From Big Medical Encyclopedia

SEXUAL PERVERSIONS (synonym: perversions, paraphilias) — painful disturbances of an orientation of sexual desire or ways of its satisfaction.

Classification and the nomenclature

Exists several tens of classifications and P.'s nomenclatures and. Difficulty of streamlining in this area is connected with variety of the terms designating the same P. and., and inconsistency in views of independence of a number of forms. The most widespread is P.'s division and. on two groups: perversions of an orientation sexual desire (see) and the perversions which are defined not so much by an object of sexual desire, how many the nature of the actions causing an orgasm and sexual satisfaction. Refer homosexuality, pedophilia, zoophilia, a narcissism, fetishism to the first, etc. Carry a sadism, masochism, exhibitionism, a transvestitsizm, a triol-ism, frottage to the second group, etc.

Homosexuality (grech, homos equal, identical + lat. sexus a floor) — an inclination to persons not opposite (heterosexuality) as it happens normal, and the same floor. Also the persons finding sexual desire to both floors — a bisexualism (Latin of bi-double + sexus a floor meet). At the same time sometimes gomo-and heterosexual installations alternate, replacing each other. Ulrichs suggested to call male homosexuality an uranism, the male homosexual an urning, and the woman — urnindy. To male homosexuality carry an efebofiliya — sexual desire to young men and an androphylia — sexual desire to adult men. A kind of male homosexuality is the paederasty (grech, pais, paidos the boy + egao to love), or a sodomy when sexual intercourse (see. Sexual intercourse ) it is carried out by means of introduction of a penis to an anus of the boy or the adult man; the homosexual playing an active role is called as a pedikator, the player passive — kinede or patikusy. Roles of homosexuals can easily change. Female homosexuality is designated lesbian love or a sapfizm, by name by the Ancient Greek poetess Sapfo living in the first half 6 century BC on the lake of Lesbos and singing of this form P. and. Depending on age of the preferred object distinguish a corophilia — sexual desire to girls, a partenofiliya — to girls, a gynecophilia — to adult women, a graofiliya — to old women. Imitation of the sexual intercourse between women is called a tribadiya (grech, tribo to rub).

Pedophilia (grech, pais, paidos the boy + phileo to love) — sexual desire to children, a geronthophilia (grech, the aged man + phileo to love geron) — to old men, a pigmalio-nizm — to statues, a necrophilia (grech, dead + phileo to love nekros) — to corpses. Sometimes defilement of corpses is designated also the term «bertranizm» (on behalf of the fr. lieutenant Bertrán). Close to a necrophilia there is a kind of a sadism, at a cut the sexual satisfaction occurs at the act of murder or at a disfiguration of a corpse, at the same time one become widespread sexual from the act of murder, others make coitus with a corpse or subject it to a disfiguration.

Zoophilia (grech, an animal - f phileo to love zoon; synonym: a zooerastiya, a zooerotiya, bestiality, sodomy, a bestializm) — the sexual intercourses with animals, most often with goats, sheep, pigs, geese, dogs, etc.

A narcissism (by name grech, the mythological hero Narcissa who fell in love with himself; synonym: an autoerotism, an automonoseksualizm) — designation of sexual desire to. Persons with such P. and. admire the body, iron it, frig in front of the mirror. Some researchers masturbation (see. Onanism ) in general consider as a form of an autoerotism. It is difficult to agree with it since imaginations frigging, as a rule, are directed not on themselves.

At fetishism (a synonym an idolizm) sexual desire not the woman, and only separate parts of her body, napr causes, legs, hands, hair, or separate objects of its toilet — footwear, stockings, linen, etc. The patient tests orgasm (see) at contemplation of the fetish, sometimes at the same time frigs. Some of fetishists become «otrezatel of braids», others for mastering the object attracting them do not stop before theft of shoes, undershirts etc. One of the first descriptions of fetishism of footwear belongs to the fr. writer Retif de la Bretonne in this connection the term «retifizm» appeared.

