Voyeurs and their lawyers: Can ‘upskirting’ be addictive?

Over the past few months, ‘upskirting’ has been in the British news, particularly in relation to making it a criminal offence. A campaign initiated by freelance writer Gina Martin was started after she became a victim of upskirting. For those who don’t know what I’m talking about, upskirting refers to taking a photograph (typically with a smartphone) up someone’s skirt without their permission. Martin published an account of her ordeal for the World Economic Forum in April 2018 and reported that:

“Last summer, I was standing in a crowd of 60,000, on a hot summer’s day in London, waiting for The Killers to come on stage, when a man – whose advances I’d rejected – took pictures of my crotch by putting his phone between my legs as I chatted to my sister blissfully unaware. A few minutes later, I saw one of his friends looking at an intrusive picture of a woman’s crotch covered by a thin strip of fabric. I knew it was me. I grabbed the phone off him and checked. Tears filled my eyes and I began drawing attention to him: ‘You guys have been taking pictures of my vagina! What is wrong with you!?’ He grabbed me and pushed his face in front of mine, bellowing that I give him his phone back. I didn’t…The police arrived and were lovely. I was, understandably, a mess and they patiently calmed me down. What the police then did was ask him to delete the images – my evidence – and then, they told me they couldn’t do anything. ‘We had to look at the image, and although it showed far more than you’d want anyone to see, it’s not technically a graphic image. There’s not much we can do. If you weren’t wearing knickers it would be a different story.’ I was completely humiliated and devastated”.

Following this incident, and because upskirting wasn’t an offence, Martin began a campaign to get the act criminalized. Upskirting is currently an offence in Scotland but not in England and Wales. Upskirting is one of many sexual acts that are present among those individuals that have a voyeuristic disorder. In an article for the Law Gazette in July 2017 (‘Fifty shades of sexual offending’), forensic psychologist Dr. Julia Lam made countless references to upskirting in an overview of voyeuristic disorder. She noted that:

“Voyeuristic Disorder is a paraphilic/psychosexual disorder in which an individual derives sexual pleasure and gratification from looking at naked bodies and genital organs, observing the disrobing or sexual acts of others…Instead of peeping in situ using high-powered binoculars, with advances in technology such as camera phones and pin-hole cameras, voyeurs can now record the private moments with their devices: taking upskirt photos of unsuspecting individuals on escalators, or filming women in various states of undress in toilets and changing rooms. Voyeuristic behaviour is on the rise…Learning theory suggests that an initially random or accidental observation of an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity, may lead to sexual interest and arousal; with each successive repetition of the peeping act reinforcing and perpetuating the voyeuristic behaviour”.

She reported that voyeurism is the most common type of sexual offence and that voyeurs can be men or women but that “men are commonly the perpetrators in the peeping acts/upskirt, with women being the victims”. She noted that the lifetime prevalence of voyeuristic disorder is around 12% among men and 4% in women, and that the causes of voyeurism are unknown. She then went onto say:

“The new vocabulary ‘upskirt’ is both a verb (the practise of capturing an image/video of an unsuspecting and non-consenting person in a private moment) and a noun (i.e. the actual voyeuristic photos or videos made; referred as “voyeur photography”)…While most voyeurs film for self-gratification (i.e. using upskirt materials for fantasy and masturbation), there are offenders who make upskirt photos and videos specifically for uploading onto the internet (e.g. fetish and pornographic websites and video-sharing sites like YouTube) for monetary profit…Upskirt is considered a ‘serious’ crime in Singapore as it intrudes upon the privacy of unsuspecting and non-consenting individuals. Offences typically take place on escalators, in fitting rooms, public toilets or shower rooms; with the offenders trying to capture what is underneath the ‘skirts’ or private moments of the victims with a recording device which may or may not be disguise”.

She also said that in recent years in Singapore, she had assessed “a considerable number” of voyeurs that had engaged in upskirting and who were arrested, prosecuted, and incarcerated for their actions. Most of these criminal voyeurs were ‘first-timers’ (i.e., arrested and charged with upskirting for the first time), had a long history of engaging in excessive masturbation and pornography use, and that the offences were non-violent. However, she did note that although they may have been arrested for the first time, their interest in peeping and upskirting usually stemmed from adolescence. Dr. Lam also claimed that:

“Getting apprehended for [upskirting] is more a norm than an exception in this group, as it is just a matter of time that the offender would be careless or daring enough to invite apprehension. Police arrest usually serves as a final ‘wake-up call’ that breaks the offending pattern, accompanied with a great sense of shame and embarrassment. Many of these voyeurs are amenable to treatment…Most of the sufferers of Voyeuristic Disorder who came for my assessment reported their urges to upskirt and use the materials to masturbate as overwhelming, to the extent that they gave in to temptation without considering the grave consequences of their acts”.

Dr. Lam also talked about her treating upskirting voyeurs and recounted one case which she claimed was a compulsion. The case involved a male university student who was very sport active but who masturbated excessively whenever major sporting events or important exams were imminent as a coping strategy to relieve stress. Upskirting was another one of his coping strategies and he was eventually arrested for his behaviour. Dr. Lam then went on to report” 

“Every morning after he woke up, he would feel the urge to go out to find his ‘targets’. Although he knew it was very risky to take upskirt [photos] on MRT escalators, he felt compelled to satiate his urges and gratification, and was oblivious to his surroundings (e.g. passers-by security staff and CCTV) and the risk of being arrested. He could still feel the thrill and excitement, but he no longer enjoyed the act. It had become more like a compulsion…He was prescribed medication to manage his mood and urges to act out, and attended psychotherapy to work on his voyeuristic behaviour and learn more effective coping skills. He has since graduated from university, and has not breached the law with [upskirting] behaviour again”.

Dr. Lam, like other practitioners who treat sex offenders, often view extreme cases of voyeurism as a compulsion, obsession and/or an addiction. If extreme voyeurism (in general) can be seen as an addiction, there is no theoretical reason why upskirting couldn’t be viewed similarly. As far as I am aware, the case described by Dr. Lam is the only one in the academic literature of outlining and treating an individual with an upskirting disorder. As with other sexually non-normative behaviours I went online to see if there were any anecdotal accounts of addiction to upskirting and came across a few self-confessed accounts (particularly on The Candid Forum website):

• Extract 1: “I’m not sure if you could help me. I suppose it’s an addiction. I am obsessed with women’s knickers and constantly try to look up women’s skirts, even schoolgirls. I know it’s wrong but I love to see the secrets. One day I will be caught and arrested. Am I a pervert?” (‘Andy’).
• Extract 2: “I’m really starting to feel overwhelmed by this ‘addiction’ I have to upskirt videos…I just can’t seem to get enough, even when in the big picture, most of them are all the same. I have well over 3000 videos on my computer of just upskirts (not including other types of videos)…It’s also stressful to know that I may very well not get through them all, at least for a very long time (I still have yet to watch 1800 of them). There’s a lot of time involved in downloading them (waiting due to file hosting sites telling you [that] you have reached your daily limit etc., entering captcha codes). But all these videos actually amaze me at the same time, due to just how many times guys have gotten away with it…There’s a certain ‘wow’ factor I guess, but that also derives from the entire voyeur aspect of it to begin with, where a guy is able to creep up on a woman and she doesn’t even realize it…Do any of you share the same addiction as me, and do you want to get rid of it? (‘GD102’).
• Extract 3: “I used to be really addicted [to upskirting] until I made myself understand something you already know – once you’ve seen 200 asses, you’ve pretty much seen them all. There’s no point in wasting your time overindulging in the same thrill over and over again. Yeah, the excitement of seeing something you’re not supposed to see is hot as hell, but you have to set limits for yourself, and not try to fantasize too much about the upskirts you haven’t seen, and spend more time enjoying, and maybe sorting, the upskirts you already have. That’s what I’ve been doing lately” (‘Agent Ika’).
• Extract 4: “[Upskirting] really does get repetitive. For me the thrill now comes from pretending I’m a director of a film – getting new angles, upskirts from the front, whole body shots with the upskirt still showing, and always including faceshots” (‘Stimulus’).

Obviously I have no way of knowing whether these online forum confessions are true (but they seem to be). Based on these extracts, there is certainly the possibility raised that upskirting may be addictive to a very small minority of individuals. Extract 2 was particularly interesting in that the individual had never engaged in upskirting himself but his ‘addiction’ to watching upskirting videos takes up so much time in his life.

