’s anus. These individual measures were later grouped
in a global measure for any SSBs. The data presented in
this article are for recent sexual behaviors.
Analysis. Chi-square analyses were utilized to
compare the rates of SC and sexual behaviors among par-
ticipants. These analyses were also conducted in a strati-
fied fashion to assess differences across and within
genders. Odds ratios (OR) were generated for results with
significant differences. Although not explicitly discussed
in the text, the OR listed in the tables provide the reader
with a sense of the magnitude of these differences.
Results
Participant Profile
In the final sample of 1,543 respondents, there were
1,214 (78.7%) men and 329 (21.3%) women. The average
age for men was 37.46 years (range ¼18–78) and 34.03
years for women (range ¼18–70). A majority of
the male (92.7%) and female (79.3%) respondents self-
identified as either lesbian or gay; the others were bisex-
ual. The sample was also relatively diverse in terms of
race, although more so among women than men—42%
of the female respondents were White, 22.5% were
African American, 26.4% were Latino, and 3.3% were
Asian or Pacific Islander; whereas 62.2% of male respon-
dents were White, 9.1% were African American, 16.6%
were Latino, and 6.8% were Asian or Pacific Islander
(see Table 1).
SC and Behaviors by Gender
When compared in terms of SC, gay and bisexual
men in the sample reported significantly higher mean
scores on the KSCS than lesbian and bisexual women
(19.92, SD ¼9.92 vs. M¼17.13, SD ¼6.53, respec-
tively). Furthermore, there were also significant differ-
ences between the two genders when it came to the
examined sexual behaviors. Although both men
(41.0%) and women (37.6%) reported high instances of
alcohol use before sex, men (33.8%) reported a signifi-
cantly higher prevalence of using drugs before sex than
women (16.8%). Similar prevalence of any SSBs existed
between men and women in the sample. However, dif-
ferences existed for particular SSBs. For instance,
women engaged in BD significantly more often than
men (16.3% vs. 11.4%, respectively). On the other hand,
men were significantly more likely to engage in exhibi-
tionism than women (18.7% vs. 7.3%, respectively; see
Table 2).
Sexual Behaviors by SC Status
When the entire sample was examined based on SC,
distinct differences in sexual behaviors emerged between
sexually compulsive and non-sexually compulsive indivi-
duals. Falling in line with the previous research, sexually
compulsive respondents were significantly more likely to
have engaged in all studied sexual behaviors (alcohol use
with sex, drug use with sex, any SSB, SM alone, water
Table 1. Demographics
Variable Men (n¼1,214) Women (n¼329)
Age, mean (range)37.46 (18–78) 34.03 (18–70)
Gay, lesbian, or
bisexual identity
92.7% (n¼1,125) 79.3% (n¼261)
Race
White 62.2% (n¼755) 42.9% (n¼141)
African American 9.1% (n¼111) 22.5% (n¼74)
Latino 16.6% (n¼202) 26.4% (n¼81)
Asian or Pacific Islander 6.8% (n¼82) 3.3% (n¼11)
Other 5.3% (n¼64) 4.9% (n¼16)
p<.001.
KELLY, BIMBI, NANIN, IZIENICKI, AND PARSONS
304
sports alone, and exhibitionism alone) than non-sexually
compulsive respondents, with the exception of BD
(see Table 3).
Female Sexual Behaviors by SC Status
Further comparison of sexually compulsive and non-
sexually compulsive respondents within gender yielded
interesting results. Women with SC were significantly
more likely than non-sexually compulsive women to
report engaging in any SSB (45.7% vs. 21.6%, respec-
tively). In addition, sexually compulsive women were
significantly more likely to report engaging in each of
the SSBs than non-sexually compulsive women (water
sports, 22.0% vs. 5.2%; BD, 30.0% vs. 13.6%; SM,
22.4% vs. 6.1%; exhibitionism, 15.7% vs. 5.6%, respec-
tively). However, there were no significant differences
in alcohol and drug use before sex between the sexually
compulsive and non-sexually compulsive women (see
Table 4).
