Shame was trailed as a film about sex addiction. That made me curious: in around seven years as a practitioner of psychosexual medicine, latterly in a demographically diverse central London clinic, I couldn’t recall a single patient I thought of by this diagnosis. I remembered people distressed by their own, or their partner’s, use of pornography, or prostitutes (or work or alcohol) as an alternative to intimacy. I remember people struggling to connect with their partner sexually because of the specificity or unusualness of their preferences (so-called paraphilias). I remember fractious differences in libido between partners, often masking anger or pain; people unable to have sex in a loving relationship; people who viewed their genitals as dangerous or dirty; and people driven to harm themselves in grotesque ways. But none lives in my memory as a “sex …