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Chapter 15: Extreme Sexuality and Paraphilias Learning Objectives Changes in Acceptability of Sexual Behavior • Explain how sexual norms and behaviors may increase in acceptance over time. • Discuss how extreme sexuality varies across cultures. • Explain how men seem to engage in extreme sexual behaviors more than women. • Describe how sexual tourism may be an extreme sexual behavior. Paraphilias • Identify the clinical criteria of paraphilias. • Recognize some coercive and noncoercive paraphilias. • Discuss at least one theory about the origins of paraphilias. • Explain why people with a paraphilia may experience difficulty when they seek treatment. Sexual Novelty and Healthy Sexuality • Identify how sexual novelty in pleasure is normative. • Discuss mutual consent in issues of exploring sexual novelty. • Discuss some common sexual alternatives, including sex toys. Mainstreaming of Pornography and Sexual Well-Being • Describe the meaning of normative variations in the context of healthy sexuality. • Explain how pornography may increase sexual well-being but can be harmful for individuals and couples if its use gets out of control. Chapter Outline Chapter 15: Extreme Sexuality and Paraphilias Learning Objectives 15.1 Discussion Topic 15.1 Discussion Topic 15.2 Learning Objectives 15.2 Discussion Topic 15.3 Discussion Topic 15.4 Discussion Topic 15.5 Discussion Topic 15.6 Discussion Topic 15.7 Learning Objectives 15.3 Discussion Topic 15.8 I. Changes in Acceptability of Sexual Behavior • Paraphilia is a medical category that doctors created in the 1920s to describe abnormal sexual arousal to individuals, objects, or situations that departs from mainstream normative or typical behavior in a community and causes personal distress or serious problems. • Extreme sexual behavior is defined as a risky, noncoercive behavior between consenting adults that tests the limits of what a culture tolerates within its spectrum of sexual behaviors. A. Variations in Mainstream Sexual Behavior • Sexual cultures create blueprints for how people should behave, and what kind of sexual behavior they should exhibit. This does not mean, however, that everyone follows those blueprints and sexual norms mindlessly. In fact, society has witnessed an explosion in sexual variation in human populations, especially in large complex industrial countries such as the United States. B. Cross-Cultural Extremes of Sexuality • Cultures vary in terms of being more sex-positive and approving of sexual variations or more sex-negative and disapproving of them. For example, oral sex as practiced in the United States is totally unknown in some cultures. • Cultural practices that might seem risky in the United States include combining sex with practices such as harsh sexual taboos, cutting the skin, ritual beatings, fasting, and special food taboos. • Many cultures that emphasize male dominance and close bonds between males allow men to be sexually aggressive toward women, even using rape as a means of controlling women. C. Extreme Sexual Behaviors in Contemporary Society • Some experts have suggested that adult sado-masochism relationships, or S/M, are examples of extreme sexual behaviors because they feature pain and pleasure, bondage, and practices such as spanking and whipping. • Other examples of extreme sexual behaviors are engaging in frequent online sex, combining drugs with sex at parties, and engaging in numerous casual relationships including with partners who are married or as an extramarital relationship. • When something is extreme in terms of risk taking and someone does not connect this risk to their actions or they may pretend that what they are doing is not risky or harmful to themselves or others, something is amiss. In short, they may be in denial, which is a form of coping with fear or anxiety that involves distortion of reality. D. Strip Clubs—Normal or Extreme • Striptease and other types of female dance performances are culturally accepted forms of sexual entertainment in some places in the world. These highly sexual shows often feature women nude or women wearing a tiny covering over their genitals called a g-string. Some strip clubs also feature men, some frequented by gay men, and others, by heterosexual women. E. Gender and Extreme Sexual Behavior • Researchers have long known that men display a broader range of extreme sexual behaviors, as well as paraphilias, than do women. • In a meta-analysis of 150 studies, psychologists found that men express more risk-taking than women (Byrnes, Miller, & Schafer, 1999). Another large analysis of many studies also found a fairly strong relationship between sensation-seeking as a personality factor and sexual risk-taking in heterosexual men and women. F. Kinky Sex • One form of edgy sexual behavior that has emerged in recent years among consenting adults and is entering the mainstream is known as kink or kinky sex. It may involve practices such as BDSM, which is a term that refers to