011 ON SOME AVERSIVE PHENOMENA IN SEXUAL DISORDERS CLINIC
GARNIK KOCHARYAN Ukraine
Analyzes a case of twenty-year disgust to semen in a sexually dysfunctional married woman raped 22 years ago and aged 38. The disgust arose after she had seen a picture on a pornographic magazine cover, on which semen trickled down from a woman mouth on her face and neck at time of an oral-genital intercourse. That day took place multiple vomiting. After that a look and odor of semen, and even its imagining produced vomitory reactions, which were marked mainly during sexual intercourses. This disgust was gradually spread to other man’s excretions (saliva, sputum and others), and even oatmeal porridge, as its mucous consistence reminded of semen. The repeated stroke mechanism and subsequent generalization explain these aversive phenomena appearances. The psychotherapy included 4 components: 1) change of the patient’s attitude to semen (it is an important substance, which is necessary for the human kind reproduction); 2) change of her attitude to sexual intercourses (they should not be taken as mockery to women); 3) the swish technique (NLP); 4) sessions of hypnotism (the female patient experienced the rape situation in the hypnotic state repeatedly).The treatment was effective.
Bibliographic information about the publication: Kocharyan, G. S. On some aversive phenomena in sexual disorders clinic // Abstracts Book of 16th World Congress of Sexology. – Havana, March 10–14, 2003. – P. 10*.
*Full version of this my message (Kocharyan, G. S. On some aversive phenomena in sexual disorders clinic) was placed on CD of 16TH WORLD CONGRESS OF SEXOLOGY (Havana, March 10–14, 2003) (see below).
ON SOME AVERSIVE PHENOMENA IN SEXUAL DISORDERS CLINIC
Garnik S. Kocharyan
Kharkov Medical Academy of Post-Graduate Education,
Department of Sexology and Medical Psychology
81/85 Mironositskaya Str., Kharkov 61023, Ukraine
Tel: (380-57) 700-50-02; E-mail: firstname.lastname@example.org
Sexual aversion in ICD-10 is defined as follows: "The forthcoming sexual intercourse with a partner causes strong negative feelings, fear or anxiety which are sufficient to result in evasion from sexual activity”. This disturbance corresponds to F52.10 code of the above classification. The causes which can result in its appearance are different. Their examination is not our task. The purpose of the present report is to analyze one clinical observation dealing with sexual aversion. Forestalling our report, it should be noted that this case was characterized by a systematic evasion from sexual activity, but it was not always possible to avoid sexual contacts. Therefore now we are going to characterize aversion manifestations which took place just during sexual intercourses, as well as some phenomena which were conjugated with the aversion and observed outside sexual acts.
A female patient G., 38 years old, married, has got 2 children (a daughter and a son), a nurse by education (at present she does not work by her profession). She took medical advice due to sexual problems (absence of libido, a sharply weakened orgasm, etc.). Besides, she felt marked disgust at sperm (more at its appearance and less at its smell) that was manifested during sexual contacts with her husband. An interrogation revealed that at the age of 16 years the patient was raped. After that she felt hostility to all males excluding her husband with whom she had good relations. But later it turned out that the patient’s last statement was not completely corresponding to the reality. In particular, it was demonstrated by her remark that when she was caressing her husband she thought at that time: "You are the same foul creature as those who raped me”. The circumstances of the rape were as follows. At the age of 16 she got acquainted with a boy (he was 18-19). She dated him a little (2 weeks). For one of their dates he drove a motorcycle (he approached her house at 4-5 p.m.) and suggested her to ride. She agreed. The young man drove her to a forest where they were already waited for by his friends in liquor. At first, the situation was quiet, but taking of strong drinks went on and "the pretty well drunk boys decided to gambol”. The girl did not give any cause for rude treatment, but they began importuning her with the aim of raping. As she resisted, she was unmercifully beaten. Two men beat her and tore her dress. They beat her in her abdomen and liver "which hurts even today”. She was raped only by "her” boy. He introduced his penis into her vagina only for two seconds. No ejaculation took place. He said that she should not pretend as if she were a virgin (for some reason, there was no blood, though she had not had sexual contacts with any person before). He began crying at her, called her a "bitch”, used other insults and accused her of "f…cking” with all other boys. After those words she "became flabby”. When all that was taking place, one of the boys told the others they should not behave with her like that as she was not a prostitute. But they did not change their behavior after his words and he began fighting with them. Then he accompanied her on the way to her house. There she quickly changed her dress and did not tell anybody anything as there was no blood during the introduction of the penis (she considered that it should be). Besides, in order not to leave any traces, she was beaten in her abdomen. After the rape she was twice hospitalized for pains in her liver region, but never told the medical personnel to what she related them. As a result of the above rape she began avoiding any dates with boys, but very soon at school she got acquainted with a boy who became her husband as soon as she finished the school. She noticed that she got married "for love” and by mutual agreement. At the age of 17 she got pregnant. The pregnancy only accelerated registration of her marriage. She finished medical school. Her first sexual act with her future spouse was by her agreement, but she felt only fear and constraint. The childbirth did not change anything in the sexual sphere. Her hostility and animosity towards the male sex were increasing, though a loving and careful husband was near her. At the age of 18 the following event, which is important for understanding this case, took place. She was suggested to look through a pornographic magazine; on its cover she saw a woman with a male penis in her mouth, and the sperm was trickling down from the mouth along the