Another source suggesting that upskirting may be an addictive activity comes from the details of those arrested and prosecuted. For instance, one infamous example in the UK (in 2015) was the case of Paul Appleby who managed to take 9000 upskirting photos in the space of just five weeks (suggesting that he was doing it all day every day to have taken so many photos). Appleby was finally caught when he was caught bending over to take a photo up a woman’s skirt in a Poundland shop. The Daily Mirror reported that:

“The tubby pervert, who was ‘addicted’ to snapping upskirts, fled the store after he was spotted…when [police] officers found his camera and iPhone a staggering 9,000 ‘upskirt’ images were discovered. The photos had been taken between November 1 and December 4 last year. [Appleby] admitted two counts of committing an act of outraging public decency…and was given a three-year community order…[Appleby] had been prosecuted for a ‘similar matter’ of outraging public decency in London in 2010. Alistair Evans, defending claimed Appleby had committed the crime for ‘sexual gratification’ and his behaviour was a ‘compulsion and an addiction’ he needed treatment for”.

Here, the mitigating factor for Appleby’s behaviour was that he was addicted to upskirting. The fact that Appleby did not receive a custodial sentence suggests the excuse of being ‘addicted’ to the behaviour led to the judge being more lenient. Another individual who avoided a custodial sentence for upskirting offences was Andrew MacRae who claimed he was addicted to sex. MacRae had amassed 49,000 upskirt photos and videos using hidden cameras at his workplace, on trains, and at the beach. He pled guilty to three counts of outraging public decency and seven counts of voyeurism. The judge said he would spare him jail if he was treated for his “compulsive voyeurism”. A report in the Daily Mail recounted what that Judge Jeremy Donne said:

“This was undoubtedly a sophisticated, organised, planned and long-running campaign of voyeurism – again with a significant degree of planning – and members of the general public, female commuters in the main, were caught by your voyeuristic activities. Your activities were undoubtedly despicable and will cause deep revulsion in all who hear them.  Women will undoubtedly feel a need to be protected from such behaviour by the knowledge that the courts will deal with offenders severely, and men will thereby be deterred from committing such offences. On the other hand, you suffer from an illness that can be treated and you have submitted to that treatment. You have features of sexual addiction disorder with disorders of sexual preference, namely voyeurism and fetishistic transvestism – all defined in the international classification of diseases. You continue to receive treatment from psychiatrists who consider you to be at low risk of re-offending”.

Another recent British case highlighted the ingenious methods used to aid upskirting. Here, Stafford Cant used spy cameras hidden inside one of his trainers, his key fob, and his wrist watch to engage in upskirting women (as well as filming the backs of their legs) who were shopping in a Cheshire village. Acting on a tip-off, his house was raided and the police found 222,000 videos and pictures dating back seven years. ‘Addiction’ was again used as a mitigating factor in the crimes (along with depression and anxiety disorders) but this time it was not addiction to voyeurism but an addiction to collecting things. However, unlike the two cases above, Cant was jailed for three years after pleading guilty to outraging public decency, voyeurism and possessing and distributing indecent images.

Although there is little psychological literature on upskirting, there appears to be anecdotal evidence that the behaviour (in the extreme) could perhaps be conceptualized as an addiction and/or compulsion among a minority of individuals. The cases of those that have been arrested and prosecuted demonstrate that upskirting behaviour was time-consuming given the sheer number of photos and videos amassed, and that the behaviour was ultimately problem-inducing and undesirable. Given that the relatively recent rise of upskirting appears to mirror the rise in the use of smartphones and spy equipment available at affordable prices, I expect to see more such cases to be written about in psychological and criminological journals in the years to come.

Dr Mark Griffiths, Distinguished Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Fight The New Drug (2018). What’s “upskirting”, and how does porn culture feed this twisted trend? July 5. Located at: https://fightthenewdrug.org/whats-upskirting-and-how-does-porn-culture-feed-this-twisted-trend/

Jolly, B. (2015). Upskirt pervert who took 9,000 secret photos in just five weeks avoids jail. Daily Mirror, January 28. Located at: https://www.mirror.co.uk/news/uk-news/upskirt-pervert-who-took-9000-5058048

Keay, L. (2018). Live Nation executive who built-up sordid library of 49,000 upskirt pictures by filming women on trains, the beach and at work is spared jail as his wife stands by him. Daily Mail, January 5. Located at: http://www.dailymail.co.uk/news/article-5239815/LiveNation-executive-Andrew-MacRae-avoids-jail-upskirt.html

Lam, J. (2017). Fifty shades of sexual offending – Part 1. The Law Gazette, July. Located at: http://v1.lawgazette.com.sg/2017-07/1910.htm

Martin, G. (2018). What happened to me was wrong. Time to make it illegal, too. World Economic Forum, April 9. Located at: https://www.weforum.org/agenda/2018/04/what-happened-to-me-was-wrong-time-to-make-it-illegal-too/

Petter, O. (2018). Upskirting: What is it and why are people trying to make it illegal” The Independent, June 18. Located at: https://www.independent.co.uk/life-style/upskirting-explained-law-rules-criminal-offence-photos-skirt-consent-women-gina-martin-a8401011.html

Shepherd, R. & Smithers, D. (2018). The public school pervert who spent years secretly filming up women’s skirts in one of Britain’s wealthiest villages. Manchester Evening News, March 29. Located at: https://www.manchestereveningnews.co.uk/news/greater-manchester-news/alderley-edge-upskirt-film-pervert-14470375

The Strait Times (2016). Taking upskirt photos may be symptomatic of voyeuristic disorder. July 30. Located at: https://adelphipsych.sg/straits-times-taking-upskirt-photos-may-be-symptomatic-of-voyeuristic-disorder/

Wilson, H. (2004). Peeping Tom’s secret weapon. The Independent, July 8. Located at: https://www.independent.co.uk/news/science/peeping-toms-secret-weapon-552402.html

Paint what you do, it’s the way that you do it: The (not so) secret sex life of Salvador Dali

In a previous blog, I briefly overviewed the influence that the Catalonian surrealist artist Salvador Dali had made on psychology (based on a couple of articles I had published about him earlier in my academic career – see ‘Further reading’ below). In that blog I briefly mentioned some of the strange aspects in his life relating to his sexuality and sexual desires but did not go into any details. In this article, I delve a little deeper into Dali’s sexual psychology and concentrate on some of the more extreme aspects of his life. I’m certainly not the first person to do this given that there are various online articles covering similar ground such as ‘Five sadistic and depraved secrets of Salvador Dali’, ‘10 depraved secrets of Salvador Dali’, and ‘17 unbelievably weird stories most people don’t know about Salvador Dali’. In a nutshell (and if you believe everything you read about him), Dali didn’t like sexual intercourse, was ‘addicted to masturbation’, was a sexual voyeur, was obsessed by buttocks, had an interest in necrophilia, was sexually attracted to Adolf Hitler and hermaphrodites, and was a candaulist (i.e., he liked to watch his wife have sex with other men).

The first observation to make concerning Dali is that he had little interest in sexual intercourse. All Dali’s biographers make reference to this because this was something that Dali admitted himself (for instance in his book The Unspeakable Confessions of Salvador Dali). In Ian Gibson’s (1998) biography The Shameful Life of Salvador Dali, it notes that Dali had been fixated on his unusually complex sexuality since his teenage years. Dali wrote that:

”For a long time I experienced the misery of believing I was impotent…Naked, and comparing myself to my schoolfriends, I discovered that my penis was small, pitiful and soft. I can recall a pornographic novel whose Don Juan machine-gunned female genitals with ferocious glee, saying that he enjoyed hearing women creak like watermelons. I convinced myself that I would never be able to make a woman creak like a watermelon”.