Male Sexual Behaviors by SC Status
It is interesting to note that the profile of SC and sex-
ual behaviors for men was converse to that of the
women. The sexually compulsive men were significantly
more likely than the non-sexually compulsive men to
report engaging in the use of alcohol with sex (46.0%
vs. 38.9%, respectively) and drug use with sex (39.4%
Table 2. Male Versus Female Comparisons
Variable
Men
(n¼1,214)
Women
(n¼329)
Odds
Ratio
Confidence
Interval
Sexual compulsivity19.92 (SD ¼6.92) 17.13 (SD ¼6.53)
Any alcohol with sex 41.0% (n¼372) 37.6% (n¼94)
Any drugs with sex33.8% (n¼344) 16.8% (n¼48) 2.53 1.81–3.55
Any specialized sexual behavior 29.0% (n¼299) 26.7% (n¼72)
Any water sports 10.0% (n¼108) 9.5% (n¼24)
Any bondage and discipline11.4% (n¼122) 16.3% (n¼48) 1.51 1.05–2.17
Any sadomasochism 7.5% (n¼81) 8.8% (n¼26)
Any exhibitionism18.7% (n¼198) 7.3% (n¼22) 2.91 1.84–4.62
p<.05.
Table 4. Comparisons Between Sexually Compulsive and Non-Sexually Compulsive Women
Variable
No Sexual
Compulsivity
(n¼267)
Sexual
Compulsivity
(n¼61)
Odds
Ratio
Confidence
Interval
Any alcohol with sex 37.1% (n¼76) 40.9% (n¼18)
Any drugs with sex 15.3% (n¼36) 24.0% (n¼12)
Any specialized sexual behavior21.6% (n¼51) 45.7% (n¼21) 3.01 2.58–5.88
Any water sports5.2% (n¼13) 22.0% (n¼11) 5.10 2.14–12.24
Any bondage and discipline13.6% (n¼33) 30.0% (n¼15) 2.73 1.34–5.53
Any sadomasochism6.1% (n¼15) 22.4% (n¼11) 4.48 1.91–10.48
Any exhibitionism5.6% (n¼14) 15.7% (n¼8) 3.11 1.23–7.86
p<.05.
Table 3. Comparisons Between Sexually Compulsive and Non-Sexually Compulsive Respondents
Variable
No Sexual
Compulsivity (n¼1,108)
Sexual
Compulsivity
(n¼431)
Odds
Ratio
Confidence
Interval
Any alcohol with sex38.5% (n¼327) 45.2% (n¼372) 1.32 1.02–1.72
Any drugs with sex27.5% (n¼262) 37.2% (n¼129) 1.56 1.21–2.03
Any specialized sexual behavior26.5% (n¼256) 33.0% (n¼114) 1.43 1.10–1.86
Any water sports8.4% (n¼85) 12.5% (n¼46) 1.72 1.86–2.48
Any bondage and discipline 11.9% (n¼118) 14.1% (n¼52)
Any sadomasochism6.9% (n¼69) 10.2% (n¼38) 1.54 1.01–2.33
Any exhibitionism14.6% (n¼145) 20.7% (n¼75) 1.53 1.12–2.08
p<.05.
SEXUAL COMPULSIVITY AND BEHAVIORS
305
vs. 31.5%, respectively). However, there were no signifi-
cant differences in the practice of SSBs between the men
(see Table 5).
Discussion
This article provides an examination of SC and parti-
cular sexual behaviors of GLB men and women from a
community-based sample. It provides a contrast
between gay men and lesbians with regard to the con-
nection of SC to various sexual practices. As one of
our goals, we aimed to characterize SC among members
of the GLB community. Supporting previous research
and our first hypothesis, gay and bisexual men were
higher in SC than lesbian and bisexual women, with
regard to their higher mean scores on the KSCS. The
reasons for this statistical difference are still largely
unknown. Some have suggested that this difference
may reflect the larger male dominant structure of
society. In general, men, be they homo-, hetero-, or
bisexual, tend to reap more benefits then women in a
patriarchal society. Yet, as men, they may also inherit
adverse consequences of being a man, such as SC.
When looking at our entire sample by gender, we
found that men were more likely to use alcohol before
sex then women, which falls in line with our second
hypothesis. Additionally, men were more likely to use
drugs before sex. Furthermore, when looking at the SSBs,
we found that women were more likely to engage in BD
than men. In contrast, it was men who were more likely
to engage in exhibitionism. Thus, our third hypothesis
was supported with regards to some SSBs, but not all.
