Sexual fantasy alternation: procedural considerations

Leonard and Hayes (1983) reported several clinical trials of the sexual fantasy alternation procedure, a form of orgasmic reconditioning. Due apparently to unfamiliarity with several essential components of the procedure, their results were equivocal and they questioned the clinical utility of the technique. In this report the Leonard and Hayes study is evaluated on the issues of subject selection, evaluation of pre-treatment baseline data, prediction for direction and magnitude of effect, mechanisms of effect and ethical concerns. It is concluded that, if clinicians respect certain basic conventions, the sexual fantasy alternation procedure is considerably more orderly than the authors believe.

Gender identity in childhood and later sexual orientation: follow-up of 78 males

Two groups of males were evaluated on parameters of gender identity, initially in boyhood and later in adolescence or young adulthood. One group was composed of 66 clinically referred boys whose behaviors were consistent with the diagnosis of gender identity disorder of childhood. The other group consisted of 56 volunteers selected on the basis of demographic matching. Two-thirds of each group were reevaluated for sexual orientation; 30 of the 44 who previously had shown extensive cross-gender behavior and none of the 34 in the comparison group were bisexually or homosexually oriented.

The development of the drive object concept in Freud's work: 1905-1915

In 1905 Freud established the idea of an object of an instinctual drive as the basic object concept of psychoanalysis. He also introduced the derivative concepts of object directedness, object choice, and object finding. While taking these steps he simultaneously deemphasized the importance of drive objects in sexual life, contradicted himself on whether drives are autoerotic or object-directed in infancy, and made incompatible statements about whether or not object choice occurs before puberty. Freud's clinical work, reflected especially in the major case reports and a series of papers on fantasy, led to an apparent recognition of complexity in the mental life of children far greater than had been described earlier. The increased attention to and appreciation of mental content in childhood especially augmented Freud's understanding of the role of drive objects, object directedness, and object choice in infancy. This, in turn, led him to postulate a sequence of organizations of sexual life, named according to the zonal drive source plus the mode of object directedness, a process of theory development that continued through 1924. Object choice and, to a lesser extent, object directedness are concepts derived from and dependent upon the concept of drive object. Both require, however, explanatory constructs besides drive constructs. In 1915 Freud defined the term "object" in the context of stating his drive theory. Freud used the term object with several new modifying words during this decade. No new object concept was introduced, however, in this work, although some steps in that direction appeared to be in progress.

Bilateral testicular pain due to masturbation interruptus

A case is reported of a young man with apparent idiopathic pain in the testicles, inguinal regions, and perineum. An unusual cause and mechanism were found. A personality of antisex attitudes with a sense of guilt and sex-suppressive tendencies was observed. These were the underlying but indirect factors in the causation of pain exposed only on inquiry into his personal habits; otherwise the pain most likely would have been labelled as "functional" or psychologic.

Ejaculatory incompetence: a theoretical formulation and case illustration

Three theoretical formulations of ejaculatory incompetence have been proposed in the literature. They include: (1) aversive conditioned inhibition of the ejaculatory reflex, (2) an "autosexual" orientation associated with discrepant levels in the cognitive and physiological dimensions of sexual arousal, and (3) a discriminative learning model. These three models are discussed in relation to their theoretical and therapeutic implications. Clinical data supporting the discriminative view is presented.

An unusual autoerotic death: asphyxia with an abdominal ligature

A case of accidental death resulting from an autoerotic episode involving a high abdominal ligature is reported. Pathologic findings, physical evidence, and the psychological investigation are discussed.

Mirror masturbation

A case is presented of an analytic patient who reported adolescent and adult mirror masturbation in the context of a struggle for psychic differentiation and separation from his mother. A model is elaborated in which magical manipulation and transformation of the self- and object images are facilitated by masturbatory mirror play. The role of impersonation and transformation as another man or woman is explored. Visual hunger, traumatic overstimulation, incestuous games, and fear of actually committing incest with a seductive parent are proposed as genetic contributants . Mirror masturbation is understood as a dramatic play which defends against castration anxiety and attempts to master childhood sexual overstimulation by active repetition and re-creation.

