Growing Up Sexually

The Sexual Curriculum (Oct., 2002)

[to Volume II Index]

[to Main Index Page]

  [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [I] [II] [III] [IV]


Janssen, D. F. (Oct., 2002). Growing Up Sexually. Volume II: The Sexual Curriculum: The Manufacture and Performance of Pre-Adult Sexualities. Interim Report. Amsterdam, The Netherlands

11 [previous chapter] [next chapter]

Medicalisation and Curricularisation of Sexual Behaviour Trajectories[1]



"What law cannot suppress, a fear of the supernatural does. As, for example, the current belief that self-abuse in a boy causes hair to grow on the palm of his hands"[2].





Summary: This chapter is concerned with demonstrating how cultures, expanding on Foucault's thesis, universally resort to biological and nosological legitimisations of moral choices connected to given sexual behaviour curricula. It is further argued that this tendency continues to be a definite hallmark of contemporary Western society, particularly in the issue of age stratification.



Contents [up]


Medicalisation and Curricularisation of Sexual Behaviour Trajectories. 50


11.0 Introduction.. 50

11.1 Sexual Categories, Growth and Disease. 50

11.1.1 Medicalising Sexarche. 50

11.1.2 Children's Allo- and "Auto"-Erotic Bodies: Nosological vs Cultural Discourse 50

11.2 Traumatology to Trauma: The Shaping of Traumatic Sex Discourses. 50

11.3 Medicalised Curricula and Sexual Control 50

11.4 Perspectives. 50


Notes. 50



11.0 Introduction [up] [Contents]


Medicalisation, according to Foucault, served as a "[procedure] by which that will to knowledge regarding sex [scientia sexualis], which characterizes the modern Occident, caused the rituals of confession to function within the norms of scientific regularity" (1976 [1981:p65, 67]), relocating ("emigrating", deploying) sin, excess or transgression to one of its final places, under the rule of the normal and the pathological, the "true discourse" of the medical scene. In recent debates, it has been argued, consensual sex in adolescence has become increasingly medicalised (as well as criminalized) within a discourse centralising adolescents' "best interests" and the role of the state as parens patriae[3].


Medicalisation of sexual categories, however, is a part of the ethnohistory of many parts of the world. With respect to overcoming illness, Whiting and Child[4] had expected that beliefs regarding the therapeutic properties of areas of behaviour (e.g., sexual activity) would show some connection with corresponding behaviour that in childhood had been satisfying through a long period of indulgence on the part of adults; the results seemed disappointing[5]. However, Whiting and Child did not consider "sexual avoidance" beliefs to be applied to sexual socialisation (that is, phase-specified avoidance and abstinence proscriptions). To some extent these beliefs hypothetically represent the undercurrent of any sexual behaviour socialisation (curricularisation) effort. Similarly, they did not consider "therapeutic" beliefs to be applied to the anticipation of future sexual health or functioning (that is, prevention of dysfunctions, and securing or enhancing natural functions).


Departing from Foucault's ethnohistorical absolutism in delineating medical discourses, the present article intents to elaborate on the uses of these "therapeutic" beliefs in an attempt to map the universal nosological principle in sexual behaviour curricularisation.



11.1 Sexual Categories, Growth and Disease [up] [Contents]


Sex acquires the status of an interfering element in development through the nosological association with (1) presumed antecedents, and (2) presumed consequences. That is, sex is the indicator or the cause of disease or misfortune. As such, genetic explanations of sexual practices have frequently been used to promote the association with a nosological theme. In the ethnohistorical record, this is seen to have been applied to homosexuality, female sexuality, incest configurations, those orientations designated paraphilic, and phase specific sexuality (e.g., paradoxia sexualis)[6]. In fact, this issue represents a discourse on a variety of social problems being explained through the concept of disease (Thomas Szasz)[7], and as such most likely satisfies a cultural need, or fills up a cultural void. Illustratively, Hallowell (1949 [1955:p294])[8] observed that among the Ojibwa


"[…] it is believed that any departure from culturally evaluated sex behavior provokes its own penalty- disease and sometimes death. […] The universe is simply constituted in such a way that disease automatically and inevitably follows sexual transgression. This means that ultimately no one can escape moral responsibility for his sexual conduct. He must contemplate it in that light".