The contrast analysis of sexually compulsive and
non-sexually compulsive individuals revealed a number
of analogous findings. The sexually compulsive respon-
dents scored higher on all examined behaviors, except
BD. Thus, supporting both the fourth and the fifth
hypotheses, the sexually compulsive individuals were
more likely to engage in alcohol and drug use prior to
sex, as well as a variety of SSBs such as water sports,
SM, and exhibitionism. Although women may not face
significant detriment to physical health through an
increase in SSBs, these findings are especially worrisome
for men. From the wellness perspective, the risk of con-
tracting HIV increases for those suffering from SC, par-
ticularly because, for men, those with SC appear to have
increased rates of using impairing substances, such as
drugs and alcohol, which may influence such risks.
Thus, this information may be of most use to health
professionals who work with sexually compulsive indivi-
duals or design preventive health messages. For exam-
ple, public health campaigns to highlight the
connection between compulsive sexual behavior and
drug use may raise awareness within the community
and lead to community policing of the problem (e.g.,
the crystal methamphetamine campaigns; see Nanin,
Parsons, Bimbi, Grov, & Brown, 2007).
SC remains a concern from public health and preven-
tion perspectives. The increased risk of HIV infection
for persons who experience SC is perhaps one of the
most threatening consequences, particularly for gay
and bisexual men. Kalichman and Rompa (1995, 2001)
demonstrated a relation between unprotected sex and
SC among heterosexuals, gay and bisexual men, and
men and women living with HIV. Other researchers
(Parsons, Bimbi, & Halkitis, 2001; Reece, 2003) have
reported similar findings. Thus, beyond the extent to
which SC disrupts the lives of those who experience it,
there are significant public health ramifications.
Finally, the analysis of sexually compulsive and non-
sexually compulsive individuals by gender yield the most
unique findings. Sexually compulsive men tended to
focus on the use of alcohol and drugs prior to sex while
mostly neglecting any SSBs. In contrast, sexually com-
pulsive women tend to concentrate on ‘‘kinky’’ beha-
viors such as water sports, BD, SM, and exhibitionism
while paying little attention to any substance use. This
finding is interesting in that it highlights the gendered
nature of sexual practices in the manifestation of SC.
These observed behavioral differences suggest that
SC may drive a need for sexual experimentation and
excitation; yet, this may manifest itself in varying
gendered forms. Again, the prevalence of SSBs and their
meaning among sexually compulsive women is unclear.
Perhaps as in the case of exhibitionism, which for a long
Table 5. Comparisons Between Sexually Compulsive and Non-Sexually Compulsive Men
Variable
No Sexual
Compulsivity
(n¼841)
Sexual
Compulsivity
(n¼370)
Odds
Ratio
Confidence
Interval
Any alcohol with sex38.9% (n¼251) 46.0% (n¼120) 1.34 1.0–1.79
Any drugs with sex31.5% (n¼226) 39.4% (n¼117) 1.42 1.07–1.87
Any specialized sexual behavior 28.1% (n¼205) 31.1% (n¼932)
Any water sports 9.5% (n¼72) 11.0% (n¼35)
Any bondage and discipline 11.4% (n¼85) 11.6% (n¼37)
Any sadomasochism 7.1% (n¼54) 8.3% (n¼27)
Any exhibitionism 17.6% (n¼131) 21.5% (n¼67)
p<.05.
KELLY, BIMBI, NANIN, IZIENICKI, AND PARSONS
306
time was considered an exclusively male phenomenon,
the practice of SSBs among women was simply
neglected, leaving women underrepresented. Likewise,
engagement in SSBs may be a sign of transgression
and sexual exploration. Women are typically character-
ized as passive sexual beings. To engage in SSBs would
be a form of active engagement with one’s sexuality.
Thus, SSBs may be a means for women with heightened
sexual desire or compulsive sexual urges to express
themselves in an even more active fashion.
Our findings do not provide reasons why gay and
bisexual men are more likely to report SC than lesbian
and bisexual women. As noted in the introduction, some
researchers have speculated that the overall hegemonic
functioning of male sexuality within the American cul-
tural sphere could possibly be one of the explanations.
Most likely, there are also other, more specific, reasons;
however, they lie outside the scope of this study, and
must be assigned to future research.
It is important to note some of the general limitations
of our study. The data used were self-reported, and the
survey was completed at a public event, which could
increase the likelihood of socially desirable responses.
