Sex differences in compulsive sexual behavior disorder

Background – Compulsive sexual behavior is a failure to control intense, repetitive sexual impulses or urges, resulting in sexual behavior that causes marked distress or impairment. Studies on compulsive sexual behavior report a higher prevalence of CSBD among men. There are sex differences in the symptoms and behaviors associated with CSB, like sexual arousal and motivation. Methods – A systematic search in PubMed/Medline and Scopus databases between January 2000 and January 2026, using search terms related to compulsive sexual behavior. Results – While CSBD is more common in men, neuroticism and stress vulnerability contribute importantly to CSBD symptoms in women. Human sexuality is associated with neurotransmitters, hormones, and genes, in particular genes responsible for dopamine, which is associated with novelty seeking, impulsivity, and may influence sexual activity. Neuroimaging studies outlined sex differences in neural responses to sexual stimuli in men in fMRI. Men with CSBD showed an activation of reward areas in the brain in response to sexually explicit stimuli. Their higher sensitivity to the rewarding value of sexual cues may contribute to their increased risk of addictive or compulsive sexual behaviors. Studies on CSBD indicate that impulsivity and psychiatric comorbidity are common across both genders. Finally, childhood trauma and abuse are often reported in individuals seeking treatment for sex addiction, particularly among women. Implications – Little is known about sex differences in CSBD. Although childhood adversities may contribute to the development of CSB in both women and men, further research is needed to determine whether the groups respond differently.