Sexual Strands

Understanding and Treating Sexual Anomalies in Men

Ron Langevin

• Publisher: Routledge
• Year: 2013
• Print ISBN: 9780898592054
• eBook ISBN: 9781317838579
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Homosexuality, transsexualism, bisexuality, pedophilia, sexual aggression and rape, fetishism, physical abnormalities, and sexual dysfunction are among the sexual anomalies discussed in this timely and comprehensive review. The origins and treatment of unusual sexual behaviors are analyzed from the perspective of orgasmic preference and are illustrated with clinical case examples drawn from the author's many years of work in research and treatment of sexual anomalies.

I

INTRODUCTION TO THE ASSESSMENT AND TREATMENT OF SEXUAL ANOMALIES

1	A Model for Studying Sexual Anomalies

DEFINITION OF SEXUAL ANOMALY

A scientific definition of a concept should attempt to be as objective and value free as possible. This is not easy in the study of sexual behavior which is often laden with emotional and moral values. Older terms like “pervert” evoke a reaction even today. With current political movements to liberalizing attitudes toward sex, one is now faced with a battle of rhetoric. Ten years ago, “sexual deviation” seemed like a nonperjorative statistical concept but some individuals have deemed it unacceptable too. Terms such as “sexual variant” and “sexual anomaly” are currently popular although it may be just a matter of time before they also assume prejudicial connotation.

In practice, I have found the term “sexual anomaly” first suggested by Hirschfeld⁶ and defined as “unusual sexual behavior” is nonthreatening to patients seeking help. The therapist’s attitude to the sexual behavior, of course, is more important than the words he may use and it often is conveyed implicitly in his therapeutic approach. The term “sexual anomaly” has been selected for use in this book because it covers a wide range of behavior and it is familiar to therapists and theorists working in the area. It implies that the sexual behavior in question is not typical of the general population.

The Stimulus Response Matrix

One is faced with a dilemma in studying sexual anomalies. Although theories abound about their origin and nature, systematic controlled empirical studies are very few in number. Some theories appear to be based on a few case studies or on speculation alone. Often theories apply only to a single anomaly rather than to a range of them. Much basic research is still needed that focuses on the question of what stimulus the sexually anomalous male is responding to, and how he prefers to react. Since so little is available in the way of factual information, a simple organizing model—the stimulus response matrix—will be used. It attempts to bring together what is known and integrate it. Understanding exhibitionism, rape, and so forth offers a means for evaluating treatment as well. More complex theories such as psychoanalytic interpretations of sexual anomalies can be scrutinized in terms of the matrix. In this way, the book can be more empirical and factual and not be locked into preconceived notions.

Two questions recur throughout the book: what is the sexually anomalous male erotically reacting to and how is he reacting? The stimulus part of the matrix is what is being reacted to sexually. Table 1.1 shows the range of stimuli that have been studied and which are considered important in a wide range of sexual behaviors. The list will be elaborated as our knowledge grows with research studies.

TABLE 1.1
The Stimulus Response Matrix of Sexual Behavior

The Stimuli	The Responses
1. Body Characteristics A. Mature B. Immature C. Male shape D. Female shape 2. Gender Behavior A. Masculine B. Feminine 3. Other Behaviors A. Pleasure-Pain B. Dominance-Submission C. Courtship 4. Miscellany A. Fetish – garments, hair fire, etc. B. Animals	1. Intercourse A. Vaginal B. Anal 2. Oral-Genital 3. Masturbation 4. Exhibiting 5. Peeping 6. Rape 7. Touching 8. Frottage 9. Obscene Calls 10. Cross Gender Dressing A. Transvestism B. Transsexualism

The first set of stimuli is body characteristics. Normal men respond most erotically to the mature female body shape but also to some extent to the pubescent girl and the female child⁴. The great similarity between these body shapes may explain the reactions of normal healthy men. However, some men who are pedophiles (literally, lovers of children) react most to the female child. Analogous reactions apply to homosexual men. Most prefer the mature male body but some, the homosexual pedophiles, react most to male children. Differences in reactions to parts of the body are less variable than one may expect. The relative size of a mature woman’s breasts may seem important to an individual but examined over a large number of men, it is not⁷. In fact, normal men react most erotically to the pubic area and less so to the breasts⁴.

Males of most species are larger than females and size can influence sexual interaction. The dramatic influence of size on sexual behavior is illustrated by the laughing dove birds². The male and female do not have clear color differences as many birds do. When a small male is caged near a larger one, he ceases to display in a male way and begins to show characteristically female behavior. Relative size may relate to dominance and submission in humans and may be important in homosexual behavior where both partners are same sexed and in pedophilia and incest when a great difference in size may be evident.

Men are usually taller and heavier than females but when a man is shorter and/or lighter than a woman, he may not be as sexually appealing in spite of ‘good looks’. Body type may also play a role in erotic arousal. Traditional females tend to prefer the tapering “V” physique while less traditional females are more variable^{9 14}. Negative feelings about one’s body can relate to heterosexual difficulties¹¹. Little research on sexual anomalies has been carried out on this seemingly important variable.