The terms «sadism» and «masochism» were entered by R. Krafft-Ebing on behalf of the fr. writer de Sade (D. A. - F. de Sade) and the Austrian writer L. Sacher-Masoch which represented these P. in the works and. The sadism is characterized by receiving sexual satisfaction from causing to the partner of suffering in this or that form, beginning from insults, abuse, threats, humiliations and finishing a beating, castigation (flagel-lyantizm), drawing wounds («podka-lyvatel») or other more or less heavy damages, up to voluptuous murder that some researchers also carry to a sadism. At masochism, contrary to a sadism, the patient derives sexual pleasure when the person of an opposite sex subjects it to moral humiliation, causes it physical pain etc. According to it A. E. Che-remshansky suggested the terms «sadism» and «masochism» to replace with the terms «nasilnichestvo» and «stradalchestvo», and D. N. Stefanovsky — «an erotic tiranizm» and «an erotic passivizm». Eylenburg (And. Eulenburg) tried to put into practice the term «algolagniya» (grech, algos pain + lagneia a coition, lust) and to call a sadism active, and masochism a passive algolag-niya. The sadism and masochism are often combined among themselves therefore some researchers prefer to speak about a sado-masochism as one form. The same person can act in active, in a passive role. The sadism can be directed to persons not only an opposite, but also floor (sado-homosexuality), and also to animals (zoosadism). Carry the aspiration to soil clothes of persons of other floor, hl to a sadism. obr. women. As masochism consider the aspiration to be soiled with urine, a stake, allocations from generative organs (pikatsizm). Kind of masochism is the servilizm, or a pazhizm, at Krom the man feels sexual satisfaction, being at the woman who is pleasant to it on position of the servant or page, and also the rare form, at a cut of the patient aims to be exposed to surgeries for the purpose of receiving sexual pleasure.

Exhibitionism (Latin exhibitio presentation, exposure) — the sexual satisfaction which is caused an exposure of the generative organs in full view of women or children. A scopophilia (to see fr. voir), or a skopofiliya (grech, skopeo to observe, consider + phileo to love) — the sexual pleasure arising at secret peeping behind the sexual intercourse (is more rare behind defecation) made by other persons. A peculiar combination of symbolical exhibitionism and scopophilia is the koprofemiya (grech, kopros dirt + lat. femina the woman) — the aspiration to say in the presence of persons of an opposite sex roughly shameless, indecent words with the purpose to cause confusion and shame.

Transvestitsizm (Latin of trans-through, a feather + to dress vestire) is characterized by the fact that the patient becomes widespread sexual, putting on the dress inherent to an opposite sex (usually the man — a women's clothing). At a transvestitsizm most often there is no identification to other floor. A smaller part of transvestites is homosexuals, most of them keeps heterosexual installation. Therefore the transvestitsizm is considered by nek-ry researchers as a special form of fetishism.

At a triol-ism (grech, treis, tria three, three) or pluralism (Latin of pluralis multiple) the group of three or more people makes sexual intercourses in the presence of each other.

Frottage (fr. frottage, from frotter to rub, rub) — the sexual pleasure arising at friction about persons of an opposite sex in crowd, in the crowded tram, etc. At a coprolagnia patients feel sexual pleasure, inhaling a smell of urine or excrement of persons of an opposite sex.

Except listed, there are also other, more rare forms P. and. Despite so developed nomenclature, to-ruyu easy to expand by means of a combination of various Greek and Latin words, the existing P.'s division and. it cannot be recognized as satisfactory. It depends not only on the fact that new forms P. are constantly described and., but also from the fact that the existing forms are not firmly ogranichennsh. Classification is at a loss also the fact that the most various combinations and P.'s combinations often meet and., napr, sadism and masochism, masochism and fetishism of hands, passive flagellyan-tizm and exhibitionism; masochism and fetishism of fur.

It should be noted that for all P. and. qualitative changes of sexual desire are characteristic. It is impossible to consider a perversion just quantitative weakening of sexual desire — frigidity (see. Sexual coldness ) or strengthening of sexual desire (satiriazis — at men and a nymphomania — at women), an erotomania, or hyper eroticism, at both floors, an aydoyoma-niya — painful voluptuousness. A specific place is held by an onanism (masturbation, an ipsation), extreme prevalence to-rogo, especially in awkward age, complicates its reference to mental pathology. I. I. Mechnikov considered an onanism as expression of the disharmony in development of a human body which is characterized by the fact that sexual desire ripens earlier than there are conditions allowing to satisfy it in the natural way. Masturbation shall be considered as a perversion only if the adult, and sometimes and the married person prefers this form of satisfaction to the normal sexual intercourses.

