Monthly Archives: December 2013
Stats entertainment (Part 2): A 2013 review of my personal blog
My last blog of 2013 was not written by me but was prepared by the WordPress.com stats helper. I thought a few of you might be interested in the kind of person that reads my blogs. I also wanted to wish all my readers a happy new year and thank you for taking the time to read my posts.
Here’s an excerpt:
The Louvre Museum has 8.5 million visitors per year. This blog was viewed about 860,000 times in 2013. If it were an exhibit at the Louvre Museum, it would take about 37 days for that many people to see it.
Getting in line for the barber queues: A brief look at ‘haircut fetishism’
In a previous blog I briefly examined trichophilia. According to Dr. Anil Aggrawal’s 2009 book Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices, trichophilia is a sexual paraphilia (sometimes called trichopathophilia, hirsutophilia, and/or hair fetishism) in which individuals derive sexual pleasure and arousal from human hair (most commonly head hair). Since writing that blog, I have come across (what appears to be) a sub-type of trichophilia – ‘haircut fetishism’ that appears to share some behavioural and psychological similarities with depiliation fetishism (that I also examined in a previous blog). According to an article written for Wikipedia:
“A person with a haircut fetish is sexually and/or emotionally aroused by having their head hair cut, by cutting the hair of another, by watching someone get a haircut, or any combination of these. Haircut fetishist can be either male or female. The haircut fetish usually manifests as a desire to see head hair, often long hair, being cut off or even shaved, and often extends to a desire to witness or fantasize about non-consensual haircuts (including punishment, revenge, military/school /prison/religious induction or other kinds of forced haircuts)”.
One of my oldest friends that I was at university with owns a number of barber shops in the north of England and told me that haircut fetishism is well known in hairdressing circles and that there is a real niche market in ‘forced haircut fetishism’. As far as I am aware, there is no published academic or clinical research on haircut fetishism although there is a lot of anecdotal information about its existence. For instance, there hundreds of haircut videos on the internet, with a substantial majority of these that cater for those who are sexually aroused from seeing someone having their hair cut against their will (i.e., non-consensual coercive ‘forced’ haircuts). The article written for Wikipedia appears to confirm my own observations:
“[Haircut fetishism] would appear to be a widespread fetish, as there are many hundreds of websites devoted to it, based in countries all over the world, but it is a seemingly secret fetish, largely unrecognized by or commented upon by the media, or even acknowledged in western culture. There is no evidence to suggest that haircut fetishism extends to any significant practice of actual imposed non-consensual haircuts. Some haircut fetish websites advertise for and pay individuals to be filmed and photographed having their hair cut off. Other websites publish fantasy stories about haircuts, or track the long-to-short hair makeovers of celebrities. Some sites provide lists of haircutting scenes in literature or movies”.
There are (and have been) various hair-fetishist magazines (most of which are American), such as The Yankee Clipper, The Razor’s Edge, and The Bald Truth (although the latter may appeal as much to depiliation fetishists as haircut fetishists). There are certainly loads of websites that haircut fetishists can visit including CutsCuts, Bald Beauties, Haircut.net, Extreme Haircut, and Barber Shop Video (to name just a few). No-one appears to have any idea about the prevalence of haircut fetishism and the claims made in the Wikipedia article on the topic does not contain a single verifiable reference. For instance, the article asserts that:
“The haircut fetish can also extend to a general sexual preference for women or men with short hair or shaved heads. A haircut fetish is essentially pretty benign and harmless. In most cases, you aren’t hurting anyone by engaging in this fetish. In many cases, the fetish can even by a positive thing. It can add a certain degree of excitement to one’s sexual life and can lead one to take notice and care of his appearance. Many haircut fetishists, both male and female, claim their fetish began when their own hair was non-consensually cut short during childhood or puberty”.
One of the real problems in evaluating anything beyond the existence of haircut fetishism is that the paragraph above could apply to almost any niche fetish. I could replace the word ‘haircut’ with (say) ‘nail manicuring’ and the paragraph would still read well and still have face validity. Almost all fetishes are arguably harmless, don’t hurt anyone, and develop during childhood and adolescence and are often associated with a specific incident or event. Despite the lack of empirical research, there are certainly indicators that there are enough haircut fetishists for group events and conventions. For instance, the Wikipedia article notes:
“The first organized haircutting club for women was the ‘Progressive Hair Club’ first established in 1994. It sponsored [four] Ms Bald pageants in the USA and produced numerous haircutting videos. Similar clubs for men, such as the ‘International Leather Men’ have a subgroup of [haircut fetishists]. Some men form national and local groups to arrange ‘Clipper Parties’. In 2000, the first of the new breed of erotic headshaving websites came on the scene, ‘Headshave’, now known as ‘Bald Beauties’. Run by Katt and Wolfe, ‘Bald Beauties’ was the first website to portray head shaving as an erotic art on the Internet. For men, numerous websites have existed since the early 1990s [such as ‘Le Man To Man’, ‘Male Short Cuts’, ‘Slickville‘, and ‘Buzzed Hard‘]”.
In the name of research, I did check out all these sites and they all appear to cater for haircut fetishism (apart from Slickville that is more concerned with the fetishization of male hairstyles with creams and gels). From my own online research visiting these sites, it would appear that haircut fetishism is enjoyed by both males and females, and that such websites cater for both gay and straight individuals. It would also appear that for some people, it is themselves getting haircuts that is the primary source of arousal, whereas for others it is watching someone else get a haircut. There also appear to be individuals that are sexually aroused by both (i.e., themselves or others getting haircuts). The Wikipedia article adds that:
“The fetishist is often aroused by images (pictures, video, or fantasy) of the action of seeing hair being cut, the surrounding environment (barbershop / salon), and the tools used in haircutting (barber chair, barber cape, hair clippers and clipper blades, scissors, combs, hair tonics, pomades, dressings, dryers, shampoo bowls, etc…The haircut fetish finds its roots in both ancient Greece, biblical stories and religious rites. In mythology strength is associated with hair (Samson and Delilah). In Christian, Buddhist and Hindu religions, Tonsure is an established rite combining hair deprivation with purity of the body”
The other dimension in relation to hair fetishism concerns whether the haircut is voluntary or forced upon the individual. This latter dimension overlaps with both sexual sadism and sexual masochism but this aspect appears to have been all but ignored in the few online writings I have come across. The only article of any length on haircut fetishism is an online essay written by Robert Kesse who writes from the perspective of being a hair fetishist himself. Kesse defines haircut fetishism in the same way as found on the Wikipedia page but then goes on to say that the fetish isn’t necessarily harmless or benign:
“[Hair fetishism] CAN compromise one’s quality of life. In my case I no longer could feel an attraction towards my boyfriend because he had longer hair, and found myself compulsively and continually getting extreme haircuts that did not suit me. Suddenly, this interest in haircuts had become more of a curse than a blessing and I became depressed and lonely”.