face to the neck (below, the word "picture” will be used as the equivalent). Then she thought: "What filth, what a nasty thing”. She vomited. "I was vomiting during the day. I could not come to myself for the whole day”. The disgust at the appearance of sperm and its smell existed up to the day when she took medical advice. Our thorough interrogation managed to specify that having seen the above picture she periodically vomited during the whole day ("from the morning to the very evening not less than 5-6 times, maybe even more, and could not eat for a long time”). Since that time the very recollection of this picture produced a marked vomitive response (reflex) which was suppressed by her. The same thing took place when ejaculation of sperm into her mouth or vagina was expected. In this connection, she noticed that every time when her husband felt an orgasm and "was finishing”, but she did not see the sperm and did not smell it, "it makes me sick just to think about it” and she saw the picture with a resultant vomitive response. At that moment the following thought developed in her: "Now it is the finale and the main thing is not to vomit, to refrain, to control myself anyhow and not to demonstrate…”. In the process of the following interrogation the patient reported that later the negative visual (real or reproduced) effect of the sperm was accompanied by an unpleasant effect of its smell. We managed to reveal that the patient did not exclude an association of such an effect of the picture with the rape, but she could not affirm it. Later in the process of psychotherapy she managed to realize this association. It turned out that in the process of a sexual act she thought that the male both enjoys and "also ejects different …”. Often at that time the following thoughts appeared: "And I should smell, swallow it, give you pleasure; all males are violators, idiots…”, etc. She remembered that when she saw the picture she thought: "In order to give you enjoyment we have to bear such an insult, such filth”. Her husband knew that she developed a vomitive response to the sperm though she tried to keep it. Once during sexual intercourse he touched his spouse’s abdomen and felt her inclination to vomiting. After that for a month he did not make any attempt to have sexual contacts with her. He knew about presence of such a response in his wife for a long time and interpreted this phenomenon as a result of her hostility towards him. The patient noticed that she was very fastidious, and with age her fastidiousness was increasing. In addition to the above facts, one more important circumstance was revealed. It turned out that after the patient saw the mentioned picture on the magazine cover she developed disgust at all other male discharges (saliva, nasal discharges, etc.). She reported that having finished medical school she was working for 5 years as the head of an infant-feeding center at her village, and then during 8-10 years at the children’s department of a hospital. Later the department was closed and she was offered to work as a nurse either at a polyclinic or the therapeutic department. She could not work at that department owing to her increased fastidiousness. But later, as the patient noticed, a worse thing took place. "I got to work at TB dispensary (I was working there for 2 years). Each duty turned inside of my intestines out” (she meant the patients’ sputum). During a purposeful specifying interrogation she pointed out again that the above disgust at all male discharges had appeared before her work at the TB dispensary, after the time when she saw the picture on the magazine cover. Moreover, the patient reported the following fact: "I even do not drink any kissel, do not eat oatmeal porridge. I used to like it so much, my mother cooked it so tasty. I do not eat it now because there is some slime in oatmeal porridge”. In response to my question that she might work not following her vocation, the patient said: "Oh, no; when I worked at the children’s department I was not fastidious about either children’s snivel or their feces”. In confirmation of her words about her quiet attitude to children’s discharges the patient reported: "It is said that one’s own shit does not stink, but we adopted a boy and I have no negative attitude to his different discharges either”. We also managed to reveal that her attitude to female discharges was much quieter than to male ones.
In order to eliminate the patient’s disgust at sperm, the following therapeutic program which included 4 structural components was developed.
1. It was necessary to change her attitude to sperm. In this connection, the patient’s attention was focused on the fact that the sperm is very valuable by its composition as it contains proteins, lipids (fats), carbohydrates, vitamins, microelements, as well as other components, and side by side with the ovule it is absolutely necessary for creating a new human life.
2. It was also necessary to change the patient’s attitude to a sexual act in the sense that it should not be taken by her as humiliation of a woman. In this connection, she was told that during sexual intercourse males eject sperm, thereby losing a very valuable substance, but it does not occur with representatives of the female sex who do not lose their ovules during a sexual act.
As a result of ejaculation the male spends a great amount of energy and in the overwhelming majority of cases is not able to have another sexual act during some period (which is not the same in different males). Therefore Taoism suggests males to master certain psychophysiological methods preventing any ejection of their sperm during sexual contacts (M. Chia, D.A. Arava, 1996). Using these recommendations some far advanced followers of this system have only a few ejaculations during their whole life. In compliance with tenets of Taoism, the main losses of energy in the males take place during ejaculation, while the main losses of energy in the females occur during menstruations rather than in the process of a sexual act (M. Chia, M. Chia, 1995). From the above, it follows that a sexual act should not be regarded as giving some "gain” to the male, but quite on the contrary ("After his ejaculation he is not capable of anything. It is you who f…cked him, but not vice versa”). As a result of these explanations, a thought was fixed in the patient that "when the male finishes it means that I f…cked him, but not he f…cked me”.