Borders between P. and. and norm not always have rather certain and accurate character; gradation from one to another can be observed. In this regard it is reasonable to allocate perversny elements — the insignificant deviations of sexual desire inherent to normal sexuality playing a role of additional and minor accessories and not being pathology; perversny tendencies — the created deforming libidos of installation which are shown in dreams and imaginations, but for one reason or another not implementable; true perversions — the implementable distorted sexual desire, a cut partsialno or completely replaces normal sex life.

An etiology and a pathogeny

On an etiology and P.'s pathogeny and. there is no uniform point of view. Several theories — genetic, neurogenic, endocrine, neuroendocrinal, conventional (uslovnoreflektorny), psychoanalytic, etc. are put forward. Each of them (except for psychoanalytic) explains distortions of an orientation of sexual desire with disturbances only of a certain stage of psychosexual development and does not give a complete picture of a pathogeny of P. and. P.'s division and. on inborn and acquired is conditional owing to the fact that psychosexual orientations form in the course of post-natal ontogenesis and are defined by interaction of social and mental factors and patholologically the changed soil, edges it is quite often deformed in the prenatal period.

The Dizontogenetichesky concept combines the listed theories, except for psychoanalytic, and considers P. and. as result of disturbances of individual psychosexual development in post-natal ontogenesis. The main components of sexuality — sexual consciousness, gender role psychosexual orientations (sexual desire) — form in the course of psychosexual development since first months of life under the influence of biological and social and mental factors. Biol, factors in the prenatal period define a sexual differentiation of the gonads, an urogenital path and structures of a brain responsible for a sexual behavior, a maternal instinct, aggression, etc., and in post-natal ontogenesis provide puberty and energy potential of a libido. Social and mental factors influence formation of sexual consciousness and gender role, define an orientation of sexual desire.

In psychosexual development it is possible to allocate several stages, formations of the main components of sexuality. At the first stage (from 1 year to 5 — 7 years) the sexual consciousness — understanding of accessory of people around and the belonging to the defined sex forms. This formation happens under the influence of the microsocial environment, but is substantially determined biologically. Carry a transsexualism to disturbances of sexual consciousness — strong feeling of belonging to an opposite sex, despite correct, corresponding to a genetic floor, formation of gonads, an urogenital path and secondary sexual characteristics. The transsexualism comes to light usually up to 5 years and does not belong to P. and.

At the second stage (from 5 — 7 to 12 years) under the influence of the microsocial environment there is a choice and development of gender role, the most corresponding to psychophysiological features of the child and oriented to ideas of a maskulinnost of an ilifemininnost, Distortions of gender role are shown in its transformation (a femininny stereotype of behavior at men and masculine — at women) and in orientation of the personality in behavior on excessive accentuation of nek-ry features of gender role. In response to administration of oestrogenic drug at feminized male gomoseksua fishing reactions on female type, and at nek-ry are revealed. the female homosexual-sualok — on men's; it allows to assume that disturbances of a prenatal differentiation of a brain affected transformation of gender role and further promoted formation of a homosexual inclination, but did not predetermine its emergence. Disturbances of gender role can be caused also by influence of the microsocial environment (a social tion of the child of an isol, the wrong sex education, education as hyper guardianship and t. On) and mental disturbances.

At the third stage (from 12 — 13 to 21 — 26 years) there is a formation of psychosexual orientations, i.e. formation of Platonic, erotic and sexual components of sexual desire that in the subsequent defines the choice of the preferred object (people, an animal, a subject) with his specific features (a sex, outward, behavior, etc.), and also need for implementation of sexual desire of a certain situation and a number of the consecutive actions sometimes making the real ritual. Disturbances of this stage of psychosexual development are also P. and.