I found Kesse’s account interesting because he attempted a psychological analysis of his own fetish toward haircuts and described his treatment intervention. He sought therapy for his fetish and also managed to get a number of different psychotherapists to talk about his case on an online forum. According to Kesse, all the therapists agreed that the underlying factor in Kesse’s haircut fetish was a fear of emasculation (i.e., a deprivation of his male identity). This clearly appears to be related to the fact that Kesse was a gay man. For instance, in a section entitled ‘A Portrait of a Typical Haircut Fetishist’, Kesse argued:
“At some point in these [male haircut fetishists’] lives, their subconscious mind made an intrinsic connection between their masculinity, and the length of their hair. They may have felt effeminate in some aspect of their lives. Almost all of those who have this interest are gay men. Society usually associates male homosexuality with effeminacy. In fact, when most people say ‘real man’ what they really mean is ‘a heterosexual man’. Thus, it is quite possibly the case that these men subconsciously internalized a fear of being found not to be a ‘real man’…At some point, their subconscious mind received the idea that their masculinity and hairstyle were unbreakably linked. They may have received such a message from their parents, peers, even the media. Many fetishists remember being forced into a short haircut as a child, or admiring the short haircuts of boys or men who embodied masculinity growing up. Thus, these men came to associate masculinity with short hair, and came to judge their own masculinity and that of other men by the length of their hair. This association can become so strong that many men feel emasculated when they do not have a short hairstyle. They may subconsciously use their hairstyle to feel more masculine in the presence of other men as well as women. As a result, they may feel a compulsive urge to get a haircut more often than is really necessary”.
Kesse goes on to assert that these sub-conscious associations are irrational (i.e., masculinity is not inherently linked to hair length) and that the desire to have one’s haircut (at least in his own case) is compulsive. He then claims that gay men adopt other behaviours to hide the feelings of emasculation (e.g., wearing leather jackets, appearing macho in front of others, talking in a misogynistic fashion, etc.). Kesse then talks about other haircut fetishists and how the internet potentially makes things worse for them:
“Most of the men I have met in the haircut community have been men in their 30s [through to] their 60s. The fetish is not as common among younger men. (Probably because it was more common for people to question a man’s gender identity by the length of his hair in the past than it is today.) Studies have shown that fetishists tend to have poor social skills and tend to become isolated from others. This seems to be the case for many of the haircut fetishists I have met. Most are perpetually single, and can suffer from bouts of loneliness. The internet, which at first seems a blessing, can become these men’s worst enemy as it gives them a means to interact with other fetishists without having to leave their home and no motivation to do anything but indulge in their fetish. We may find that the internet community will only serve to further isolate these individuals, and perpetuate already latent addictive/compulsive tendencies”.
Kesse then went on to describe the intervention used to overcome his irrational thinking (i.e., rational-emotive-behavioural therapy [REBT]). This approach appears to have been successful to Kesse but he does go on to say that there are other methods of treatment for pervasive/invasive fetishism including pharmacotherapy, aversion therapies, and other (unnamed) psychotherapies. However, Kesse found REBT to be “the most direct and fastest means to change” in overcoming his haircut fetishism. I would love to see a more formal (clinically published) account of Kesse’s treatment as such an intervention might be of great utility to others that feel their fetish is not benign and harmless.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Aggrawal A. (2009). Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices. Boca Raton: CRC Press.
Kesse, R. (2007). The anatomy of a fetish. June 27. Located at: http://haircutfetish.wordpress.com/2007/06/22/the-anatomy-of-a-fetish/
Wikipedia (2013). Haircut fetishism. Located at: http://en.wikipedia.org/wiki/User:Kaldari/Haircut_fetishism
Under where shall we look? A brief look at extreme fashion
While I was researching a blog on bride fetishism, I came across a number of articles on fetish bride wear including a paper by Frances Ross on “extreme lingerie design” (Ross is Visiting Lecturer at the London School of Fashion). At the beginning of her paper, Ross asserts that there has been an increasing “academic interest in erotic lingerie as a retail and ethical subject” and citing papers such as ‘Deviation as a key to innovation: Understanding a culture of the future’ (by Trudy Barber in 2004), ‘Ethical perspectives on the erotic in retailing’ (by Tony Kent in 2005), and ‘Erotic retailing in the UK (1963-2003): The view from the marketing mix’ (by Tony Kent and R. Brown Berman in 2006). Ross’ paper examines commodity fetishism for different forms of erotic lingerie (e.g., corset, suspender belt, stockings, etc.). She notes that:
“Previous research on [the retailer] Agent Provocateur had identified the fact that erotic lingerie is generally an under researched fashion segmentation and this became the driver for revisiting the upmarket design-led brand and conducting a comparative study with the more demographically working to lower middle-class lingerie ranges of Ann Summers”.
Ross classes erotic lingerie into one of four categories: (i) fantasy dressing up, (ii) corsets and teddies, (iii) bras, panties, suspender belts and stockings, and (iv) shoes (although I’m not persuaded that ‘shoes’ are a type of lingerie).
Ross argues that the opening of Ann Summers shops (“a sex supermarket [that sells] marital aids and exotic lingerie”) in 1970 resulted in a “cultural shift from sleaze to respectability; private space to public space and deviance to normal sexuality”. Sexy lingerie became something to enhance “lifestyle sexual consumption rather than sordid sleaze purchases” resulting in “High Street respectability” for Ann Summers stores by the 2000s. The chain of Agent Provocateur (AP) stores began selling sexy lingerie in 1994. (I hadn’t realised that AP was co-founded by Joseph Corré, the son of fashion designer Vivian Westwood and Sex Pistols’ manager Malcolm McLaren; given his parents’ love of bondage fashion wear, I perhaps shouldn’t have been surprised).
According to a 2006 article in the Daily Telegraph, Agent Provocateur caused “the second sexual revolution…Lingerie turned from something worn exclusively in the bedroom to seduce your man, into a fashion statement”. Ross also quotes from a 2006 article in The Observer about the shops’ beautifully designed “fetishised female undergarments such as crotchless taffeta knickers, gossamer negligees, epizoic teddies, [and] sternly-boned corsets” and that such lingerie is available to buy along with “S&M accessories that range from bedroom jewellery nipple tassels to handcuffs and bejewelled whips”.