3. Another direction in elimination of the aversion to sperm consisted in the use of the swish technique (R. Bandler, 1994), one of the techniques of neuro-linguistic programming. The session conducted by us had the following course.
At first I asked the patient to see the above picture on the magazine cover with the sperm pouring out on the woman’s face. Then the session was continued and everything took place as it is described below.
Therapist: Now I want you see this picture in another way, and the image of yourself who is looking at it quietly, with new knowledge and understanding how you would like to see it, how you would like to perceive it.
Patient: Yes, there is some shift (she means the result of our previous cognitive-orientated work – the 1st and 2nd components of psychotherapy), because if I had been told about it before then now I would have developed a vomitive response (though this image did cause a negative response, the latter was less than after the previous picture).
Therapist (continuing): I want you see another image of yourself, with new knowledge and understanding when you are looking at the sperm. Then again a large bright image/scene, when she saw the picture on the magazine cover for the first time, was reproduced. But it was not accompanied by any marked aversive response, i.e. though the response was negative its intensity was small. In this reproduced image we found some small dark spot on her face, its shape resembled a button and its illumination was significantly less than that of the rest of the image. The patient was induced to see there an image of the woman with another, alternative attitude to the sperm. Then we enlarged the image, intensified its brightness and flapped the previous image away with the new one. As a result, the new bright image occupied the whole screen. Nevertheless, appearance of the image of the woman looking at the sperm in another way was again accompanied by development of unpleasant sensations. After that the patient was given an instruction to open her eyes. In the same way, the stroke was made twice more. Then, during the 4th stroke, we asked her to see the woman, who absolutely quietly responded to the sperm, in the dark spot located on the face of her image on the screen. When we were making the stroke we said it was her who was that woman, and she saw her face instead of the woman’s one. The patient reported that her attitude to that picture was quiet. The 5th stroke was made according to the same scenario as the previous one. The response to the sperm in a new image, which flapped away the old one when the patient saw herself at the age of 18 years looking at the picture on the magazine cover, was similar, i.e. no aversion to the sperm was revealed.
4. It should be noted that the above psychotherapeutic effects were not the only ones.
The fact is that even prior to the use of «the stroke method» the patient underwent the first session of hypnocatharsis when she was "plunged” into the situation of the rape and experienced it again. Later (after execution of the stroke method) we conducted 2 such sessions more. The therapeutic effect of hypnocatharsis on the aversion to sperm should be taken into consideration too, as it releases the organism from unresponded pathogenic energy supplying neurotic symptoms. We would like to emphasize that after the second hypnocathartic session, when the patient was still in the hypnotic state, we asked her to remember herself again at the age of 18, just at the moment when for the first time she saw the picture in question on the magazine cover. It was made so that the patient precisely restored in her memory what exactly caused vomiting then. When this situation was reproduced she said that when she saw the sperm she thought: "It is not enough that men humiliate women, but this physical violation is accompanied by such a nasty thing, such filth”.
The provided treatment was effective.
Thus, on the basis of analysis of this observation it is possible to conclude that the rape was a severe sexual psychic trauma for the patient and it resulted in development of sexual dysfunctions in her, as well as (by the mechanism of generalization) a negative attitude to all males. To a considerable extent, it extended to her husband too, and her perception of him was not uniform. Her good attitude to him as a human being was accompanied by a negative attitude to him because he represented for her all males in general. The picture seen 2 years later on the magazine cover resulted in the development of multiple vomiting and then in the aversion to sperm for many years. This factor (the picture seen) should be regarded as the resolving one, because the internal tension causing the diseased state was initially triggered by the rape and the situation conjugated with it. At the very moment when the patient saw the picture on the magazine cover it was associated with the psychotraumatizing effect of the rape; the patient fully realized it only in the process of psychotherapy given to her many years later. By the mechanism of generalization the disgust spread to all discharges from the male organism (sputum, slobber, etc.) and, moreover, kissel and oatmeal porridge because their slimy consistence was associated with the appearance of sperm. The provided psychotherapy (the article selectively examines treatment of aversion to sperm) was effective.
Bibliographic information about the publication: Kocharyan, G. S. On some aversive phenomena in sexual disorders clinic // Abstracts Book of 16th World Congress of Sexology. – Havana, March 10–14, 2003. – P. 10.*
*Full version of this my message (Kocharyan, G. S. On some aversive phenomena in sexual disorders clinic) was placed on CD of 16TH WORLD CONGRESS OF SEXOLOGY (Havana, March 10–14, 2003).
General information about the author, his articles and books (freely available) are on his personal website http://gskochar.narod.ru/