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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.

Bite sighs: A beginner’s guide to odaxelagnia‬

In a previous blog on vampirism as a sexual paraphilia, I briefly mentioned the related behaviour of odaxelagnia. Both Dr. Anil Aggrawal’s Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices and Dr. Brenda Love’s Encyclopedia of Unusual Sex Practices define odaxelagnia as a sexual paraphilia concerning individuals who derive sexual pleasure and arousal through biting or being bitten. Obviously, odaxelagnia is sometimes associated with sexual vampirism but it would appear that most forms of sexual biting do not involve bloodletting.

In her Encyclopedia of Unusual Sex Practices, Dr. Brenda Love included a relatively lengthy entry on sexual biting and reported that “biting is used by some to sexually excite their partner. It is done on the neck, ears, lips, nipples, back, buttocks, genitals, inner thighs, etc. The pressure used depends on their partner’s pain tolerance”. She also notes that sexual biting is one of the “easiest and most accepted methods” in sexual sadism and sexual masochism. She also claims that sexual biting produces an “increased sensation [and] brings some individuals who are emotionally stressed out of their physical numbness, back into touch with their bodies”. In the 2007 book, Miscellany of Sex, Frances Twinn reported that on the islands of Trobriand (off the east coast of New Guinea), the biting off of a woman’s eyelashes is viewed by the people who live there as a passionate activity!

Three separate books (Dr. Anil Aggrawal’s Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices, Dr. Brenda Love’s Encyclopedia of Unusual Sex Practices, and Arlene Russo’s Vampire Nation) all make reference to the fact that sexual biting has it’s own separate section in the Kama Sutra (written by the Indian philosopher Mallanaga Vatsyayana in the 4th century). As Aggrawal notes:

“The Kama Sutra goes so far as to name all the different kinds of [sexual] bites and scratches, including those focused on the breasts and nipples. Eight kinds of bites are described in the chapter ‘On Biting, and the Means to be Employed with Regard to Women of Different Countries’ These are (i) the hidden bite, (ii) the swollen bite, (iii) the point, (iv) the line of points, (v) the coral and the jewel, (vi) the line of jewels, (vii) the broken cloud, and (viii) the biting of the boar”.

The earliest published empirical research concerning sexual biting was arguably reported by the US sexologist Alfred Kinsey. He and his colleagues reported that about half of all the thousands people they surveyed said they had been sexually aroused from being bitten during sex. However, earlier academic references to sexual biting were made by [British psychologist and sexologist] Havelock Ellis in his 1905 book Studies in the Psychology of Sex. He wrote that:

The impulse to bite is also a part of the tactile element which lies at the origin of kissing. As Stanley Hall notes, children are fond of biting, though by no means always as a method of affection. There is, however, in biting a distinctly sexual origin to invoke, for among many animals the teeth (and among birds the bill) are used by the male to grasp the female more firmly during intercourse. This point has been discussed in the previous volume of these Studies in reference to ‘Love and Pain’…The heroine of Kleist’s Penthesilea remarks: ‘Kissing (Küsse) rhymes with biting (Bisse), and one who loves with the whole heart may easily confound the two”.

In Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices, Dr. Aggrawal made a number of references to sexual biting in relation to both sadism and necrophilia. In the former, he noted that oral sadists manifest “fantasies of chewing, biting, or otherwise using the mouth, lips, or teeth aggressively or destructively”. In the latter, he noted that one particular type of necrophiliac (so-called ‘role-playing necrophiles’) sometimes have vampire fantasies where “the lover simulates a killing by biting the neck”. Aggrawal reported the case of a woman who imagined she was a vampire. “She would ask her husband to pretend he was dead and then stimulate his organ with her mouth. She would then pretend that the resulting erection was rigor mortis, and this would give her erotic pleasure”.

Dr. Charles Moser and Dr. Eugene Levitt surveyed 225 sadomasochists (178 men and 47 women recruited via an advert in a sadomasochistic magazine) about their sexual behaviour and published their findings in the Journal of Sex Research. Among their sample, the most common sadomasochistic activities were bondage and flagellation and bondage (50% to 80% of the sample). Painful activities (biting, use of ice or hot wax, and face slapping) were less common (37% to 41% of the sample). The most painful activities engaged in (piercing, branding, burning, tattooing, insertion of pins) were the least common (7% to 18% of the sample). These results suggest that biting (among the S&M community at least) is relatively commonplace.

As noted in a previous blog, there has been some clinical research on sexual vampirism (i.e., the rare phenomenon that involves the letting of blood by cutting or biting and accompanied by sexual arousal). In relation to this sort of sexual biting, there has been a lot of psychological theorizing, particularly from a psychodynamic perspective. Dr. P. Jaffe and Dr. F. DiCataldo (1994) published a paper on clinical vampirism and made a number of speculations. Basing some of their thinking on a 1972 paper by Lawrence Kayton in the Journal of Youth and Adolescence, they wrote:

“Kayton considers that the vampire myth gives ‘a unique phenomenological view of schizophrenia’ and indeed overt vampiristic delusions have been associated most notably with this disorder. The connection is particularly salient in the more gruesome cases involving cannibalistic and necrosadistic behavior that resemble the content of schizophrenic delusional material acted out. These cases generally present massive disorganized oral sadistic regressions, depersonalization, confused sexuality, multiple concurrent delusions, and thought disorder in content and form. Psychodynamic explanations draw attention to Karl Abraham’s biting oral stage during which the infant uses his teeth with a vengeance to Melanie Klein’s description of children’s aggressive fantasies’ and to W.R.D. Fairbairn’s notion of intense oral sadistic libidinal needs formed in response to actual maternal deprivation”.

I can’t say I’m convinced by any of these explanations but as there is a paucity of good data, no better theories have been put forward on this behaviour specifically (although there are alternative behavioural theories involving classical and operant conditioning that help in explaining paraphilic behaviour more generally).

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.

Criminal Justice Degrees Guide (2008). 10 unusual fetishes with massive online followings. November 10. Located at: http://www.criminaljusticedegreesguide.com/features/10-unusual-fetishes-with-massive-online-followings.html

Ellis, H. (1905). Studies in the Psychology of Sex (Volume 4). Located at: http://www.gutenberg.org/files/13613/13613-h/13613-h.htm

Jaffe, P., & DiCataldo, F. (1994). Clinical vampirism: Blending myth and reality. Bulletin of the American Academy of Psychiatry and the Law, 22, 533–544.

Kayton, L. (1972). The relationship of the vampire legend to schizophrenia. Journal of Youth and Adolescence, 1, 303-314.

Love, B. (2001). Encyclopedia of Unusual Sex Practices. London: Greenwich Editions.

Moser, C., & Levitt, E.E. (1987). An exploratory descriptive study of a sadomasochistically oriented sample. Journal of Sex Research, 23, 322–337.

Russo, A. (2008). Vampire Nation. Woodbury, MN: Llewellyn Worldwide.

Twinn, F. (2007). The Miscellany of Sex: Tantalizing Travels Through Love, Lust and Libido. London: Arcturus.

Vatsyayana, M. Kama Sutra, Lancer Books, New York, 1964 (originally written 4th Century AD).