Sexually Transmitted Diseases - I. I. Mavrov 2005

Sexual Deviations
Sexual Perversions

Sexual perversions (paraphilias) are pathological deviations in the orientation of sexual drive or the Methods of its satisfaction, representing a departure from the norm in fulfilling the sexual instinct that has become an end in itself. They may stem from congenital factors, intrauterine conditions, endocrine disorders, Nervous system lesions, and other causes. They can also arise under METABOLISM/18.html">The Influence of unfavorable environmental factors. Additionally, a conditioned-reflex genesis of perversions is frequently observed. Upbringing plays a significant role in The Development of Various Forms of sexual perversions, particularly conditions where an adolescent or young adult prematurely receives intense erotic stimulation or takes "lessons" from more experienced peers.

Unlike normal sexual intercourse with a person of the opposite sex, there are numerous and diverse deviations in the orientation of sexual drive (e.g., homosexuality, pedophilia, zoophilia, narcissism, fetishism, etc.) and pathological methods of its gratification (sadism, masochism, exhibitionism, transvestism, froteurism, etc.).

Homosexuality (homoeroticism) is a state of sexual arousal characterized by an erotic attraction toward persons of the same sex—that is, a man experiences sexual desire for a man, and a woman for a woman. Homosexuality is widespread, occurring across all continents and among all peoples. For instance, in the USA, true homosexuals account for about 4% of men and 3% of women. Furthermore, by the age of 45, 13% of women have experienced an orgasm induced by homosexual relations; 27% of women in England have engaged in homosexual acts at least once in their lifetime, and 6% have become exclusive homosexuals. In Ukraine, homosexuality (both male and female) is observed in approximately 1–3% of cases.

The issues surrounding homosexuality encompass not only biological and medical aspects but also social and legal dimensions regulated by policies and laws designed to govern the rights of both sexes and their offspring regarding sexual relations and their consequences. Modern shifts in Sexual Behavior, along with The Emergence of new-generation Sexually Transmitted Infections—most notably AIDS—have confronted society as a whole, and healthcare in particular, with novel ethical challenges associated with Sexual deviations, including homosexuality.

Homosexuals are generally divided into four groups:

a) individuals with an exclusive sexual drive toward their own sex;

б) individuals who retain sexual attraction toward the opposite sex as well;

в) individuals with a homosexual drive who simultaneously exhibit feminine character traits in men and masculine traits in women;

г) homosexuals possessing physical CHARACTERISTICS OF THE opposite sex: feminized men (lacking facial Hair, with a high-pitched voice, developed Mammary Glands, widened pelvis, etc.) and masculinized women (with facial hair, a deep voice, a masculine gait, underdeveloped mammary glands, etc.).

Male and female homosexuals are often categorized relative to their same-sex partners as masculine and feminine, or active and passive. Masculine homosexuals—whether men or women—assume a more active, traditionally male role; feminine homosexuals, regardless of their biological sex, assume the female role and are classified as passive homosexuals.

Sometimes, psychological changes are also observed in homosexuals. In particular, male or female homosexual behavior manifests through corresponding psychological conduct. Their sexual activity typically consists of relieving sexual tension through mastography (often mutual manual satisfaction) or utilizing natural body orifices (Mouth, rectum, etc.). It is essential to distinguish homosexuality as a pathological drive toward persons of one's own sex from non-pathological homosexual behavior. Since human sexual drive is under conscious control, homosexual behavior may not develop even in the presence of inversion. For example, a man or woman with inverted sexual orientation may compel themselves to marry and have children. Conversely, homosexual behavior can also manifest in healthy individuals under the influence of coercion, material gain, imitation, or seduction—such as when adolescents are seduced by homosexuals or when individuals lacking access to normal sexual life resort to mutual masturbation, which is sometimes observed in correctional facilities. In such cases, these individuals can easily resume a normal heterosexual life afterward.