Ross’ paper examines the development of extreme fashion from tight-lacing corsets through to modern erotic lingerie and argues that the meaning of clothing is constantly being redefined. Interestingly, she also historically examines whether the corset was something that women aspired to wear or was a garment that represented psychological and physical oppression. More recently, Ross claims that Bizarre magazine (a magazine that I used to write articles on sexual paraphilias for back in the late 1990s and early 2000s) “perpetuated the fetish of tight-lacing throughout all issues often showing women in corsets or wearing clothes with nipped-in waists on the front covers” and listed a number of examples from specific issues. She also notes how corsets used to be limited in colour and how such extreme corset fashion has evolved into luxury wear. More specifically she wrote:
“Corsets come in two main colour ways black and a version of the original pink fabric which has connotations of domesticity and innocence rather than dominatrix fetishism. Black lingerie has often been used to ‘…suggest wantonness and availability…’ (Wilson-Kovacs, 1996 p. 173) but this now also has a post-modern layered meaning of being sophisticated. Both styles of corsets are catered for at Provocateur but Ann Summers focuses on the black dominatrix range, however, the lacing and bones are all codified rather than real. This shows how lingerie has become a luxury fashion item rather than just utility underwear…The original Victorian corset signified respectable morality while also attracting attention to the exaggerated female shape, Wilson-Kovacs says this presented the ‘…female form in an erotically constructed fashion and…become an object of fetishist enthusiasm’ (2001; p. 169). The aesthetic and commodity fetishisation of the corset is popular with both genders in much of the demographic population, because it has in the last 50-60 years been associated with scandal, worn by showgirls, film stars and courtesans”.
According to Ross, it wasn’t until the 19th century that underwear started to move away from the corset to separate undergarments (knickers, bras, suspender belts, stockings, etc.). Suspender belts and stockings served a different (erotic) function to the corset (i.e., they “fetishised the lower erogenous zones of the body” whereas the corset accentuated waists and breasts). Ross also argued that the introduction of red undergarments had “connotations of sexual excitement” as evidenced by retailers such as AP introducing red coloured lingerie. Ross also argues that stockings are back in vogue and argues:
“Clearly the role of the stockings in erotic lingerie is important to the look of the leg and buttocks and despite the 1960s and early 70s shift to tights because of the shortness of the mini-skirt, the stocking has made a definite come-back for many reasons. These include, comfort and hygiene as well as the sensual nature of the nylon which now can be made to feel more like the original silk stocking”.
Ross then turns her academic attentions to bras and panties. Obviously bras have a functional purpose in supporting and shaping breasts (that Ross points out become more important as women age). She claims that men and women both like “the look and feel of well designed erotic bras and pants as the prelude to a sexual encounter”. She then brings in some Freudian sexuality theory and argues that:
“If made in sensual fabrics such as silk, satin or fine cotton this increases the seductiveness. As Hamlyn writes ‘It restricts direct access to the naked object, but it also has the ability to suggest, enhance, and draw attention to what it covers over and adorns’ (2003, p. 11). Both female and male fetishes for fabrics such as velvet and fur can be understood by Freud’s theory that ‘pieces of underclothing, which are so often chosen as a fetish, crystallize the moment of undressing, the last moment in which the woman could not be regarded as phallic’ (Freud, 1977; p. 355)…Bizarre [magazine] codifies Freud’s Oedipal theory with images of ladies wearing fur, frilly pants and sheer see-through garments that expose underwear…Freud considers fur to be symbolic of female genitalia hair, so as commodity fetishism and retail psychology become more sophisticated in their understanding of sex selling, this form of conspicuous consumption trim on erotic lingerie continues to be popular…The knowledge that certain fabrics excite the senses, touch, sight and even smell is again documented by Freud in his discussion on fetishism”.
Ross also takes a sideswipe at Foucault’s concept of “sex being confined to the home and the words not dared to be spoken (Rabinow, 1991)” and claims this is now simply outmoded as evidenced by high street shops such as Ann Summers and Agent Provocateur. She argues that (i) ‘underwear’ has become fashionable ‘outer wear’, (ii) ‘sleaze’ (citing the work of Kent, 2005) has become blurred with ‘respectability’, and (iii) ‘dressing up’ “for sexual pleasure has become normalised so ‘Deviance’ is considered just ‘Normal sexuality’ not perversion”.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Barber, T. (2004). Deviation as a key to innovation: understanding a culture of the future. Foresight, 6(3),141-152.
Freud, S. (1997). On Sexuality. London: Penguin Books Ltd.
Gamman, L. & Makinen, M. (1994,) Female Fetishism: A New Look. London: Lawrence & Wishart Ltd.
Hamlyn, A. (2003). Freud, Fabric, Fetish. Textile: The Journal of Cloth & Culture 1 (1). March, p. 9.
Kent, T. (2005). Ethical perspectives on the erotic in retailing. in Qualitative Market Research: An International Journal, 8, 430-439.
Kent, T. & Berman Brown, R. (2006). Erotic retailing in the UK (1963-2003): The view from the marketing mix. Journal of Management History, 12(2), 199-211.
Kunzle, D. (2004). Fashion & Fetishism: Corsets, Tight-Lacing & Other Forms of Body Sculpture. Gloucestershire: Sutton Publishing.
Ross, F. (2007). Extreme lingerie design: from ‘Bizarre’ fantasy to High Street. In: Extreme Fashion: Pushing the Boundaries of Design, Business and Technology (Conference Proceedings of the International Foundation of Fashion Technology Institute). New Delhi, India: IFFTI.
Ross, F. & Ranchhod, A. (2006, July), ‘eTailing Strategies within the Intimate Apparel Market’, Academy of Marketing Conference London.
Steele, V. (1996). Fetish Fashion, Sex and Power. Oxford: Oxford University Press.
Steele, V. (2005). The corset: A cultural history. Yale: Yale University Press.
Storr, M. (2003), Latex & Lingerie: Shopping for pleasure at Ann Summers Parties. Oxford: Berg.
Wilson-Kovacs, D. (2001). The Fall and Rise of Erotic Lingerie. In: William J.F (Ed.), Dressed to Impress: Looking the Part. Oxford: Berg.
What a drag: A brief look at cigarette smoking and nicotine dependence
Cigarette smoking among adults (i.e., those aged 18 years and over) has been a highly prevalent behaviour in Great Britain for decades but overall rates have significantly declined in recent times. Figures show that the highest recorded level of nicotine smoking among British males was in 1948 when four-fifths smoked (82%) although at that time only two-thirds smoked manufactured cigarettes (as the rest smoked pipes and/or cigars). The highest recorded level of nicotine smoking among British females was in the mid-1960s (45%) slightly higher than the prevalence rate of 41% in 1948.