However, efforts were made to remedy the problem of
socially desirable responses through the provision of
quiet, secure spaces for the survey’s completion. In addi-
tion, the data collection took place at public gay and les-
bian community events and, therefore, may not fully
generalize to these populations as a whole, particularly
to GLB men and women who do not actively participate
in GLB community events. This limitation is buffered by
the finding that this method for sampling members of
the GLB community is comparable to other sampling
methods for this population (Halkitis & Parsons,
2002). A final limitation is the relatively small number
of women in the study, which led to some small cell sizes
for the analysis of behaviors of women only and, thus,
tempers our enthusiasm for these findings. Despite these
minor limitations, our study has yielded important
findings on SC and the sexual practices associated
with the problem, and provides an overview of SC and
sexual practices for both men and women in the GLB
community.
These findings about SC and associated sexual
behaviors are particularly important because they come
from a community sample. They allow us to assess the
prevalence of such behaviors within the wider commu-
nity rather than drawing on a clinical population, who
may be seeking help due to significant problems asso-
ciated with their sexual behaviors. In this regard, we have
a truer sense of the ways in which these behaviors play
out for men and women in the community more broadly.
In addition to the data on SC and sexual behaviors in
this community sample of GLB individuals, this study
has yielded numerous questions for further inquiry.
Future research, relying on qualitative methods, could
uncover and explore some of these ‘‘unknowns.’’
Furthermore, a research sample that includes sexually
compulsive men and women of all sexual orientations
would permit a broader understanding of this phenom-
enon, its antecedents, and how it interacts with gender
and sexual identity. Data from such research can only
advance the field of sexual health research, as well as
inform public health endeavors focused on promoting
sexual health for men and women of all sexual orienta-
tions and identities.
References
Alison, L., Santtila, P., Sandnabba, N. K., & Nordling, N. (2001).
Sadomasochistically oriented behavior: Diversity in practice and
meaning. Archives of Sexual Behavior,30, 1–12.
Barth, R. J. & Kinder, B. N. (1987). The mislabeling of sexual impul-
sivity. Journal of Sex and Marital Therapy,13, 15–22.
Benotsch, E. G., Kalichman, S. C., & Cage, M. (2002). Men who have
met sex partners via the Internet: Prevalence, predictors, and
implications for HIV prevention. Archives of Sexual Behavior,
31, 177–183.
Benotsch, E. G., Kalichman, S. C., & Kelly, J. A. (1999). Sexual com-
pulsivity and substance use in HIV-seropositive men who have sex
with men: Prevalence and predictors of high-risk behaviors.
Addictive Behaviors,24, 857–868.
Benotsch, E. G., Kalichman, S. C., & Pinkerton, S. D. (2001). Sexual
compulsivity in HIV-positive men and women: Prevalence, predic-
tors, and consequences of high-risk behaviors. Sexual Addiction &
Compulsivity,8, 83–99.
Black, D. W. (2000). The epidemiology and phenomenology of
compulsive sexual behavior. CNS Spectrum,5, 26–35.
Black, D. W., Kehrberg, L. L. D., Flumerfelt, D. L., & Schlosser, S. S.
(1997). Characteristics of 36 subjects reporting compulsive sexual
behavior. American Journal of Psychiatry,154, 243–249.
Breslow, N., Evans, L., & Langley, J. (1985). On the prevalence and
roles of females in the sadomasochistic subculture: Report of an
empirical study. Archives of Sexual Behavior,14, 303–317.
Bux, D. A. (1996). The epidemiology of problem drinking in gay men
and lesbians: A critical review. Clinical Psychology Review,16(4),
277–298.
Carey, M. P., Braaten, L. S., Jaworski, B. C., Durant, L. E., &
Forsyth, A. D. (1999). HIV and AIDS relative to other health,
social, and relationship concerns among low-income women: A
brief report. Journal of Women’s Health and Gender Based Medi-
cine,8, 657–661.
Carnes, P. (1991). Don’t call it love: Recovery from sexual addiction.
New York: Bantam.
Chen, J. L., Kodagoda, D., Lawrence, A. M., & Kerndt, P. R. (2002).
Rapid public health interventions in response to an outbreak
of syphilis in Los Angeles. Sexually Transmitted Diseases,29,
285–287.
Cochran, S. D., Ackerman, D., Mays, V. M., & Ross, M. W. (2004).
Prevalence of non-medical drug use and dependence among
homosexually active men and women in the U.S. population.
Addiction,99, 989–998.
Coleman, E. (1992). Is your patient suffering from compulsive sexual
behavior? Psychiatric Annals,22, 320–325.