Most societies have their own elaborate sexual pathology, but the tendency of nosologising being especially suitable for curricular control is not routinely appreciated. The measure describing "beliefs that sex is dangerous" of Broude and Greene (1976)[9], for instance, was not specified for life phase. However, Broude had previously (1975:p382)[10] argued that the sexosophy surrounding premarital sex was dichotomous via a biomedical rationale, and this folklore may account for the whole sexological system (e.g., Becker, 1984:p52-3, 56)[11].



11.1.1 Medicalising Sexarche [up] [Contents]


Invariably coitocentric, societies tend to operationalise (legitimise) "coitus" as either poetic (necessary, natural, productive, promoting, constructive, stimulating, curricular) or as contrapoetic (destructive, exhausting, depleting, degrading, optional, exchangeable, distracting, extracurricular, contracurricular). This conceptualisation transudates various levels of social reality via circumstantial factors derived from political/ideological[12], religious or secular perspectives. This protagonist/antagonist axis is dramatically represented by the dichotomous cultural positions that conceptualise its enactment as a magical sine qua non or accelerator[13], or as a necessary antecedent[14] of pubertal development (as is characteristic of Melanesian and Amazonian societies). These are not idiosyncratic or even monolithic ideologies; rather, this dichotomy describes cases in which explanations are either phase-specified and utilised as such to legitimise a given curriculum or agenda, and/or cases where sexuality is attributed with a degree of omnipotence (ancient Greece, up until 20th century Europe) that would prove the applicability of, facilitate or corrupt a given moral curriculum.


One might argue, for instance, that the "poetic" belief was a legitimisation for prepubertally consumed age stratified marriage or routine seduction (Australian Aboriginals, Bororó, Masai, Lepcha, Canela)[15]. Both the Apinayé and the Kaska apply negative biomedical associations to masturbation but poetic qualities to coitus; Kaska coitarche, however, was a negative experience, the belief being used both as a preventative warning and to pressure girls into "confessing" the presumed antecedents of menarche after its occurrence. The "belief" therefore provides the correct impression of curricular control.



11.1.2 Children's Allo- and "Auto"-Erotic Bodies: Nosological vs Cultural Discourse


Looking at the ethnographic record, antimasturbatory arguments are known to be derived from nosological beliefs[16] (apart from traumatological and hygienic rationale) and magical beliefs (Kogi) apart from the seemingly idioyncratic curricular rationales found in some societies[17]. In most cases of nosological threats[18], nosological rationale (i.e., culture-wide belief) is unlikely but not ruled out on the subcultural level. The control on early allosexuality is likewise issued by nosological beliefs[19], nosological threats[20] as well as "hypercorrect" communications regarding fertility[21]. An antiparallel attitude is found in cases where abstinence of early intercourse is thought to cause dysfunction (Nimar Bahilis).


The historionosographic tool in sexology aims at rewinding the moral traditions in medical verdicts specified for the entities construed in clinical practice. In an illustrative paper Gillis (1996)[22] examines the early development of writings on infant and childhood thumb-sucking in American paediatric textbooks since 1878. He discusses the integration and consolidation of this suctus voluptibilis into common American paediatric coverage by observing that it found pathological and nosological anchors (p65) in its being classified as a "functional neurological disease". The parent, nurse and non-paediatric physicians were incapacitated in their potential expertise, and the habit was pathologised by its association with orofacial deformity and sexualised (thus, pathologised) by its association with masturbation. The paediatrician was considered a coloniser rather than the self-declared explorer of the unknown terrain of infancy (p73) and paediatrics was identified as "an early intellectual example of contextual or relative "truth" " (p64), by virtue of its anchoring the child's behaviour in its assumed adults consequences. As summarised:


"The emerging paediatric discourse […] included ideas of the unique world of the healthy infant and child requiring special expertise to interpret pathology; the exclusion of other possible authorities; development as a critical time in the life of a human being; the consequences of abnormal development for adulthood and therefore the race; prevention as a therapeutic strategy" (p73).