A 2003 study by Dr. M. Jarvis in the journal Addiction reported that since 2000 the overall adult smoking rates in Great Britain had been declining by around 0.4% per year. More recently, the British prevalence rates of smoking remained constant at 21% between 2007 and 2009 (according to a 2013 report by Action on Smoking and Health [ASH]). According to the 2013 Office for National Statistics report, the most recent prevalence rate is 20% (21% of men and 19% of women). This equates to around 10 million British adult cigarette smokers. Smoking prevalence rates are highest in young adults. More specifically, in the 20-24 year age group, the prevalence rate of nicotine smoking is 30% in males and 28% in females. Only 1% of children are nicotine smokers at the age of 11 years. By the age of 15 years, 11% of children are regular smokers. As the 2013 ASH report noted:
“Since the mid 1970s cigarette consumption has fallen among both men and women. The overall reported number of cigarettes smoked per male and female smoker has changed little since the mid 1980s, averaging 13 cigarettes per smoker per day. As in previous years, men smoked slightly more per day on average than women and there was an association between consumption and socio-economic group. In 2011, smokers in manual occupations smoked an average of 14 cigarettes a day compared with 11 a day for those in managerial or professional groups… In 2011, 63% of smokers said they would like to stop smoking altogether. Other ways of measuring dependence include how difficult people would find it to go for a whole day without smoking and how soon they smoke after waking… In 2011, 60% of smokers said they would find it hard to go for a whole day without smoking. Eighty-one per cent of heavier smokers (20 or more a day) said they would find it difficult, compared to 32% of those smoking fewer than 10 cigarettes per day”.
Like drug addictions more generally, nicotine addiction is a complex combination of influences including genetic, pharmacological, psychological, social and environmental factors. In 2010, the US Surgeon General asserted that “there is no established consensus on criteria for diagnosing nicotine addiction” but that there are a number of symptoms can be viewed as addiction indicators such as:
- Drug use that is highly controlled or compulsive with psychoactive effects
- Stereotypical patterns of use
- Continued use despite harmful effects
- Relapse following abstinence accompanied by recurrent cravings.
A 2000 report by the Royal College of Physicians also noted that nicotine fulfils criteria for defining an addiction and states that:
“It is reasonable to conclude that nicotine delivered through tobacco smoke should be regarded as an addictive drug, and tobacco use as the means of self-administration…Cigarettes are highly efficient nicotine delivery devices and are as addictive as drugs such as heroin or cocaine.”
One of the key characteristics of drug addiction or dependence on a substance is the degree of compulsion experienced by the user. Since 1992, the British General Lifestyle Survey (which typically surveys around 15,000 adults from over 9000 households annually) has asked three questions relevant to nicotine dependence and addiction. The first is whether the person would like to stop smoking, the second is whether person would find it easy or difficult not to smoke for a whole day, and the third is how soon after waking up they smoke their first cigarette. Since 1992, there has been almost no change in any of the three measures.
The latest 2013 survey reported that 63% of smokers said they would like to stop smoking altogether and 60% felt it would be difficult for them to go a day without smoking. Four-fifths (81%) of heavy smokers (i.e., those smoking 20 or more cigarettes a day) said they would find it difficult to give up smoking compared to one-third (32%) of lighter smokers (i.e., those smoking less than 10 cigarettes a day). The average number of cigarettes smoked per day is 13, and 14% smoke a cigarette within five minutes of getting up in the morning, a figure that rises to 35% among heavy smokers who smoke more than 20 cigarettes a day. Research consistently shows that approximately two-thirds of smokers want to quit the behaviour yet the majority are unable to do so, which is also suggestive of a genuine addiction. Those that do try to quit smoking typically experience a wide range of withdrawal symptoms including craving for nicotine, irritability, anxiety, difficulty concentrating, restlessness, sleep disturbances, decreased heart rate, and increased appetite or weight gain.
Outside of Great Britain, tobacco and other drug use prevalence have been examined extensively among youth and adults. For example, by the Monitoring the Future research group in the U.S. (http://monitoringthefuture.org). They reported that daily (20 or more days in last 30 days) cigarette smoking varied from 11.4% among 18 year olds to 17% among 50 year olds. One may infer that daily cigarette smoking is addictive use, though several studies measure tobacco (nicotine) addiction specifically. Tobacco addiction (dependence) among older teenagers has been found to vary between 6% and 8%. Studies have found a prevalence rates of between 1.7% to 9.6% for tobacco addiction among college students.
In a 2004 issue of the Archives of General Psychiatry, Dr. Jon Grant and colleagues found a prevalence of 12.8% for tobacco addiction among a U.S. national sample of adults. A few years later in a 2009 issue of the American Journal of Public Health, Dr. R.D. Goodwin and colleagues found a prevalence of 21.6% and 17.8% for tobacco addiction among a U.S. national sample of male and female adults, respectively. It appears that daily smoking demonstrates about the same level of prevalence as direct measures of dependence, particularly among adults.
In a 2011 study that I carried out with Dr. Steve Sussman and Nadra Lisha, we estimated that past year nicotine dependence prevalence in the general adult population of the U.S. as being approximately 15%. A different summary of research on the epidemiology of drug dependence has shown that of all people who initiate cigarette use, almost one-third become addicted smokers (32%), a figure that is much higher addiction rate than for users of heroin (23%), cocaine (17%), alcohol (15%) or cannabis (9%).
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Action on Smoking and Health (2012). Nicotine and addiction. London: Action on Smoking and Health.
Action on Smoking and Health (2013). Smoking statistics: Who smokes and how much. London: Action on Smoking and Health.
Benowitz, N. (2010). Nicotine addiction. New England Journal of Medicine, 362, 2295–2303,
Carpenter C.M., Wayne, G.F., & Connolly, G.N. (2007). The role of sensory perception in the development and targeting of tobacco products. Addiction, 102, 136-147.
Goodwin, R.D., Keyes, K.M., & Hasin, D.S. (2009). Changes in cigarette use and nicotine dependence in the United States: Evidence from the 2001-2002 wave of the National Epidemiologic Survey of Alcoholism and Related Conditions. American Journal of Public Health, 99, 1471-1477.
Grant, B.F., Hasin, D.S., Chou, P., Stinson, F.S., & Dawson, D.A. (2004a). Nicotine dependence and psychiatric disorders in the United States. Archives of General Psychiatry, 61, 1107-1115.
Information Centre for Health and Social Care (2011). Smoking drinking and drug use among young people in England in 2011. London: Information Centre for Health and Social Care.
Jarvis, M. (2003). Monitoring cigarette smoking prevalence in Britain in a timely fashion. Addiction, 98, 1569-1574.
Office for National Statistics (2012). The 2010 General Lifestyle Survey. London: Office for National Statistics.
Office for National Statistics (2013). The 2011 General Lifestyle Survey. London: Office for National Statistics.
Sussman, S., Lisha, N. & Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.
Wald, N. & Nicolaides-Bouman, A. (1991). UK Smoking Statistics (2nd edition). Oxford: Oxford University Press.
The Reich Stuff: A brief look at Nazi fetishism
“I love your blonde hair/I kiss your pigtails/And I could not share/The scratch of your nails/And though you mark me/Your eyes so glassy/Oh why did you have/To be so Nazi?/Remember the curls/Of the Deutscher Girls?/A love of mine/From down on the Rhine” (Deutscher Girls, Adam and the Ants).
