011 ON SOME AVERSIVE PHENOMENA IN SEXUAL
DISORDERS CLINIC
GARNIK KOCHARYAN Ukraine
kochargs@rambler.ru
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: kochargs@rambler.ru
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/