It was in his teenage years that Dali acquainted himself with the pleasures of masturbation even though he had a fear that it would cause homosexuality, impotence, and madness. However, sexual self-gratification became his primary (and many biographers allege only) sexual activity he engaged in throughout his life, often in front of a mirror. It’s also been noted by many authors that Dali “associated sex with decay” and that the roots of this association were due to his father’s strange form of sex education (such as being shown sexually explicit photographs of individuals with advanced, untreated sexually transmitted infections that Dali described as “the color of hell”). After viewing the pictures of grotesque genitalia, Dali started to associate sexual activity with decay and putrefaction (which came to the fore in his paintings). In his 1942 autobiography (The Secret Life of Salvador Dali) he even claimed that he became interested in necrophilia but was then later “cured” of it (but to what level his interest spanned is unknown). Dali had many obsessions including a deep fascination of buttocks (both men’s and women’s) as well as many phobias including female genitalia and a fear of castration (and appears to be the basis of his infamous painting The Great Masturbator). As a 2014 article by Jackie Fuchs noted:

“These fears and obsessions – along with a lifelong fascination with ants – became recurrent motifs in his paintings. In ‘The Great Masturbator’, Dali’s first significant work, a woman believed to be Dali’s future wife Gala rises out of a downward-facing head, which is suspended over a locust swarming with ants. The positioning of the woman’s mouth next to a thinly clad male crotch suggests fellatio, while the trickle of blood on the male figure’s thighs reflects Dali’s castration anxiety (see below)”.

A 2011 online article in Living in Philistia by Joshua White makes other allegations about Dali’s early childhood saying that he might have been sexually abused by one of his schoolteachers and that he might have had an incestuous relationship with his sister (although I’ve found little evidence of these allegations):

“[Dali] later pinned his ‘impotence’ on his father, as well as his mother, and naturally Dali went on to fantasise of sodomising his dying father. This also might explain the direct kind of gynophobia Dali later developed. It has been suggested that he was molested by a teacher who used to have Dali sit on his lap while he stroked him. That would explain the artist’s lifelong hatred of being touched. The subject of twelve of his early paintings was Dali’s sister Ana Maria, a number of which tellingly depict her from the rear, which has led some to conclude that the relationship between them may have been incestuous. The sex life of Salvador Dali was not a common one to say the least”.

An online article by Mateo Sol also alluded to Dali’s poor relationship with his parents. On one occasion Dali exhibited an artwork in which he wrote “Sometimes, I spit for fun on my mother’s portrait.”  His father asked him to publicly apologise but Dali declined to do so. Following this incident, Dali sent his father a condom in the post (into which he had added his own semen) with a short note that simply read: “This is all I owe you”.

Dali’s wife and muse Gala (born in Russia as Helena Diakanoff Devulina) appears to have dominated Dali from their first meeting in 1929 (figuratively, psychologically, and arguably sexually given that almost no physical intimacy took place between Dali and Gala). It’s also generally agreed among scholars that Dali was a virgin when he married Gala (at least heterosexually) and they remained married for 53 years until Gala’s death. Gala was ten years older than Dali and had many sexual conquests before they married. Gala might perhaps best be described as a ‘swinger’, and at the time she met Dali was married to Paul Éluard (the poet) who both adhered to the sexual philosophy of ‘free love’.

Many biographers describe Gala as a highly-sexed nymphomaniac. Éluard and Gala were constantly sexually unfaithful to each other and (according to some accounts) encouraged each other’s infidelity. Gibson’s biography recounted Dali and Gala’s ‘mutual degradation’ of each other and Dali became some who tolerated all her extra-marital lovers. According to Zuzanna Stranska in a 2017 article in the Daily Art Magazine, Dali bought Gala a castle in Púbol (Girona) in 1968, but Dali was not allowed to visit without Gala’s written permission (and described in Joshua White’s article as Gala’s “fuck-nest” rather than a ‘love-nest’). It was here that Gala entertained her younger lovers.

It’s also been claimed that Dali had a homosexual relationship with poet Federico García Lorca (but has never been verified). It’s been alleged by a number of authors that Lorca twice tried to seduce Dali (and Dali said “Lorca tried to screw me twice”). Lorca was shocked when Dali married Gala because (according to a 2009 paper in the PsyArt Journal by Zoltán Kováry) “he was convinced that the painter had erection only with a finger in his anus”. Although Dali claims never to have had a relationship with Lorca, it appears they did have one sexual liaison because Dali wrote that: “I tried sex once with a woman and it was Gala. It was overrated. I tried sex once with a man and that man was the famous juggler Frederico Garcia Lorca. It was very painful”. Dali also wrote that: 

“Deep down I felt that [Lorca] was a great poet and that I owe him a tiny bit of the Divine Dali’s asshole. He eventually bagged a young girl, and she replaced me in the sacrifice. Failing to get me to put my ass at his disposal, he swore that the girl’s sacrifice was matched by his own: it was the first time he had ever slept with a woman”.

According to the article by Joshua White, Dali was arguably more homosexual than heterosexual. He claimed that: 

“[Dali] developed a penchant for persuading youths to drop their trousers and masturbate as he watched. He hoarded thousands of photos with many different lads. There has been a long speculation over the exact sexuality of the exhibitionist painter. We might be able to trace the misogynistic, or more accurately gynophobic, tendencies of Dalinian art down to Dali’s fear of a particular part of the female anatomy. To put it more bluntly, Salvador Dalí was a self-professed worshiper of the female posterior. The extent of this obsession drew the concern of his fellow Surrealists, he denied he was coprophagic one minute and in the next instance would state ‘true love would be to eat one’s partner’s excrement.’ Perhaps we should keep in mind that the Catalonians are a very scatological people, for it is custom before eating to exclaim “Eat well, shit hard.” The specific preference he had was for hermaphrodites, which he never encountered and only ever fantasised about. Not masculine or feminine, androgyne was the order of the day”.

Consequently, masturbation became Dali’s only physical sexual activity throughout his life. While this might be psychologically devastating for most people, his sexual psyche, tortured sexuality, and sexual inadequacy are critical to understanding the great art he produced. It certainly appears he had a great fascination with masturbation. For instance, Brian Sewell, the British art historian, claimed that Dali once asked him strip naked, lie down in the foetal position, and masturbate in front of a sculpture of Christ. Dali’s voyeuristic tendencies have also documented by others, most notably the alleged weekly orgies that Dali used to host which not only catered for Dali’s love of voyeurism but also his candaulism (where he would enjoy other men having sex with his wife). The most infamous story was told by American singer and actress Cher who arrived at Dali’s apartment mid-orgy. She picked up “a beautiful, painted rubber fish. Just fabulous. It has this little remote-control handset, and I’m playing with it, and the tail is going back and forth, and I’m thinking it’s a child’s toy. So I said to Salvador: ‘This is really funny.’ And he said: ‘It’s wonderful when you place it on your clitoris’”.

It has also been claimed that Dali had a perverse obsession with Nazi leader Adolf Hitler. Most individuals in the surrealist movement were politically left-wing but Dali was expelled for being a Nazi sympathiser (an allegation that Dali strenuously denied). Whether he was a Nazi sympathiser or not, Dali definitely painted a number of artworks featuring the ‘great dictator’ including The Enigma of Hitler and Hitler Masturbating. In his book (The Unspeakable Confessions) Dali also said that he “often dreamed of Hitler as a woman” and that Hitler “turned [him] on in the highest…His fat back, especially when I saw him appear in the uniform with the Sam Browne belt and shoulder straps that tightly held in his flesh, aroused in me a delicious gustatory thrill originating in the mouth and affording me a Wagnerian ecstasy”. An online article by Stephan Roget notes that there’s a good chance that Dali said such things for shock value, but also notes that Dali didn’t appear to have problems with what the Fuhrer was doing in Nazi Germany.

Most Dali scholars believe he was a sexual voyeur and derived great sexual arousal from watching other people (including his wife) have sex. According to the article by Jackie Fuchs:

“[Dali] was attracted to androgynous bodies – women with small breasts and men having feminine lines. Dali wrote of his ‘penetrating voyeur experiences’ during childhood and even titled one of his early paintings ‘Voyeur’.”

Joshua White also noted that:

“Originally [Dali’s] art served as a vent for the eccentricities, fetishes and obsessions that lurked beneath the surface of a shy Catalonian boy. But as he crafted a persona through which he could express these same things with almost the same level of impunity, then the standard of his art went into a steep decline in his later years. The sexual ambiguity, explicit paraphilia and vivid androgyny found so exuberant in Dalinian artwork…The 20th Century leitmotifs of sex and paranoia are conjoined twins in Dali’s work…We find some of the worst nightmares of the 20th Century conjured up by the more sinister works he churned out, while the juxtaposition with sex introduces a sadomasochistic element into the situations portrayed”

Perhaps the best (or worst, depending upon your viewpoint) eye-opener concerning Dali’s alleged sex life was a book first published in 2000 by former dancer and (struggling) actor Carlos Lozano entitled Sex, Surrealism, Dali and Me (and translated into English by Clifford Thurlow; a reprinting of the book in 2004 with new material was published by Thurlow as The Sex Life of Salvador Dali: The Memoirs of Carlos Lozano). Given that Dali had been dead over a decade by the time this book was published it’s hard for any of the stories to be substantiated (particularly as Lozano died shortly after the book was published). After starting out as one of Dali’s nude models, Lozano claimed he became Dali’s young lover and was Dali’s main confidante in the last two decades of his life. Among the book’s revelations were that Dali: (i) orchestrated sex games for his celebrity guests (including the King of Spain, the artist Marcel Duchamp, actor Yul Brynner, and Prince Dado Ruspoli), (ii) was obsessed with humiliating friends for his own amusement and sexual gratification (such as forcing them to strip and then getting them to engage in sexual acts of his choosing) while he masturbated from the side lines, and (iii) forced a famous Hollywood actress to strip naked and crawl through a plastic ‘uterus’ to allow her to re-experience birth.