The first time I ever associated Nazism with sexuality was as a young teenager listening to Adam Ant sing Deutscher Girls in Derek Jarman’s 1978 punk rock film Jubilee. The punk rock movement – and particularly the Sex Pistols and Siouxsie and the Banshees – were arguably the architects of ‘Nazi chic’ (defined by Wikipedia as “the approving use of Nazi-era style, imagery, and paraphernalia in clothing and popular culture, especially when used for taboo-breaking or shock value rather than out of genuine sympathies with Nazism”) when one of the Pistols’ entourage appeared on the London-region only television show Today (December 1, 1976) wearing a swastika armband. The Wikipedia entry on Nazi chic notes:
“In the 1970s punk subculture, several items of clothing designed to shock and offend The Establishment became popular…[Johnny] Rotten wore the swastika another time with a gesture that looked like a Nazi salute. In 1976, Siouxsie Sioux of Siouxsie and the Banshees was also known to wear a Swastika armband with fetish S and M clothing, including fishnets and a whip. These musicians are commonly thought to have worn such clothing for shock value…rather than being genuinely associated with any National Socialist or fascist ideologies”.
As an avid Adam and the Ants fan, I devoured every lyric of every song. One of Adam Ant’s heroes was Dirk Bogarde – as evidenced by the first album being named after him – Dirk Wears White Sox. The song Dirk Wear White Sox (a live favourite at their early gigs) wasn’t actually on the album and was never actually released on any official Ant recording. One of the reasons for this may have been because of the controversial lyrical content that also linked sex and Nazism via concentration camps:
“You gotta concentrate on kink/In a concentration camp/All dressed up like little David/In a concentration camp…You can get a uniform for free/Shiny boots of soft black leather/Oh how proud your mum will be”.
The inspiration for the song may well have been the controversial film The Nightporter starring Bogarde as a former Nazi SS officer (Maximilian Theo Aldorfer) and his “ambiguous” relationship with concentration camp survivor Lucia Atherton (played by Charlotte Rampling). As the Wikipedia entry on the film notes:
“Flashbacks show Max tormenting Lucia, but also acting as her protector. In an iconic scene, Lucia sings a Marlene Dietrich song ‘Wenn ich mir was wünschen dürfte’ to the concentration camp guards while wearing pieces of an SS uniform, and Max ‘rewards’ her with the severed head of a male inmate who had been bullying the other inmates, a reference to Salome. Thirteen years after World War II, Lucia meets Aldorfer again; he is now the night porter at a Vienna hotel. There, they fall back into their sadomasochistic relationsip relationship…The film depicts the political continuity between wartime Nazism and post-war Europe and the psychological continuity of characters locked into compulsive repetition of the past. On another level it deals with the psychological condition known as Stockholm Syndrome”.
There is obviously a big difference between Nazi chic and Nazi fetishism (although there may be overlaps for some adherents). The online Urban Dictionary defines Nazi fetish as:
“Somebody who becomes sexually aroused when seeing someone of the Aryan race in an SS Nazi, Third Reich uniform or Holocaust/Hitler related uniforms. Charlotte Rampling in ‘The Night Porter’ would be a Nazi Fetish for some men or women”.
Academically there has been little written on Nazi fetishism. I went searching online and found dozens of confessions by people claiming to enjoy and be fans of Nazi fetishism (as well as lots of websites – such as the uniform fetish site at Live Journal – that feature lots of sexually provocative Nazi fetish clothing). Here are some of the online admissions that I found. Obviously I can’t guarantee their veracity but they all seemed genuine to me:
- Extract 1: “Don’t get me wrong. I DO NOT IN ANY WAY support their murders, torture, or anything of the sort. I would never support such heinous actions. That being said…I like Nazis. I like the uniform, the boots (Yesss, the boots), the fact that they’re German/speak German, as well as the whole ‘Aryan’ look. Neatly combed blonde hair, blue eyes. My friends think I’m insane, because I’m half black and I like blonde Nazis. Anyway, I love the masculinity they seemed to have. It’s very attractive. It’s a fetish I have”.
- Extract 2: “I am a girl and I am turned on by The Nazi look blonde hair blue eyes and uniform, I can’t help but have thoughts about it is there something wrong with me? I think the holocaust was awful and I hate what the Nazis did but I just can’t help it, am I normal to have a weird fetish?”
- Extract 3: “Nazi fetishes are actually fairly common in BD/SM. There used to be tons of Nazi-themed pornography and general exploitation movies although as the years following WW2 pass it is becoming more uncommon…The taboo and violence attached to Nazis makes them a popular fetish for people of many races, religions, and sexual orientations. Nazi fetishism is currently most popular in Asian and in gay pornography”.
- Extract 4: “Lately, I’ve found myself getting a little too excited thinking about what most would call Nazi fetishism. I already had a bit of a German fetish, what with the accents and appearances, but when the SS uniforms started sneaking into my fantasies, when the idea of a little Nazi roleplay started to really appeal, things were different. I even fantasize about my love interest in the uniform (which is ironic because he is quite far from being an Aryan)!…I’ve uncovered other fetishes I have and now see how this fits in. (i) German accents are extremely sexy to me, (ii) I have always liked uniforms and nice clothes. (iii) taboo appeals to me quite a bit, [and] (iv) power and being dominated appeals to me” (z0mbiequeen)
- Extract 5: “I have a fetish for uniforms and I don’t blame someone for having a Nazi fetish, people who are sharply dressed do look pretty sexy, especially the women’s clothing. I don’t have a fetish for the accents and everything German…It could also be how Nazis are frowned upon, so having a fetish for something so controversial and wrong makes it dirty?” (lovingpegasister)
- Extract 6: “[Nazi] fetish is so common in many circles, from anime cosplay to gothic culture. They had the most badass uniforms at the time and they still look hot on just about anyone” (derBunker)
The Nazi clothing appears to be a fundamental part of the fetish and would appear to be a sub-type of uniform fetishism (that I outlined in a previous blog). In 2007, Roxy Music singer Bryan Ferry appeared to praise the Nazi style (both in fashion and architectural terms) when he was quoted in a German newspaper as saying: ‘The way that the Nazis staged themselves and presented themselves, my Lord!…I’m talking about the films of Leni Riefenstahl…And the buildings of Albert Speer and the mass marches and the flags – just fantastic. Really beautiful”. However, Ferry’s comments caused huge controversy and he then clarified his comments by saying: “I apologise unreservedly for any offence caused by my comments on Nazi iconography, which were solely made from an art history perspective”. This type of apology is very similar to the caveats made by Nazi fetishists online in justifying their like of Nazi imagery from a sexual perspective.
Arguably the most high profile case of Nazi fetishism was Max Mosley (youngest son of Sir Oswald Mosley, the former leader of the British Union of Fascists and former head of Formula One’s governing body) who was caught in 2008 on video with five prostitutes playing concentration camp fetish games. One article quoted [unnamed] “experts” saying: “While the Nazi concept is not unusual in sadomasochistic circles, playing both sides in such a kinky ritual is unusual”. Another (less high profile) case was that of Gareth Meade, a senior council officer in London (UK), who lost his job for gross misconduct after his involvement in Nazi fetishism was exposed by a Sunday newspaper. Photos of Meade posing in Nazi regalia was found on a gay sex website. Meade claimed in the newspaper interview that he was “not a racist” and that his sexual activity was “a private fetish”.
