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Dora's hysteria and the maturation of Sigmund Freud's transference theory: a new historical interpretation.

The emergence of Freud's 1905 revision and elaboration of transference theory is situated within the context of his emerging understanding of neurosogenesis. Immediately after the seduction theory lost its credibility in the fall of 1897, Freud maintained a traumatic model for hysteria and increasingly hypothesized that repressed childhood masturbation was fundamental to the creation of hysteria. Following this interest in masturbation, Freud--influenced in part by Havelock Ellis's concept of autoerotism--put forth his first post-seduction theory model of neurosogenesis in December 1899. In this model two different developmental stages of psychosexual object relatedness-the "autoerotic" and the "alloerotic"--determined and differentiated later psychoneurotic symptomatology. This etiological schema organized the next psychopathological writing Freud did, his "Fragment of an Analysis of a Case of Hysteria," in which Ida Bauer's hysteria was seen as due to oral zone autoerotic overstimulation and, later, to her object-directed genital masturbation. Freud in a postscript reasoned that in the analytic situation the production of neurotic symptoms ceases and is replaced by the creation of transferences. Hence it is argued that Freud, following his new two-tiered understanding of neurosis, expanded his formal description of transference by creating two analogous forms of transference, the "reprint" and the "revised edition."

Adolescent↗

[Assessment of orgasmic capacity of postmenopausal women].

OBJECTIVE: To correlate the capacity of healthy postmenopausal women to have orgasms (during intercourse or by solitary masturbation) with psychosocial, behavioral, climacteric, hormonal and interpersonal factors. METHODS: Nine hundred and ninety-nine women (aged from 41 to 60 years) underwent physical and supplementary tests and answered questionnaires regarding sexual behaviour. Sixty healthy women, sexually active, with one or more years of amenorrhea, without hormone therapy and with a partner capable of intercourse were chosen from this group. A Logistic Regression Model with one dependent variable -- orgasmic capacity -- and seventeen independent variables -- psychosocial, behavioral, interpersonal, climacteric and hormonal factors -- was developed. RESULTS: The orgasmic capacity correlated significantly with the practice of masturbation (p=0.000), with pleasure in embracing and caressing the partner's body (p=0.036) and with the presence of vaginal dryness (p=0.021). CONCLUSIONS: This study shows that the most important factors were interpersonal and behavioral and that the other parameters considered were not statistically significant. Women with vaginal dryness, who however engage in masturbation and maintain an affective relationship with their partner, obtain an equal or a greater number of orgasms when compared to the frequency of sexual intercourse.

Adult↗

Naltrexone in the treatment of adolescent sexual offenders.

BACKGROUND: Naltrexone is a long-acting opioid used clinically in alcoholism, drug abuse, bulimia nervosa, obsessive-compulsive disorder, and impulse-control disorders. This study investigated whether naltrexone can decrease sexual arousal in legally adjudicated adolescent sexual offenders. METHOD: In an open-ended prospective study, naltrexone was given to 21 adolescents participating in an inpatient adolescent sexual offenders program who met any of the self-reported criteria of (1) masturbating 3 or more times per day, (2) feeling unable to control arousal, (3) spending more than 30% of awake time in sexual fantasies, or (4) having sexual fantasies or behavior that regularly intruded into and interfered with their functioning in the treatment program. After having been treated for more than 2 months, 13 patients had their naltrexone administratively stopped, thus providing a before, during, after, and resumption-of-treatment design. Behavioral changes were monitored daily with a fantasy-tracking log and a masturbation log. A positive result was recorded if there was more than a 30% decrease in any self-reported criterion that was applicable to each specific patient and this benefit lasted at least 4 months. Data were collected from July 2000 to December 2002. Leuprolide was given if naltrexone was not sufficiently helpful in controlling sexual impulses and arousal. RESULTS: Fifteen of 21 patients were considered to have a positive result and continued to respond for at least 4 months to an average dose of 160 mg per day with decreased sexual fantasies and masturbation. Dosages above 200 mg per day were not more helpful. Administrative discontinuation of naltrexone in a subset of 13 patients resulted in reoccurrence of symptoms that began when the dose taper reached 50 mg per day. There were no changes in clinical chemistries. Five of 6 patients who did not benefit from naltrexone responded favorably to leuprolide. CONCLUSIONS: Naltrexone at dosages of 100 to 200 mg per day provides a safe first step in treating adolescent sexual offenders. It is possible that the benefits observed here will generalize to the larger population of non-socially deviant hypersexual patients or "sexual addicts."

