IB HUMAN SEXUALITY
SEXUAL VARIATIONS & PARAPHILIAS
Dr ML Ng
Psychiatry
Thu 19-09-02
Definition of Normal
- Statistical
- Developmental
- Philosophical
- Cultural
- Political
- Pragmatic
Requirement for a Normal Sex Life
- Sexual Identity
- Sex Role Behaviour
- Sexual orientation
- Courtship Behaviour
- Sexual Function
- General Health
Abnormal Sexual Condition
- Gender identity problems ®
Transsexualism, hermaphroditism
- Gender Role Behaviour Problems ®
Transvestism
- Sexual orientation problems ®
Bestiality, Homosexuality, Fetishism, Paedophilia, Gerontophilia, Necrophilia, Coprophilia, Pygmalionism, Incest
Common Sexual Condition
- Courtship behaviour problems ®
Voyeurism, Sadomasochism, frottage, toucherism, bondage, rape
- Sexual Dysfunctions
- Sexually transmitted diseases
HOMOSEXUALITY
Causation of Homosexuality
Psychoanalytical
- Higher incidences of psychosexual trauma on clinical and non-clinical samples of male homosexuals
- Nature of trauma
- Mother ®
too close, too binding
- Father ®
passive, hostile, detached, absent
- Parental attitudes ®
puritanical, moralistic
The Normal Sex Life
|
|
Child |
Adoles. |
Adult |
Widow |
|
Sexual Awareness |
?? |
? |
+ |
? |
|
Autoeroticism |
??? |
? |
? |
? |
|
Courtship |
??? |
? |
+ |
? |
|
Extramarital sex |
???? |
?? |
?? |
? |
|
Sex and marriage |
???? |
?? |
+ |
? |
|
No. of sex partners |
0 |
0 |
1 |
0 |
|
Divorce/remarriage |
???? |
?? |
? |
0 |
Other Abnormal Terms
- Variant ®
Conscious, intentional, statistically not normal
- Alternative ®
Conscious, intentional, ideological choice
- Alternate ®
Involuntary, statistically not normal
- Deviant ®
With suffering and deprivation, politically ideologically not normal
Definition of Disease
- Morbid process with a characteristic train of symptoms
- Morbidity ®
Debilitation due to: Known, suggestive or presumed causes; Of a biochemical, neurological, structural, or psychological nature
- Excluding that of a social nature
Is homosexuality a disease?
- US 1973 ®
DSM-II – Sexual Orientation Disturbance
- US 1978 ®
Sexual orientation disorder replaced by paraphilias, no homosexuality; Ego-dystonic homosexuality created (DSM III)
- US Current ®
Homosexuality removed in DSM IIIR, DSM IV
- WHO 1978 ®
One of the sexual deviation disorders (ICD9); Parliamentary Assembly of the Council of Europe 1981; Recommend deletion of homosexuality in ICD
- WHO 1992 ®
Homosexuality removed (ICD – 10)
- Chinese Medicine ®
Homosexuality never considered a disease
The Hetero-Homosexuality Continuum
Rates of Homo/Heterosexuals (US Males-Kinsey 1948)
Epidemiology of Human Sexuality
- All Society
- Ford and Beach 1952
- 76 non-US societies
- 2/3 Consider homosexual as normal or acceptable
Causes of Homosexuality
DARWINIAN
- Heterosexuality is morphogenetic
- Polymorphous sexuality
- Natural selection
- Heterosexuality and its variations
- Support: Homosexuality observed in different species: Bull, cow, stallion, donkey, cat, ram, goat, pig, antelope, elephant, hyena, monkey, ape, rabbit, lion, porcupine, hamster, mice, porpoise, lizard, bird……
GENETIC
- Kallman 1952 ®
DZ vs MZ twin pairs. Concordance for homosexual: DZ:MZ = 15% : 100%
- Kolb 1963 ®
7 MZ not concordant
- Heston & Field 1968 ®
5 MZ, only 2 concordant
- Pillard & Weinrich 1985 ®
DZ:MZ = 24%:57%
- Hamer et al 1997 ®
maternal uncles and cousins ?X-linkage (Xq28)
CONGENITAL
- Cross-sexual behaviour in rodents by artificial foetal androgen/oestrogen manipulations
- Foetal exposure to stilboestrol associated with increased lesbian interests in female adults
- 3rd interstitial nucleus of the anterior hypothalamus of homosexuals smaller.