It is clear from reading about Dali’s various (s)exploits that his sexual behaviour and sexuality were extreme but that much of his early great art derived from his strange sexual psyche. While some of the alleged sexual behaviours may have been embellished over the years, all of the allegations appear to have some truth in them. Many may argue that Dali’s sex life (or absence of it) was as surreal as his paintings, but none of this takes away from the fact that his art is awe-inspiring to many (myself included).

Dr. Mark Griffiths, Distinguished Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Brennan, A. (2016). 11 seriously strange things you didn’t know about Salvador Dali. GQ, May 11. Located at: https://www.gq-magazine.co.uk/article/salvador-dali-facts

Dali, S. (1942). The Secret Life of Salvador Dali. Dial Press.

Dali, S. (1976). The Unspeakable Confessions of Salvador Dali. New York: W.H. Allen.

Fuchs, J. (2014). 10 depraved secrets of Salvador Dali. Listverse, May 26. Located at: http://listverse.com/2014/05/26/10-depraved-secrets-of-salvador-dali/

Gibson, I. (1998). The Shameful Life of Salvador Dali. New York: WW Norton & Company.

Griffiths, M.D. (1989). Salvador Dali and psychology. BPS History and Philosophy Newsletter, 9, 14-17.

Griffiths, M.D. (1989). Salvador Dali, surrealism and psychology. Psychology PAG Quarterly, 4, 15-17.

Griffiths, M.D. (1994). Heroes: Salvador Dali. The Psychologist: Bulletin of the British Psychological Society, 7, 240.

Kovary, Z. (2009). The enigma of desire: Salvador Dalí and the conquest of the irrational. PsyArt Journal, June 29. Located at: http://www.psyartjournal.com/article/show/kovry-the_enigma_of_desire_salvador_dal_and_th

Lopez, A. I. (2016). Five sadistic and depraved secrets of Salvador Dalí. Cultura Colectivia, August 22. Located at: https://culturacolectiva.com/design/the-sadistic-and-depraved-salvador-dali-secrets/

Maclean, A. (2016). Your ultimate guide to Salvador Dali. Dazed, September 27. Located at: http://www.dazeddigital.com/artsandculture/article/32985/1/your-ultimate-guide-to-salvador-dali

Roget, S. (no date). 17 unbelievably weird stories most people don’t know about Salvador Dali. Ranker. Located at: https://www.ranker.com/list/crazy-salvador-dali-facts/stephanroget

Stranska, Z. (2017). Dali and Gala – the love story. Daily Art Magazine, February 14. Located at: http://www.dailyartmagazine.com/dali-gala-great-love-story/

Sol, M. (2013). 7 eccentric things you didn’t know about Salvador Dali. Loner Wolf. Located at: https://lonerwolf.com/salvador-dali/

Thorpe, V. (2000). Hollywood, sex and the surrealist. The Guardian, February 20. Located at: https://www.theguardian.com/uk/2000/feb/20/vanessathorpe.theobserver

Thurlow, C. (2004). The Sex Life of Salvador Dali: The Memoirs of Carlos Lozano. Tethered Camel Publishing.

White, J. (2011). The divine anus of Salvador Dali. Living in Philistia, August 5. Located at: http://livinginphilistia.blogspot.com/2011/08/divine-anus-of-salvador-dali.html

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.

Come undone: A beginner’s guide to Traumatic Masturbatory Syndrome

I’m not quite sure where I first read about it, but Traumatic Masturbatory Syndrome (TMS) appears to be a controversial phenomenon that is not widely accepted in the medical and sexological communities. According to the Healthy Strokes website:

“[Traumatic Masturbatory Syndrome] is the habit of masturbating in a face-down position against a bed or floor, which puts excessive pressure on the penis, and can interfere with sexual relations. The most common problems TMS sufferers have are inorgasmia – inability to reach orgasm during intercourse – or delayed orgasm. Many TMS sufferers also experience erectile dysfunction”. 

The term ‘Traumatic Masturbatory Syndrome’ originates from a 1998 paper in the Journal of Sex and Marital Therapy by Dr. Lawrence Sank. His paper described what he believed was “a previously unreported pattern of atypical masturbatory behavior, which presents as either an erectile or orgasmic disorder in men”. He outlined four case studies of men who masturbated daily in a prone position over many years. I wrote to Dr. Sank and he kindly sent me his paper. Sank’s paper began by outlining the fact that there are many texts and manuals for women on how to masturbate and how to overcome being non-orgasmic, but little for men. He pointed out that problems in erectile functioning and orgasm among males appears to result, not from their inability to masturbate but from the inability to masturbate correctly (Sank’s emphasis on the word ‘correctly’). The four cases that Sank reported on were all physically healthy and there were no problems urogenitally, neurologically, hormonally or vascularly. Here are brief summaries of the four cases Dr. Sank wrote about:

• Case 1 [Mr. A]: A 62-year old heterosexual married Black male who was referred for impotence – “He had been married over two years but the couple had not had successful intercourse…He learned at age 8, from his local priest, that any pleasure from touching his penis was the equivalent of ‘re-crucifying Jesus’…The compromise that Mr. A reached was to not use his hand but to rub his penis against his bed clothes and/or pillow without manual guidance. He believed that this would mitigate the seriousness of his sin…This method of sexual expression lasted through several decades of almost daily practice….Mr. A pursued a series of relationships with women…He would rub extremely vigorously against his partner usually to a point where any erection was lost… Mr. A’s masturbatory history is significant for the unique prone position that he engaged in daily over many years”.

• Case 2 [Mr. B]: A 35-year old gay single Asian male referred for an inability to attain or sustain any erection and an inability to achieve orgasm during intercourse – “Mr. B’s history was significant for the absence of what he called a ‘phallic oriented puberty’…He was not able to achieve orgasm until his early 20s. At that time all masturbation was accomplished by rubbing his penis against his mattress in a prone position while fantasizing about being penetrated by a male. He would do this on a daily basis, always eventuating in orgasm. In his late 20’s he found a male lover with whom he would characteristically engage in mutual, manual masturbation…Any stimulation by his partner eventuated in mutual exhaustion since no effort was sufficient, no matter how prodigious, to trigger Mr. B’s orgasm…Mr. B reported that masturbation, while in a prone position, felt ‘more natural’, was speedier, and required far less effort. Mr. B’s explanation was that he imagined his masturbatory preference to be a logical outgrowth of his shame at not having ‘good, working equipment’…Being face down allowed him to hide his embarrassment”.

• Case 3 [Mr. C]: A 24-year old gay white male referred for inability to reach orgasm – “When, on rare occasions, Mr. C did achieve orgasm, it was always with a flaccid penis and never accompanied by any pleasurable sensation…Positionally, Mr. C would invariably masturbate while lying on his stomach, his hands made into fists with his penis between his thumbs. He would thrust downward creating intense friction between the lateral portion of his penile shaft and the knuckles of his thumbs. There would be no erection. The frequency of masturbation was 5-7 times per week. Before treatment, when Mr. C tried masturbating in a more typical fashion he was capable of obtaining an erection but never a strong one nor was there any subsequent orgasm”.

