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Cory Silverberg

The Rights and Privileges of Masturbation

By May 16, 2011

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In case you hadn't heard about it already, May is National Masturbation Month. I usually "celebrate" this month in private. When I do take public advantage it's to talk about masturbation as a sexual health educator and I tend to focus on the good stuff: Masturbation is a form of self-love, it's a great way to learn about your body and your sexuality, it's free, and it feels good. But any real conversation about sex can't be all positive. Sexuality may be a wonderful thing, but it's also the site of much shame and pain. So when a colleague of mine, a therapist who works with a lot of transgender and transsexual clients, updated me on what's been going on with revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM), I thought it was a good opportunity to talk about a different side of masturbation.

So let's play a game. Think about the last four or five times you masturbated. Try to recall where you were, what you were doing, and what you were thinking and/or fantasizing about.

Got it in your mind? Good. Now how would you feel about sharing, in vivid detail, your masturbatory fantasies? And not with a close friend or lover. Picture telling a doctor. Who is writing everything down. In a file. With your name on it.

Here's another question. If you were going to tell this doctor the content of your masturbatory fantasies, would you say that they would have an accurate or complete sense of who you are as a person? How much would you say they understand about your life, your thoughts or feelings, your experience of your body, and of being in the world with other people? What exactly do you think that your masturbatory fantasies reveal about who you 'really' are?

This actually isn't a game, and it's certainly not funny if you're someone who wants to access health care services and support in order to transition from the gender you were identified as at birth to the gender you feel yourself to be. Those among us who might have this experience who variously get called, or claim the identities/labels of transsexual, transgender, gender variant, gender dysphoric (to name only a few) often have no choice but to submit to precisely this kind of masturbation interrogation, despite the fact that there is no compelling evidence (or, one might argue, well thought out rationale) for demanding such information.

The reason doctors ask these questions is because a small group of researchers with anachronistic notions of sexuality, gender, and mental health, and too much power have long argued that there is a connection between our gender identity (how we experience ourselves as men, women, masculine, feminine, or otherwise) and our sexual orientation (who we are primarily sexually attracted to). And they also think that what you think about when you masturbate is an essential part of diagnosing both (since their theories apparently allow them to know us and the meaning of our fantasies, better than we know ourselves).

While billions of us live our lives experiencing both gender and sexual desire as two complicated, alternatively interwoven and independent threads of experience and are made to publicly account for them in only the rarest circumstances, if you want help in making the outside of your body match the way the inside of your body feels, you have to explain yourself which, according to the 'logic' of the DSM, means explaining your masturbatory fantasies to a stranger.

There was some hope that this throwback to Freudian notions of sexual development would finally be dropped from the new DSM. Researchers, many of them, have been actually listening to their research subjects, and clinicians, some of them, have been paying attention to their clients. The result was beginning to sound like something that treated people with respect and dignity (though far from perfect since people must still call themselves disordered to access care).

But as it stands today, it appears as if the masturbation question will remain, as will other questions designed to "prove" or "reveal" one's sexual orientation. Not because these questions offer any demonstrable benefit to the people who are asking for support. But because these few researchers (folks who publish studies with titles like The Sex Ratio of Older Siblings in Non-Right-Handed Homosexual Men and Anatomic Autoandrophilia in an Adult Male) would like to collect data so they can publish more studies like the aforementioned. The understanding being that their research agendas trump your rights.

Lest this sound like too much of a theoretical argument remember what we're talking about. We're talking about you being forced to share your fantasies with someone who has control over what sort of medical care you will receive, and is going to provide it based on how well your fantasies meet their expectations. It's humiliating, and among other things it is, or should be, clinically inexcusable.

I love masturbation, and I do think we'd all be better off if we were having more public conversations about masturbation on a societal level. But doing so ethically, and doing so in a way that doesn't simply repeat past injustices, means acknowledging that we don't all have the same access to our basic rights.

So until we all have the privilege of keeping our private thoughts private, let's give some thought to the power of masturbation and the legacies of disempowerment that allow pleasure to be subverted by power and look forward to the day when we can all have the right to celebrate masturbation on our own.

Read more - DSM-5 Development: Gender Dysphoria in Adolescents or Adults

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Comments
May 18, 2011 at 11:12 am
(1) Cuckholddon says:

I’m not entirly convinced that the masterbation question should be eliminated!
My thoughts tend to be more about healthy “attitudes” reguarding sexualiy,the body& it’s functions and being able to talk about it openly and without any feelings of guilt!
As with any “problem”–If one can’t talk openly, It won’t get resolved!
There are still folks who can’t talk with doctors& have to be allmost crictly ill before they will talk about certian health problems,so instead of the doc. finding& treating the “small” problem -It becomes a serious problem!

May 18, 2011 at 8:20 pm
(2) ramswrsw says:

@Cuckholddon: As a sex therapist I do ask masturbation questions, but I ask them in a way that respects clients’ rights not to disclose, and try to stick with what is relevant to the issue they present.
For me, there is a world of difference between inviting an open discussion about a person’s masturbation and what Cory is describing: a close-ended interrogation designed to meet the criteria of a therapist’s agenda.

