Sexology
Chapter 14
Variations in sexual behaviour

When is sexual behaviour abnormal?

Defining abnormal

Sexual behaviour varies greatly from one culture to the next.
There is a corresponding variation in what is considered to be abnormal.

Statistical definition
An abnormal sexual behaviour is one that is rare.
This definition does not give us insight into the psychological or social functioning of the person.

Sociological approach
A behaviour that violence the norms of society.

Psychological approach
The three criteria of abnormality are discomfort, inefficiency and bizarreness.

Medical approach
Exemplified by the definitions included in the DSM-V.
Paraphilia: intense and persistent unconventional sexual interest.

The normal-abnormal continuum

There is a continuum from normal to abnormal sexual behaviour.
This continuum holds for many of the sexual variations.

Fetishism

Fetishism: a person’s sexual fixation on some object other than another human being and attachment of great erotic significance to that object.
A fetishistic disorder: sexual fantasies, urges, or behaviours involving the use of non-living objects to produce or enhance sexual arousal with or in the absence of a partner, over a period of at least 6 months and causing significant distress.

Inanimate-object fetishes can be roughly divided into two categories

• Media fetishes
• Form fetishes

Why do people develop fetishes?

Psychologists are not sure what causes fetishes to develop.
Three theoretical explanations

• Learning theory
  Fetishes result from classical conditioning
  A learned association is built between the fetish object and sexual arousal and orgasm.
• Cognitive theory
  Fetishes (or other paraphilics) have a serious cognitive distortion in that they perceive a nonconventional stimulus as erotic.
  Further, the perception of arousal is distorted.
  • They feel driven to the sexual behaviour when aroused, but the arousal may actually be caused by feelings of guilt and self-loathing
    There is a chain in which there are initial feelings of guilt as thoughts of the unconventional behaviour, which produces arousal, which is misinterpreted as sexual arousal, which leads to a feeling that the fetish ritual must be carried out; it is, and there are temporary feelings of relief, but the evaluation is negative, leading to further feelings of guilt and self-loathing
• Sexual addiction model

Fetishism typically develops early in life.

Cross-dressing

Cross-dressing: dressing as a member of the other gender.
Done by a variety of people for a variety of reasons.

• Male transsexuals may go through a stage of cross-dressing in the process of becoming women
• Drag queens typically cross-dress as caricatures of traditional gender roles
• Female impersonators: a man or women who impersonates a specific woman as a part of a job in entertainment

Some men regularly dress in female clothing to produce sexual arousal and experience sexual excitement.
Transvestic disorder: the practice of dressing as the opposite sex in order to experience sexual excitement, which causes emotional distress or impairs social or interpersonal functioning.

Cross-dressing is almost exclusively a male sexual variation.
Reasons

• Our culture’s tolerance of women who wear masculine clothing and intolerance of men who wear feminine clothing
• Women’s clothing is by design sexual and erotic, whereas men’s clothing is functional

Occasional cross-dressing is one of the harmless, victimless sexual variations, particularly when done in private.
It is a problem when it becomes so extreme that it is the person’s only source of erotic gratification, or when it becomes a compulsion the person cannot control and it therefore causes distress in other areas of the person’s life.

Sadism and masochism

Definitions

Sexual sadist: a person who experiences intense sexual arousal from the suffering of another person.
Sexual masochist: a person who experiences sexual arousal from being beaten, bound, humiliated, or made to suffer.
Then experienced for at least 6 months and causes distress or impairment, it is a paraphilic disorder.
Bondage and discipline: the use of physical or psychological restraint to enforce servitude, from which both participants derive sensual pleasure.
Dominance and submission: the use of power consensually given to control the sexual stimulation and behaviour of the other person.

Both B-D and D-S encompass a variety of specific interactions that range from atypical to paraphilic.

Sadomasochistic behaviour

Sadomasochism (S-M) is a rare form of sexual behaviour.
In nonparaphilic forms it is quite common.

There is a spectrum of activities that constitute S-M.
People who become involved in it often have tried a variety of these behaviours and find only some of them satisfying.
They develop a script of activities that they prefer to enact each time they engage in S-M, with less intense behaviours being much more common.

Sexual sadist and masochist do not consistently find experiencing pain and giving pain to be sexually satisfying.
Pain is arousing for such people only when it is part of a carefully scripted ritual.