A recent 2013 paper published by Dr. David Lopez and Dr. Ellis Godard in the journal Popular Culture Review studied Nazi fetishism using online forum data (a method that I have also been using to study rare paraphilic behaviours and which I have recently published a couple of papers on – see ‘Further Reading’ below). They also view the fetish as a type of uniform fetish. Their paper notes that:
“Nazi uniform fetishists and role-players represent the diversity of BDSM subculture as it is a very unique activity with a specific form of expression. The most salient form of this expression is seen in the style and fashion of these fetishists and role-players. Style and fashion express autonomy, proclaims messages, establishes boundaries, and generates definitions of a subculture (Hebdige, 1979). For uniform fetishists, the uniform creates a context for the BDSM scene. A Nazi uniform is just one type of uniform fetish. We suggest for these participants, they are attracted to Nazism as a movement steeped in violence and evil and the uniform is representative of this movement. BDSM practitioners use the term ‘scene’ when referring to erotic power exchange”.
Lopez and Godard collected data from a BDSM site that had over 900,000 members. They then focused on specific discussion groups within the main site. One of these groups comprised individuals that were interested in ‘Nazi Uniform Fetish and Roleplaying’ [NUFR] and had 617 members. They also noted that there were at least 12 other similar groups with an interest in Nazi fetishism including ‘Females of the Third Reich’ (114 members) and ‘SS [Shutzstaffel] Protection Squad] Uniforms and Those Who Love Them’ (162 members). The NUFR group was chosen as the site to study as it had the biggest number of members and the most detailed postings from its members about Nazi fetishism. The data were content analysed and comprised over 300 threads (approximately 10,000 comments). The authors reported that members discussed the uniforms themselves, including where to acquire them and pointedly disavowed white supremacy and anti-Semitism, emphasizing only the erotlcism associated with the uniforms. They also reported that many posts commented on the sex appeal of the uniforms. In response to a post asking “What makes a sexy Nazi?” one respondent noted that:
“A well cared for athletic, mature female body, subtly made up fair skin and hard steely blue eyes, long dark hair gathered up carefully in a high ponytail. She is very stylish and well groomed, a pristine women’s tailored Black SS uniform laid out for her on the bed beside her as she sits gracefully at her dressing table in her delicate, demure lingerie and Fully fashioned seamed and Cuban heel Nylons leaning elegantly forward and to the side to pull up the zips on her gleaming almost mirror polished Black Leather 5″ heel knee boots. Her visor cap, Black Leather Gloves, 4ft bull whip and SS officer’s belt on her pillow along with the heavy Leather holster that shrouds her 9mm P38. The interest in Nazi role-playing and the Nazi fetish is for most people (I can’t vouch for everyone), is a stimulating response to strong imagery, well tailored uniforms, and notions of power and fear”.
As with the online posts I found online, Lopez and Godard noted that their participants were “very careful and go to great lengths to establish that they are not anti-Semitic or supremacists”, and were fully aware that confusion is possible. For instance, some respondents noted:
- Example 1: “People tend to automatically assume that someone who finds the uniform or the role-play sexy, is actually a Nazis themselves. Which I’m sure can be the case from time to time but couldn’t be further from the truth for me. I’m actually the exact opposite”
- Example 2: “There are a lot of Jews in this group, like me. Except we’re clever enough to know the difference between a fetish and actually committing racist acts”
- Example 3: “The biggest fan of my ex’s SS-uniform was a friend of ours who is Jewish”
- Example 4: “Jews like to play Nazis and Nazis like to play Jews”
- Example 5: “I’m a Jew who likes to keep being a Jew in my Nazi torture role-playing”
The authors also noted that not one post they examined expressed explicit anti-Semitism. It was the violent nature of Nazism, not anti-Semitism that motivated the self-presentation of individuals as ‘Nazis’ among Nazi uniform fetishists. They also added that it was the image of violence that was being portrayed, more than the actual violence. This is because BDSM play is highly controlled (as evidenced by, consensual scene negotiation and the use of safe-words). Based on the (mainly) qualitative data collected, Lopez and Godard concluded that:
“Nazi uniform fetish and role-play is just that, the playing of a role. The fetish serves to enhance the BDSM experience and has little to do with white supremacy or anti-Semitism. The world of BDSM is an erotically charged arena that incorporates a variety of interests, desires, and tastes. It is the association with evil that participants in Nazi uniform fetish and role-play find appealing. The self-presentation of erotic evil serves to contribute to the quality of the BDSM experience and allow participants in this subculture a safe and accepting environment in which to explore and express their fetish. This suggests, as oxymoronic as it sounds, that evil isn’t all that bad. The incorporation of evil symbols in a safe, non-harmful, consensual manner to enhance one’s pleasure suggests some performances (i.e., role-playing) serve a purpose in popular culture; it allows us to be bad”.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Betts, P. (2002). The new fascination with fascism: The case of Nazi modernism. Journal of Contemporary History, 37, 541-558.
Fuchs, M. (2012). Of Blitzkriege and Hardcore BDSM: Revisiting Nazi Sexploitation Camps. In Elizabeth Bridges, Kristin T. Vander Lugt, & Daniel H. Magilow (Eds.), Nazisploitation: The Nazi Image in Low-Brow Film and Culture (pp. 279-294. New York: Continuum.
Griffiths, M.D. (2012). The use of online methodologies in studying paraphilia: A review. Journal of Behavioral Addictions, 1, 143-150.
Griffiths, M.D., Lewis, A., Ortiz de Gortari, A.B. & Kuss, D.J. (2013). Online forums and blogs: A new and innovative methodology for data collection. Studia Psychologica, in press.
Hebdige, D. (1979). Subculture: The Meaning of sSyle. New York: Methuen & Co.
Lopez, D. A., Godard, E. Nazi (2013). Uniform fetish and role-playing: A subculture of erotic evil. Popular Culture Review, 24(1), 69-78.
Rocker, S. (2010). Council officer sacked for Nazi ‘fetish’. Jewish Chronicle, March 22. Located at: http://www.thejc.com/news/uk-news/29730/council-officer-sacked-nazi-fetish
Wikipedia (2013). Nazi chic. Located at: http://en.wikipedia.org/wiki/Nazi_chic
A toning for reward and punishment: A brief look at the impact of colour on gambling behaviour
Researchers and those working in the gambling industry have been interested in the factors that lead to the acquisition, development and maintenance of gambling. Aside from individual differences, the combination of the situational characteristics of the environment, and the structural characteristics of the actual game being played have been highlighted as critical ingredients in determining these behaviours in relation to gambling. This idea parallels with that of store designers who manipulate various features of the environment in shops to encourage purchase behaviour in consumers.