A second set of stimuli is the gender behavior of the potential sex partner. Tomboyish behavior in a mature female may turn off many men whereas ultra feminine behaviors may be a stimulus to excitement. For example, a woman in a pair of muddy jeans who is swearing and smoking a cigarillo would generally be less stimulating to the average North American male than a woman in a pretty dress who is clean and wearing a touch of perfume. However, tastes vary and different cultural subgroups may dictate what is important. Some men transgress cultural standards and dress like women (transvestites) or want to be converted into women by surgery (transsexuals). These anomalies are usually referred to as gender dysphoria and the concept of “gender identity” has received considerable attention in the professional literature.

When researchers have attempted to determine what is the “essence” of gender behavior, they usually come up against a blank wall. Questionnaires developed in the 1920’s and 1930’s are interesting to peruse because they reveal cultural stereotypes of what was characteristically male and what was female at the time^{10 13}. Taking a bath was considered more feminine and taking a shower more masculine. Occupational choices also reflect gender identification. The female would more appropriately desire clerical/secretarial work and the male manual labor. Considering that women did not work in business at all in the 1800’s and now, in light of the women’s rights movement, that they are working in many more fields, one can appreciate that such indices of gender identification or masculinity-femininity are time bound and suspect. Gender behavior has been considered important in sexual anomalies and it will be noted throughout the book.

Other stimulus behaviors in Table 1.1 include pleasure, pain, dominance, submission and courtship. These are rather ill defined for scientific purposes and have only begun to be studied in systematic research. Considering them intuitively for the time being, most men are excited when a female shows some sign of sexual response. Pleasure on her part in terms of gestures or verbal statements that she is enjoying the sexual interaction are arousing to them. However, some men may be more excited by a woman’s pain, fear or displeasure in unwanted sexual events such as rape. Some males may find being dominant in a relationship facilitates intercourse and they may be rather rigid about it (See ^{1 5} for theoretical issues in animal related studies). Mr. A, a pedophilic patient, said the thing he liked most about children was their utter dependence on him, particularly his own children with whom he has sexual contact on a number of occasions. He was not generally sexually aroused by his wife until “she was in tears and on her knees at his mercy.” Dominance will be discussed again under sadism and pedophilia.

Courtship behavior refers to the culturally determined sequence of events and exchanges between men and women, which are accepted in establishing a sexual relationship. This may be divided into four phases: searching, pretactile interaction, tactile interaction and genital union³. In the first stage, partners seek each other out or let each other know they are available. In our culture, going to socials, dances, and so forth is common. Once two individuals agree to “try each other out”, there is a more or less prolonged exchange (dating, talking on the phone, etc.) prior to some preliminary sexual interaction (petting and kissing) until finally, intercourse completes the sequence. Men vary in their style of accomplishing this sequence and the rapidity of so doing. Women are similar and in fact may attract more men by their particular courtship behavior. Some men may show a pathological distortion of the usual sequence and this will be noted when exhibiting, peeping and rape are discussed later.

The final stimulus category is a miscellany of items, and there are others, but they are not encountered too often. One will find occasionally in a clinical setting some patients who exhibit fetishes, usually for female undergarments, hair or at times for fire. Rare also are cases of bestiality⁸ or zoophilia (literally lover of animals) in which there is some sexual contact with an animal and cases of necrophilia which involves contact with a dead body. However the dynamics of zoophilia have been described¹².

The response side of the matrix describes how the sexually anomalous male reacts to the series of stimuli just listed. This can be in a variety of ways such as vaginal, oral or anal contact. Anal intercourse is rare but can be enjoyed by both heterosexuals and homosexuals. In some cases, it can be a means of degrading the victim or of causing pain.

Oral genital exchanges are common among both homosexuals and heterosexuals today in North America⁸. About 3/5 of males have oral-genital experiences and for this reason, it is difficult to label it “unusual” and to evaluate pathological implications.

Masturbation is commonly practiced by the sexually deprived and by younger men who do not have sex partners available to them or who are inexperienced in obtaining sexual gratification with a partner. However, it is also a major outlet for several sexual anomalies: exhibiting, peeping, touching, frottage, transvestism and various fetishes.

Exhibiting is the display of the genitals to a female stranger often apparently with no other interaction desired. Watching sexual intercourse or women undressing at the movies and burlesque theater is a pasttime for some young men but it only becomes an anomaly when it is a preference at maturity and is associated with orgasm. Rape is a familiar term and involves sexual intercourse with a nonconsenting female but there is more. Force m...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Dedication
• Contents
• Preface
• Part I Introduction to the Assessment and Treatment of Sexual Anomalies
• Part II Stimulus Preference Anomalies
• Part III Response Preference Anomalies
• Part IV Physical Disorders
• Part V Concluding Remarks
• Appendix One Sexual History Questionnaire – Male
• Appendix Two A Sample SHQ Profile
• Subject Index