Dodge, B., Reece, M., Cole, S. L., & Sandfort, T. G. M. (2004). Sexual
compulsivity among heterosexual college students. Journal of Sex
Research,41, 343–350.
Donnelly, D. & Fraser, J. (1998). Gender differences in sado-
masochistic arousal among college students. Sex Roles,39,
391–407.
SEXUAL COMPULSIVITY AND BEHAVIORS
307
Ernulf, K. E., & Innala, S. M. (1995). Sexual bondage: A review
and unobtrusive investigation. Archives of Sexual Behavior,24,
631–654.
Gold, S. N. & Heffner, C. L. (1998). Sexual addiction: Many concepts,
minimal data. Clinical Psychology Review,18, 367–381.
Gold, S. N. & Seifer, R. E. (2002). Dissociation and sexual addiction=
compulsivity: A contextual approach to conceptualization and
treatment. Journal of Trauma & Dissociation,3, 59–82.
Grov, C., Parsons, J. T., & Bimbi, D. S. (2008). In the shadows of a pre-
vention campaign: Sexual risk behavior in the absence of crystal
methamphetamine. AIDS Education and Prevention,20, 42–55.
Halkitis, P. N. & Parsons, J. T. (2002). Recreational drug use and
HIV-risk sexual behavior among men frequenting gay social
venues. Journal of Gay and Lesbian Social Services,14, 19–38.
Hollender, M. H., Brown, C. W., & Roback, H. R. (1977). Genital
exhibitionism in women. American Journal of Psychiatry,134,
436–438.
Hugh-Jones, S., Gough, B., & Littlewood, A. (2005). Sexual exhibi-
tionism as ‘‘sexuality and individuality’’: A critique of psycho–
medical discourse from the perspective of women who exhibit.
Sexualities,8, 259–281.
Kafka, M. P. (1994). Paraphilia-related disorders—Common, neglected,
and misunderstood. Harvard Review of Psychiatry,2, 39–40.
Kafka, M. P. (1997). Hypersexual desire in males: An operational defi-
nition and clinical implications for males with paraphilias and
paraphilia-related disorders. Archives of Sexual Behavior,26,
505–526.
Kalichman, S. C. & Rompa, D. (1995). Sexual sensation seeking and
sexual compulsivity scales: Reliability, validity, and predicting
HIV risk behavior. Journal of Personality Assessment,65, 586–601.
Kalichman, S. C. & Rompa, D. (2001). The sexual compulsivity scale:
Further development and use with HIV-positive persons. Journal
of Personality Assessment,76, 379–395.
Kasl, C. S. (2002). Special issues in counseling lesbian women for sex-
ual addiction, compulsivity, and sexual codependency. Sexual
Addiction & Compulsivity,9, 191–208.
Koh, A. S. (2000). Use of preventive health measures by lesbian, bisex-
ual, and heterosexual women: Questionnaire survey. Western
Journal of Medicine,172, 379–384.
Lewis, R. & Adler, K. (1994). Come to me baby or what’s wrong with
lesbian SM. Women’s Studies International Forum,17, 433–441.
Marshall, W. L., Payne, K., Barbaree, H. E., & Eccles, A. (1991).
Exhibitionists: Sexual preferences for exposing. Behavioral
Research and Therapy,29, 37–40.
Matthews, M. A. (2005). Lesbians who engage in public bondage, dis-
cipline, dominance, submission and sadomasochism (BDSM).
Unpublished dissertation, Widener University, Chester, PA.
Miller, K. W., Wilder, L. B., Stillman, F. A., & Becker, D. M. (1997).
The feasibility of a street-intercept survey mehtod in an African-
American community. American Journal of Public Health,87,
655–658.
Missildine, W., Feldstein, G., Punzalan, J. C., & Parsons, J. T. (2005).
S=he loves me, s=he loves me not: Questioning heterosexual
assumptions of gender differences and romantic attraction. Sexual
Addiction & Compulsivity,12, 1–11.
Moser, C. (1988). Sadomasochism. Journal of Social Work & Human
Sexuality,7, 43–56.
Muench, F. & Parsons, J. T. (2004). Sexual compulsivity and HIV:
Identification and treatement. Focus: A Guide to AIDS Research
and Counseling,19, 1–3.
