Since the term was coined in 1983, “sex addiction” has become so embroidered in our self-help vocabulary that most of us stopped questioning it. The term gets bandied about whenever Bill Clinton logs extracurricular time with an intern or Eliot Spitzer gets caught having sex in his socks or David Duchovny separates from his wife. Recently “Sex Rehab” host Dr. Drew Pinsky made headlines by suggesting that Tiger Woods has a sex addiction. It’s become the go-to defense for extramarital affairs (I’m not an asshole; I’m an addict!) and been sold to “Oprah” viewers eager to diagnose their porn-loving husbands as both addicts and assholes.

Patrick Carnes, the leading expert in sex addiction, defines it as “any sexually related, compulsive behavior which interferes with normal living and causes severe stress on family, friends, loved ones, and one’s work environment.” But here’s the tricky part: What’s the difference between the symptom of a compulsive disease and a disease itself? Repeatedly lathering up in the sink is a sign of OCD. We don’t call those people hand-washing addicts, now, do we? Unlike most addictive substances, sex can’t be smoked, snorted or mainlined. The term isn’t recognized in the DSM (the Diagnostic and Statistical Manual of Mental Disorders), the bible of therapists everywhere (although along with other controversial diagnoses, like those relating to gender identity, sex addiction is being debated for a new version). But for many sex educators and sex-positive experts, hearing the term spoken about so casually, so frequently, is nothing short of maddening.

“People can behave in compulsive, self-destructive ways,” popular Savage Love columnist Dan Savage writes in an e-mail. “It is possible to fuck too much, or fuck too many people, or fuck your life up fucking. But sex isn’t a chemical substance. It’s not a drug.”

Addiction experts argue it’s the hit of dopamine delivered during orgasm that is abused. (Similar arguments are used to explain gambling and shopping addictions.) But equating those “powerful hoo-haa endorphins,” as Savage puts it, with harder substances like crack is “just ye olde sex negativity on display.”

Other skeptics take issue with the model for sex addiction diagnosis. An online test designed by Carnes casts a wide, sweeping net in its search for signs of the condition. Anyone who enjoys regular masturbation, has a porn collection, or indulges in an active fantasy life will likely be labeled a potential addict … potentially in need of Patrick Carnes’ services.

Richard Siegel, a licensed sex therapist, says he frequently comes across “normal, healthy college-aged guys” who have been unfortunately convinced by “flimsy pop psychology” tests that they are sex addicts for simply masturbating every day. When “Sex Rehab” star Nicole Narain, she of the Colin Farrell sex-tape fame, went on “The Joy Behar Show” in November, she complained about staying in bed all of one day to masturbate. This gave longtime sex writer (and former Salon columnist) Susie Bright a good laugh. “It is of the same tradition of hair growing on your palms from masturbating too much! It’s a werewolf fantasy,” she said.

Says Savage, “We live in a culture that’s torn between titillation and condemnation — that’s Dr. Drew’s whole shtick, actually. Titillate and condemn, condemn and titillate.”

The sex addiction world does indeed seem scolding and puritanical at times. Carnes’ screening test asks whether your sexual behavior has “hurt anyone emotionally,” whether you have used sex and “romantic fantasies” as “a way for you to escape your problems” and whether you “feel controlled by your sexual desire.” Pain, fantasy, desire — these are all normal parts of sexuality. Similarly, the test asks about paying for everything from a dating site to a dirty magazine. As for having a healthy and moderate interest in polyamory, swinging, BDSM, strip clubs, bath houses? Fuhgettaboutit. The truth, says Savage, is that “sex addiction” is merely a clinical euphemism for “sex they disapprove of for moral reasons.” As Dr. Marty Klein, a sex therapist and the author of “America’s War on Sex: The Attack on Law, Lust and Liberty,” once wrote: “These people are missionaries who want to put everyone in the missionary position.”

What makes the debate over sex addiction such a sticky one, though, is that not all of “these people” are that way. To hear sexual addiction therapist Sharon O’Hara describe the sex she would like her patients to enjoy is to feel as though you have stumbled into a Tantric sex workshop: ” We want you to feel more connected to [your partner] and the universe in general — to have transformational sex.” As for those who like to take a walk on the kinky side, she says, “I won’t sit in judgment” — so long as they are honest with their partners and feel comfortable with their lifestyle, instead of imprisoned by it.

Consider the case of writer Benoit Denizet-Lewis, the author of “America Anonymous: Eight Addicts in Search of a Life,” which chronicles his own recovery from sex addiction. “I have no judgment about men having anonymous sex,” he told me over the phone. “The only judgment I have is that it had taken over my life and I couldn’t stop. I think there are people who can live their life in the pursuit of sex, and have a pretty limited life, and they may be OK with that.” For him, that simply wasn’t the case. “It ceased to be about sex,” he says. “It was about numbing my feelings and feeling validated and wanted and loved.” In a Modern Love column that ran in the New York Times at the start of the year, he shared a portion of a rehab writing exercise in which he was to “give voice to the addict” inside him: “I will make Benoit lie and manipulate and chase sex every hour of every day, until he can’t feel anything anymore, until everything good and decent about him is removed … I keep him numb so he can function.”

Even “Sex Rehab”-ber Jennie Ketcham, a former porn star known as Penny Flame who starred in her own rough-sex guide, waxes poetic about the preciousness of sex: “It is the ultimate display of intimacy and should be treated as such,” she wrote in an e-mail. “This isn’t to say we shouldn’t be kinky, or dirty, or have a great time in between the sheets. I just want to care about the person I’m getting dirty with, and I want them to care about me. I want sex to be as meaningful and beautiful as it is filthy and kinky.” These aren’t Puritans by any stretch. They are people whose lives have been steamrolled by behavior they didn’t feel they could stop.

There is a staunchly religious and traditional fringe of the sex addiction community, though. Many conservative Christian counselors and organizations, including Focus on the Family, provide “treatment” for both sex addiction and homosexuality, often conflating the two. That certainly explains much of the resentment within the liberal, sex-positive community. But most sex addiction experts do not subscribe to that parochial view. The Sexual Recovery Institute has clearly stated it does not consider homosexual relationships a sign of sex addiction.

For the most part, the larger community acknowledges that “healthy” sex is subjective, so diagnoses of sex addiction often rely on the patients’ feeling ashamed about their behavior. Still, who among us doesn’t sometimes feel ashamed? We live in a world polluted by sexual shame and taboos. You might feel embarrassed about your porn collection — but is it because you’re morally opposed to it or because you worry your significant other might find it and ream you out? Do you regret last night’s one-night stand because you did it compulsively without being able to stop, or because you’re afraid of being labeled a slut?

As Susie Bright put it, we’re all “fearful of lust” and “being found out” as sexually abnormal or sick — but that doesn’t mean that we actually are.