According to the dizontogenetichesky concept, P. and. fixing of the separate hypertrophied manifestations of psychosexual development inherent to its early stages result. These are not simply relic, and undergone changes in ontogenesis and the unripe forms of behavior of children's and teenage age which joined in sexual desire. As the background promoting P.'s formation i.g and also defining their expressiveness serve various options of a psychosexual dizontogenez (disturbance of individual psychosexual development of an organism from the moment of conception until the end of life) which consist in distortions of gender role and in disturbances of terms and rates of psychosexual development. Depending on a background it is possible to allocate three groups P. and. Tranzitorny, replaceable, P. and. are observed in the absence of an opportunity to adequately realize sexual desire, napr, in the period of youthful hyper sexuality, at long isolation of adults in same-sex collectives. They are usually combined with the correct psychosexual development and disappear at normalization of sex life.

The second group is made by P. and., forming against the background of a delay of psychosexual development, i.e. lag of terms of formation of sexuality from average norm (from passport age). The delay of psychosexual development is usually caused by delay of puberty, mental deviations and influence of the microsocial environment. It is expressed in disturbances of communication with persons of an opposite sex and a delay of formation of sexual desire at Platonic and erotic stages (see. Sexual desire ), what results in impossibility of adequate implementation of a libido. In these cases P.'s formation and. lasts many years, they do not mention a kernel of the personality (character and outlook of the person), long are not implemented, exist in the form of perversny tendencies and reflect difficulties of communication with persons of an opposite sex.

Carry P. to the third group and., forming against the background of premature psychosexual development (the early formation of sexuality advancing average age norms and puberty), a cut it is caused in most cases by mental disorders or corruption and seduction from teenagers, adults and elderly persons. At mental disturbances sexual desire usually advances sexual activity, and at corruption and seduction on the contrary. A necessary condition for premature psychosexual development is decrease in excitation thresholds of the nervous structures providing an ejaculation and an orgasm. At premature psychosexual development the stage of formation of psychosexual orientations accumulates on a stage of formation of gender role that promotes bystry and strong inclusion in sexual desire of inadequate forms of its implementation, alloyage of the deformed inclination with gender role and a kernel of the personality. In these cases of P. and. define behavior; they are firm during all life and usually a rezistentna to therapy.

Disturbances of gender role leave a mark on P.'s formation and., and at a sadism and masochism define their emergence. Patol. the stereotype of the behavior oriented to excessive accentuation of nek-ry features of gender role causes formation of a sadism at men and masochism at women, transformation of gender role — a sadism at women and masochism at men. These frustration define a role, to-ruyu, irrespective of a floor, the homosexual in contacts will play.

Options P. and. at various mental diseases often reflect psychopathological features of the personality, napr, at hysterical psychopaths (see. Psychopathies ) exhibitionism and a narcissism, at excitable — exhibitionism and pedophilia in combination with a sadism, at tormozimy — a scopophilia, pedophilia, fetishism and bestiality can be observed.

Treatment and Prevention

P.'s Treatment and. it is complicated. It shall be long and complex, include various psychotherapeutic techniques (see. Psychotherapy , Hypnosis ) and to be directed to elimination patol, inclinations and formation of adequate communication with persons of an opposite sex.

P.'s prevention and. consists in the prevention of various pathogenic influences promoting distortion of sexual desire and includes early diagnosis and timely treatment at children and teenagers of the mental diseases causing premature psychosexual development; prevention at children (from the earliest age) disturbances of communication; prevention of corruption and seduction, including access to pornographic editions.

By the Soviet legislation the sodomy is considered as a crime and is punished by imprisonment for a period of up to 5 years, and under the aggravating circumstances — up to 8 years (Art. 121 of UK RSFSR, 1960). Other criminal actions connected with P. and., are not provided by special articles, but can get under action of Art. 113 (torture), Art. 119 (the sexual intercourse with the person which did not reach puberty), Art. 120 (dissolute actions), Art. 228 (production, distribution and advertizing of a pornography), etc.

See also Sexual crimes .

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E. A. Popov, G. S. Vasilchenko, V. M. Maslov.