bondage/discipline (BD) and sadism/masochism (SM). • Kinky sex involves a wide range of practices that are present in some sexual cultures and even the broader mainstream, but it does not have the precise characteristics of a paraphilia. • One of the characteristics of kinky sex is sexual fetishism. Sexual fetishism is when an object or body part, whether a raincoat or buttocks, arouses intense sexual interest and urges, and may launch a person into an uncontrollable episode alone or with another person, typically leading to sexual gratification. G. Sex Tourism and Extreme Sexuality • In the 21st century, people’s sexual adventuring may be exploitative, or worse, when it includes sex tourism. Experts often refer to sex tourism as prostitution tourism, which means traveling for the purpose of having sex in return for money or goods (Puccia, 2009). This form of prostitution is strongly related to poverty and the inability to find other work (Correa et al., 2009). • Men are the most frequent sexual tourists, either as individuals or groups, but more women are having such experiences as well. There also appears to be a growing market or women who may seek sex with locals once they arrive at popular destinations, such as Machu Picchu, Peru (Bauer, 2008). H. When Extreme Sexual Behavior Becomes Compulsive • Compulsive behavior is any behavior that an individual is unable to control even though he or she has repeatedly tried to do so. • When compulsive behavior is applied to extreme sexual behavior, it can resemble what some therapists refer to as sexual compulsivity, which indicates a person’s inability to control sexual urges (Carnes & Adams, 2002). The actions of people who spend hundreds of hours watching porn or who pay thousands of dollars for sex suggest sexual compulsivity. o Other clinicians use the term hypersexuality to refer to similar behaviors as compulsive sexuality. • Of all forms of sexual compulsive behavior, the one that is most controversial in the media, in popular culture, and to some extent in research, is sexual addiction, which is increasingly thought of as a disorder of intimacy. II. Paraphilias A. Clinical Criteria of Paraphilias • Today psychiatrists, medical doctors, psychologists, sexologists, and other clinicians employ the standard diagnostic criteria of the Diagnostic and Statistical Manual of the American Psychiatric Association, also known as the DSM. The current edition of the manual, DSM-IV-TR, 2000-06, defines a paraphilia as a psychological disorder (APA, 2000). • Looking ahead to the next edition of the DSM (DSM 5), currently scheduled for publication in 2013, the American Psychiatric Association is considering a distinction between paraphilias that do not cause personal distress or impairment or harm to others and those that do. The reason these new criteria are important and helpful is that for the first time, clinicians would be able to make a clear distinction between a healthy person with a non-normative sexual behavior, such as a sexual urge associated with an object, and a person whose nonnormative sexual urges cause distress, impair daily functioning, or harm others. • The diagnosis “paraphilic disorder” requires a lot more than people straying from the cultural norm in their sexual behavior, even if they manifest extreme sexual behaviors that might look like a paraphilia but are not. People’s ability to function must be impaired; then there may be symptoms of distress and possible harm to others. • This diagnosis of paraphilia involves four key traits as established by the DSM-IV-TR (APA, 2000): o An intense, recurring sexual fantasy, sexual urge, or behavior o Involvement with nonhuman objects, children, or nonconsenting adults, as well as pain, suffering, or humiliation to the self or to others o Behavior that has typically lasted for at least 6 months o Significant distress or impairment associated with the sexual urges as manifested in the person’s social, occupational, or other areas of life B. Categories of Paraphilias • Paraphilias can be divided into those that involve coercion and those that do not. • Coercive paraphilias involve the use of force against another person. • Noncoercive paraphilias are those that involve only one person or involve consent between adults to engage in a variety of practices that may involve pain, humiliation, pleasure, and other emotions. • Coercive paraphilias: o Voyeurism—The “peeping Tom,” as commonly described in popular culture and the media, is different from the paraphilia of voyeurism. Someone can engage in voyeurism as extreme sexual behavior for a variety of reasons, one of which may include being dared to do it. o Exhibitionism—This paraphilia is the act of a person becoming sexually aroused by exposing his or her genitals to unsuspecting victims. o Frotteurism—This is the act of a person rubbing his or her genitals against another person, typically a man against a woman. Pedophilia—Of all the coercive paraphilias, this one may inflict life-long trauma on