The Relationship Between Compulsive Sexual Behavior and Sexual Risk Behavior: A Systematic Review of the Literature

Compulsive sexual behavior (CSB), a clinical syndrome involving out-of-control sexual thoughts, urges, and behaviors, is considered a significant driver of sexual risk behavior. However, there are currently no systematic reviews examining evidence for this association. Thus, the present systematic review seeks to collect and evaluate all existing evidence for such an association. A total of N = 76 studies were identified, and results generally confirm there is a positive association between CSB and sexual risk behavior. In most studies, CSB is positively associated with condomless sex frequency, number of partners, drug use before sex, and other sexual risk factors (i.e. condom use self-efficacy, risk-reduction intentions, condom use resistance, etc.). There is more limited evidence for an association between CSB and alcohol use before sex, and several studies found non-significant associations or mixed effects based on factors like gender and specific sexual behavior (i.e. vaginal vs. anal sex). Few studies explored mediating or moderating factors, making the mechanisms of this association unclear. Studies also disproportionately focus on men who have sex with men and HIV risk. We discuss implications of these findings and provide guidance for future research in this area.