No fuss over pus? A bizarre case of oral partialism

According to Dr. Martin Kafka in a 2010 issue of the Archives of Sexual Behavior, partialism refers to “a sexual interest with an exclusive focus of a specific part of the body” and occurs in both heterosexual and homosexual individuals. Dr. Kafka also noted in the same paper that partialism is categorized as a sexual paraphilia ‘not otherwise specified’ in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, and then goes on to say that “individuals with partialism sometimes describe the anatomy of interest to them as having equal or greater erotic attraction for them as do the genitals”. Scientific research indicates that the most prevalent from of partialism is podophilia (i.e., sexual arousal from feet). Historically, partialism was viewed as synonymous with sexual fetishism. However, Dr. Kafka noted that there is a “diagnostic separation of partialism (intense, persistent, and ‘exclusive’ sexual arousal to a non-genital body part) from fetishism (intense and persistent sexual arousal to non-living objects, including some body products)”. Although I accept this very subtle difference, I essentially view partialism and fetishism as one and the same. In the 2008 book Sexual Deviance: Theory, Assessment and Treatment, Dr Judith Milner and colleagues noted that:

“In ‘partialism’, the paraphilic focus is on some part of the partner’s body, such as the hands, legs, feet, breasts, buttocks, or hair. Partialism appears to overlap with morphophilia, which is defined as a focus on one or more body characteristics of one’s sexual partner…it is unclear whether these two categories are unique paraphilias or different names for the same paraphilia. Historically, some authors (e.g., Berest, 1971; Wise, 1985) have included partialism as part of the general definition of fetishism, which once included both parts of bodies and nonliving objects (e.g., shoes, underwear, skirts, gloves). Again, however, the [DSM] criteria for fetishism indicate that the focus must involve the ‘use of nonliving objects’, which eliminates body parts from meeting this criterion”.

One of the most bizarre cases of partialism in the academic literature is a case study (of ‘oral partialism’) by Dr. Brian McGuire and colleagues published in a 1998 issue of the Journal of Sex and Marital Therapy. As far as I can see, the case has only been cited three times in the academic literature. One of these sources was Dr. Raj Persaud’s 2003 book From The Edge Of The Couch (and it is from this book that I have taken the case from).

The case in question involved a single and severely obese man in his late teens that lived at home with his father and sister (his parents had separated some years before), and of borderline intellectual disability. The father described his son as a recluse that spent the majority of the day alone in his room with little or no social interaction with anyone except his family (and even then the social interactions were minimal). The man had very poor personal hygiene (described as typically wearing torn and dirty clothes), rarely washed or bathed, and his weight was estimated at around 300 pounds. As a consequence of his very poor hygiene, the teenager “developed ulcerated sores under his arms, above the pubis, and in the groin area” (that he had for most of the teenage years). To treat the sores and skin ulcers he was prescribed a course of antibiotics. However, overall compliance by the man was low (taking just over half of the tablets initially prescribed) – even though he was extensively monitored by the medical staff taking care of him. The man then claimed that he had lost his antibiotics at home. It was then that the medics discovered what was really going on and why he didn’t want to take his medication. The unhealed sores and ulcers had taken on sexual significance for the man. As Dr. Persaud summarized:

“Upon questioning, the patient reported that he was easily sexually aroused and habitually masturbated at least twice a day, and more often four or five times a day. Ejaculation would always occur. He reported interest in the opposite sex and said that he often fantasized. However, the fantasy content and its accompanying behavior never involved sexual intercourse, nor indeed any conventional sexual act. The patient’s primary sexual fantasy stimulus was that of a women’s mouth, although the fantasy never involved kissing or oral stimulation…Rather, he imagined the woman licking her fingers or gently biting her own lips. Simultaneously, the patient would put his own fingers into the ulcers/sores in his groin and/or under his arms and then lick the pus from his fingers. It appears that he ingested the pus and found both the smell and taste exciting, although he was unable to pinpoint exactly the sexually stimulating aspect of this act. He reported that it was the mere sight of a women with her fingers to her mouth or lips was adequately arousing to initiate masturbation with the accompanying fantasy image and oral behaviour”.

As I’ve noted in many of my previous blogs, almost every (seemingly non-sexual) fluid that can come from a human body has a corresponding sexual paraphilia and/or fetish. This includes urine (urophilia), faeces (coprophilia), vomit (emetophilia), blood (menophilia, clinical vampirism, vorarephilia), saliva (spit fetish), breast milk (lactophilia), and pus (acnephilia). Obviously this bizarre case arguable shares some similarities with acnephilia (as both involve sexual arousal to pus) but they are different in terms of its sexualization.

At the outset, the man was given some psycheducation about the unhygienic nature of the sexual behaviour that initially resulted in a behavioural decrease of his strange sexual behavior – although the oral sexual fantasies still persisted. (Such psychoeducation has also been successfully used in the treatment of other sexual paraphilias. For instance, a case reported by Dr. R. Denson in a 1985 issue of the Canadian Journal of Psychiatry used psychoeducation as part of his treatment of a urophile). In his commentary on the case, Dr. Persaud said that it was open to debate as to whether the behaviour should be treated as problematic and/or psychopathological as (despite the arguably unsavoury nature) it had little impact on other people and wasn’t seen by the individual in question as problematic.

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

Further reading

Berest, J. J. (1971). Fetishism: Three case histories. Journal of Sex Research, 7, 237–239.

Denson, R. (1982). Undinism: The fetishization of urine. Canadian Journal of Psychiatry, 27, 336–338.

Kafka, M. (2010). The DSM diagnostic criteria for fetishism. Archives of Sexual Behavior, 39, 357–362.

Kafka, M. P. (2010). The DSM diagnostic criteria for paraphilia not otherwise specified. Archives of Sexual Behavior, 39(2), 373-376.

McGuire, B.E., Choon, G.L., Nayer, P., & Sanders, J. (1998). An unusual paraphilia: Case report of oral partialism. Sexual and Marital Therapy, 13, 207-210.

Milner, J.S., & Dopke, C.A., & Crouch, J.L. (2008). Paraphilia not otherwise specified: Psychopathology and theory. In D. R. Laws & W. O’Donohue (Eds.), Sexual deviance: Theory, assessment, and treatment (2nd ed., pp. 384-428). New York: Guilford.

Penix, T.M. (2008). Paraphilia not Otherwise Specified: Assessment and treatment. In Laws, D.R. & O’Donohue, W.T. (Eds.), Sexual Deviance: Theory, Assessment and Treatment (pp.419-438). New York: Guildford Press.

Persaud. R. (2003). From The Edge Of The Couch. London: Bantam Press.

Wise, T.N. (1985). Fetishism – etiology and treatment: A review from multiple perspectives. Comprehensive Psychiatry, 26, 249–257.