INTRODUCTION: The addition of compulsive sexual behavior disorder (CSBD) into the ICD-11 chapter on mental, behavioral, or neurodevelopmental disorders has greatly stimulated research and controversy around compulsive sexual behavior, or what has been termed "hypersexual disorder," "sexual addiction," "porn addiction," "sexual compulsivity," and "out-of-control sexual behavior." OBJECTIVES: To identify where concerns exist from the perspective of sexual medicine and what can be done to resolve them. METHODS: A scientific review committee convened by the International Society for Sexual Medicine reviewed pertinent literature and discussed clinical research and experience related to CSBD diagnoses and misdiagnoses, pathologizing nonheteronormative sexual behavior, basic research on potential underlying causes of CSBD, its relationship to paraphilic disorder, and its potential sexual health consequences. The panel used a modified Delphi method to reach consensus on these issues. RESULTS: CSBD was differentiated from other sexual activity on the basis of the ICD-11 diagnostic criteria, and issues regarding sexual medicine and sexual health were identified. Concerns were raised about self-labeling processes, attitudes hostile to sexual pleasure, pathologizing of nonheteronormative sexual behavior and high sexual desire, mixing of normative attitudes with clinical distress, and the belief that masturbation and pornography use represent "unhealthy" sexual behavior. A guide to CSBD case formulation and care/treatment recommendations was proposed. CONCLUSIONS: Clinical sexologic and sexual medicine expertise for the diagnosis and treatment of CSBD in the psychiatric-psychotherapeutic context is imperative to differentiate and understand the determinants and impact of CSBD and related "out-of-control sexual behaviors" on mental and sexual well-being, to detect forensically relevant and nonrelevant forms, and to refine best practices in care and treatment. Evidence-based, sexual medicine-informed therapies should be offered to achieve a positive and respectful approach to sexuality and the possibility of having pleasurable and safe sexual experiences.

Center for Sexual Health and Intervention Czech National Institute of Mental Health Klecany 25067 Czech Republic

Centre de Recherche Interdisciplinaire Sur Les Problèmes Conjugaux Et Les Agressions Sexuelles Montréal QC H3C 3J7 Canada

Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen 2200 Denmark

Department of Psychiatry Centre of Postgraduate Medical Education Warsaw 01 809 Poland

Department of Psychology and Life Sciences Faculty of Humanities Charles University Prague 18200 Czech Republic

Department of Psychology Université de Montréal Montréal QC H3C 3J7 Canada

Department of Psychology University of Nevada Las Vegas Las Vegas NV 5030 United States

Eli Coleman Institute for Sexual and Gender Health University of Minnesota Minneapolis MN 55454 United States

Institute for Sex Research Sexual Medicine and Forensic Psychiatry University Medical Center Hamburg Eppendorf Hamburg 20251 Germany

Sexological Clinic Mental Health Center Copenhagen University Hospital Mental Health Services Copenhagen CPH 2200 Denmark

William James Center for Research Department of Education and Psychology University of Aveiro Aveiro 3810 193 Portugal

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Identification and comprehensive characterization of moral disapproval and behavioral dysregulation-based pornography-use profiles across 42 countries