Among male homosexuals, there is structural heterogeneity in homosexual behavior, manifesting in various patterns. In the first pattern, the heterosexual component of sexual behavior remains predominant, characterized by a marked lack of discrimination in choosing women, the absence of an interpersonal component in sexual desire, and the concurrent presence of both heterosexual and homosexual liaisons.

In the second pattern, the homosexual component outweighs the heterosexual one. While these men may marry and have children, they concurrently maintain numerous homosexual relationships.

The third pattern is characterized by the near-complete disappearance of the heterosexual component, leaving only a faint attraction to women. These men exhibit specific objective indicators: their marriages (if contracted) are typically fragile and seemingly serve a "socially protective" function. Through this, such individuals project an image of heterosexual activity to society, posing as normal men; in reality, however, they represent an extreme manifestation of homosexual deviation. An analysis of their sexual behavior may reveal distinct, sometimes sharply delineated subcultures among them.

Female homosexuality manifests as lesbianism, or sapphism. Female homosexuals, much like men, may lead a conventional heterosexual lifestyle, marry, and bear children. Analogous to male homosexuality, two forms of female homosexuality are distinguished—active and passive. Active homosexuals are women who imitate male behavior in both sexual and non-sexual interactions and psychologically identify as men; passive homosexuals are those who firmly identify with the female sex. According to A. M. Svyadoshch and E. M. Derevynska (1964), the active form of homosexuality was identified in 58% of examined female homosexuals, and the passive form in 42%.

Active homosexuals typically direct their sexual energy toward younger girls or women. Men fail to arouse them sexually; even the mere thought of a man's caresses, let alone sexual intimacy, is repulsive to them. Initially, they tend to conceal their sexual interest, presenting themselves as devoted, attentive friends who are eager to help and frequently give gifts. Gradually, having won the friend's trust and affection, they begin to display increasing tenderness, securing permission to caress and kiss before progressing to sexual acts. Only a small minority exhibit homosexual aggression without preliminary courtship. Homosexual women strive at all costs to elicit an orgasm in their partner, often demonstrating considerable skill in doing so.

Most active homosexuals initially seek to establish a psycho-erotic mood in their partner, then proceed to general bodily caresses, attempting to identify erogenous zones. Subsequently, depending on the Location of these zones, they apply targeted stimulation.

Unlike heterosexual women, some active homosexuals display a high degree of sexual aggressiveness. They pursue the object of their affection with great persistence and tenacity, seeking intimacy, and in some cases, resorting to threats and direct aggression. Physically, about 60% of active homosexuals exhibit prominent masculine features—strongly developed musculature, a narrow pelvis, broad shoulders, a masculine gait, awkward movements, a coarse voice, and male-pattern pubic hair distribution. Roughly 40% of active homosexuals are indistinguishable in physique and appearance from heterosexual women. It should be emphasized that masculine somatic and psychological traits are sometimes observed in healthy heterosexual women as well, meaning they cannot serve as a sole basis for diagnosing homosexuality, although they occur more frequently in active homosexuals than in heterosexual women.

Passive homosexuals assume the female role in both sexual and non-sexual interactions. In appearance, they are indistinguishable from typical women. As a rule, they enter into homosexual relationships either before engaging in heterosexual activity or when failing to find satisfaction in marriage. Many of them experience loneliness, a need for tenderness and affection, and a desire for a close companion. Typically, a passive homosexual initially views her prospective partner as an attentive, affectionate, devoted, and loving friend—sometimes as a strong figure to lean upon. However, a time eventually comes when erotic infatuation takes precedence, and initial expressions of tenderness evolve into homosexual relations.

Most passive homosexuals achieve orgasm As a result of their partner's sexual actions, often more intensely than during sexual intercourse with men. Many develop a strong infatuation with their partner that gradually transforms into deep attachment. A homosexual couple is thus formed, in which one woman assumes the male role and the other the female role. Such couples frequently maintain their relationship for many years, disguising it as friendship, and the eventual breakup with a partner is sometimes experienced as exceptionally painful.

