How to talk to your GP about porn use

You are thinking about telling your GP. You have probably rehearsed the opening line a few times, in the car or at the kitchen table, and decided against it. The thing that keeps stalling the appointment is not the GP. It is the gap between what you know about your own use and what you imagine the receptionist, the GP, and the notes system are going to do with that information.

This post is the calm walk-through. What to book, what to say, what the NHS can actually offer, and where the limits are. It assumes you are an adult in the UK, that you are not in acute crisis, and that you want a straight answer rather than reassurance. By the end you should know enough to make the appointment, and have a short script you can take with you on your phone.

Should you bring this up with your GP at all?

In most cases, yes. There are two solid reasons that are worth knowing before you book.

The first is clinical. Compulsive Sexual Behaviour Disorder (CSBD) was added to the ICD-11 in 2019 as an impulse-control disorder (Kraus et al., 2018). It is a recognised condition. The NHS uses ICD-11. This is not a fringe complaint and not a moral matter; it is something a GP can legitimately treat as a presenting concern, in the same category as compulsive gambling or any other impulse-control problem. You do not have to argue for it as real. The diagnostic manual the GP works from has already done that.

The second is practical. Compulsive porn use overlaps heavily with depression, anxiety, ADHD, sleep problems, and sometimes erectile dysfunction (Brand et al., 2019; Bőthe et al., 2020). The GP can address the comorbid issues directly, often in the same appointment, and that frequently shifts the porn use even before anyone touches the porn use itself. A treated depression, a treated ADHD, six weeks of consistent sleep: these change the substrate the compulsion is feeding on. Skipping the GP because you are convinced porn is the only problem often misses the most treatable adjacent ones.

There is one situation where the GP is not the right first step. If you are in acute crisis, with active suicidal ideation or self-harm, ring Samaritans on 116 123 (free, 24/7) or NHS 111 and select option 2 for the urgent mental health service in your area. The GP is good for the medium term. Crisis is a different service.

It is worth knowing, before you go in, that most men with this problem never raise it with anyone. That is one of the reasons the prevalence data is so noisy: the people who would skew the surveys are also the people least likely to fill them in. The size of the silent population is part of why GPs see less of this than they probably should, and part of why your appointment, however awkward it feels to you, is unremarkable from their side.

What a UK GP appointment actually looks like

A few structural facts will save you a lot of grief.

A standard NHS GP appointment is 10 minutes. That is not long for a conversation that includes any preamble, and you can feel the clock if the GP is running late. The single most useful thing you can do before the appointment is ask the receptionist for a double appointment. You do not have to explain why. The phrasing that works:

"I'd like a double appointment, please. It's for a sensitive issue and I'd rather not say more."

That is a complete sentence in NHS reception. Practices book sensitive double appointments routinely; the receptionist will not push.

You can also request a specific GP at most practices. If there is a GP in the surgery you have already met and felt comfortable with, ask for them. If you have a preference about gender, ask for that. Practices cannot always honour the request, but they will try. If you do not know the GPs, the practice website will usually list special interests; "mental health" or "men's health" listed as an interest is a reasonable signal.

Telephone and video appointments are an option at most practices. Many people find them easier for first conversations about this topic. You can be at home, you can have your notes in front of you, and you do not have to walk past the receptionist on the way out. If a face-to-face appointment is the bit stopping you booking, default to telephone.

A word on notes. Anything you discuss goes onto your GP record. For most readers this is not worth worrying about. For a small number of readers (anyone applying for certain life insurance, security clearance, or specific occupational health roles), the wording in the record can matter later. You are allowed to ask the GP to use general wording in the notes, such as "compulsive behaviour" or "mental health concerns," rather than naming the specific behaviour. Most GPs will accommodate this if you ask. Most readers will not need to. Mentioning it once so the people who do need it know it is an option.

How to book the appointment

Most UK practices use Patchs, eConsult, AccuRx, or phone. Whichever route your practice uses, the booking step is short.

You do not need to tell the receptionist anything beyond "I'd like a longer appointment to discuss a sensitive personal issue." If you are filling in an online triage form and there is a "reason for appointment" box, something like "ongoing mental health concern I'd like to discuss confidentially" is enough. You do not have to name the topic before you are in the room.

Book the follow-up slot at the time of booking if your practice allows it. Two weeks out, ideally. The reason is in the section below: the first conversation rarely resolves anything, and a pre-booked follow-up removes the friction that usually stops the second appointment happening.

The script: what to actually say in the appointment

This is the load-bearing section. The opening sentence is the only thing you really need; everything after it is the GP doing their job. Three openings, ranked from low-disclosure to direct, so you can pick the one that fits the conversation you are willing to have today.

Opening 1. Low-disclosure, for the very anxious.

"I think I have a compulsive behaviour that's affecting my life. I'd like to talk about treatment options, including therapy referrals."