May 19, 2011 at 4:03 am
(3) Someone facing this in the next few months says:

I am a trans person who soon will be facing these barriers to receiving treatment.

@Cuckholddon: The thing is, I don’t HAVE a sexual “problem.” I have a gender-related problem that, to me, has very little to do with my sexuality.

I (and every trans person is different, so I only speak for myself) feel like I have a hormone disorder; my body produces sex hormones in the wrong ratios, which gives me a misgendered appearance. If I go to the doctor asking for medical help correcting this appearance, I want the doctor to treat that problem. Not to decide for me that there’s something wrong with my sexual desires/behaviors, even when I feel no sexual distress at all. And I definitely don’t want the doctor to withhold treatment for my gender problem if I turn out not to have the “sexual problem” he wants to find!

Imagine how it would feel to go into the doctor with dizziness and painful headaches, but be refused treatment because you can walk a straight line. And add to that the emotional discomfort of telling a total stranger about your intimate feelings. And the additional distress of having those feelings evaluated, graded, and judged, and a judgment passed on you based on the score that you get!

Furthermore, it’s all well and good to say things like “people shouldn’t be ashamed of speaking about masturbation.” But trans people are a very specific, small minority that has been historically eroticized, exoticized and also reviled and oppressed, and now forced to expose their sexual selves. Forcing a powerless patient who needs medical care to disclose this kind of information isn’t promoting sexual openness. It’s singling out vulnerable patients who may be willing to go through any indignity to obtain care.

It almost makes me want to stay in the closet and live with the pain and loneliness of gender dysphoria instead of putting myself at the mercy of professionals who will likely never be in as helpless and needy a situation as mine. :(

May 21, 2011 at 6:47 pm
(4) no way says:

My refusal to undergo this sort of interrogation has delayed my access to surgery for a number of years and worsened my depression and anxiety enormously, to the point where I’ve been on social assistance for the last four years.

Even if I had felt comfortable discussing my sex life and practices with a doctor (which I do not, for reasons the above commenter described), the gender clinic I was legally required to attend would have refused to believe me or approve my treatment because I am gay and thus in their eyes a (confused) masculine heterosexual woman. (Other strikes against me include disability resulting in the inability to work or attend school full-time and an ‘insufficiently masculine’ new name.)

As a citizen of my country, I am supposedly protected from discrimination based on sex, disability, and sexual orientation. I am also supposedly entitled to receive essential medical care for free.

Thankfully the laws have changed recently and it’s now likely I’ll be able to have surgery before the end of the year, but that doesn’t make me any less furious. As a citizen of my country, I am supposedly protected from discrimination based on sex, disability, and sexual orientation. I am also supposedly entitled to receive essential medical care for free. Meanwhile, I’ve had to spend years living in poverty while trying to access the necessary care to improve my situation and health… only to be told that as a gay man with a mental illness, I wasn’t entitled to receive help.

To the commenter above me: I’m so sorry you have to go through this. Good luck.

May 16, 2012 at 7:39 pm
(5) MMJ says:

This is my first time posting. I’m a medical student and i’ve been following your blog for sometime. I think your website is a fantastic resource in general. This post, however, has left me with many unanswered questions! First, in our training as medical students we are taught to collect detailed histories, including sexual, spiritual, and social histories. They are all things that make up who we are as human beings. So i don’t think it’s wrong for a physician to ask about masturbatory fantasies. Secondly i couldn’t find anything in the DSM IV or V criteria about masturbation specifically or about how sexuality necessarily must be part of gender. There may be something in state, or federal laws (which are NOT part of medicine per se, but intersect with how care is delivered) that i am not aware of. I must say, my heart goes out to anyone who has experienced discrimination at the hands of a physician or the medico-legal complex. I do understand there is much that is not right out there, but there are many caring psychiatrists, psychologists and physicians that work with BGLT patients in a non-judgemental, open way. A sex change is a major operation and just like a physician shouldn’t just give you xanax because you say you are anxious and should dig deeper, changing your

May 16, 2012 at 7:39 pm
(6) MMJ says:

physical sex to match your internal gender should be done in an understanding, but comprehensive manner. In order for this to be safe and equitable the psychiatric and psychological professions need standards and guidelines that are as evidence based as possible. In closing the evidence we have about masturbation and gender may be unpleasant in its clinical coldness, but research is no less important isn understanding the human psyche than is compassionate care in understanding and working with patients with gender dysphoria AND research must be broad and include details so we know how best to help a client/patient. The questions must be asked, as unpleasant and uncomfortable as it may be. I only hope most health care professionals exercise compassion and empathy in these encounters.

May 16, 2012 at 7:45 pm
(7) MMJ says:

I forgot to add one thing about evidence: who’s to say masturbation is not clinically relevant? You seem to believe this with relation to sex change, and it may be true, but I have to ask why?

May 17, 2012 at 1:41 pm
(8) kdiva says:

I totally understand how this issue could be difficult to discuss for some people. However, I have been in therapy for depression,anxiety and my bi-curious issues of wanting to be with a woman even though I am married to a man. I have no problem sharing my sexual/masturbation fantasies with my therapist,I think he should know everything that is going on in my head.!!

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