Nanin, J. E., Bimbi, D., Brown, J., Severino, J., & Parsons, J. T. (2005,
May). Profiles of gay=bisexual men who engage in specialized sexual
behavior. Paper presented at the Western Region conference of the
Society for the Scientific Study of Sexuality, San Francisco, CA.
Nanin, J. E., Bimbi, D. S., & Parsons, J. T. (2006, November). Preva-
lence and psychosocial correlates of specialized sexual behavior
(SSB) and ‘‘extreme’’ sexual behaviors among gay and bisexual
men. Paper presented at the national conference of the Society
for the Scientific Study of Sexuality, Las Vegas, NV.
Nanin, J. E. & Parsons, J. (2006). Club drug use and risky sex among
gay and bisexual men in New York City. Journal of Gay and
Lesbian Psychotherapy,10, 111–122.
Nanin, J. E., Parsons, J. T., Bimbi, D. S., Grov, C., & Brown, J. T.
(2007). Community reactions to campaigns addressing crystal
methamphetamine use among gay and bisexual men in New York
City. Journal of Drug Education,36, 297–315.
Nordling, N., Sandnabba, N. K., Santtila, P., & Alison, L. (2006).
Differences and similarities between gay and straight individuals
involved in the sadomasochistic subculture. Journal of Homo-
sexuality,50(2=3), 41–57.
Parsons, J. T., Bimbi, D., & Halkitis, P. N. (2001). Sexual compulsivity
among gay=bisexual male escorts who advertise on the Internet.
Sexual Addiction & Compulsivity,8, 101–112.
Parsons, J. T., Kelly, B. C., Bimbi, D. S., & Morgenstern, J. (2008).
Functional effects of sexual compulsivity among gay and bisexual
men. Unpublished manuscript.
Parsons, J. T., Kelly, B. C., & Wells, B. E. (2006). Differences in club
drug use between heterosexual and lesbian=bisexual females.
Addictive Behaviors,12, 2344–2349.
Parsons, J. T., Severino, J. P., Grov, C., Bimbi, D. S., & Morgenstern,
J. (2007). Internet use among gay and bisexual men with com-
pulsive sexual behavior. Sexual Addiction & Compulsivity,14,
239–256.
Qualand, M. C. (1985). Compulsive sexual behavior: Definition of a
problem and an approach to treatement. Journal of Sex and
Marital Therapy,11, 121–132.
Reece, M. (2003). Sexual compulsivity and HIV serostatus
disclosure among men who have sex with men. Sexual Addiction
& Compulsivity,10, 1–11.
Rosario, M., Hunter, J., & Gwadz, M. (1997). Exploration of sub-
stance abuse among lesbian, gay, and bisexual youth: Prevalence
and correlates. Journal of Adolescent Research,12, 454–476.
Skinner, W. F., & Otis, M. D. (1996). Drug and alcohol use among les-
bian and gay people in a southern U.S. sample: Epidemiological,
comparative, and methodological findings from the trilogy
project. Journal of Homosexuality,30, 59–92.
Spengler, A. (1977). Manifest sadomasochism of males: Results of an
empirical study. Archives of Sexual Behavior,6, 441–456.
Stall, R., Paul, J., Greenwood, G., Pollack, L., Bein, E., Crosby, G.,
et al. (2001). Alcohol use, drug use, and alcohol related problems
among men who have sex with men: The Urban Men’s Health
Study. Addiction,96, 1589–1601.
Tomassilli, J. C., Golub, S. A., Bimbi, D. S., & Parsons, J. T. (in press).
Behind closed doors: An exploration of kinky sexual behaviors in
urban lesbian and bisexual women. Journal of Sex Research.
Weinberg, M. S., Williams, C. J., & Moser, C. (1984). The social
constituents of sadomasochism. Social Problems,31, 379–389.
Weinberg, T. S. (1987). Sadomasochism in the United States: A review
of recent sociological literature. Journal of Sex Research,23,
50–69.
Weinberg, T. S. (1994). Research in sadomasochism: Review of socio-
logical and social psychological literature. Annual Review of Sex
Research,5, 257–279.
Weinberg, T. S. (2006). Sadomasochism and the social sciences: A
review of the sociological and social psychological literature.
Journal of Homosexuality,50(2=3), 17–40.
Wiederman, M. W. (2003). Paraphilia and fetishism. The Family
Journal,11, 315–321.
KELLY, BIMBI, NANIN, IZIENICKI, AND PARSONS
308