Sexual behavior of unmarried Colombian University students: a five-year follow-up

The results of a 5-year follow-up survey on the sexual behavior of unmarried Colombian University students are reported. On the whole, these findings corroborate the earlier data. Coital incidences of 93.9% among males and 38.3% among females, as well as the important role prostitution still plays in the sexual lives of males, show that the double standard is much in force. However, there are indicators of its erosion, such as male students' decreasing reliance on prostitutes as sources of sexual outlet and the appreciable incidence of female premarital coitus, which could reach 50% among those students that eventually marry.

An analysis of self-reported sexual behavior in a sample of normal males

Ninety-eight presumably normal London men, age 20-35 and sexually active in a stable relationship, responded to an invitation at their work place to participate in a detailed sexuality interview. The interview was developed by a group of WHO collaborators to measure possible effects on sexual functioning resulting from various medical regimens (for example, a male contraceptive pill). It assessed frequency of coitus and masturbation during the previous 4 weeks, a variety of subjective ratings of sexual interest, satisfaction, and quality of relationships, as well as reports of the nature and incidence of various sexual problems. The study sample's responses displayed internal consistency and in general supported the inference that the sample was not atypical. The data appear to support Westoff's (1974) notion that the frequency of coitus has increased since the early normative reports by Kinsey et al. (1948). Most importantly, the results of principal components analyses point to the fact that overall sexual drive or "libido" (e.g., frequency of sexual behavior) is independent of several other possibly significant dimensions, including latency to orgasm, quality of sexual experience, autoeroticism, and the incidence of erectile difficulties. It is concluded that the sexuality interview provides potentially useful baseline data against which to evaluate effects of sexual therapy or drug regimens.

A male with autoerotic asphyxia syndrome

Approximately 250 deaths per year in the United States are attributed to the dangerous sexual paraphilia of autoerotic asphyxia. There are few studies of live practitioners of this practice which includes the act of self-asphyxiation, usually by hanging, while masturbating. Common features of the syndrome is the adoption of the role of a female transvestite, the use of pornographic material, the special kind of location for the hanging ritual, and the dynamics arising out of having a dominant mother and physically ill father. With adolescent males the ritual tends to be solitary, while in adults the tendency is to move into a homosexual couple practice that has sadomasochistic features. The source of such a practice is an enigma to researchers in spite of the long-known history of its occurrence. Few practioners have been studied while alive, and most practitioners have been studied by psychological autopsy. The authors report the history of a 24-year-old male, with a 10-year practice of autoerotic asphyxia who was first seen for a conversion reaction which affected his ability to walk. His symptoms began soon after a vigorous and repetitive engagement in his hanging ritual which left him very light-headed and weak-kneed. He believed he had caused himself permanent physical damage and he sought professional assistance at that time.

[Compulsive masturbation in the child]

Onanism is approached on a theoretical base. Evolutive and pathological significance is also studied. Characteristics of children, family and children attitudes, personality structure, onanism pattern on children and parents fantasies are observed. The importance of affection demand and a permissive therapy is emphasized.

Sexual fantasy and activity patterns of females with inhibited sexual desire versus normal controls

Until recent years, female sexual fantasy was generally associated with psychopathology or negative qualities. Sexual fantasy is now regarded by the cognitive-behavioral schools as a normal occurrence serving adaptive functions. No investigation has been made comparing the sexual fantasy and activity patterns of women with a specific sexual dysfunction and women with a satisfactory sexual adjustment. This study compared responses to a fantasy questionnaire completed by 30 women reporting a satisfying sex life and 25 women who came to a sexual dysfunction clinic with a complaint of inhibited sexual desire. This study confirms that females with inhibited sexual desire fantasize less during foreplay, coitus, masturbation and general daydreaming than the controls. The content of fantasies in both groups is similar. The females with inhibited sexual desire do not masturbate less often and do not have fewer orgasms through masturbation than the controls. The females with inhibited sexual desire have fewer orgasms through intercourse alone.