The homosexual orientation in passive homosexuals is less pronounced than in active ones. When placed in a favorable environment, they frequently transition back to a heterosexual lifestyle, particularly if their maternal instincts remain intact. If a man is subsequently capable of providing sexual satisfaction, this return to normal sexual life can prove stable.

The causes of homosexuality remain not fully elucidated. Various viewpoints regarding its origins generally reduce to the following theories: genetic, endocrine, neurogenic, neuroendocrine, intrauterine, psychoanalytic, and conditioned-reflex. Numerous researchers (M. Hirschfeld, 1922; J. Sander, 1934; D. Habel, 1950; D. West, 1983, etc.) maintain that homosexuality is genetically determined. The hereditary nature of homosexual orientation is supported by observations of homosexuality in monozygotic and dizygotic twins, as well as in multiple members of the same family. The hypothesis that endocrine disorders may form one of the biological bases of homosexual behavior is reinforced by the emergence of homosexual tendencies in adrenal cortex hyperfunction, Treatment with high doses of Male Sex Hormones, and elevated estradiol levels.

Conversely, some reports indicate that endocrine disorders play no significant role in the genesis of homosexuality (A. M. Svyadoshch, E. M. Derevynska, A. S. Grinshpun, et al.). The neurogenic theory is supported by cases of homosexuality developing in previously heterosexual individuals suffering from infectious diseases affecting the Central Nervous System, encephalitis, severe trauma, or neurotoxic damage. These findings suggest that disruptions in certain cerebral mechanisms can trigger homosexuality. G. Durner (1972) along with M. McCulloch and I. Waddington (1981) propose that homosexuality results from intrauterine neuroendocrine pathology, arising from a disturbance in the differentiation of sexual behavior centers in the fetal Hypothalamus due to Hormonal Influences. Specifically, homosexuality develops in a genetically male fetus possessing Testes if androgen levels prove insufficient at the critical period, and in a genetically female fetus in the presence of excess androgens or estrogens. Nevertheless, not all cases of homosexuality can be accounted for by this theory. Certain psychoanalysts view homosexuality as a result of arrested sexual development at an early stage, precluding heterosexual object choice. Others consider various forms of homosexuality to be acquired—arising from adverse environmental influences (early sexual overstimulation, deprivation of contact with the opposite sex, difficulties in social interaction, or specific viewpoints during personality formation).

The theories outlined above rely on various Factors influencing the development of homosexual orientation, yet they often overlook the Clinical forms of homosexuality stemming from diverse etiologies. The active form of female homosexuality and the passive form of male homosexuality are, in most cases, rooted in a pronounced deviation of psychosexual development. This is corroborated by the frequency of opposite-sex somatic and psychological traits manifesting in these patients since childhood. Such inversions are highly likely to be caused by both genetic and exogenously induced disruptions in the Differentiation of the fetus's sexual centers during the critical period (the 4th to 6th month of intrauterine life), aberrations in maternal or fetal sex hormone production, or the administration of sex hormones to the mother during Pregnancy. Furthermore, they may result from pathological secretion of gonadotropins or sex hormones, or an acquired or innate reduced sensitivity of the fetal hypothalamus to hormonal signals.

According to A. Ehrhardt and G. Money (1968), female infants whose mothers received male sex hormones during pregnancy to prevent Miscarriage frequently exhibited "boyish" behavior—that is, characteristic traits typical of most active homosexuals.

Inversions acquired as a result of organic Brain lesions, endocrine disorders, or other conditions developed in adulthood are extremely rare. Situational factors do not play a decisive role in the onset of active female homosexuality or passive male homosexuality.

The passive form of female homosexuality is likely rooted in conditioned reflex pathways linking the experience of orgasm with the woman who triggered it. For many healthy women, sexual desire toward a man arises only after they begin experiencing orgasms. Consequently, if a woman's sexual life with a man lacks sexual satisfaction, it can foster the fixation of her sexual desire onto a woman who successfully provided that gratification. An enhanced predisposition to forming extremely robust conditioned Reflexes may also contribute to this dynamic.