Causes of sadomasochism

The causes of sadism and masochism are not precisely known.
The theories discussed in the section of fetishes can be applied here as well.

A theory points to childhood sexual abuse that causes sadistic fantasies.
For the child experiencing abuse, these fantasies are functional, helping the child coping with the abuse.
If sexual arousal is paired with the fantasies, they may influence sexual behaviour.

Another theory points out a masochist is motivated by a desire to escape from self-awareness.
It may be a unusually powerful form of escape because of its link with sexual pleasure.

Bondage and discipline

Sexual bondage: the use in sexual behaviour of restraining devices that have sexual significance.
There is a marked imbalance in preferences for the active ‘top’ and the passive ‘bottom’ roles.
Most people, regardless of their sexual orientation, prefer to be ‘bottom’.

Dominance and submission

Sociologists emphasize that the key to S-M is not pain, but rather dominance and submission (D-S).
This is a social behaviour embedded in a subculture and controlled by elaborate scripts.
D-S is a carefully controlled performance with a script.
Complex social arrangements are made in order to reduce the risk.

• Initial contacts are usually made in protected territories which are inhabited by other D-Sers who play by the same rules
• The basic scripts are widely shared, so that everyone understands what will and will not occur
  When the participants are strangers, the scenario may be negotiated before it is enacted
• As the activity unfolds, very subtle non-verbal signals are used to control the interaction

Voyeurism and exhibitionism

Voyeurism

Voyeur: a person who experiences sexual arousal from viewing unsuspecting person(s) who are nude, undressing, or having sex.
It becomes a paraphilia when it is manifested by fantasies, urges, or behaviours for at least 6 months, and they cause marked distress and interpersonal difficulty.

It is much more common among men than among women.
They typically want the person they view to be a stranger and do not want them to known what they are doing.
The element of risk is important.

Exhibitionism

Exhibitionist: a person who derives sexual gratification from exposing his genitals to an unsuspecting person.
They are usually men.
When fantasies, urges, or behaviour involving surprise exposure of the genitals to a stranger lasts at least 6 months and causes distress or difficulty, it is a paraphilic disorder.

Sexual offenders possess fewer social skills than non-offenders.

The exact causes of exhibitionism are not known, but a social learning-theory explanation offers some possibilities.
The parents might have subtly – or perhaps obviously – modeled such behaviour to the man when he was a child.
In adulthood, there may be reinforcement for the exhibitionistic behaviour because the man gets attention when he performs it.
In addition, the man may lack the social skills to form an adult relationship, or the sex in his marriage may not be very good, so he receives little reinforcement from normal sex.

Both voyeurism and exhibitionism are considered problematic behaviour when the other person involved is an unwilling participant.

Hypersexuality or asexuality

Hypersexuality

Hypersexuality includes

• Nymphomania: an excessive, insatiable sex drive in a woman
• Satyriasis: an excessive, insatiable sex drive in a man

In practice it is difficult to say when a person has an abnormally high sex drive.
Nymphomania or satyriasis is often defined by the spouse.

Hypersexuality: an excessive, insatiable sex drive in either men or women.
It leads to compulsive sexual behaviour in the sense that the person feels driven to it even when there may be very negative consequences.
The person is never satisfied by the activity, and he or she may not be having orgasms, despite all the sexual activity.

Hypersexuality properly measured/defined appears to be distinct from high desire.

Hypersexuality in women is associated with impersonal sexual activity.
The definition may need to be different for men and women.

Asexuality

Asexuality: having no sexual attraction to another person.
This is different from not engaging in sexual behaviour or not being in a relationship.
Asexuals do not necessarily report suffering from distress or other negative influence on their lives.
But there is normal physiological arousal capacity in women.

Research so far indicate that asexuality is a lack of sexual attraction, not an orientation or a desire disorder.

Cybersex use and abuse

The internet is thought to be especially likely to lead to addictive or compulsive behaviour because it is characterized by

• Anonymity
• Accessibility
• Affordability

Intense and persistent use of the internet for at least 6 months in ways that significantly impair daily life or cause distress may constitute hypersexuality.

It is likely that only a small number of men and women access sexually explicit materials in ways that fit the definition of a paraphilic disorder.

The most common characterization of problematic internet use involving sexually explicit materials is porn(ography) addition.
But neurophysiological changes similar to other addictions have not been found.
Conditioning and the desire to experience sexual gratification may account for the repeated activity.