- Larger anterior commissure
PSYCHOANALYTIC
- Psychological recapitulation theory ®
ontogeny recapitulates phylogeny
- Polymorphous sexuality ®
(1) Normal development à
Heterosexual (2) Psychosexual trauma à
Sexual deviations
SEDUCTION
- Homo and heterosexual males had equal experiences of being homosexual seduced
SEGREGATION
- More homosexual behaviour, but as part of a general adverse effect of no heterosexual contacts or outlets
POOR ADJUSTMENT ABILITY
- Moral relaxation
- Homosexuals persist in the most severely repressive civilisation
- Rate of paedophilics in homos and heteros are equal
- Rate of homosexuals not increase after decriminalisation
Rates of Indecent assault in Hong Kong
| |
On Males |
On Females |
| |
Rate per 100,000 |
|
1979 |
5.5 |
22.7 |
|
1980 |
32.0 |
24.1 |
|
1981 |
11.0 |
16.9 |
|
1982 |
4.0 |
17.0 |
Management of Homosexuality
- Nil
- Of adjustment, neurotic or personality problems: Supportive psychotherapy; Environmental manipulation; Drugs
- Re-orientation ®
Supportive or analytic therapy; Behavioural therapy; Anti-testosterone
INCEST
- Definition: Sexual activity between individuals close by blood relationship that are prohibited to marriage ®
How Close?
- Cultural variations ®
Legends; In Western royal family; Tibetans and minority tribes in China; Hawaiians, Polynesians
- Origin of the Incest Taboo ®
Instinctual; Familiarity; Psychoanalytic; Genetic knowledge; Role disruption; Social reciprocity; Life expectancy; Learning theory
Prevalence of Incest
- US: 5-15%
- Child sexual abuse ®
1/5-1/3 of all women had some sort of childhood sexual encounter with adults, 4-12% of women had sex with a relative, 1/100 had it with her father or step-father
SEXUAL INCLINATION/ PREFERENCE
- Not a scientific definition
- Variation of Sexual interests within a normal range
- Types of interests
- Definition of normal
- Definition of disease
Paraphilias
- Disorders of fantasy, urge or practices
- Insistent
- Repetitive
- Distressing to the person
Lists of Paraphilias
- Acrotomophilia (amputee partner)
- Adolescentilism (Impersonating an adolescent)
- Andromimetophilia (male impersonator partner)
- Apotemnophilia (self-amputee)
- Asphyxiophilia (inducing cerebral anoxia, usually by means of self-applied ligatures or suffocating devices, while the individual masturbates to orgasm. The most common practitioners of this paraphilia are adolescent and young adult males)
- Autaonistophilia (live-show self display)
- Autassassinophilia (self-staged own death)
- Autonepiophilia (infantilism, wearing diapers)
- Biastophilia (raptophilia, rape)
- Catheterophilia (arousal from the use of catheters)
- Chrematistophilia (blackmail payment)
- Chronophilia (age discrepancy)
- Coprophilia (faeces)
- Ephebophilia (adolescent partner)
- Erotophonophilia (lust murder)
- Exhibitionism (indecent exposure)
- Fetishism (an object that replaces people as primary object of love)
- Formicophilia (crawling things)
- Frotteurism (rubbing body against partner or object for arousal)
- Gerontophilia (attraction to a partner whose age is that of different generation)
- Gynemimetophilia (female impersonator partner)
- Hypbristophilia (criminal partner)
- Hyphephilia (tactile fetish)
- Hypoxyphilia
- Infantilism (cross-dressing as a young child for sex play)
- Kleptophilia (arousal from stealing)
- Klismaphilia (enema)
- Masochism (ability to transfer emotions caused by pain to erotic feelings or as median in which to analyse weaknesses and strengths)
- Mixophilia (scoptophilia) (arousal from looking at sexually stimulating scenes)
- Morphophilia (arousal from person with a different physique)
- Mysophilia (filth)
- Narratophilia (erotic story telling)
- Necrophilia (sex with corpses)
- Nepiophilia (arousal by infants of opposite sex)
- Olfactophilia (arousal from odours)
- Pedophilia (sex with minors)
- Peodeiktpphilia (penile exhibitionism)
PROBLEMS IN SEXUAL EQUALITY
- What types to equalise? Biological/Psychological sex?
- What range to equalise? Full/limited range?
- Base on what reasons? Causation/? Health/disease? Biological/psychological causation? Social effect?