Adolescent↗

[The power of science in Tissot's L'Onanisme].

The Swiss physician Tissot published in 1760 the first edition in French of L'Onanisme, a book which dealt with the diseases caused by masturbation and had a deep and lasting influence. For the first time the problem of masturbation was tackled from a strictly medical angle. Tissot used observation and logical reasoning, and rejected acts of faith. However, behind this fierce rationalism a religious morality was concealed, which was never explicitly expressed but could be guessed through some expressions, in particular through the idea of 'nature'. The latter concept related back to the physical laws, to the moral laws and to the religious laws at the same time. If Tissot's medical discourse had more influence than the preceding religious and moral discourses, it is because of the rationality of its line of argument, which could lead to a real internalization of the message by the reader. Letters to Tissot show indeed that sick people did not see the interdiction of masturbation as coming from an external authority, but as coming from themselves. The power relationship was not any more between two persons, but between the reason and desires of a single individual.

History, 18th Century↗

Video reveals self-stimulation in infancy.

UNLABELLED: The medical literature on early childhood masturbation is sparse. Only 12 patients who presented with infantile self-stimulation under the age of 1 y are described. During the last 2 y, five girls under 1 y of age presented at our department with self-stimulating behaviour. The diagnosis of this behaviour was difficult, but could be made by watching a video of the attacks. Infantile self-stimulation is often misdiagnosed and unnecessary investigations and useless treatments are often prescribed. Video recording can be of great help to put forward the correct diagnosis. Masturbation is not so uncommon and treatment consists mostly in reassuring the parents. It can, however, be associated with behavioural problems. Few data are available on the clinical outcome of childhood masturbation, but most children seem to develop normally. CONCLUSION: Infantile self-stimulation should always be considered in the differential diagnosis of "strange episodes or attacks".

Diagnosis, Differential↗

Sexual activities of Malaysian adolescents.

This paper examines data on the sexual activities of 1,200 Malaysian adolescents aged 15-21 years based on a probability household sampled survey carried out in Kuala Lumpur in 1986. Sexual behaviours like premarital sexual intercourse, contraceptive usage and masturbation were presented. Of the 1,181 unmarried respondents, 9% (105) reported having had sexual intercourse; males were significantly more experienced compared to females. Older age groups were also found to be more sexually active than the younger ones. Among those who had experience dating (n = 521), 20% (105) have experienced sexual intercourse, 44% (228) have kissed and necked, and 35% (183) have experienced petting, while 24% (130) have had no physical intimacies. Poor use of contraception was also revealed. The most commonly used were condoms, oral contraceptives and withdrawal. With regard to masturbation, males begin this practice relatively earlier than females. Almost half of those who indulged in masturbation were worried by the act, especially the females. Implications of the findings are discussed.

Adolescent↗

Effects of antihypertensive drugs atenolol and nifedipine on sexual function in older men: a placebo-controlled, crossover study.

Investigated the adverse sexual effects of two antihypertensive drugs, atenolol and slow-release nifedipine, in a placebo-controlled, randomized, crossover study. Subjects were 16 older men (mean age = 66.6 years, SEM = 1.4) with mild to moderate hypertension. Subjects completed daily self-reports on 13 measures of sexuality: frequency of desire, coitus, noncoital partner sex, masturbation, morning erections, spontaneous erections, orgasms in coitus and masturbation, firmness of morning, masturbatory and coital erections, and subjective pleasure in coitus and masturbation. Except for a significant decrease in masturbatory erectile firmness with nifedipine therapy, variables did not differ between the two drug treatments or between either drug and placebo. Although the sample was relatively small, small differences between treatment means suggest that these antihypertensive agents are fairly benign relative to sexual function in men.

Aged↗

Sexual dysfunction in men undergoing infertility evaluation: a cohort observational study.

