Having a strong desire to have sex is not inherently harmful or unhealthy. There is no solid dividing line between what’s healthy or not healthy. Sexual desire can vary to a large degree from person to person. It’s only when the behaviours or urges start to influence work, relationships, or everyday functioning that it becomes a problem.

People may have to lie to cover up behaviours, feel the compulsion to have sex at inappropriate places or with people who do not give consent, or feel intense guilt for having these compulsions. About 3-6% of the population and almost 20% of college students experience certain parts of their sexual behaviours as out of control, such as feeling compelled to have sex and viewing too much porn. Traditional pathology-based models tend to treat them as either compulsive behaviour disorder or sex compulsion. However, both these models are not evidence-based and
outdated.

The newest model to assess and treat this kind of behaviours is the out-of-control sexual behaviours (OCSB) model. It is based on the six sexual health principles: consent, nonexploitation, protection from STI/HIV infection and unintended pregnancy, honesty, shared values, and mutual pleasure. As long as a person’s sexual desire satisfy these criteria, it’s healthy and okay. This model doesn’t view OCSB as a pathology but as a conflict between the affective part of our brain that feels the desire and the deliberative part of the brain that passes moral judgment on the desire/behaviours.

When they are in conflicts, people subjectively feel their desires or behaviours are out of control. OCSB can cause moral struggles. Due to social, cultural, or religious reasons, people may feel it’s morally wrong even to have the desires. This moral incongruence usually leads to a higher depression rate, alcohol use, relationship distress, anxiety, sexual dissatisfaction, and spiritual difficulties. Sometimes the desires are normal, but it's the perception of it being abnormal that stresses people.

There’s no evidence to support the eradication of out-of-control behaviours. Trying to do that can be unethical and harmful. However, therapy can help clients to determine whether and how to express these desires in a healthy way. OCSB treatment groups are also helpful in normalizing having these desires and behaviours, discussing effective and ineffective coping strategies, disclosing boundary-crossing, and managing commitments.

Another side of OCSB is attachment-related issues. Attachment is the fundamental human need to feel securely connected with another figure that cares about our well-being and accepts who we are. People may use porn as partial fulfillment of missing/mismatching attachment needs during childhood. It’s important for people to address the underlying attachment wounds and find ways to satisfying that important need in real life.