Thus, it can be said that active female homosexuals are generally born with a predisposition specifically toward the active form of homosexuality, whereas passive ones are made. The analogue of passive female homosexuality is active male homosexuality, which is based on the fixation of initial strong sexual experiences onto the person who provoked them.

Individuals with heightened sexuality or paraphilias are well aware of society's moral standards, yet they do not always adhere to them. Frequently, despite having a stable family, they engage in numerous sexual affairs. They tend to exhibit promiscuous sexual behavior, alcohol abuse, and an impulse to frequently change jobs. Complex interpersonal dynamics often arise within their families. While cautious when choosing acquaintances, they easily succumb to liaisons with casual partners when under the influence of alcohol.

It is worth emphasizing that homosexuality is widespread in urban areas, particularly in large cities. Furthermore, the number of homosexual individuals engaged in prostitution is on the rise.

Deviant sexual practices and a dissolute lifestyle lead to the spread of sexually transmitted infections (Syphilis, Gonorrhea, chlamydia, mycoplasmosis, AIDS, etc.). Unusual sexual practices also give rise to infections with atypical localization, such as proctitis, pharyngitis, Conjunctivitis, gonococcal intertriginous Skin lesions, and so forth.

Erotophobia is the fear of sexual intimacy or aversion to sexual contact. It is observed in individuals who lack self-confidence, have lost The ability to understand The Significance of their actions, or struggle to control the emotions and desires that drive the realization of sexual drive.

Narcissism (autoeroticism) is a form of paraphilia in which sexual gratification is achieved through the contemplation of one's own nude body or specific parts thereof, including the genitals, sometimes accompanied by masturbation. This orientation of sexual drive, wherein one's own body is preferred as the object of sexual attraction, is termed autoeroticism.

Exhibitionism is a form of paraphilia in which sexual satisfaction is attained by exposing one's genitals in the presence of individuals of the opposite sex, representing a male equivalent of masturbation in the presence of a woman. The counterpart to exhibitionism is voyeurism (visionism), a type of paraphilia where sexual pleasure arises from observing the genitals or secretly watching the sexual acts of others. This category also includes a peculiar variant known as erotic zoophilia, wherein sexual arousal occurs while observing the mating behavior of animals.

Exhibitionism and voyeurism occur predominantly among males and are exceedingly rare among females.

Fetishism is a sexual attraction triggered not by the woman herself, but rather by specific parts of her body (hand, FOOT, Nose, eyes of a particular color, hair) or details of her attire (shoes, stockings, underwear, hairpins, gloves, handkerchiefs, etc.), and occasionally by objects or traits unrelated to another person (scents, voice timbre, a painting, a statue, etc.). For instance, a bare hand that serves as a fetish for a man ceases to be one when gloved, or conversely, a bare leg may fail to arouse him, whereas wearing a stocking endows it with fetishistic properties.

Normally, the sight of the female body, specific scents (such as perfume), or items of women's clothing can have an arousing effect on a man. In pathological fetishism, intense sexual arousal is triggered by the sight of specific body parts, articles of women's clothing, or even memories and mental images of them. In this state, the man loves only his fetish rather than the woman to whom it belongs. Some fetishists will even resort to theft (of shoes, undergarments, etc.) or cutting off locks of hair to acquire the objects of their desire. The patient achieves orgasm while contemplating the fetish, sometimes masturbating in the process.

Transitional forms between fetishism and normality are numerous, and the boundaries between normal and pathological behavior are sometimes blurred. To some degree, every person is a fetishist to a certain extent. Fetishism is encountered primarily in men and extremely rarely in women, which may be explained by the fact that women are significantly less likely than men to react sexually to visual stimuli.

A variant of fetishism is sexual attraction toward elderly individuals (gerontophilia). This is more frequently observed in infantile girls with weak sexual drives who seek out a man not so much as a lover, but rather as a strong, protective friend and father figure capable of surrounding them with care.