children. Pedophilia is the sexual urge and gratification related to minors, especially prepubertal males and females. Pedophilia is the most reviled and perhaps the most widespread of the coercive paraphilias. It involves the sexual exploitation of children. Why would someone find children sexually arousing? The answer is complex because people who are pedophiles have few things in common except that most of them are men, the vast majority identify themselves as heterosexual, many were sexually victimized as children, and they may live in very lonely or alienated circumstances. Other research shows some similar findings and some additional ones: Incarcerated sex offenders have higher rates of psychopathology compared to the general population. Increased psychopathology is associated with a greater number of paraphilias. Some of these individuals appear to have arrested emotional development. They may have been victims of sexual child abuse. They may be inclined to view child pornography online. • Noncoercive paraphillias o Sadism and Masochism—The term “S and M” refers to sadism (S) and masochism (M), which are sexual practices related to giving and receiving pain. Sadism is inflicting pain on one’s sexual partner, to create sexual pleasure for the person inflicting the pain. Its counterpart is masochism, which is inflicting pain on oneself for the purpose of pleasure. Sadism and masochism together create a complex system of sexual practices (Stoller, 1991). In fact, S and M behaviors are difficult to categorize as either coercive or noncoercive because they may or may not involve distress to the individual or pose a problem of consent, because some adults willingly consent to these sexual practices. o Transvestic Fetishism—In transvestic fetishism, men get sexually aroused by wearing women’s clothes. Typically, transvestic fetishism involves heterosexual men from an older generation. o Autoerotic Asphyxiophilia—One of the most peculiar noncoercive paraphilias is autoerotic asphyxiophilia, which is sexual arousal by near suffocation. Individuals who engage in this practice choke or suffocate themselves to get sexually aroused; when oxygen is cut off suddenly people may experience feelings of giddiness and pleasure not unlike the feelings experienced during masturbation. o AB/DL—These initials stand for the paraphilia of adult baby and diaper lover fetishism, also known as paraphilic infantilism. AB/DL is expressed when an adult dresses and acts as a baby and wants the adult partner to treat him or her as a baby. C. Popular Culture and Media Influence • Mass media and popular culture may contribute to many people knowing about paraphilias including some of the most rare ones. For example, websites exist for a paraphilia that was once unknown to the general public: Abasiophilia, which is the sexual attraction to people who use leg braces. • Another fetishism popularized by media is robot fetishism, which is sexual arousal brought on by a robot or androidlike being. D. Origins of Paraphilias • Psychoanalytic Theory— Psychoanalytic theory focuses on inner conflict and unresolved incestuous fantasies and how these may lead to paraphilias. It also focuses on obsessions, such as the unconscious male fear of castration. Freud (1905) suggested that paraphilias result from the unsuccessful negotiation of conflicts that begin in childhood. If a person’s psycho-sexual development did not progress normally from these childhood conflicts, the person may develop sexual urges that they express at a later time as a paraphilia. o The concept of love maps is based in psychoanalytic theory (Money, 1986). Love maps, which are brain templates for attraction and sexual expression, emerge around the age of 8 or 9 years. A love map may combine both the image of an idealized lover and the script and technique for sexual action. Such abnormal love maps might be the result of any number of factors or stressors during this developmental period, such as a lack of close attachment and love from parents, traumatic experiences that leave lifelong scars, or desires that children are afraid to express. Ultimately, paraphilias might be abnormal love maps that develop in childhood (Money, 1986). • Behavioral Theory—Behavioral theory and the process of conditioning may be how certain paraphilias develop. Paraphilias are a result of conditioning in which a stimulus and a response become accidentally “hard wired” for sexual pleasure in a particular person (Brannon, 2010). If a nonsexual object is repeatedly associated with a pleasurable sexual activity, the object becomes sexually arousing. • Sociobiological Theory—Sociobiology is the study of the biological aspects of behavior. In the treatment of paraphilias, a genetic theory has emerged that in a very general way connects genetic variations to the extremes of human sexual behavior. These extreme variations, perhaps even paraphilias, are seen as indirectly related to the survival of the species (Gardner, 1993). According to this view, different