I have an interest in treating patients with psychosexual disorders. Unfortunately it's not so much of a thing in the US though there are certainly psychiatrists who have interest in some aspects of this in the US like richard balon(at wayne state), robert taylor seagraves (case), stephen levine (case), adam keller ashton (buffalo), martin kafka (mclean). Renee Sorrentino is very well known for her work with sex offenders. Internationally, kevan wylie in the UK, marcel waldinger in the netherlands (he invented "restless genital syndrome"), and several people at UBC in vancouver are quite well known.
I worked with several patients who had "sexual addiction"/compulsive sexual behavior - interestingly one of these patients responded very well to depakote, but no response with SSRIs or naltrexone and limited engagement in therapy. In my experience, all the patients I have seen with compulsive sexual behavior (often reporting >1000 sexual partners, compulsive masturbation, and getting HIV, HSV, syphilis, warts etc) meet criteria for either borderline or narcissistic personal disorder. I had one patient who became impotent with a new lover because he feared he would give him HIV (patient was poz) but really it was because he liked him and couldn't cope with having sex with someone he liked. I had another patient with gynecomastia who developed social anxiety/BDD and didn't want anyone to see him naked and wouldn't have sex without using meth. Treatment was with exposure therapy where he was tasked to have sex (when not intoxicated) and with his clothes off. I had another patient reported a compulsion to watching porn including bestiality, children, and various other stuff.
Lots of patients I have seen still have conflicted thoughts about their own sexuality. One of my young male patients became very distressed about having sexual thoughts or images enter his head about women. he loved zoloft because it suppressed his libido. I had another patient whose psychosis was quite clearly driven by his latent homosexuality, which was less latent when he presented to the ER with a frying pan stuck up his arse and suicidal.
Your general psychiatrist is most likely to come across (no pun intended) drug-induced sexual dysfunction and treat that which can be fun. I once saw a patient who was dying of cystic fibrosis who was on effexor and all he wanted was to be able to masturbate. (that was his chief complaint) so I switched him to mirtazapine and he was very happy with that. Also I have had more grateful patients for prescribing a PDE-5 inhibitor than any other drug.
Geriatric psychiatrists often deal with sexual dysfunctions and also sexual behavior in their demented patients. Forensic psychiatrists may work with sexual offenders, sexually violent predators etc. Addiction psychiatrists may work with process addictions like sex or pornography addiction. Psychoanalysts will make everything about sex, or your mother, or having sex with your mother