This gets you into the conversation without naming the specific behaviour. The GP will ask follow-up questions; you can disclose at the pace you choose. Most people end up naming it within the first few minutes once the conversation is underway. If you never do, that is still a useful appointment; "compulsive behaviour" is enough for a Talking Therapies referral.

Opening 2. Clearer, recommended default.

"I've been struggling with compulsive pornography use. It's affecting [my sleep / my relationship / my work / my mood]. I'd like to understand what support is available through the NHS."

This is the version that gets the most useful 10 minutes for most people. It names the behaviour, names a concrete impact (impact is what GPs work from clinically), and frames the appointment as a help-seeking one rather than a confession. The impact you cite does not need to be the worst one. The one that is easiest for you to say out loud is fine.

Opening 3. Direct, for readers who want to be specific.

"I think I meet the criteria for compulsive sexual behaviour disorder. It's in the ICD-11. I'd like a referral to talking therapies and to discuss whether anything else might help."

Use this if you have read the criteria and they fit, and you want the appointment to start at the clinical level rather than the disclosure level. Some GPs will know CSBD by name; many will not. Either is fine. Naming the ICD-11 tells the GP that you have read about the condition and are not asking them to validate it as real.

After whichever opening you use, the GP will take it from there. The following phrases are useful to have ready, in case the conversation needs nudging in a direction:

• "Can you refer me to NHS Talking Therapies?"
• "I'd also like to be assessed for [depression / anxiety / ADHD / sleep problems]."
• "Are there any specialist services in the area that take referrals for this?"
• "Can we discuss whether medication might help with [the comorbid issue]?"
• "Please can the notes use general wording for now?"

You can self-refer to Talking Therapies in England without the GP doing it; see the section below. Many people still prefer the GP to make the referral, partly because it puts the issue formally on the record, partly because the GP can flag relevant comorbidities in the referral letter.

One practical move that helps more than people expect: bring a written list. A printed sheet, or your phone notes, with the opening line and the follow-up phrases on it. Memory degrades fast under low-grade panic, and people regularly forget what they came in to say. A GP seeing a patient hand them a printed list of points is unremarkable; they see it every day.

What the GP can actually do

Be calibrated about this. The NHS is not bottomless and the GP is not a CSBD specialist, but the appointment is still worth having.

Refer to NHS Talking Therapies (formerly IAPT). This is the main route. Free at point of use, evidence-based, usually delivered as CBT, sometimes as guided self-help or group therapy. The therapists are trained in CBT for depression and anxiety rather than in CSBD specifically, but CBT generalises usefully and the structure of Talking Therapies will give you several weeks of consistent contact with a clinician. Waitlists vary by region; expect several weeks to a few months for one-to-one CBT.

Treat comorbidities. This is often where the biggest practical shift comes from. SSRIs for depression or anxiety, sleep medication for short-term sleep restoration, referral for ADHD assessment, treatment for erectile dysfunction where relevant. Many people with compulsive porn use have one or more of these untreated in the background, and treating them changes the floor the compulsion is operating on.

Signpost. A good GP will mention the COSRT directory for sex and relationship therapists, the BACP directory for general therapists, and any local services that take referrals for compulsive sexual behaviour. Most GPs will not know about specialist services off the top of their head; ask anyway. The answer is sometimes yes.

Be a fixed point. After the appointment, there is one person in the NHS who knows about it. That changes the cost of the next conversation, and the one after. Continuity matters in primary care more than the system gets credit for, and your second appointment about this is structurally easier than your first because of what you said in this one. That alone is worth the 10 minutes.

What the GP probably can't do

Be honest with yourself about the ceiling.

The NHS rarely has CSBD-specialist therapy as a named service. There are a small number of NHS services that take referrals for compulsive sexual behaviour (some via the broader sexual health or psychosexual services pathway), but most areas do not have one. The realistic offer for most readers is general Talking Therapies, which is useful but not specialist.

Most GPs have had little CSBD-specific training. The condition is recent in the manuals; CSBD was added to ICD-11 only in 2019 (Kraus et al., 2018), and undergraduate medical training tends to lag the manuals by several years. You may know more about the construct than your GP does. That is not a failure of the GP. Treat it as one more reason to have the printed list and the named diagnosis ready, so the appointment can move past definitional ground quickly.

If a GP reacts badly, which is rare but not unknown, you can ask to see a different GP at the same practice. You do not owe a bad first conversation a second one with the same clinician. A reasonable phrasing for the receptionist: "I'd prefer to see a different GP for the follow-up, please."

The NHS Talking Therapies self-referral route

This is the bit a lot of people do not know about, and it is genuinely useful.

In England, you do not need a GP referral to access NHS Talking Therapies. You can self-refer directly. Go to nhs.uk and search "find a talking therapies service." Enter your postcode and you will be shown the service for your area; each service has its own self-referral form, usually a short online questionnaire. Once submitted, the service will contact you for a triage call, typically within one to two weeks.