• Case 4 [Mr. D]: A 35-year old heterosexual single white male referred for primary erectile dysfunction – “Mr. D masturbated on a daily basis since adolescence. The quality of the erection during masturbation was reported to be of ‘poor rigidity’…but always eventuated in orgasm. Positionally, Mr. D would be prone, lying on his face and chest, using both hands – one hand grasping his penis, the other hand placed over the first…Only subtle changes in pressure from his hand served to heighten his arousal to the point of obtaining a semi-rigid, non penetrable erection and then orgasm…He has never been able to sustain his erection beyond several seconds of intercourse nor has he achieved orgasm…When asked as to why he masturbated in this statistically unusual manner, Mr. D expressed surprise that it was so unusual and hypothesized that it must have arisen out of being a shameful activity at which he wouldn’t have wanted to be caught. In addition, the tight clutching of his penis during masturbation parallels Mr. C’s traumatizing handling of his penis during masturbation and Mr. A’s vigorous, exhaustive masturbatory rubbing against his bedding or partner”.

Dr. Sank duly acknowledged that the case material presented was anecdotal and he made it clear in his paper that he wasn’t suggesting the “distinguishing variables of position plus frequency or either, alone, are necessary or sufficient for causing the erectile or orgasmic dysfunctions described in these cases”. In the cases of A, C and D:

“The punishing handling of the penis might co-occur with these two variables because a prone position, due to its awkwardness and lack of freedom of motion, would seem to require a great deal of intensity if the subject is to derive the requisite pleasurable sensations associated with masturbatory activity. The daily regimen of masturbation might also have served to raise the threshold of sensation, thus requiring even more intense stimulatory activity to enable orgasm. Unfortunately this heightened intensity would likely raise the threshold for pleasurable sensation even higher…the proverbial vicious circle”

Dr. Sank reported that all his patients were successfully treated and overcame their presenting symptoms. Sank did not describe the treatment in any detail (saying it was beyond the scope of the paper) but involved the “re-sensitizing what the patient treats as a desensitized organ through both individualized behavioral exercises and psychotherapy when appropriate”.

On the basis of his admittedly anecdotal findings, Dr. Sank recommends that pubescent teenagers should be taught proper masturbatory techniques (either by parents, by teachers, and/or by paediatricians). However, as far as I am aware, no other academic or clinical paper has followed up the work of Sank. The Wikipedia entry relating to TMS was removed in 2009 (presumably because of lack of evidence). However, according to an article on masturbation on the Right Diagnosis website, some sources, still continue to give credence to the idea of TMS. The article cites the 1994 book by sex therapist Eva Margolies (Undressing The American Male) who condemned masturbation by rubbing against a pillow or mattress. The same article also quotes the work of and Dr. Josie Lipsith and her colleagues in a 2003 issue of Sexual and Relationship Therapy that suggests masturbation could play a part in male psychogenic sexual dysfunction (although this seems to be little more than citation of Dr. Sank’s original paper).

Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Go Ask Alice (2006). Traumatic Masturbatory Syndrome. November 17. Located at: http://goaskalice.columbia.edu/traumatic-masturbatory-syndrome-tms

Healthy Strokes (2013). Facts about prone masturbation. Located at: http://www.healthystrokes.com

Lipsith, J., McCann, D. & Goldmeier, D. (2003). Male Psychogenic Sexual Dysfunction: The Role of Masturbation. Sexual and Relationship Therapy, 18, 448-471.

Margolies, E. (1994). Undressing the American Male: Men with Sexual Problems and What Women Can Do to Help Them. New York: Penguin.

Right Diagnosis (2013). Masturbation. Located at: http://www.rightdiagnosis.com/m/masturbation/wiki.htm

Sank, L.I. (1998). Traumatic masturbatory syndrome. Journal of Sex and Marital Therapy, 24, 37-42.

Slow pain coming: A brief look at benign masturbatory cephalalgia

In a previous blog, I examined the medical research on individuals that suffer severe headaches as a result of having sex (known in the clinical and medical literature as ‘coital cephalalgia’ and ‘benign coital headache’). In such circumstances, the headache typically occurs at the brink of orgasm. While researching that particular blog, I also came across a number of papers (mainly case studies) that reported that these types of headache could also occur during masturbation (known as ‘benign masturbatory cephalalgia’ (BMC). (Here, the term ‘benign’ defines a primary headache syndrome not caused by any intracranial disorder).

The first paper that I read on BMC was a case account by Dr. Frederick Vincent in a 1982 issue the Archives of Neurology. Although benign orgasmic cephalgia had already been well described in the medical literature (particularly among males), Dr. Vincent reported the case of a 28-year old woman with orgasmic cephalalgia that developed during masturbation. This was reported by Dr. Vincent as the first ever case of BMC. The young woman “suffered a sudden throbbing occipital headache as she became orgasmic by masturbation”. The headache lasted an hour accompanied by mild nausea, but no other neurologic symptoms. As a result of this case, Dr. Vincent argued that the term ‘coital cephalagia’ should be dropped and simply called ‘orgasmic cephalagia’ irrespective of whether the headache was self-induced (i.e., masturbatory) or caused by having sexual intercourse.

Following the publication of Vincent’s case study, Dr. James Lance immediately responded in the same journal saying that he had reported the cases of three of his patients whose headaches were brought on by masturbation. Lance also agreed that the term coital cephalalgia was too restrictive, but then argued that:

“Orgasmic cephalalgia ignores the premonitory headache that may build up as sexual excitement mounts before orgasm. Benign sex headache (using ‘sex’ in the popular sense) is an all-embracing, albeit unpoetic, term and is comparable with benign cough headache. It is worth emphasizing that neither condition is always benign”.

A 2004 case study published by Dr. Marcelo Valenca and colleagues in the journal Headache: The Journal of Head and Face Pain noted that only five cases of patients with thunderclap headache precipitated by sexual activity had been identified in the medical literature. In their paper, they reported the case of a 44-year-old woman that suffered both coital and masturbatory headaches during orgasm. After carrying out a number of medical tests they concluded that the women had experienced cerebral arterial narrowing shortly after her orgasmic headache attacks and that this “supported the hypothesis that segmental vasospasm may exert a role in the pathogenesis of this uncommon type of headache”.

A number of papers on orgasmic cephalagia have been published by Dr. Achim Frese and his colleagues. In a 2004 issue of the journal Neurology, Frese led a study examining the demography, clinical features, and comorbidity of headache associated with sexual activity (HSA) in interviews of 51 participants. They reported that HSA was not dependent on specific sexual habits and most often occurred during sexual activity with the usual partner (94%) and during masturbation (35%).

A 1998 paper by Dr. Daniel Jacome in Headache: The Journal of Head and Face Pain reported something slightly different but related to BMC. More specifically, Dr. Jacome reported the cases of two single men described as having masturbatory-orgasmic extracephalic pain (i.e., an ice-pick like pain that occurred in the neck of one of the men, and in the groin and genitalia of the other). Both men had pre-existing medical conditions (i.e., compressive spondylitic cervical myelopathy in the first case, and a tethered cord and intraspinal lipoma in the second case). These two unusual cases represent examples of extracephalic ice picklike pain triggered by sexual activity, in the absence of orgasmic cephalgia.

A more recent 2012 paper by Dr. Amy Gelfand and Dr. Peter Goadsby in the journal Pediatrics examined primary sexual headaches in two male adolescents. One of the two cases (a 16-year-old boy) developed headaches at the moment of orgasm, building up in intensity over 5 to 10 seconds, and then continuing for between 10 seconds to 2 minutes before stopping. The authors also reported that headaches occurred irrespective of whether orgasm was achieved through intercourse or masturbation. He was not formally treated because after several months, the patient no longer experienced the headaches with orgasm.

Finally, a 2006 paper by Dr. Ambar Chakravarty in the journal Cephalalgia examined data from 24 Indian patients (18 males and 6 females) over a 20-year period (1985–2004) that suffered preorgasmic headaches. Dr. Ambar reported that three of the youngest male patients (aged 19–23 years) had experienced masturbatory headache. One of the female patients (aged 30 years) only experienced orgasmic headache during masturbation (i.e., she never experienced headaches during sexual intercourse).

Summarizing the medical literature on orgasmic cephalagia as a whole (i.e., on coital and masturbatory cephalagia), the 2012 paper by Gelfand and Goadsby concluded that:

“The orgasmic subtype of primary sex headache is more common than the gradual onset pre-orgasm type and has received more attention in the medical literature…In the orgasmic subtype, headache onset is explosive and severe. Orgasms achieved through either sexual intercourse or masturbation can trigger the headache. The headache location is variable, although most often bilateral. The quality is typically pounding or throbbing. Duration of headache ranges from minutes to several hours. Age at onset is classically in the late thirties or early forties, and there is a male predominance. The natural history of the disorder is that after several months it typically remits, although some patients will have a chronic course lasting over a year, and recurrences are possible”.