A distinct variant of fetishism is transvestism, a paraphilia in which sexual arousal and gratification are achieved by cross-dressing in the attire of the opposite sex (typically female). Such individuals often exhibit a psychological inclination to present themselves in The Role of the opposite sex. While their general sexual orientation remains directed normally, male transvestites predominantly prefer masculine-appearing women, whereas female transvestites tend to favor feminine-appearing men.

Sadism is a form of sexual arousal wherein gratification is achieved through the infliction of physical pain upon a partner. The methods of tormenting a partner vary widely and may be driven by physical or psychological means—such as degrading, berating, or mocking the sexual partner. In some instances, this urge is masked by passionate embraces. Sometimes, during an initial, ostensibly refined phase, a man provokes a woman's maximal readiness for intimacy only to abruptly cut off contact, deriving pleasure from her subsequent reaction. When physical methods are employed, they typically involve pain stimuli ranging from mild to severe, inflicted through bodily harm before or during sexual intercourse. A sadist may achieve orgasm merely by watching the torment endured by the victim.

A sadistic act can escalate imperceptibly, shifting from a normal sexual drive into an impulsive act, violence, or even murder. Beginning with a seemingly innocent, gentle pinch, it can culminate in the most refined and bestial forms of torture and abuse inflicted upon the victim. In such cases, the act of cruelty replaces the sexual act itself—meaning There is a fusion of cruelty with sexual lust. Sexual intercourse is sometimes even performed with an already strangled or stabbed victim (necrophilia).

Sadism is more commonly observed in men. While manifestations of sadism are exceedingly rare in heterosexual women, sadistic inclinations are quite frequently observed among active female homosexuals.

The genesis of sadistic manifestations is diverse. They are associated with neuroses and psychopathies, conditioned reflex mechanisms, the disinhibition of the ancient instinct of sexual aggression coupled with a sense of personal inferiority, which expresses itself as a drive for sexual dominance. Sadism is also viewed as a manifestation of hypermasculinity.

Treatment for sadism aims to disrupt the persistent pathological conditioned reflex underlying this paraphilia and is based on psychotherapy, redirecting sexual stimuli toward other spheres (physical culture, sports, physical labor, art, etc.), and The Use of hypnosis. Prevention of sadism is likewise grounded in these principles.

Masochism (the pursuit of pleasure through suffering, or absolute gratification derived from a state of suffering) is a paraphilia in which a patient obtains sexual satisfaction by experiencing physical or moral torment inflicted by a sexual partner. A masochist experiences arousal and pleasure while immersed in suffering, powerlessness, and defenseless submission to the partner's cruelty, violence, and rough treatment. Men find ultimate bliss in total subjugation to a woman, requiring her to humiliate, beat, inflict pain upon, and treat them harshly. Female masochists frequently derive satisfaction if the object of their affection strikes, insults, or forces them to grovel at their feet, and so forth.

In some cases, pleasure derived from pain also occurs during normal sexual intercourse—such as playful biting during caresses—yet in masochism, this phenomenon, which normally merely accompanies intercourse, assumes an exclusive and singularly decisive role. The craving for physical or psychic suffering is simultaneously coupled with an urge for complete subjugation to the sexual partner. A peculiar variant of masochism involves jealousy-based perversion, where a man desires not only for his wife to flirt with another man, but actually seeks their physical intimacy, after which his own subsequent sexual act with her proves to be exceptionally intense.

Unlike sadism, masochism is observed more frequently in women than in men, possibly because women possess a heightened psychological inclination toward submission during sexual intimacy. The experience of helplessness, submissiveness, and inability to resist takes center stage in these masochistic experiences. At its core, masochism may stem from The formation of a conditioned reflex bond between the sensation of pain and intense sexual arousal. By its origin, masochism does not develop on any specific sexual foundation, but rather typically results from a psychogenically inhibited and deviated drive development. It is encountered primarily among psychopaths and neuropathps, individuals exhibiting mental retardation, degenerates, the mentally ill, as well as those with diminished or absent ethical sensibilities.