In Scotland, Wales, and Northern Ireland, the equivalent services exist but the routes differ. Check your local NHS website rather than assuming the English route applies; the structures are genuinely different, and a fabricated URL helps nobody.

The reason to know about self-referral is options. If your GP is unavailable for several weeks, or the appointment did not produce the referral you wanted, you can refer yourself in parallel. There is no penalty for going both routes.

Private and supplementary options

Calm version, for completeness.

The BACP and COSRT directories let you search for therapists by specialism. COSRT in particular includes a "sex addiction" or "compulsive sexual behaviour" filter that surfaces therapists with relevant experience. Private therapy in the UK is typically £60 to £120 per session at time of writing, with London at the higher end. CSBD-specialist therapists are not common, are mostly in cities, and often have waitlists; getting on one now is worth doing even if you intend to start with the NHS route.

For the gap between weekly sessions, which is where most slips happen, evidence-based supplementary tools include blockers (Covenant Eyes, Canopy), education apps (Brainbuddy, Fortify), and Telegram-native coaching (Iris). The structural argument for combining them is in the tools review. Most people who get durable change end up using more than one, deliberately.

A short comparison of the routes

Route	Cost	Wait	Depth
GP referral to Talking Therapies	Free	Several weeks to a few months	General CBT, not CSBD-specialist
Self-referral to Talking Therapies	Free	Several weeks to a few months	General CBT, not CSBD-specialist
Private therapist (BACP / COSRT)	£60–£120 per session	Days to weeks	Up to CSBD-specialist if you choose carefully
Between-session tools (blockers, apps)	£0–£15 per month, typically	Immediate	Environment and in-the-moment support, not therapy

Most people who get durable change use a combination: GP for the comorbid issues, Talking Therapies or a private therapist for the structured work, and a tool or two for the gap between sessions.

After the appointment

Three short things.

Write down what was decided in the 10 minutes after you leave. Memory in the room and memory in the car park are different. The referral name, the medication name if any, the date of the follow-up, the name of the GP. A note on your phone is fine.

Book the follow-up before you talk yourself out of it. This is the single move that distinguishes the people who get traction from the people who do not. If the practice allows it, book at reception on your way out. If not, do it the same evening.

If you came out feeling worse than you went in, that is normal. First conversations about this are rarely satisfying. The mind has been holding the topic privately for a long time, and the experience of saying it out loud, even to a sympathetic clinician, tends to surface more emotion than people expect (Tangney, Stuewig, & Mashek, 2007). Give it 48 hours before deciding whether the appointment "worked." The body needs that long to settle, and the picture looks different on the third day.

Closing

The GP appointment is one step. It does not fix anything on its own. What it does is open doors that were closed before: the Talking Therapies referral, treatment of the comorbid issues, a named person in the system who knows about it. The work itself happens in the weeks and months after, in therapy, in your own environment, and in the moments between sessions. The appointment is the door, not the room.

If you want a version of the pattern map to take into the appointment with you, the Iris pattern quiz takes about five minutes and produces a written picture of your high-risk profile. People often find the conversation with the GP easier when they can show the clinician what they have already worked out about the shape of their own use. It is also a reasonable thing to do on the bus on the way there.

References

Brand, M., Wegmann, E., Stark, R., Müller, A., Wölfling, K., Robbins, T. W., & Potenza, M. N. (2019). The Interaction of Person-Affect-Cognition-Execution (I-PACE) model for addictive behaviors: Update, generalization to addictive behaviors beyond Internet-use disorders, and specification of the process character of addictive behaviors. Neuroscience & Biobehavioral Reviews, 104, 1–10.

Bőthe, B., Tóth-Király, I., Potenza, M. N., Orosz, G., & Demetrovics, Z. (2020). High-frequency pornography use may not always be problematic. The Journal of Sexual Medicine, 17(4), 793–811.

Kor, A., Fogel, Y. A., Reid, R. C., & Potenza, M. N. (2013). Should hypersexual disorder be classified as an addiction? Sexual Addiction & Compulsivity, 20(1–2), 27–47.

Kraus, S. W., Krueger, R. B., Briken, P., First, M. B., Stein, D. J., Kaplan, M. S., Voon, V., Abdo, C. H. N., Grant, J. E., Atalla, E., & Reed, G. M. (2018). Compulsive sexual behaviour disorder in the ICD-11. World Psychiatry, 17(1), 109–110.

Marlatt, G. A., & Gordon, J. R. (Eds.). (1985). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. Guilford Press.

Tangney, J. P., Stuewig, J., & Mashek, D. J. (2007). Moral emotions and moral behavior. Annual Review of Psychology, 58, 345–372.

Witkiewitz, K., & Marlatt, G. A. (2004). Relapse prevention for alcohol and drug problems: That was Zen, this is Tao. American Psychologist, 59(4), 224–235.

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If reading this helped, the Iris pattern quiz is a five-minute way to map your own pattern before the appointment. Free, no card.