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

Further reading

Chakravarty, A. (2006). Primary headaches associated with sexual activity—some observations in Indian patients. Cephalalgia, 26(2), 202-207.

Frese, A., Eikermann, A., Frese, K., Schwaag, S., Husstedt, I. W., & Evers, S. (2003). Headache associated with sexual activity: Demography, clinical features, and comorbidity. Neurology, 61(6), 796-800.

Gelfand, A.A., & Goadsby, P.J. (2012). Primary sex headache in adolescents. Pediatrics, 130(2), e439-e441.

Jacome, D.E. (1998). Masturbatory-orgasmic extracephalic pain. Headache: Journal of Head and Face Pain, 38(2), 138-141.

Lance, J. W. (1976). Headaches related to sexual activity. Journal of Neurology, Neurosurgery & Psychiatry, 39(12), 1226-1230.

Lance, J. W. (1983). Benign masturbatory cephalalgia. Archives of Neurology, 40(6), 393.

Østergaard, J. R., & Kraft, M. (1992). Benign coital headache. Cephalalgia, 12(6), 353-355.

Redelman, M. (2010). What if the ‘sexual headache’ is not a joke. British Journal of Medical Practitioners, 3(1), 40-44.

Valenca, M. M., Valenca, L. P., Bordini, C. A., Da Silva, W. F., Leite, J. P., Antunes‐Rodrigues, J., & Speciali, J. G. (2004). Cerebral vasospasm and headache during sexual intercourse and masturbatory orgasms. Headache: The Journal of Head and Face Pain, 44(3), 244-248.

Vincent, F. M. (1982). Benign masturbatory cephalalgia. Archives of Neurology, 39(10), 673.

Bottling it up: A brief look at penile strangulation

While I was researching a blog on urethral manipulation I came across a paper entitled ‘Penile strangulation by a hard plastic bottle’ by Dr. Satish Jain and his colleagues published in a 2004 issue of the Indian Journal of Surgery. As the paper explains:

“Penile strangulation is a rare injury and most require only removal of the constriction and conservative management. Penile strangulating objects are usually rings, nuts, bottles, bushes, wedding rings etc. in an adult, while in children they tend to be rubber bands threads or hair coils. In adults these constricting penile bands, whether expandable or non-expandable, are placed deliberately by the person himself for masturbation or by the female counterpart to prolong erection. In children these are used to prevent enuresis and incontinence or as an innocent childish experiment. Because these bands occlude penile venous flow, most patients present to the emergency with penile edema” [an edema is a swelling caused by fluid in body tissue].

They reported the case of a 27-year old man who turned up at hospital needing emergency treatment for an extremely swollen penis and unable to urinate. This occurred as a result of placing his penis inside a hard plastic bottle as a masturbatory aid. In short, the neck of the bottle got stuck, constricting the penis base. The paper then described how the bottle was removed:

“The hospital carpenter was called to assist in cutting open that bottle. With the use of iron cutting saw…first the bottle was cut near the neck and then the bottle neck was cut open slowly and diagonally. The penis was held slightly bent downwards. Once one end of the bottle neck was cut open, the plaster spreader (used by orthopaedician) was use to hold the cut ends open and the whole bottle neck was cut opened and removed after 15 minutes of struggle…Penile edema subsided completely in a week and patient had an uneventful recovery. There was no erectile dysfunction or decreased uroflow”.

This case was relatively easy to treat and on the less serious side. Later in the paper, the authors note that more serious medical complaints can arise including ulceration (skin inflammation and/or lesion), necrosis (death of body tissue), urinary fistula (abnormal opening of the urethra) or even gangrene (death and decay of body tissue due to loss of blood supply). Unsurprisingly, these latter conditions most often occur because the patient is too shy or embarrassed to seek medical help.

It was after reading this paper that I went searching for other cases and found many papers on the topic (far too many to outline here). However, I thought I would pick out some that caught my eye. Penises stuck inside bottles seemed (somewhat predictably) to feature quite heavily. For instance, Dr. C.K. Ooi and colleagues reported two cases of “unusual” penile strangulation in a 2009 issue of the Singapore Medical Journal. One of the cases was a 77-year old man who got his penis stuck in a bottle. Although the bottle was successfully removed in the emergency ward the patient subsequently developed post-obstructive diuresis (i.e., excessive urination). The second case was a 60-year old man who got his penis stuck inside a metallic ring. An orthopaedic cutter was used to remove the ring and there were no long-term complications. Another paper by Dr. Matthias May and colleagues in a 2006 issue of the International Urology and Nephrology reported the case of a 49-year old man who got his penis stuck in a polyethylene terephthalate (PET) bottle. (Ethylene terephthalate is a light plastic material that is – according to various papers I read – “nearly indestructible”). After trying to cut the bottle off with a scalpel and then a glass saw, the bottle was finally removed by cutting it longitudinally with an oscillating saw (that was normally used for cutting off patient plaster casts).

A more recent case in a 2011 issue of the International Journal of Biological and Medical Research by Dr. Uday Shamrao Kumbhar and colleagues reported the case of a 46-year old man who got a plastic bottle neck stuck on the base of his penis following attempted masturbation. More specifically, they reported that:

“The man came after 14 [hours] with gross penile edema and impaired penile sensation distal to the constriction…The nature of the plastic bottle neck was such that an attempt at cutting the device was difficult. We retrieved the constructing device by cutting it by soldering gun (used for electrical soldering by electrician). Cuts were taken at two places – 3 and 9 o’clock positions. The only hurdle was heat generated during the soldering, which was overcome by intermittent soldering and pouring cold normal saline in between”.

The patient recovered fully and following removal had a normal erection, could masturbate and have sex without problems. The most recent case I came across was published in a 2014 issue of Case Reports in Urology. The authors (Dr. Avinash Chennamsetty, Dr. David Wenzler and Dr. Melissa Fischer) reported the case of a 49-year-old man that turned up at the Emergency Department complaining that his penis was swollen and painful. The authors reported that nine days prior to coming into hospital the man had placed a metallic constriction device over his penis for an “autoerotic motive” but then found that he couldn’t remove it. The authors noted that:

“He was able to urinate but had a decreased force of stream. Physical exam revealed a tightly encircling metallic ring with peripheral cogs placed on the mid shaft of the penis causing severe penile engorgement and edema. The metal appeared to be a very hard alloy with thickness measuring 5–7mm depending on the location. The penile skin under the ring was excoriated and necrotic. Due to the incarceration time, degree of necrosis, and significant distal edema, simple lubrication, compression, and manual removal were not an option for fear of amputation. Manual and electric ring cutters were used, but after several attempts, we were unable to do more than scratch the surface of the metal ring. The patient was given procedural sedation and a tongue depressor was placed beneath the metal ring to provide soft tissue protection. Using the pin cutter, enough force was generated in one attempt to snap the ring into two separate pieces”.

Another different kind of penile strangulation – with more serious consequences – was reported by Dr. A. Nuhu and his colleagues in a 2009 issue of the West African Journal of Medicine. In this instance, a middle-aged Nigerian managed to get a round metallic nut stuck on his penis. For five days the man had delayed coming into hospital for treatment even though he was unable to urinate properly (in fact he had trouble urinating at all). By the time he went for medical help, his penis had developed gangrene. Unfortunately, the only treatment option available was a complete amputation of his penis.

It is also worth mentioning that a number of papers I came across purely describe the methods that can be used in the “extrication of penile entrapment” such as a detailed report by Dr. Guang-Ming Liu and colleagues in a 2012 issue of the International Urology and Nephrology that described the “technique of suture traction in conjunction with Dundee…performed for the management of penile entrapment in polyethylene terephthalate bottle neck” that they claim can be performed “without any special tools required in the management of penile entrapment involving PET bottles [and can] be applied safely for the low-grade penile injury”.

Within two weeks of removal, the man’s penis had fully recovered and he was able to resume sexual activity. Another earlier 2001 paper by Dr. Mark Detweiler in the Scandinavian Journal of Urology and Nephrology outlined treatment guidelines “according to level of penile trauma for penile incarceration by metal devices”. Detweiler analysed all previous cases of penile strangulation (aka penile incarceration) and divided treatment interventions into four groups going from the safest to the most dangerous to perform: (i) string techniques with and without aspiration [removal] of blood from the glans; (ii) pure aspiration techniques; (iii) cutting devices; and (iv) surgical techniques.