OBJECTIVE: To study psychosexual problems in men undergoing infertility evaluation. DESIGN: A cohort observational study. SETTING: Male infertility diagnostic center. PATIENT(S): Four hundred twelve men undergoing infertility evaluation between 1999 and 2001. INTERVENTION(S): Baseline and follow-up data on sexual functions. Semen analysis for samples collected by masturbation. A second analysis was requested in 2 weeks upon finding an abnormality of semen parameters. Penile vibratory stimulation to help men who failed to collect semen on their second or subsequent appointments. MAIN OUTCOME MEASURE(S): Sexual functions (erection and orgasm) during the time of infertility evaluation. RESULT(S): Seven of 412 men were excluded from the analysis due to a past history of sexual dysfunction. Of the remaining 405 men, 46 (11%) failed to collect semen by masturbation for a second semen analysis after repeated (2-4 times) attempts at 2- to 3-day intervals. Nine of these men (20%) were able to collect semen using vibratory stimulation. All 46 men experienced problems with erection or orgasm and had severe anxiety during attempts to masturbate and during sexual contact with their partners. CONCLUSION(S): Our study indicates that some men may experience sexual dysfunction of a psychogenic nature in response to the diagnosis of infertility.

Adult↗

[Sexual behaviour and use of condoms by adolescents in our environment].

OBJECTIVE: To identify sexual behaviour in adolescents. DESIGN: Transversal, descriptive study, by means of an anonymous structured questionnaire. SETTING: Urban secondary school. PARTICIPANTS: Simple random sample of 84 students (4th year of ESO--c. 15/16 years old). MAIN MEASUREMENTS: Personal details, sexual practices, use of condoms. RESULTS: 61.9% were girls. Average age was 16.4 (95% CI, 16.2-16.6). They had a girl/boy-friend or casual partner (33.7%) and stable partner (60.7%). 82.2% had total or sufficient trust. Boys' first masturbation was between 14 and 16 (46.8%). 100% had done so by the age of 16. 72.3% of girls had never masturbated at this age (P<.001).Boys' first kiss on the lips occurred between 14 and 16 (46.8%); 100% had done so by 16. 60.7% of girls had done so between 14 and 16, and 92.2% by 16.30.1% of boys had had their first experience of coitus by the age of the questionnaire, whereas 22.5% of girls had. Both sexes used a condom on 71.4% of occasions.38.1% had sex with penetration, 46.2% masturbated. 22.2% had had 2 sexual partners, 8.9% had had 3, and 40.0% had had 4 or more. Condoms were used in 83.3% of relationships with penetration. CONCLUSIONS: This is a sexually active population, susceptible to sexually transmitted diseases (STD) and unwanted pregnancies, as it does not use condoms in every relationship involving penetration. Health education activities need to be encouraged.

Adolescent↗

Puberty, sexual milestones and abuse: how are they related in eating disorder patients?

In order to assess the relationship pubertal development, sexual milestones and childhood sexual abuse in women with eating disorders, 44 patients with restricting anorexia nervosa (RAN), 26 with bulimic anorexia nervosa (BAN), 29 with bulimia nervosa and also with a history of anorexia nervosa (BN/HistAN), and 69 with bulimia nervosa but without a history of anorexia nervosa (BN) completed questionnaires on pubertal and sexual development and unpleasant sexual experiences. Forty-four female college students complete the sexual development questionnaire only. Different eating disorder groups were found to be similar in terms of their pubertal development. All eating disorder groups showed delays in aspects of their psychosexual development (age at first kiss, masturbation, genital fondling and first sexual intercourse) compared with the control group, although to a different degree. The RAN group was delayed on almost all sexual milestones whereas the other groups were delayed on only some. On some variables, most noticeably on first sexual intercourse, restricters also were more delayed than the other eating disorder groups. Similarly, the median number of sexual partners differed significantly between groups (RAN = 1, BAN = 2, BN/HistAN = 4, BN = 4, controls = 5, P < 0.0001). Eating disorder patients, in particular RAN patients, were less positive about sexual relationships than controls, but did not differ from controls in attitudes to masturbation, marriage, children or pregnancy. Of the eating disorder patients 22-31% had been sexually abused during childhood. A history of abuse affected attitudes to masturbation, but did not appear to affect sexual development.

Adolescent↗

Secondary school teachers' perception of pupils' undesirable behaviours.