Cybersex: two or more persons engaging in sexual talk for the purpose of sexual pleasure.

Research suggest high rates of co-occurence with other disorders.
People whose internet use is problematic are more likely to be depressed, report sleep disturbances and report alcohol and drug abuse.

Other sexual variations

Asphyxiophilia

Asphyxiophilia: the desire to induce in oneself a state of oxygen deficiency in order to create sexual arousal or to enhance excitement and orgasm.
This is very dangerous.

Little is known about asphyxiophilia.
Most of the deaths attributed to the practice involve men.

Men and women engage in asphyxiophilia in the belief that arousal and orgasm are intensified by reduced oxygen.
There is not way to determine whether this is true.

Zoophilia

Zoophilia: sexual contact with an animal.
Researchers suggest that a preference for sexual activity with animals can be explained by learning theory in that the rewards offered by sex with animals are immediate, easy, and intense, and thus extremely reinforcing.

It appears to be rare.

Other variations

Frotteurism: deriving sexual satisfaction form fantasies, urges, or behaviours involving touching or rubbing one’s genitals against the body of a non-consenting person.
Milder forms than frotteuristic disorder are common, and often intentional.

Troilism: three people having sex together.
Often a variant on voyeurism.

Saliromania: a desire to damage or soil a woman or her clothes.
The man becomes sexually excited and may ejaculate during the act.

Coprophilia: deriving sexual satisfaction from contact with fences.
Urophilia: deriving sexual satisfaction from contact with urine.

Necrophilia: deriving sexual satisfaction from contact with a dead person.
It is very rare and is considered by experts to be psychotic and extremely deviant.

Sexsomnia: automatic, unintentional sexual behaviours during sleep.
May cause negative psychological after-effects and relationship problems.
It is considered a sleep disorder.

Prevention of sexual variations

People whose behaviour falls at the abnormal end are cause for concern.

• Primary intervention
  Intervening in home life or in other across during childhood to help prevent problems form developing or trying to teach people how to cope with crises or stress so that problems do not develop
• Secondary prevention
  To diagnose and treat the problem as early as possible once it has arisen, so that difficulties are minimized

Disturbance on one of three components in development might lead to different sexual variations

• Gender identity
• Sexual responsiveness
• Formation of relationships with others

The idea is the try ensure that as children grow up their development in each of these components is healthy.

Treatment of sexual variations

Medical treatments

Various medical treatments for sexual variations have been tried.

• Surgical castration
  But, a reduction in testosterone levels in humans does not always lead to a reduction in sexual behaviour
  Cannot be recommended
• Hormonal treatment
  The use of drugs to reduce sexual desire
  Two ways
  • Drugs that reduce the production of androgen in the testes
  • Antiandrogens that bind to androgen receptors in the brain and genitals, blocking the effect of androgen
• Leuprolide acetate (LA)
  A synthetic analogue of gonadotropin-releasing hormone, the continued use of which suppresses androgen production and reduces sexual fantasies and drive
• Alternative psychopharmacological treatments
  Influence patient’s psychological functioning and behaviour by their action in the central nervous system.

Both hormonal and psychopharmacological treatment should be used as only one element in a complete program of therapy, which would include counseling and treatment for other emotional and social benefits.

Cognitive-behavioural therapies

Comrehensive programs include

• Behaviour therapy to reduce inappropriate sexual arousal and enhance appropriate arousal
• Social skills training
• Modification of distorted thinking
• Relapse prevention
  Helping the person identify and control or avoid whatever triggers the behaviour

Different treatments may be needed for male and female persons diagnosed with paraphilic disorders.

Skills training

Persons with paraphilias engage in their behaviour because they have great difficulty forming relationships, and so they do not have access to appropriate forms of sexual gratification.
Such people may benefit from a treatment program that includes social skills training.
These programs may also include very basic sexuality education.

AA-type 12-steps programs

Sexual addition theory argues that many people who engage in uncontrollable, inappropriate sexual patterns are addicted to their particular sexual practice.
The appropriate treatment is one of the 12-steps programs modelled on Alcoholics Anonymous.

Little research data exists on these programs.
But not quite effective.

What works?

Only CBT-based programs are consistently shown to be effective.

Programs are more effective with some types of offenders than others.