Situational characteristics are typically those features of the environment that may encourage people to gamble in the first place, and in some cases to keep on gambling. Examples of such characteristics could include accessibility (e.g., the number of outlets or opportunities to gamble, membership rules); sensory factors (e.g., atmospherics, light, colour and sound effects); the use of advertising; access to other things (e.g., cash machines, alcohol, food); physical comfort (e.g., seating, temperature); and social facilitation (the presence or absence of other people in the vicinity). These are often acquisition factors and are often important in the initial decision for an individual to gamble. Structural characteristics are features of the game itself that can contribute to the development and maintenance of gambling behaviour. These can be reinforcing to the player as they offer constant rewards. For instance, the ‘aura’ of a slot machine may offer excitement, arousal and tension in terms of its high event frequency, near misses, stake size, and the use of music, lights and colour.
One characteristic that can impact on both a situational and structural level in gambling is colour. For instance, this can be manipulated and/or adapted in terms of the design of a slot machine or scratchcard, an Internet gambling website, or the décor and ambience of a gambling environment. Research more specifically into the psychology of colour has been somewhat controversial in how it affects individual emotions. The majority of literature in the colour psychology field has come from advertising and marketing papers. This is because they are interested in colour selection in the way that it may facilitate the sale of their products. It has been speculated that learning about consumers’ emotional reactions to colour can be a useful predictor of purchase behaviour. This is because certain colours can provoke a particular positive or negative reaction. For instance, red has consistently been found to be stronger, more exciting, and more arousing than blue. This concept has been applied in a variety of situations in an attempt to manipulate people’s behaviours. However, a lot of this evidence is anecdotal, as it is not based on any sort of controlled experimental design.
Colour preference has been explained in terms of cultural significance and associative learning. It has been suggested that associations of colour that have been developed in the past have been forwarded as explanations of perceptions of colour today. For example, blue has been associated with night, dark and quiet. Warm colours, such as red, are used in order to attempt to arouse consumers such as in gambling environments. Across cultures, red has predominantly been found to be the most effective in influencing human emotions. Individual responses to colour have also been explained in relation to the arousal that they produce. It has been suggested that colours that are on the extreme ends of the colour spectrum (e.g., red and violet) generate greater arousal than those in-between. However, when red and blue have been compared in terms of their influences on arousal, differences have been found between them, with red producing greater cortical arousal.
With regards to the gambling literature in this field there has been minimal research conducted looking at the impact of colour on gambling. In an observational study I published with Helen Swift back in 1992, we reported our findings about various situational characteristics of five English amusement arcades. We noted that the interiors were generally red or towards the red end of the colour spectrum. This observation appears to suggest that gaming venue designers make use of the principle of red light exciting whilst gambling. Light and colour effects have developed in their sophistication over recent years and the gaming and casino industry have taken advantage of this when designing machines, games, and gaming venue interiors.
An old 1982 study by Graham Stark and colleagues in the journal Current Psychological Research provides one of the few empirical contributions assessing the effects of coloured light on gambling behaviour. Their study found that compared to gambling under blue light, gambling under red light leads to more risks taken, higher stakes made, and more frequent bets. They suggested that because blue is less arousing it leads to slower performance, as their attention is not specially focused on the task. As red was highly arousing it caused participants to focus on the salient aspects resulting in faster bets. The arousing effects of red were speculated to increase overt behaviour.
Similar types of research study have also been carried out on computer gaming. For instance, a study led by Dr. Sandy Wolfson in a 2000 issue of Interacting With Computers examined the effects of music and lighting on computer game play. It was found that red lighting led to participants underperforming in the latter games played (compared to blue), although initially both groups improved continuously. The red group’s heart rate also decreased in line with their decline in performance. This was explained in terms of red initially being more arousing, which led to higher concentration and less error rates than blue, but as time went on they became desensitized to its arousal.
A more recent experimental investigation by Jenny Spenwyn, Dr. Doug Barrett and myself in a 2010 issue of the International Journal of Mental Health and Addiction reported what we believe was the first ever empirical study into the combined effects of both music and lighting colour on gambling behaviour. While playing an online version of roulette, participants took part in one of four experimental conditions; (1) gambling with fast tempo music under normal (white) light, (2) gambling with fast tempo music under red light, (3) gambling with slow tempo music under normal (white) light, and (4) gambling with slow tempo music under red light. We reported a significant interaction between light and music for betting speed, and that the speed at which participants gambled was increased while playing under red light and fast tempo music.
It is clear that situational characteristics of gambling environments (including colour) appear to have the potential to play a role in the acquisition, development and maintenance of gambling behaviour. The success of the gambling establishment’s situational and structural characteristics (where success is defined as an increase in gambling due to the situational or structural characteristic) depends upon the psycho-situational and/or psychostructural interaction. The importance of a characteristic approach to gambling is the possibility of pinpointing more accurately where an individual’s psychological constitution is influencing gambling behaviour. Such an approach also allows for psychologically context specific explanations of gambling behaviour rather than explanations that focus solely on personality and individual differences.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Babin, B.J., Hardesty, D.M., & Suter, T.A. (2003). Colour and shopping intentions: The intervening effect of price fairness and perceived affect. Journal of Business Research, 56, 541-551.
Bellizi, J., Crowley, A.E., & Hasty, R.W. (1983). The effects of colour in store design. Journal of Retailing, 59, 21-45.
Bellizi, J. A. & Hite, R.E. (1992). Environmental colour, consumer feelings and purchase likelihood. Psychological Marketing, 9 (5), 347-363.
Friedman, B. (2000). Designing Casinos to Dominate the Competition. Reno, NV: Institute for the Study of Gambling and Commercial Gaming, University of Nevada.
Griffiths, M.D. (1993). Fruit machine gambling: The importance of structural characteristics. Journal of Gambling Studies, 9, 101-120.
Griffiths, M.D. & Parke, J. (2003). The environmental psychology of gambling. In G. Reith (Ed), Gambling: Who wins? Who looses? pp. 277-292. New York: Prometheus Books.
Griffiths, M.D. & Swift, G. (1992). The use of light and colour in gambling arcades: A pilot study. Society for the Study of Gambling Newsletter, 21, 16-22.
Grossman, R. P., & Wisenblit, J. Z. (1999). What we know about consumers colour choices. Journal of Marketing Practice: Applied Marketing Science, 5 (3), 78-88.
Parke, J. & Griffiths, M.D. (2006). The psychology of the fruit machine: The role of structural characteristics re-visited. International Journal of Mental Health and Addiction, 4, 151-179.
Parke, J. & Griffiths, M.D. (2007). The role of structural characteristics in gambling. In G. Smith, D. Hodgins & R. Williams (Eds.), Research and Measurement Issues in Gambling Studies. pp.211-243. New York: Elsevier.
