Enema of the state of mind: A beginner’s guide to klismaphilia

Klismaphilia – a term coined by Dr Joanne Denko in the reporting of two case studies early 1970s (‘klisma’ is the Greek word for ‘enema’) – is a very unusual variant in sexual expression in which an individual obtains sexual pleasure from receiving enemas (i.e., the cleansing of the colonic canal via anal douching). Less commonly, some people also get sexual pleasure from the giving of enemas to other people. Typically, it is warm water that is used to clean the lower rectum although other substances have been reported including coffee, yogurt, air, whisky, wine, beer, cocaine, epoxy resin and even cement (see case study below). For instance, Dr Anil Hernandas and colleagues from Medway Maritime Hospital (in Gillingham, UK) reported a unique case of a unemployed 27-year old patient self-administering epoxy resin (a liquid used as a masonry adhesive) for anal sexual gratification. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders classifies it under the diagnosis of “Paraphilias, Not Otherwise Specified”.

Dr Alfred Kinsey’s surveys of sexual behaviour of males and females in the late 1940s and early 1950s research specifically mentioned women using enemas as a masturbatory aid but no such practice was reported by males. Although Kinsey’s research provided evidence that klismaphilia was engaged in by women, as with most paraphilias, it is typically males who are more likely to be klismaphiliacs. Published research on klismaphiliacs is rare and it is thought that most klismaphiliacs keep their engagement in this activity very secret.

The little research into klismaphilia suggests that the act of receiving enemas can cause intense stimulation and produce pleasurable sensations (e.g., gaining pleasure from a large, water distended belly or the feeling of internal pressure). Enemas cause mechanical distension of rectum that then cause stimulation of nerve endings supplying the pelvic organs (i.e., stimulating the rectal stretch receptors). It has also been reported that drugs that are administered rectally (including aqueous and alcoholic solutions) are absorbed very rapidly and has a “mainlining effect” similar to that of intravenous drug injection.

Typically, klismaphiliacs retrospectively report discovering these very particular sexual desires after being given enemas sometime in their childhood. Published case studies suggest that klismaphilia ost likely arises in those children who received them as children by a loving and affectionate mother. This association of loving attention with anal stimulation may eroticize the experience for some people so that as adults they may manifest a need to receive an enema as a substitute for or necessary prerequisite to genital intercourse.

Following the publication of her two case studies, Dr Joanne Danko published a study in the mid-1970s on 15 klismaphiliacs. Based on these limited data, she concluded that klismaphiliacs comprised one of three groups she labeled Type A, Type B and Type C.

• Type A: These individuals were unhappy, believed their klismaphilic behaviour as abnormal, and kept the behaviour compartmentalized. The behaviour originated in childhood and the enemas were usually self-administered. Some of the cases in this group also engaged in other paraphilic behaviour (e.g., fetishism, masochism, coprophilia).
• Type B: These individuals were similar to Type A individuals, but accepted the condition and were more likely to engage in klismaphilia with their sexual partner.
• Type C: These individuals engaged in multiple paraphilic behaviours with other similar like-mined individuals, and their klismaphilia was integrated with a range of other praphilic behaviours (e.g., transvestism, masochism).

Back in 1991, the American sexologist Dr William Arndt placed advertisements in sex magazines to recruit klismaphiliacs. He managed to survey 22 individuals (all males except for one female) and aged 25 to 54 years. Most were homosexual (80%; the other 20% were bisexual) although nearly two-thirds were married (or had been married). They typically engaged in enema use twice a week and half of the klismaphiliacs reported the enemas were self-administered. The remainder gave and/or received enemas from their sexual partner. Just over one-third of the sample (40%) had other paraphilic interests that typically revolved around sexual masochism (e.g., being spanked).

In a 1982 American Journal of Psychotherapy paper, Jeremy Agnew (1982) provided a physiological perspective on klismaphilia concentrating on the ritualization of insertion, filling, and expulsion components. He compared the physiological similarities between rectal stimulation and vaginal intercourse and said that the behaviour was reinforcing. This observation – taken together with the work of Dr Danko – suggests that much of the klismaphiliac’s behaviour is maintained by both classical and operant conditioning. In a later 2000 paper, Agnew also noted that some individuals receive such extreme pleasure from the practice that they reach orgasm. He also links klismaphilia with sadomasochistic activities.

Accidental rectal trauma and the lodging of foreign bodies in the gastrointestinal tract have been widely reported in the medical literature. Arguably the most notorious case of klismaphilia is that reported by Dr Peter Stephens and Dr Mark Taff in the American Journal of American Pathology. They wrote about a young man who turned up at the hospital complaining of rectal pain. After an examination by the doctor, it became apparent that there was a stony hard mass lodged in the man’s rectum. Upon further questioning, the patient revealed that four hours earlier, he and his boyfriend had been “fooling around” and that after stirring a batch of concrete mix, the patient had laid on his back with his feet against the wall at a 45 degree angle while his boyfriend poured the mixture through a funnel into his rectum. The concrete had set and was eventually removed. On removal, a ping-pong ball was also found. The reason a ping-pong ball was also found in the rectum was because klismaphiliacs use the ball as a plug to promote retention and increase stimulation. The use of such a device suggests the person was an experienced klismaphiliac.  As Dr Anil Hernandas and colleagues conclude “as the exploration of anal eroticism increases in popularity, more and more cases of complications as a direct result of their abuse are likely to be encountered”.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Agnew, J. (1982). Klismaphilia: A physiological perspective. American Journal of Psychotherapy, 36, 554–566.

Agnew, J. (2000). Klismaphilia. Venereology, 13(2), 75-79

Arndt, W.B. (1991). Gender disorders and the paraphilias. Madison, CT: International Universities Press.

Boglioli, L.R., Taff, M.L., Stephens, P.J. & Money, J. (1991). A case of autoerotic asphyxia associated with multiplex paraphilia. American Journal of Forensic Medicine and Pathology, 12, 64– 73.

Denko, J.D. (1973). Klismaphilia: Enema as a sexual preference. American Journal of Psychotherapy, 27, 232–250.

Denko, J.D. (1976). Klismaphilia: Amplification of the erotic enema deviance. American Journal of Psychotherapy, 30, 236–255.

Hemandas, A.H., Muller, G.W. & Ahmed, I. (2005). Rectal Impaction With Epoxy Resin: A Case Report. Journal of Gastrointestinal Surgery, 9, 747–749.

Kinsey, A. C., Pomeroy, W. B., Martin, C.E., Gebhard, P.H. (1953). Sexual Behavior in the Human Female. Philadelphia, PA: W.B. Saunders Company.

Kinsey, A. C., Pomeroy, W. B., Martin, C.E., (1948). Sexual Behavior in the Human Male. Philadelphia, PA: W.B. Saunders Company.

Stephens, P. & Taff, M. (1987). Rectal impaction following enema with a concrete mix. American Journal of Forensic Medicine and Pathology, 8, 179–182