paraphilias may enhance an individual’s level of sexual excitation through a process of adaptation that results in increased procreation, and thus survival of the species (Buss, 2004). That is, with greater sexual excitation, even when forced, there is more reproduction. E. Treatment of Paraphilias • A few types of treatments may help people deal with paraphilias. Some of these treatments help many types of problems, such as 12-step programs that are applied to alcoholism and other addictions. III. Sexual Novelty and Healthy Sexuality • Sexual novelty in a very general way means creative exploration of what is sexually arousing and satisfying. This is mainstream sex and may also involve kinky sex, using all kinds of props, such as music, candles, scented oils, fragrant baths, and sex toys. Sexual novelty might include changing the place of sexual intercourse, such as from a bedroom to the kitchen table, the garage, the great outdoors, or the backseat of a car. Partners may rent a hotel room for the night or take a vacation to renew their sexual fun and joy. A. Sex Toys, Vibrators, and Related Sexual Enhancements • Sex toys, vibrators, and other items people use to enhance sexual pleasure should be made from nontoxic material, they should be sold only to adults, and they should be used in ways that do not inflict harm on someone. IV. Mainstreaming of Pornography and Sexual Well-being • Pornography has moved from the bizarre to the mainstream, but in its more extreme forms remains controversial or illegal, as in the case of child porn. Research is now revealing how pornography is being used as part of people’s sexual recreation and in this sense, how soft pornography has become a fixture of modern society, especially given its online accessibility. Key Terms Paraphilia—pattern of sexual behavior characterized by sexual arousal to individuals, objects, or situations that departs from mainstream normative or typical behavior and may cause serious personal distress, impair daily functioning or harm to others Extreme sexual behaviors—risky, noncoercive behaviors between consenting adults that test the limits of what a culture tolerates within its spectrum of sexual behavior Sado-masochism relationships (S/M)—relationships that may involve pain and pleasure, bondage, and other practices, such as spanking and whipping Denial—a form of coping with fear or anxiety that involves distortion of reality and its perception Kink or kinky sex—adult consensual sexual practices that are becoming mainstream, including spanking, tickling, and bondage, and a variety of different forms of sexual interests BDSM—refers to bondage/discipline (BD) and sadism/masochism (SM); power plays and role acting that is not necessarily sexual Sexual fetishism—an object or body part that arouses intense sexual interest and urges, and may launch a person into an uncontrollable episode alone or with another person, typically leading to sexual gratification Sex tourism—traveling for the purpose of having sex in return for money or goods Compulsive behavior—behavior that individuals are unable to control even though they have repeatedly tried to do so Sexual compulsivity—a person’s inability to control sexual urges; not a paraphilia Hypersexuality—frequent or sudden expression of sexual urges; not a paraphilia Sexual addiction—a controversial disorder of intimacy; not a paraphilia Coercive paraphilia—a sexual practice that involves the use of force against a sexual partner Noncoercive paraphilia—a sexual practice that involves only one person or involves consent between adults to engage in a sexual practice that may involve pain, humiliation, pleasure, and other emotions Voyeurism—the act of secretly watching someone undress or engage in some kind of intimate or sexual behavior Exhibitionism—the act of exposing genitals to unsuspecting victims for the purpose of sexual arousal Frotteurism—the act of rubbing one’s genitals against another person Pedophilia—sexual urges and gratification related to minors, especially prepubertal females and males Sadism—the act of inflicting pain on one’s sexual partner, to create sexual pleasure for the person inflicting the pain Masochism—the act of inflicting pain on oneself for the purpose of pleasure Transvestic fetishism—a form of fetishism in which a man becomes aroused by wearing women’s clothes Autoerotic asphyxiophilia—a form of fetishistic arousal from near suffocation AB/DL—a type of fetishism in which an adult dresses as a baby and the adult partner treats him or her like a baby; also called paraphilic infantilism Abasiophilia—sexual attraction to people who use leg braces Robot fetishism—arousal to a robot or androidlike being Love map—a cognitive template for attraction and sexual expression believed to develop in childhood Sexual novelty—creative exploration of what is sexually arousing and satisfying to one or both partners Instructor Manual for Human Sexuality: Self, Society, and Culture Gilbert Herdt, Nicole Polen-Petit 9780073532165, 9780077817527