Spenwyn, J., Barrett, D.K.R. & Griffiths, M.D. (2010). The role of lights and music in gambling behavior: An empirical pilot study. International Journal of Mental Health and Addiction, 8, 107-118.
Stark, G.M., Saunders, D.M, & Wookey, P.E. (1982). Differential effects of red and blue coloured lighting on gambling behaviour. Current Psychological Research, 2, 95-99.
Valdez, P. & Mehrabian, A. (1994). Effects of colour on emotion. Journal of Experimental Psychology, 123 (4), 394-409.
Wolfson, S., & Case, G. (2000). The effects of sound and colour on responses to a computer game. Interacting With Computers, 13, 183-192.
Yoto, A., Katsuura, T., Iwanaga, K. & Shimomura, Y. (2007). Effects of object colour stimuli on human brain activities in perception and attention referred to EEG alpha band response. Journal of Physiological Anthropology, 26, 373-379.
Sheathing troubles: The strange case of accidental condom inhalation
While researching a previous blog on condom snorting, I came across an interesting case study of ‘accidental condom inhalation’ (and no, I promise I am not making this up). The case dates back to 2004 and was published by Dr. C.L. Arya and colleagues in the Indian Journal of Chest Diseases and Allied Sciences (IJCDAS).
Anyone who has kids will know that (just out of curiosity) they commonly put things in their mouths. The IJCDAS paper made reference to a number of medical studies that have shown inhaled items include things that can be from the edible (nuts, seeds, beans, etc) to the non-edible (plastic objects, screws, needles, pins, etc). They also note that when inhaling such objects, it doesn’t always lead to immediate medical symptoms or complications (such as choking, wheezing, coughing, etc.). However, the case that Dr. Arya and colleagues reported on was a little out of the ordinary.
The case involved a 27-year-old woman who was a schoolteacher. For a six-month period she had been suffering from a persistent cough where she was coughing up mucus along with some pneumonia symptoms. Initial examination showed nothing of consequence. Further tests took place and the paper reported that:
“The chest radiographs carried out subsequently showed development of a non-homogeneous right upper lobe lesion, not resolving either with antibiotics or a four-month trial of an empirical anti-tuberculosis treatment instituted by various practitioners. No symptomatic relief was obtained with either therapy. [A later] chest radiograph demonstrated a right upper lobe collapse-consolidation of lung. The opacity led us to promptly carry out a video-bronchoscopy, which gave impression of a white membranous object protruding from the collapsed right upper lobe bronchus. On probing further, it was noticed to be an inverted bag-like structure ‘sitting’ in the bronchus and having a flap-like action. A rigid bronchoscopy was then performed and the object was easily removed with biopsy forceps, though, it tore into pieces during procedure”.
As you will have noted from the title of this blog, the pieces were identified as being from a condom. The woman and her husband eventually recalled to the medics (after much probing by the medics) that there was an incident that occurred where a condom had become loosened while the wife was performing oral sex on her husband. During this particular sexual act, the woman had experienced a bout of coughing and sneezing and without her knowing she had accidentally inhaled her husband’s condom.
One of the reasons that the accidental inhalation went unnoticed for so long was because the inhaled object was of “soft, elastic and rubbery consistency that [was] unlikely to cause a direct lung injury”. The authors noted that:
“The airway obstruction of the right upper lobe segments produced by [the condom], could have resulted in the retention of secretions and the infection of corresponding lung segments, which may have become radiologically visible as a non-homogeneous right upper lobe collapse-consolidation. Despite mechanical obstruction, the flap-like action of condom (as noticeable on video-bronchoscopy) probably continued to clear secretions from right upper lobe, contributing to the delay in radiologic presentation of case”.
The medics were unsure whether the woman had genuinely accidentally swallowed the condom or whether she was just too embarrassed to report the incident and/or didn’t relate the incident to her subsequent symptoms. The authors also claimed that the original physicians who examined the woman were responsible for the condition being prolonged as they had failed to suspect that a foreign object (i.e., a condom) was the cause of the non-resolved pneumonia. They then noted that:
“Perhaps, views of physicians were guided by the age of patient (that was less suited for a suspicion of an inhaled foreign body), and also the fact, that a disease like tuberculosis was so highly prevalent in this part of world that a preference for the institution of [anti-tuberculosis treatment] was quite natural”.
Together, all of these reasons are likely to have resulted in a delayed diagnosis. The authors also noted that:
“Even following the condom retrieval [both husband and wife] were understandably hesitant in disclosing it owing to the nature of affair concerned (involving one’s privacy), the unusual nature of coitus performed (via an oral route) and the inhalation of a discrete object (like condom). The possibility of seminal aspiration also taking place simultaneously may not be ruled out…The case has certain atypical features, of which, the foremost relates to the type of inhaled object, i.e., a condom, which has not been reported in the literature to the best of our knowledge…[Another] atypical feature was adult-age of patient, that by any means, would be least expected to be associated with any foreign body inhalation”.
The authors speculated as to whether this incident was a one-off or whether such incidents were more widespread and were being under-reported because the Indian sub-continent has “a traditional conservative culture” where “people tend to have religious attitudes and sex is largely considered to be a subject limited to a person’s private life”. The authors concluded that:
“Perhaps, the young lady in our case was also quite apprehensive about fellatio, a fact that could have played a part in the condom inhalation. It is much desirable that sex taboos prevalent on the sub-continent are curbed and greater sexual awareness created in the people’s minds”.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Agarwal, R.K., Banerjee, G., Shembish, N., & Jamal, B.A., Kareemullah, C. & Swaleh, A. (1988). Foreign bodies in the tracheobronchial tree: A review of 102 cases in Benghazi, Libya. Annals of Tropical Paediatrics, 8, 213-16.
Arya, C.L., Gupta, R. & Arora, V.K. (2004). Accidental condom inhalation. Indian Journal of Chest Diseases and Allied Sciences, 46, 55-58.
Ben-Dov, I. & Aelony, Y. (1989). Foreign body aspiration in the adult: An occult cause of chronic pulmonary symptoms. Postgraduate Medical Journal, 65, 299-301.
Causey, A.L., Talton, D.S., Miller, R.C., Warren, E.T. (1997). Aspirated safety pin requiring thoracotomy: Report of a case and review. Pediatric Emergency Care, 13, 397-400.
Lyons, D.J., McClod, D., Prichard, J., Dowd, D., & Clancy L. (1993). Very long retention of bronchial foreign bodies: Two new cases and a review of the literature. Irish Medical Journal, 86, 74-75.
Murthy, P.S., Ingle, V.S., George, E., Ramakrishna S. & Shah, F.A. (2001). Sharp foreign bodies in the tracheobronchial tree. American Journal of Otolaryngology, 22, 154-56.
drmarkgriffiths 