Treatment. Therapeutic interventions must take into account the underlying causes that provoked masochistic patterns and their manifestations. Standard treatment for masochism is largely identical to the treatment of neuroses. Alongside pharmacological agents, practitioners recommend psychotherapeutic techniques and methods aimed at influencing the patient's psyche, which can occasionally be of decisive importance. Treatment Selection must carefully factor in the patient's personality traits and ethical and moral guidelines.

Picacism is the drive to intensify the sensation of orgasm by engaging in sexual intercourse via non-vaginal routes. This category includes coitus per oris (oral sex); coitus inter manias, or narvasadata (insertion of the Penis between a woman's breasts); axillary coitus, and similar practices.

Pikacists are not satisfied with conventional methods of sexual intercourse, instead turning the face or the anal opening into a sexual organ. They force women, particularly young girls, to perform oral sex on their sexual Organs, or they themselves perform oral sex on women. At the same time, female pikacists willingly, and not without pleasure, offer their anal opening and mouth as a substitute for the Vagina.

Froteurism is a form of sexual deviation in men in which sexual arousal and gratification are achieved by rubbing the genitals against the outer clothing of women in public places. Froteurism may also occur when normal sexual intercourse can take place (or does take place), but sexual gratification is attained by rubbing clothed or unclothed genitals against some part of a woman's body.

Zoophilia (bestiality, sodomy) is a sexual deviation in which an animal—most commonly a female donkey, goat, pig, dog, rabbit, and occasionally chickens or geese—serves as the object of sexual attraction. Sexual contact with animals occurs primarily among intellectually limited, debauched individuals. Zoophilia is frequently accompanied by the torture of animals (zoosadism), whereby sexual arousal or orgasm is achieved through the torment or killing of the animal.

In modern society, zoophilia is not subject to criminal liability, but it is condemned on moral and ethical grounds. Typically, an individual does not develop a persistent sexual attraction to animals; such urges disappear when normal sexual gratification becomes attainable.

Pedophilia is a sexual deviation in which sexual desire is directed toward children. Pedophiles are generally elderly men or those with low sexual potency who are timid and self-doubting. The onset of pedophilia is often facilitated by the persistence of sexual drive coupled with declining potency. Pedophilic acts in these cases involve exposing oneself to young girls, touching their genitals, or exhibitionism.

In women, cases of pedophilia are extremely rare. As a rule, adolescent girls become the objects of sexually abusive actions. In many instances, girls are seduced by friends or family members.

Incestophilia is a form of sexual behavior manifested through sexual contact between relatives. Incestophilia is more widespread than previously believed, observed in 15–17% of surveyed women and men who engage in sexual relations with relatives (V. V. Krishtal, S. R. Grigoryan, 1999). Such sexual relationships occur between brothers and sisters, children and their parents, grandparents, aunts, or uncles. Father-daughter incest is frequently encountered; however, boys also regularly become victims of sexual harassment by women.

Sexual contact between relatives can cause emotional trauma and lead to various negative consequences. Victims of incest often exhibit low self-esteem, feelings of guilt, shame, depression, alienation, and sexual maladjustment. Incestuous relationships serve as a source of severe psychological trauma for children and adolescents, who react very painfully not only to the fact of such sexual relations but also to the betrayal inflicted upon them by a trusted person.

Families where incest occurred often exhibited a history of sexual harassment by parents, brothers, sisters, or both. Among those who practice sexual relations with relatives, many are emotionally immature, deeply religious, or suffer from alcoholism. Sexual aggression toward relatives is most commonly displayed by dissolute, unstable individuals. Sexual relations between family members, particularly between a son and mother, are observed among intellectually disabled or mentally abnormal individuals, who frequently fall victim to other sexual crimes.

The prohibition of incest—sexual relations between close relatives and consanguineous marriages—exists among many peoples. This is driven, on the one hand, by the desire to prevent the disorganization of family life and, on the other hand, to avert the appearance of genetically determined anomalies in offspring.

Necrophilia is a sexual deviation in which sexual gratification is achieved through sexual intercourse with a corpse. It is observed in perverse psychopaths who commit murders for the subsequent purpose of gratifying their sexual drive. In some cases, sexual satisfaction is attained solely by having a corpse present or by the patient creating one in their imagination (necrofetishism). Necrophilia is exceptionally rare.

