Abstract
Hypersexuality has been a debated disorder, which has not been able to secure its place into the classificatory systems. This article was aimed to report a female with hypersexuality in Bangladesh. Mrs X, a 20-year-old married lady, presented with the complaints of irritability, low mood, sleep disturbances for last one month. As per Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria and mental state examination findings, she was labeled as a case of major depressive disorder and borderline personality disorder. Her early childhood was uneventful, and she got married 2 years back after having a love relationship with the person. Immediately after her marriage, she was used to enjoy sex for 5 to 6 hours daily as she used to enjoy 5 to 6 orgasms per day. The couple enjoyed their sex daily, even the in the days of menstruation. For last one year her husband stopped daily intercourses as well as the duration of the intercourses was also decreased below 1 hour. Subsequently, the lady felt disturbances and used to demand sex more time as well as orgasms daily. She used to consume pornography, masturbate, and started extramarital relationship for sexual activity. She enjoys her persistent thoughts, fantasies regarding sex; however, she became frustrated when she was not getting expected duration and expected number of orgasms. She asked her husband to divorce her as he was not being able to have intercourses for 5 to 6 hours daily. This is the first reported case of hypersexuality in a sexually conservative country like Bangladesh which may open the whole hidden problem.
Introduction
Hypersexuality has been a debated disorder that has not been able to secure its place in the classificatory systems of mental disorders.1 Classificatory systems such as the Diagnostic and Statistical Manual for Mental Disorders did not include it due to inadequate evidences on diagnostic criteria.1 More than 7 total sexual outlets by any means per week has been considered as a demarcation point to identify hypersexuality.1-5 However, generally it has been estimated to affect 3% to 6% of the population.1 Multiple terms have been used to describe the same entity such as compulsive sexual behavior, sex addiction, hyperphilia, paraphilia-related disorder, or simply “out-of-control” sexual behavior.1,3 Excessive sexual desire in females is referred to as “nymphomania” in the literature (male counterpart being satyriasis). Nymphomania is commonly characterized by extremely increased sexual drive, excessive partnered sexual behavior, and promiscuity.6 It has at times been classified as an obsessive–compulsive disorder, sometimes as an impulse control disorder, and sometimes as an addiction disorder in terms of its etiological aspect.1 The behaviors include excessive compulsive masturbation, excessive consumption of pornography, excessive sexual acts with consenting adults, cyber and/or telephone sex use, and strip clubs attendance.7 Hypersexuality is often treated with serotonergic medications, hormonal agents, naltrexone, topiramate, and even neuromodulation techniques with varied levels of success.8
Bangladesh is a country without any formal sex education, resulting in abundances of myths and misconceptions. Sexuality, sexual behaviors, and sexual disorders have not been encouraged to be talked about openly.9,10 There is dearth of research on sexuality and sexual disorders. It was aimed to report a female with hypersexuality in Bangladesh which is the first case to be disclosed as well as discussed in the country.
Case
Mrs X, a 20-year-old married lady of middle socioeconomic class, presented with complaints of irritability, low mood, and sleep disturbances for the last 1 month. As per Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria and mental state examination findings, she was labeled as a case of major depressive disorder and borderline personality disorder. However, her personal history revealed another aspect of psychopathology. Her early childhood was uneventful, she was continuing her study at graduation level, and got married 2 years back after having a love relationship. However, she had insecure, avoidant attachment with her parents as she was brought up by her maternal grandmother in early days. Immediately after her marriage, as reported, she used to enjoy sex for 5 to 6 hours daily and she used to enjoy 5 to 6 orgasms per day. The couple enjoyed their sex daily even the in the days of menstruation. For the last 1 year, however, her husband stopped daily intercourses, as well as the duration of the intercourses was also decreased below an hour. Subsequently, the lady felt disturbances and used to demand more time as well as orgasms daily. She used to watch pornography, masturbate, and started extramarital relationship for sexual activity. She enjoyed her persistent thoughts, fantasies regarding sex; however, she became frustrated when she was not getting the expected duration and expected number of orgasms. She asked her husband to give her a divorce as he was not being able to have intercourses for 5 to 6 hours daily. They were not using any contraceptives as they were planning to have a child. Her menstruation is regular and normal. She had no history of substance abuse, and group or club sex experiences.
Her routine investigations revealed no abnormality. She was prescribed fluoxetine and dialectic behavior therapy and suggested further follow-up.
Discussion
Hypersexuality has been described by excessive appetites for sexual behaviors and has not been reported in Bangladesh previously.3 This article thus aimed to report the first case of hypersexuality in Bangladesh. The 20-year-old lady had hypersexual behavior; however, she does not think of it as a problem. Instead, she enjoys her fantasies and repeated persistent sexual thoughts which may preclude diagnosing. However, her relationship with her husband has been destroyed and she has filed for a divorce to ensure her needs relating to sexual life are met. She has been suffering from major depressive disorder and borderline personality disorder. Previous studies found that the mean age of onset of hypersexuality was 18.7 years; males are 5 times more prone to suffer from this disorder.1 Previous studies revealed mood disorders (major depression or dysthymia, bipolar affective disorder), schizophrenia, anxiety disorders, substance abuse, personality disorders, obsessive–compulsive disorders, attention-deficit hyperactivity disorder, paraphilic disorders, and phobic disorder in association with hypersexuality.1,3,7,11-13 The lady used to enjoy intercourses, masturbation, pornography, telephone sex and cybersex. Similar pattern was found in previous researches where a composite of 6 items was used to measure impersonal sex which included frequency of sex, masturbation, pornography, group sex, and extra-dyadic sex, number of sexual partners yearly and per active year, and preference for a casual sexual lifestyle.5
Sexual behavior is an important instinctual component in survival which is pleasurable and has primal rewarding properties.1 However, it can turn into an addiction at which point it can be problematic.1 Hypersexuality is a controversial entity regarding its classification, diagnosis, as well as etiological explanation. Quantification of hypersexuality is also another problematic issue. This article could be an important baseline evidence of hypersexuality in Bangladesh.
Conclusions
To the best knowledge of authors, this is the first reported case of hypersexuality in the sexually conservative country Bangladesh. This article is expected to raise the issue of hypersexuality among clinicians.