From his short account we learn that obviously competitive interests of authorities struggling for (new) social identities (at the cost of others'), the association of sexual/behavioural hygiene and prophylactic conceptualisations of development, and the conceptual paradigms of paediatric intervention, childhood sexuality and developmental pathology are most intimately connected[23]. A celebrated commenter on "sexual cultures", Money[24] regards masturbation theories as "sexosophical" rather than sexological, placing its development alongside that of health food and exercise theories. In the older literature, "masturbation" was included or discussed within various pathognomic domains[25], primordially without much regard for life phase: "behaviour problems", "behaviour disorders", "difficulties of personality", "personality disturbances", "minor neuroses", "neurotic disturbances", "sex disorders", "sex problems", "sexual deviations", "habits", "bad habits", and "habit disorders". A 1974 symptom listing by the U.S. based Group for Advancement of Psychiatry included "anal masturbation" under disturbances related to body functions, bowel functions, "masturbation" under disturbances related to body functions, habit patterns, and a group of problems in "sexual adjustment", as a subcategory of disturbances of social behaviour.


Very much analogously, this has been the story of childhood sexuality within the larger modern Western sexological discourse, and analogous examples can be given for the Jewish[26], and Russian[27] case, historically both strongly medicalising and psychiatrisising cultures that have (effectively) restricted developmental sexualities on this basis.

It may be hypothesised that the world-spread nosological concept of sexual behaviour, especially that of masturbation, may in selected cases be due to a missionary influence. Auto- and allosexual behaviours may seem to fall victim to an analogous system of pathologising only in a minority of cases (e.g., Bororó).


In 19th century literature, masturbation was condemned on the argument that it caused insanity, rather than, as before, interfering with conjugal sex; it thus changed it status from moral category to nosogenic agent[28]. The narrative bringing this message, however, suggested a merging of moralistic and nosographic arguments. However, the early literature cannot univocally be accused of a hidden curricularisation agenda, since its initial (as opposed to later) coverage was hardly age or phase specific[29]. Masturbation pathologies addressed the infant more explicitly only around 1850, and this inclusion was probably based on orgasmogenic (rather than semen depletion) theory, which is likely since pre-1900 authors commonly commented on infantile orgasm[30].



11.2 Traumatology to Trauma: The Shaping of Traumatic Sex Discourses [up] [Contents]


A literature search points out that the initial occurrence of biologically curricularising functions such as menarche, spermarche and orgasmarche are universally interpreted traumatologically when not adequately anticipated (chapter 12). It is also apparent that these unanticipated biological milestones (particularly menarche) are universally associated with shame and guilt curricula that characterise gendered cultures as pathologising ones. The parallel between cultural and individual discourse is striking, a pattern sufficiently demonstrated for the gender binary but not for the life phase perspective. This, too, is a characteristic cultural choice.


Speculation on modern exponents of the tendency to medicalise moral discourses immediately fall victim to both medical and moral objections; essentially, this represents the rejection of antipsychiatric claims. One thesis, for instance, holds that "sexualisation" of children after socially stigmatised events is inappropriately psychiatricised by means of ad hoc "traumatological" models. The behaviour involved present a moral concern (essentially, the violation of curricular principles) but is "traumatologised" through association with the concurrently traumatologised perpetrator, and through the culture-specific anticipation of adverse "consequences". This storyboard transforms the transmission of sex in that of trauma, ready to be labelled an "abuse cycle". The redefinition of sex from moral to medical category blends cultural constructions of both; the blend being more than a matter of narrative, sex becomes trauma. And as sex continuously haunts cultures as well as individuals, so does trauma.

In sum, sexologists act as nosologists designating patient identities/roles to sexual individuals.




11.3 Medicalised Curricula and Sexual Control [up] [Contents]


Medicalisation is a way of defining devalued personal and social conditions as "illness" and then subjecting them to medical labels and treatment[31]. The culture-identifying process of medicalisation as defined as "the way in which the jurisdiction of modern medicine has expanded […] and now encompasses many problems that formerly were not defined as medical entities"[32], is paralleled by the phenomenon of explaining or anticipating interpersonal (e.g., curricular) problems as person-identifying medical conditions at all. This historical definition may also include anachronic cases. In the Tukano, Ramkokamerkra, New Britain, and (provisionally) Timbira cases, the coitogenic menarche belief was observed to persist beyond contemporary applicability. This suggests that moral rationale may in selected cases not only use scientific progress to fit current moral dogmata, but even resist historical gains in public objectivity. This is an interesting case for ethnomethodologists.