Treatment of Sexual Deviations

The primary method of treatment is psychotherapy, the objective of which is to overcome strong tendencies rooted in the sexual instinct. Pharmacotherapy (symptomatic, sedative, general tonic) is also recommended. Only a small fraction of patients benefit from hormone therapy alone. It is frequently combined with psychotherapy, accompanied by a mandatory explanation of the MECHANISM OF ACTION of this treatment method in order to maximize the use of indirect suggestion.

The fundamental principles of therapy for all paraphilias include the patient's recognition of the inadequacy of their lifestyle, a fervent desire to rid themselves of the pathological drive, and the persistent, purposeful execution of the physician's corrective instructions. If a patient expects a cure without any effort on their part, demanding "strong medication" from the doctor, or if they are entirely convinced that nothing in their life can be changed, it is best in such cases to directly refuse treatment—citing a lack of internal drive to change—and suggest that the patient return only when they realize the impossibility of continuing life with a sexual deviation and desire with their whole being to be healed.

There are diagnostic criteria that allow for a preliminary assessment of potential therapeutic outcomes and thus help determine the appropriateness of treatment. In some cases, an unfavorable prognosis—and therefore the futility of treatment—can be established during the initial examination. Decisive diagnostic indicators include the patient's attitude toward the paraphilia, their recognition of the inadequacy of their drive, their anticipation of all social consequences should they yield to it, and the degree of opposition they put up against this drive.

If a patient is dissatisfied with their condition, therapy is appropriate in all cases of sexual deviations. Conversely, if the patient has long since grown accustomed to the unnatural drive, has practical experience acting on it, and not only finds it unburdensome but even regards it as something that elevates and highlights their uniqueness, treatment should not be initiated. If a young man or woman has only recently become aware of the unusual nature of their drive—which has hitherto manifested only in fantasies, with the sensual component never having been actualized due to strong social and moral constraints—such patients are in urgent need of systematic psychotherapy. In these cases, the prognosis is quite favorable, as it can lead to a complete restructuring of their drives and methods of gratification.

In cases of bisexuality, despite the clear dominance of homosexual inclination, the physician may hope that psychotherapy will successfully restructure the patient's sexual orientation. A female patient's childhood tomboyish tendencies or, conversely, marked femininity in the behavior and interests of a developing young man reduce the favorability of the prognosis; nevertheless, therapy should not be deemed useless in these cases and should still be administered.

In patients who are already actively engaged in a perverted sexual lifestyle, the likelihood of a positive therapeutic impact increases if the patient seeks medical help during a state of acute emotional crisis—especially when it is tied to the realization of impending danger or the threat of legal liability for their pathological sexual drive.

Sometimes a patient grows weary of constant internal conflict and turns to a physician as a last resort. Regardless of the specifics, an acute emotional crisis can be considered the most opportune moment to initiate treatment.

Treatment of Homosexuality. The primary direction of treatment involves a systematic, thorough Structure/133.html">Discussion with the patient regarding all aspects of the genesis of their paraphilic drive, emphasizing that whatever "gains" they have made along this path are, in essence, losses. The physician must convince the patient that love for persons of the opposite sex—featuring a harmonious combination of personal and sensual components through growing intimacy—develops, matures, and provides a person with a sense of fulfillment at all stages of life. In contrast, homosexual desire, devoid of relationship harmony, inevitably leads to emotional emptiness. Furthermore, the negative societal attitude toward homosexuality can ruin a career, provoke contempt from loved ones, entail legal liability, and so forth.

Alongside reinforcing the value of heterosexual life, the comprehensive psychotherapy program includes hypnotherapy. Suggestion applied during wakefulness, in hypnotic Sleep, or under drug-induced sleep (narcopsychotherapy) can be successfully utilized, as can autosuggestion, notably autogenic training. Hypnotherapy is particularly indicated during periods of severe emotional crisis. In such cases, the sedative effect paves the way for a strong psychotherapeutic rapport, enabling complex explanatory and corrective psychotherapy.