Finally, the most tragic case of penile strangulation I came across was one published in 2011 by Dr. Benito Morentin and colleagues in the American Journal of Forensic Medicine and Pathology. They reported that a 58-year old man was found dead at a guesthouse by a flatmate living in the house. The paper reported: 

“According to the flatmate, the deceased had not been out of his room in the last 2 weeks. Two days before the death the flatmate phoned the emergency services asking for help due to the strange behavior of the subject. When the emergency staff arrived the man refused any kind of help claiming that he did not have any medical problems at all. Clinical antecedents included paresis of the left leg due to stroke, smoking, alcoholism, and social behavior disorder. At autopsy, physical examination showed that the penis was engorged and swollen, with dark black color and evident gangrene. A plastic bottle neck was found over the base of the penis. Between the bottle neck and the penis there was a piece of condom…Histologic examination of the penis revealed severe necrosis, intense hemorrhage of the tissue due to stagnated blood, and thrombosis… Death was attributed to multi-organ failure secondary to septic shock”.

This last case is clearly an extreme and tragic case. The authors speculated that the man was simply too ashamed to seek treatment. They also believed that this is the only ever death recorded as arising from penile strangulation.

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

Further reading

Chennamsetty, A., Wenzler, D. & Fischer, M. (2014). Removal of a penile constriction device with a large orthopedic pin cutter. Case Reports in Urology, Volume 2014, http://dx.doi.org/10.1155/2014/347285

Detweiler, M. B. (2001). Penile incarceration with Metal objects a review of procedure choice based on penile trauma grade. Scandinavian Journal of Urology and Nephrology, 35(3), 212-217.

Ivanovski, O., Stankov, O., Kuzmanoski, M., Saidi, S., Banev, S., Filipovski, V., Lekovski, L. & Popov, Z. (2007). Penile strangulation: two case reports and review of the literature. Journal of Sexual Medicine, 4(6), 1775-1780.

Jain S., Gupta A., Singh T., Aggarwal N., Sharma, S. & Jain S. (2004). Penile strangulation by a hard plastic bottle: A case report, Indian Journal of Surgery, 66(3), 173-175.

Liu, G. M., Sun, G., & Ma, H. S. (2012). Extrication of penile entrapment in a polyethylene terephthalate (PET) bottle: A technique of suture traction and Dundee and literature review. International Urology and Nephrology, 44(5), 1335-1340.

May, M., Gunia, S., Helke, C., Kheyri, R., & Hoschke, B. (2006). Penile entrapment in a plastic bottle – A case for using an oscillating splint saw. International Urology and Nephrology, 38(1), 93-95.

Morentin B., Biritxinaga B. & Crespo L. (2011). Penile strangulation: Report of a fatal case. American Journal of Forensic Medicine and Pathology, 32, 344-346.

Nuhu, A., Edino, S. T., Agbese, G. O., & Kallamu, M. (2009). Penile gangrene due to strangulation by a metallic nut: a case report. West African Journal of Medicine, 28(5), 340-242.

Ooi, C. K., Goh, H. K., Chong, K. T., & Lim, G. H. (2009). Penile strangulation: report of two unusual cases. Singapore Medical Journal, 50(2), e50-52.

Shamrao Kumbhar U., Dasharathimurumu, D. & Bhargavpak, D. (2011). Acute penile incarceration injury caused by a plastic bottle neck. International Journal of Biological and Medical Research, 2(4), 1184-1185.

Palm minimization: An unusual case of Alien Hand Syndrome

In a previous blog I briefly overviewed Alien Hand Syndrome. Since writing that blog I came across an interesting case of alien hand syndrome published in a 2000 issue of the American Journal of Physical Medicine and Rehabilitation by Dr. B. Hai and Dr. I. Odderson. They reported an unusual case in which their patient had a right hemispheric stroke and subsequently experienced what the authors described as embarrassing manifestations of Alien Hand Syndrome in the form of involuntary masturbation. The case involved a 73-year old man who was brought into a hospital emergency ward by his wife because of a sudden loss of movement in the left-hand side of his body (including a slight droop on the left-hand side of his face), slurred speech and poor balance. Furthermore, he could stand if helped but was unable to walk unaided. The man had obviously had a stroke but four days later he started to experience involuntary movements of his left arm and claimed his left hand “has a mind of his own”. The paper reported that:

“He developed a tonic grasp reflex with inability to release. He also had a tendency to reach and grasp onto objects with the left hand, such as the telephone cord or the remote control for the television, and was unable to release despite verbal commands. He would persistently grab his comb or fix the collar of his shirt. He also demonstrated difficulty performing bimanual activities, such as eating”

Most worryingly, the man’s wife expressed extreme concern when her husband’s left hand would expose his genitals and start to masturbate in public. The involuntary masturbation happened on numerous occasions when talking with the nurses and doctors in the hospital, and only ever occurred with his left hand (even though the man was right-handed). The man denied that he had any history of “excessive self-stimulation, sexual dysfunction, or exhibitionism”. While in hospital, the man was dismayed and frustrated that he was unable to stop his left hand stimulating his genitals in front of other people. The authors reported that:

“A clinical impression of [Alien Hand Syndrome] was made, and magnetic resonance imaging of the brain showed an acute infarct [dead tissue] in the medial right frontal lobe [of his brain] in the anterior cerebral artery distribution involving the right anterior cingulate gyrus and the corpus callosum. After [three weeks] of acute inpatient rehabilitation, the patient was able to walk with a standard walker and negotiate stairs with rails with contact guard assist. He also began to use his left hand for bimanual activities. He was subsequently discharged to home with his family”.

After a month of treatment, the man was able to walk again unassisted but his left hand was still not under his own control (and telling the medical staff that his hand “still has a mind of his own and won’t turn things loose”). However, the good news was that the involuntary masturbation in public subsided and eventually ceased. The authors of the paper claim this is a very rare case because their patient displayed “an unusual and disturbing manifestation of uncontrolled involuntary genital fondling with the nondominant, apraxic hand and with mirroring hand movements during eating”. The authors also noted that the involuntary movements of the man’s left hand never occurred while they were carrying out medical tests and suggested that their findings indicate “the possibility of the presence of a dexterous ‘alien’ mode of control that can be distinguished from a more clumsy and slow ‘voluntary’ mode of control”. Although there is no known treatment for AHS, as I noted in my previous blog on the topic, the symptoms can be minimized and managed to some extent by keeping the affected hand occupied and involved in a task (e.g., by giving it an object to hold in its grasp). This would seem to explain why the man never masturbated while undergoing medical tests (i.e., his hands were being occupied). The authors also noted that:

“So far, at least two types of [Alien Hand Syndrome] have been described. The callosal type, as seen in our patient (lesion involving the corpus callosum with or without frontal damage), is characterized by frequent intermanual conflict and apraxia of the affected limb. The frontal type (lesion involving the left mediofrontal and callosal) is associated with dominant hand grasp reflex, compulsive movements (such as groping), restraining actions, and compulsive manipulation of tool [Feinberg, Schindler & Flanagan, 1992]”.

As I noted in my previous blog on AHS, research indicates that AHS sufferers often personify the alien hand and may believe the hand is ‘possessed’ by some other spirit or alien life form. Their hands may even appear to act in opposition to each other (such as when AHS sufferers who are also cigarette smokers put a cigarette in their mouth to set it alight, only for the alien hand to pull it out and throw the cigarette away). Such behaviour is an example of ‘intermanual conflict’ and has been given the name ‘diagnostic ideomotor apraxia’.

A number of published papers have reported that involuntary masturbation can be associated with other conditions. For instance, it has been associated with temporal lobe epilepsy. Dr. M. Cherian reported the case of excessive masturbation in a young girl in a 1997 issue of the European Journal of Pediatrics. However, until the publication of this case of AHS, it had not ever been associated with having a stroke. Dr. Hai and Dr. Odderson conclude:

“Although [Alien Hand Syndrome] is a rare phenomenon, this condition should be considered in patients who present with a feeling of alienation of one or both upper limbs accompanied by complex purposeful involuntary movement. It must be differentiated from limb neglect and anosognosia, which present with dissociation from the limb as perceived object (i.e., where the limb is not perceived as a part of the “self”), but without involuntary movement and without dissociation from control over purposeful complex action of the affected limb (i.e., where the actions of the limb are perceived as self-generated). Further studies are required to elucidate a definite anatomical explanation that can lead to accurate diagnosis, specific treatment, and rehabilitation of these patients”

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

Further reading

Biran, I. & Chatterjee, A. (2004). Alien Hand Syndrome. Archives of Neurology, 61, 292-294.