Tiefer (1996)[33] warned for sexuality in general being transformed into "a disease- and malfunction-oriented bodily function". The author argues that "removal" of social and cultural aspects of sexuality

have resulted in an "overreliance on medical explanations of sexual problems", an "overmedicalization" introducing "a new morality of sexuality and health disguised as scientific objectivity". I would like to suggest that this process occurs differently for diverse moral topics, and that medicalisation does not so as much produce, but identifies and legitimises "new" or old moralities. That is, moral discourses utilise whatever medical technology is available to institutionalise the issue within an academic curriculum.

The medicalised control and organisation of sexual behaviour trajectories (e.g., Schultz, 1982)[34] indeed is a particularly interesting one. It could be argued that regular visits to a gynaecologist's office have replaced the function of communal rites of sexual passage in preindustrial societies[35]. Clinicians might describe sexuality as a fundamental aspect of being rather than an aspect of behaviour and create an identity for their "patients" that alters both the way they view themselves and the way society views them[36]. Applied to individual trajectories, medicalised curricula come to define a major effort both to understand, and to operationalise the control of sexual behaviour. Somatisation parallels depoliticisation. The critique of medicalization holds that nosological reasoning becomes an institution of social control, that helps promulgate the dominant ideologies of a society[37] instead of challenging them. An apologist perspective argues that this is a major contribution to any society unable to organise the control and understanding of some of its moral issues in a less "debatable" way. It is a simple and in a sense "primitive" solution, whatever sophisticated dimensions it might acquire in technological societies. Even the depathologising of homosexuality was imperfect[38], which suggests (at least clinical) moral conservatism. As can be examined in recent article by Unal (2000a,b)[39] on Turkish (cf. Russian[40]) clinicians are apparently still out to "identify children who could be at risk of developing CM [childhood masturbation, accompanying "symptoms" like sweating, flushing and tachypnoea], such as children with a history of insufficient breastfeeding, sleep difficulties in the infancy period, and genito-urinary diseases" (ital.add.). The children were referred for masturbation, on the basis of the idea that it was interfering with home/school activity and/or "strongly disturbed the parents".


In attempts to negotiate "when one should be concerned", authors present "a continuum of young children's sexual behaviors, ranging from normal to pathological", while providing "tips for distinguishing inappropriate from normal sexual behaviour"[41] [sic]. Sexual play between children requires attention to determine whether it is "abusive, imitated from prior experience, and potentially transmissible to other children"[42]. Kellogg and Hoffman (1995)[43] studied unwanted sexual experiences (USEs)[44] among 342 adolescents aged 14-17 years, suggesting a difference between illegal unwanted, illegal wanted, not-illegal unwanted, and not-illegal-wanted experiences. However, this difference was not explored and at least tree types are medicalized/ pathologized: "Both illegal and unwanted sexual experiences merit professional attention and treatment" (p1457).


More importantly, stereotyped medical responses to ethical dilemmas (e.g., age disparate sexual contacts) create feedback loops that finally generate the legitimisation of its institution.



11.4 Perspectives [up] [Contents]


Specific theses addressed supra include:


(a) Beliefs about curricular normality are regulated, or at least legitimised, through biomedical principles;

(b) Beliefs about curricular abnormality are regulated, or at least legitimised, through biomedical principles;

(c) Biomedical explanations are utilised to preclude compromising of established curricular patterns, and commonly take part in ideological systems even where (c1) methodological standards have evolved beyond the immediate plausibility of the idea, or where (c2) novel data are generated and interpreted to fit established ideologies only.


The theses have been explored through cultural opinions on sexual categories such as coitarche, masturbation, and phase disparate patterns. Highly sensitive to political debate, it is recommended that these patterns be approached via less politically sensitive, established items: the medialisation of female sexualities / bodies, the medicalisation of homosexual bodies, etc.