BACKGROUND: Previous studies provide inconclusive evidence with regard to the influence that teacher, pupil and school characteristics have on teachers' attitudes towards problem behaviours. AIMS: To investigate the seriousness of several behaviours as perceived by secondary school teachers, and the extent to which these perceptions are influenced by a number of characteristics. SAMPLE: A sample of 605 randomly selected teachers from 16 state secondary schools participated in the study. METHODS: A questionnaire survey method was employed: RESULTS: Drug abuse, cruelty/bullying and destroying were perceived as the most serious behaviours whereas inquisitiveness and whispering were rated as the least serious. Significant grade level differences were observed in all but two of the 49 behaviours, these being masturbation and obscene notes. While smoking and heterosexual activity were perceived significantly more serious in Form 1-2 than in Form 4-5 pupils, the converse was true for all the remaining forms of behaviour. Irrespective of grade level, a number of significant pupil sex and teacher sex differences were observed. Whereas cheating, lying, masturbation and heterosexual activity were perceived to be significantly more serious in girls than in boys, the converse is true for dreaminess, disorderliness, silliness, quarrelsomeness, and restlessness. While female teachers perceived masturbation and obscene notes significantly more serious than male teachers the opposite is true for disorderliness. School selectivity and teaching experience were important moderators of the perceived seriousness of problem behaviours. CONCLUSIONS: The study provides additional evidence of the importance of certain teacher, pupil and school characteristics as moderators of teachers' perception of the seriousness of behaviour.

Adolescent↗

Multi-impulsivity among women with bulimia nervosa.

OBJECTIVE: The results of past research suggest the possible existence of a distinct subgroup of bulimic individuals who display multiple behaviors indicative of impulsivity (e.g., stealing, self-injury, attempted suicide, drug abuse). We further investigated potential relationships between multi-impulsivity and other clinical variables. METHOD: We compared women with bulimia nervosa (purging type) who displayed "multi-impulsivity" (n = 40) to those who did not (n = 177) with regard to symptom history and presentation, eating-disordered attitudes, and sexual experience. RESULTS: The two groups did not differ in mean age, body mass index, scores on scales of eating-disordered attitudes and traits, incidence of self-induced vomiting, sexual intercourse, or masturbation, and current frequency of binge eating and self-induced vomiting. However, relative to the comparison group, women in the multi-impulsive group reported earlier onset of binge eating and sexual intercourse, a greater incidence of laxative abuse, and use of a greater number of different substances. There were statistical trends (p < .10) toward the multi-impulsive group displaying earlier onset of self-induced vomiting, laxative abuse, and masturbation. DISCUSSION: Results are discussed in relation to the results of past research and the implications for treatment of bulimic women.

Adult↗

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.

Adolescent↗

A study of fantasy-based sexual arousal in women.

The self-reported use of sexual fantasy as an aspect of sexual behavior in natural settings was examined with respect to genital responding to both sexual fantasy and an erotic audiotape within the laboratory. It was predicted that subjects who self-reported a higher frequency of using sexual fantasy during either masturbation or sexual interaction with a partner in extralaboratory settings would be more highly responsive on genital measures of sexual arousal obtained when the subject was generating sexual fantasy within the laboratory. Forty-five female subjects (median age, 21) completed a battery of questionnaires, which included three scales of general imagery ability and frequency, and a detailed sexual history. All subjects then experienced an initial nonstimulated baseline period followed by a second baseline period and an exposure to an erotic audiotape. Genital responding was measured by vaginal photoplethysmography. Those subjects who reported more frequent use of fantasy during masturbation outside the laboratory showed greater genital responses during both fantasy and tape-elicited arousal than those reporting less use of masturbatory fantasy. One of the imagery questionnaires yielded a significant correlation with genital response in the fantasy condition. It appears that cognitive factors have predictive significance for measures of vaginal pressure pulse responses to erotic tape recordings and fantasies.

Acoustic Stimulation↗

Styles of sexual expression in women: clinical implications of multivaritanalyses.