Klismaphilia--a physiological perspective

Dr. Joanne Denko coined the work klismaphilia to describe the practices of some of her patients who enjoyed the use of enemas as a sexual stimulant. Since then questions occasionally appear in the professional literature asking about the relationship between enemas and sexual pleasure. This paper considers some of the physiological aspects of the human sexual apparatus that relate to anal sensitivity and explores why klismaphilia can be sexually grafifying. The paper starts with a discussion of the physiological basis for anal sensitivity and anal masturbation in both the human male and the human female. The paper then goes on to relate all this to the sexual sensations received from an enema, and discusses the similarities and differences between all these types of stimulation. Some of the psychological aspects of klismaphilia are also considered in relationship to the physiology involved. The paper concludes with a brief discussion of masked anal masturbation among the population at large. A comprehensive list of references from the literature is given to support these findings.

Sexuality in an aged sample: cognitive determinants of masturbation

The examination of sexual activity in old age has typically meant a consideration of sexual intercourse. Masturbation has not received a rigorous investigation with respect to the elderly, despite benefits that may be associated with this form of sexual expression. The present study reports on the relationship of masturbation with locus of control, sexual status, and sexual knowledge as part of a more general but intensive study of an elderly sample. Results indicated that the best predictor of frequency of masturbation was locus of control, while sexual status and sexual knowledge contributed somewhat less to the variance explained in frequency of masturbation. Specifically, the data support the conclusion that internals masturbate more than externals, particularly internals with high sexual knowledge and persons without sexual partners may have a slight tendency to masturbate more often than those with partners.

Adolescent sexual counseling

The physician provides a much-needed service to teenagers by counseling them regarding sexuality. A series of conferences during adolescence and use of questionnaires can facilitate discussion and point up potential problems. When the patient is confronted with a problem such as a need for contraception or an unwanted pregnancy, the physician should present all the options available and leave the final choice up to the patient. The physician is not obligated to participate in a solution that is counter to his or her moral values.

Intergenerational change in sex behavior: a belated look at Kinsey's males

This article replicates for Kinsey's male sample the decade-of-birth analyses provided in the Kinsey "female volume." Five generations of male respondents are compared in terms of total frequency of sexual activity, and frequency and incidence of nine specific categories of sexual behavior. Inj general, unmarried males born after 1900 experienced more frequent sexual outlet than did nineteenth-century males. Additionally, the proportion of total outlet devoted to various specific activities varied by birth decade. Solitary masturbation rose somewhat spectacularly in significance with the passing decades, while nocturnal emissions and animal contacts declined. Orgasms provided by heterosexual activities increased slightly for the early twentieth-century generations, but then declined to a point below their nineteenth-century levels. Although homosexual contacts accounted for a constant percentage of total outlet for unmarried males over the five generations, more males in each succeeding generation were actively engaging in homosexual activity, at least on a casual basis. Similarly, although heterosexual contacts accounted for a smaller percentage of all activity among the unmarried in later generations, more of the later-born males had engaged in such activity at least once. For married males, on the other hand, frequency of total outlet was unaffected by generation. A large and stable proportion of this outlet was provided by marital coitus. Although more males in later generations had experienced extramarital contacts, such activities accounted for a small and resonably stable proportion of total outlet, when frquency of occurrence was considered. Masturbation gained in significance, while nocturnal emissions and homosexual contacts declined, and animal contacts among the married were almost nonexistent in all generations.

A case of female autoerotic death

This paper reviews some of the types of autoerotic death which have been reported and some of the psychodynamic principles which are associated with them. As cases involving females have never been reported, this presentation offers some opportunity to see how psychiatric insight assisted police investigation of an autoerotic death. Crime scene sketching and photographic evidence complement the case material so that the reader can feel he is at the crime scene. A comparison between male and female autoerotic deaths is made.