Notes [up] [Contents]


[2] Bonnerjea, B. (1931) Some Present Day Superstitions of the White Population of the Middle West, U.S.A., Man 31, Oct.:224-5, at p225

[3] Sullivan, T. J. (1989) Sex And Consent in Adolescence: A Local Centre of Power-Knowledge. PhD Dissertation, York University (Canada) [DAI-A 50/09, p3078, Mar 1990]

[4] Whiting, J. & Child, I. (1953) Child Training and Personality: A Cross-Cultural Study. New Haven, CT: Yale University Press

[5] In only four cultures were sexual practices believed to have a specific therapeutic value; in the societies of these of which initial sexual satisfaction (ISS) could be rated (Baiga, Marquesans), it was very high (p196, 203); an association with sexual abstinence customs was not found (p210). It was further observed that sexual socialisation anxiety (SSA; high/low) was not associated with the existence of some sexogenic nosology, entirely not so when judging from ratings and only mildly so when judging from rankings (p159, 162; N=28). Judging from mean rankings, the difference in SSA in sexologically nologising vs nonnologising cultures was significant (p<.01; p164). This is also the case for ISS judging from mean ratings and mean rankings (p168).

[6] See Janssen, D. F. (July, 2001) Paradoxia Sexualis: The Biological Psychopathia Sexualis of the Child. Unpublished literature study by the author. Cf. §2.3.

[7] E.g., Szasz, Th. (1970) The Manufacture of Madness. New York: Harper & Row

[8] Hallowell, A. I. (1949) Psychosexual adjustment, personality, and the good life in a nonliterate culture, in Hoch, P. W. & Zubin, J. (Eds.) Psychosexual Development in Health and Disease. New York: Grune & Stratton, p102-23. Reprinted in Hallowell, A. I. (1955) Culture and Experience. University of Pennsylvania, p291-305

[9] Broude, G. J. & Greene, S. J. (1976) Cross-cultural codes on twenty sexual attitudes and practices, Ethnology 5,4:409-29

[10] Broude, G. J. (1975) Norms of premarital sexual behavior, Ethos 3:381-402

[11] Becker, G. (1984) The Social Regulation of Sexuality: A Cross-Cultural Perspective, Curr Perpect Soc Theory 5:45-69

[12] Guyon, who repeatedly refers to "numerous" personal experiences in the sexual lives of girls in various places, leaves no doubt to the effects of age disparate "initiations": "The early loss of virginity- and particularly, in many cases, before the onset of menstruation- reveals itself as a factor of good development and of asserted physiological balance- exactly the opposite of the neurotic girls who are found in western families and in convent schools. Girls thus initiated, even if they are very ordinary in appearance, grow beautiful. Their traits become regular, their face refines, their eyes widen and shine, their appearance become definite, their person grows healthy, their proportions harmonise. They grow taller, they attract attention [sic]. Sexual culture appears for these young plants an indispensable element highly beneficial to their development. They show none of the anćmia and lack of vitality which characterise girls who are shut up, and coddled, the victims of repression and of censure. They reach a state of equilibrium- physical, psychological and moral- which no other experience can assure". Sexual intercourse even "assists the maturation of her throat and bosom". See Guyon. R. (1950) The child and sexual activity; part II, Int J Sexol 3,4:237-47, at p243-4

[13] These include meno- , pubo- and thelopoetic concepts of coitarche, as well as the coital prerequisite for menstrual cyclus continuity. The menarche linkage is noted for the Trukese, Kaska, Australian Aborigines (Walbiri, Murgnin, Anbarra, Tiwi), Lepcha, Chewa, Tahitians, Indonesia (Adjehers, To Bada), Sandwich Islanders, Azande, Bororó, Apinayé, Ramkokamerkra, Eastern and Western Timbira, Wari' (Pakaas Novas), Pau d'Arco, Onge Andamanese, New Guineans [incl. New Ireland], Kisangani Wagenia, Tepoztecans, Alkatcho (British Colombia), Nyamwezi, and found in medieval to 19th century Europe. Coitus is believed to be a primarily thelopoetic agent among the Tanzania Parakuyo, Masai, Trukese, Tiwi, and Bororó; the Karugu assume coitus to be secondarily thelopoetic. Generally promoting qualities for male puberty are attributed in Yemen. Magical coitogenic menarche is found in the mythology in Thailand, India, and Mexico, among the Matako, Cubeo, Tukano and Kaliai (New Britain). A male parallel is reported for the Mangaia were nocturnal emissions are blamed on the visit of avaricous "ghost women" (Marshall).