Cherian, M.P. (1997). Excessive masturbation in a young girl: A rare presentation of temporal lobe epilepsy. European Journal of Pediatrics, 156, 249.

Doody, R.S. & Jankovic, J. (1992). The alien hand and related signs. Journal of Neurology, Neurosurgery and Psychiatry, 55, 806-810.

Feinberg, T.E., Schindler, R.J. & Flanagan, N.G. (1992). Two alien hand syndromes. Neurology, 42, 19-24.

Hai, B.G.O., & Odderson, I.R. (2000). Involuntary masturbation as a manifestation of stroke-related alien hand syndrome. American Journal of Physical Medicine & Rehabilitation, 79, 395-398.

Jacome, D.E. & Risko, M.S. (1983). Absence status manifested by compulsive masturbation. Archives of Neurology, 40, 523-524.

Scepkowski, L.A. & Cronin-Golomb, A. (2003). The alien hand: Cases, categorizations, and anatomical correlates. Behavioral and Cognitive Neuroscience Reviews, 2, 261-277.

Deerly beloved: Animal tissue as a masturbatory aid

A couple of weeks ago I bought a secondhand copy of The Fortean Times Book of Weird Sex by Steve Moore (mainly because it cost me only one pence at an online book store). One of the stories (on pp.96-97) concerned a bizarre story of an autoerotic death involving an adolescent boy. I checked out the reference list at the back off the book to see where the story had originated and the source was listed as an Associated Press story from Knoxville (Maryland, USA). It didn’t take me too long to track down the press release on the internet. The report said:

“A 16-year old boy in Knoxville was found dead in his bedroom in what police describe as a gruesome, horrifying death. Firefighters were called to the scene Monday morning by a neighbor who smelled something burning. When the firemen found the remains of the teenager they called the police in to investigate. At first investigators believed that they were dealing with a ritualistic murder. Posters of heavy metal rock and roll groups covered his bedroom walls, groups which are often connected with satanic worship and rituals. According to a firefighter who was on the scene, the boy was found nude, with the remains of a cow’s heart attached to his genitals. Wires had been attached to the heart and plugged into a wall socket. The boy died from electrocution, then the electricity literally cooked his remains. Investigating Officer Hardaway dismissed the ritual murder theory when detectives found several underground pornographic magazines under the boy’s mattress. One of the magazines, called ‘Ovid Now’, describes a sexual ‘toy’ that can be made from the fresh heart of a cow, a simple electrical circuit, and some batteries. This deviancy is apparently gaining limited popularity in the rural South. Practitioners get the dead heart to beat, and then use the beating organ for sexual perversions. ‘This is one of the most gruesome things I have ever seen. I can’t believe that there are people who actually enjoy this sort of thing’ Hardaway commented. The boy’s parents are currently on vacation in Florida, where they were contacted and informed about the tragedy. They were unavailable for comment”.

As I have already written a previous blog on electrophilia and published an article on the ten strangest autoerotic deaths (in the magazine Bizarre) I thought it would make the basis for a good blog. However, after a bit more investigation I discovered the story to be a fake. The Snopes.com website (also know as the Urban Legends Reference Pages) investigated the story and showed it to be completely false. The author of the article (Barbara Mikkelson) wrote:

“The [cow heart masturbation story] isn’t a bona fide Associated Press article. No such death has been recorded, let alone been reported on by the Associated Press. What we have here is a work of fiction, an inventive leg-pull. Pranksters are everywhere, both on-line and off-line. In this case, someone took his best shot at presenting a gruesomely salacious story as a news item by dressing it up to mimic the style he assumed wire service copy adhered to, resulting in a laughable Associated Press pastiche”.

The same article also reported another fictitious tale of masturbatory death by animal (in this case a lobster). Here, the story was that a women had masturbated using a live lobster and that the lobster had defecated into her vagina, implanting brine shrimp eggs that then hatched inside her. Additionally, there are a few fictional cases in literature, the most infamous being the use of an animal liver as a masturbatory aid in Philip Roth’s 1969 novel Portnoy’s Complaint. The novel is basically the monologue of (as Wikipedia describes) “a lust-ridden, mother-addicted young Jewish bachelor who confesses to his psychoanalyst in intimate, shameful detail, and coarse, abusive language”. In my previous blog on sitophilia (sexual arousal from food), I did note that processed animal tissue has been used as a masturbatory aid (the most notable being botulinonia that involves the sexual use of sausages).

However, there is one case report in the scientific literature that is definitely true. It was published in a 1990 issue of the American Journal of Forensic Medicine and Pathology by Dr. Barry Randall, Dr. Richard Vance, and Dr. Timothy McAlmont and was simply titled ‘Xenolingual eroticism’. The paper described the case of a 29-year old female that presented at an abortion clinic saying that she had missed her periods and that she had a possible pregnancy that required termination. She was given a D&C (dilatation and curettage) and a muscular “pale grey tissue mass” measuring seven centimetres in length and 3 centimetres in diameter was found inside her vaginal passage. The object removed from her vagina turned out to be a deer tongue that the woman has been using as a masturbatory aid. At the time their case study was published, Dr. Randall and colleagues reviewed all the relevant literature on masturbatory practices in the Index Medicus database and found 42 papers (of which 27 detailed autoerotic deaths and 14 describing the psychology of autoeroticism). They then noted that:

“Only one reference reviewed various nonlethal autoerotic practices. Over a 42-year period, Aliabadi et al. recorded 18 patients, only three of whom were women, who presented with foreign body insertion for erotic purposes. All three women had inserted foreign bodies into the urinary tract. Acts of autoeroticism involving vaginal masturbation with foreign objects are perhaps more common. None to our knowledge have been reported because these do not result in death or injury, and typically would not come to medical attention. The literature discloses examples of foreign bodies extracted from the male and female lower urinary tract because objects of small diameter may be retracted by natural muscular impulses into the proximal urethra and/or bladder. Indeed, according to Kinsey and others >90% of foreign bodies found in the female bladder or urethra are there as a result of masturbation. Also, large objects retrieved from the vagina are found mostly in married women aged 17-30 [years]. However, these objects, most commonly bananas, cucumbers, and other large vegetables, rarely come to surgical attention. The medical literature reveals only seven references to bestiality. None of them deals with the issue of using nonviable animal tissue for autoerotic purposes. This report is presented so that xenoerotic objects may be placed on the list of possible masturbatory tools that may come to the attention of medical personnel”.

As far as I am aware, the case study by Dr. Randall and colleagues is the only academic paper on the use of animal tissue as a masturbatory aid. I did actually cite this study in a previous blog in relation to Dr. Anil Aggrawal’s 2011 typology of zoophiles in the Journal of Forensic and Legal Medicine. The case cited by Randall and colleagues could be classed as a fetishistic zoophile. According to Dr. Aggrawal, these individuals keep various animal parts (especially fur) that they then use as an erotic stimulus as a crucial part of their sexual activity. Obviously the use of a deer tongue is rare but appears to fit the definition of a fetishistic zoophile.

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

Further reading

Aggrawal, A. (2011). A new classification of zoophilia. Journal of Forensic and Legal Medicine, 18, 73-78.

Aliabadi, H., Cass, A.S., Gleich, P., & Johnson, C.F. (1985). Self-Inflicted foreign bodies involving lower urinary tract and male genitals. Urology, 26, 12-16.

Brown, S. (1995). The Fortean Times Book of Weird Sex. London: John Brown Publishing.

Griffiths, M.D. (1999). Dying for it: Autoerotic deaths. Bizarre, 24, 62-65.

Mikkelson, B. (2006). Cowboy heart. Snopes.com, May 13. Located at: http://www.snopes.com/risque/kinky/cowheart.asp

Randall, M. B., Vance, R. P., & McCalmont, T. H. (1990). Xenolingual autoeroticism. The American Journal of Forensic Medicine and Pathology, 11, 89-92.

Snopes (2000). Lobster love. Snopes.com, January 26. Located at: http://www.snopes.com/risque/juvenile/lobster.asp

Snopes (2006). Deerly beloved. Snopes.com, February 26. Located at: http://www.snopes.com/risque/animals/deertongue.asp