Two different multivariate techniques were applied to self-reported trait and behavioral data concerning sexual behavior from a sample of North American women. Canonical correlation delineated three styles in which certain demographic attributes and cognitive indices of sexual arousal were related to forms of sexual expression. The first style was characterized by respondents who experienced high rates of intercourse and orgasm in a cohabitation arrangement but who did not necessarily report satisfaction with their sexual responsivity. A second style was characterized by older women currently without partners who expressed a liking for erotic literature and media, direct genital stimulation, and frequent masturbation but who were dissatisfied with their sexual responsivity. The third style, which included respondents most satisfied with their sexual responsivity, was characterized by women who were more aware of physiological changes during sexual arousal and who enjoyed gently seductive erotic activities, breast stimulation, and genital stimulation. A discriminant analysis showed that those women who were most highly satisfied with their sexual responsivity experienced frequent intercourse and orgasm consistency, enjoyed gently seductive erotic activities and breast stimulation, but were unresponsive to erotic literature and media. A second discriminant analysis showed that women who achieved orgasm most consistently were older, were more aware of physiological changes during sexual arousal, reported higher frequencies of masturbation and intercourse, and were less likely to be aroused by erotic preliminaries. These results are discussed within the context of the literature on the treatment and prevention of sexual dysfunction.

Adolescent↗

Changes in sex differences in sexual behavior: a replication of a study on West German students (1966-1981).

In 1966, at the start of the student movement and the sexual liberalization process, we studied the sexual behavior and attitudes of 3,666 male and female students from 12 West German universities by mailed questionnaires. In 1981 we replicated this study with 1,922 students from 13 universities (10 the same as 1966, 3 founded after 1966). In both studies the students were selected at random. Results of these comparative studies are presented with a view to the changes in sex differences. Sex differences in masturbation behavior have considerably decreased since 1966; masturbation is nonetheless still the form of sexual behavior with the most striking differences between the sexes. The sex differences in coital behavior are now reversed, female students being earlier and more active than males. As regards the tendency to change partners or for sexual relations outside a steady relationship, the differences between men and women have disappeared. In their attitudes to sexuality, female students in 1981 are somewhat more liberal than their male counterparts, whereas hardly any difference could be found in 1966. These changes in sex differences are observed in all subsamples, i.e., in young and old, in strictly religious and nonreligious students, and in students from both upper- and lower-class backgrounds (educational level of parents).

Adult↗

Subjective sexual experience in college women.

A random sample of 100 undergraduate women were interviewed about their subjective sexual experience. Sexual sensations during masturbation, oral sex, intercourse, and intercourse with concurrent clitoral massage were summarized and differentiated. Sensations labeled "orgasm" by a majority of the subjects were identified, and the suggestion was made that experiences other than that outlined by Masters and Johnson may be considered orgasmic by women in a more general population. Some support was found for Singer and Singer's typology of orgasm at a subjective level. Most subjects who experienced multiple orgasms found them no more satisfying than single ones. Clitoral and vaginal orgasms may be distinguished subjectively, but no clear preference for one or the other emerged from a consensus of the subjects. Orgasm rate was significantly related (p less than 0.001) to satisfaction during intercourse and oral sex, but not during masturbation. Some evidence was found supporting the role of social learning in developing sensitivity in the clitoris and vagina and possibly the breasts.

Adolescent↗

Unusual behaviour of captive-raised gibbons: implications for welfare.

Unusual behaviours not normally seen in the wild were studied in 52 captive agile (Hylobates agilis albibarbis) and 23 Müllers gibbons (H. muelleri spp) at three locations within the Kalaweit Gibbon Rehabilitation Project. Unusual behaviours included stereotypic behaviour (SB), human-directed masturbation and posterior presenting. These data were collected over 18 months as part of an ongoing study into behavioural adaptation of gibbons in a rehabilitation programme. Data were also collected on the unusual behaviours observed, for example, SB, human-directed masturbation and posterior presenting. I suggest causes of the abnormal behaviours and propose solutions to reduce their incidence in order to improve the gibbon's progress in rehabilitation. From this study I conclude that most gibbons can be rehabilitated from the point of view of acquiring and maintaining a normal behavioural repertoire once in suitable housing. Encouraging the gibbons to reduce and/or stop these unusual behaviours is key to the welfare of the gibbons while in the rehabilitation programme and to successful release into a forest habitat.

Animal Welfare↗