The application of motivated suggestion enables the patient to suppress any arousing fantasy at its earliest stage. Systematic use of counter-measures against the initial impulses of emerging desires quickly proves effective, substantially strengthening the patient's hope for recovery. Consequently, the psychotherapeutic rapport is deepened, and the physician's instructions are followed more meticulously.

Data regarding the effectiveness of psychotherapy for homosexuality are contradictory. Some authors (D. Curran, D. Parr, 1957) observed no positive effects from its use in any cases of homosexuality. Others (K. I. Platonov, 1962; H. Giese, 1959; L. Alexander, 1967, et al.) note positive outcomes. According to the observations of A. M. Svyadoshch (1988), psychotherapy is more effective for the passive form of female homosexuality and the active form of male homosexuality, and exhibits low efficacy for the active form of female homosexuality and the passive form of male homosexuality. However, even in congenital forms of homosexuality, complete inversion of the sexual drive is extremely rare. As a rule, some degree of bisexuality exists. Therefore, the presence of healthy sexual orientation elements in homosexuals provides an opening for psychological intervention.

In cases of homosexuality caused by marked endocrine disorders, the administration of hormones and the transplantation of glands from same-sex individuals are indicated. Castration as a treatment for homosexuality causes severe systemic endocrine disorders and, as a rule, does not alter the orientation of the sexual drive, though it occasionally results in its suppression.

Conditioned-reflex methods, analogous to those used in the treatment of alcoholism, are employed in the therapy of homosexuality. For this purpose, a fresh 1% or 0.5% solution of apomorphine hydrochloride can be used. The Mechanism of apomorphine's action is not revealed to the patient; rather, they are simply told that the prescribed medication will eliminate their homosexual drive. All mental images associated with the object of homosexual attachment, as well as homosexual acts, will become intensely unpleasant to them. The nausea and vomiting induced by apomorphine gradually become associated with homosexual intercourse, causing the latter to acquire a negative emotional valence.

Recently, a method of pharmacopsychotherapy for homosexuality has been proposed. In this approach, the patient is initially administered chlorpromazine or thioridazine (Mellaril, Sonapax), which reduces sexual drive and helps to cease homosexual activity. Against this Background, suggestion and persuasion are used to suppress old conditioned reflexes and establish new heterosexual ones, after which chlorpromazine is gradually tapered off.

F. Roeder and D. Muller (1969) developed a surgical method for treating homosexuality. The Procedure involves right-sided hypothalamotomy, following which sexual attraction to men disappears alongside feelings of aversion toward women. However, these operations are technically challenging and hazardous due to the risk of severe complications.

Treatment of other sexual deviations. Therapy for erotophobia, exhibitionism, fetishism, sadism, masochism, pica, pedophilia, incestophilia, zoophilia, and other disorders is based on the same principles as the treatment of homosexuality. It aims to identify and disrupt the persistent pathological conditioned-reflex connections underlying these aberrations.

Mastering coping techniques through autosuggestion proves effective even in treating perversions involving surrogate modes of sexual gratification (voyeurism, fetishism). Other recommended approaches include suggestion administered under hypnotic or light narcotic sleep, as well as reflex therapy techniques utilizing painful electrical reinforcement or aversion therapy.

To reduce sexual drive, chlorpromazine or thioridazine is prescribed, accompanied by psychotherapy. Thioridazine is used to curb aberrant sexual activity; complete suppression of sexual drive typically occurs within 2-4 weeks of treatment. Positive therapeutic outcomes in exhibitionism have also been observed using antidepressants such as imipramine.

Modern advancements in biochemistry, biophysics, immunology, genetics, and other biomedical sciences enable the prevention of sexual deviations. Specifically, significant progress has been made in developing precise Biochemical Methods for hormone assay in Amniotic Fluid, raising hopes that hormonal disorders in the fetus will soon be diagnosed early enough to prevent the development of perversions such as homosexuality.