[14] Up until 20th century Europe, Arapesh, Hopi, Ifaluk (New Carolines)

[15] This may well be the case among those cases where there is infant betrothal (Andamanese, Nyamwezi, Azande, New Guinea, Tahiti) or at least peripubescent marriage (Yemen). According to Swartz. one "rather sophisticated informant" suggested that "[…] men only get interested in girls when the breasts begin to develop, that perhaps both would begin without copulation, but that "we Trukese are bad and when we see a girl is almost a young woman, we want to have intercourse with her".

[16] Puerto Rico, Ghana (Akan: debated), Okinawans, Kaska, Tobatí, Russians, Thai, Suriname, premodern Europe and nonnative North-America (e.g., Germany, England, Finland, France, Spain, etc.), India (acc. Carstairs), Bororó, Apinayé, Quechuas, Jamaica (variable), Mehinaku

[17] Guajiro, Ilocos, Ewe (Ghana), nonnative North-Americans, Puerto Rico, Selk'nam

[18] Tikiri, Tetela, Taiwan, Burma, Semai, India (acc. Dube), Tobatí, Trukese, Guinea, India; premodern Europe and nonnative North-America, Shuswap

[19] Trukese, Bakuria, Nupe, Valenge, Thonga, "Sambia" (sex play with girls), Cewa, Bororó, Siriono, Jivaro

[20] Ulithi, Ute, Afikpo, Malukula, Seniang, Mochuana, Hopi, Cashinahua

[21] Ingalik, Hopi, Blood Indians

[22] Gillis, J. (1996) Bad habits and pernicious results: thumb sucking and the discipline of late-nineteenth century paediatrics, Med Hist 40:55-73

[23] It is a shame, however, that he fails to extent the orofacial or erotic concerns to present day morality and dentistry. Both stories are continued in later medicine, and very much contemporarily so.

[24] Money, J. (1983) The genealogical descent of sexual psychoneuroendocrinology from sex and health theory: the eighteenth to the twentieth centuries, Psychoneuroendocrinol 8,4:391-400

[25] Cf. Yates, A. (1982) Childhood sexuality in psychiatric textbooks, J Psychia Educ 6,4:217-26

[26] Ajzenstadt, M. & Cavaglion, G. (2002) The sexual body of the young Jew as an arena of ideological struggle, 1821-1948, Symbolic Interaction 25,1:93-116

[27] Mead, M. & Calas, E. (1955) Child training ideals in a postrevolutionary context: Soviet Russia, in Mead, M. & Wolfenstein, M. (Eds.) Childhood in Contemporary Culture. Chicago: University of Chicago Press, p179-203, see p191-2; Segal, B. M. (1977) Soviet approach to the causes of neuroses, Am J Psychother 31:577-94, see p587; Rivkin-Fish, M. (1999) Sexuality education in Russia: defining pleasure and danger for a fledgling democratic society, Soc Sci Med 49,6:801-14, esp p804-5

[28] Freedman, E. B. (1082) Sexuality in nineteenth-century America: behavior, ideology, and politics, Rev Am Hist 10,4:196-215

[29] See preparatory material.

[30] The Differential Diagnosis of Infantile Orgasm: A Historiography. Unpublished literature study by the author.

[31] Denberg, Th. D. (200) Medicalization and mother-blame: A study in the clinical management of deviance in Mexico, DAI-A 61(5-A):1920

[32] E.g., Gabe, J. & Calnan, M. (1989) The limits of medicine: women's perception of medical technology, Soc Sci & Med 28:223-31

[33] Tiefer, L. (1996) The Medicalization of Sexuality: Conceptual, Normative, and Professional Issues, Ann Rev Sex Res 7:252-82

[34] Schultz, L. G. (1982) Child sexual abuse in historical perspective, J Soc Work & Hum Sex 1,1-sup-2:21-35

[35] Schindele, E. (1997) Übergange im Frauenleben- Medikalisierung und Stigmatisierung durch die westliche Medizin, Curare 11:263-8

[36] Hansen, B. (1989) American physicians' earliest writings about homosexuals, 1880-1900, Milbank Quart 67,Suppl 1:92-108

[37] Wiatzkin, H. (1984) The Micropolitics of Medicine: A Contextual Analysis, Int J Health Serv 14,3:339-78

[38] De Cecco, J. P. (1987) Homosexuality's brief recovery: From sickness to health and back again, J Sex Res 23,1: 106-14

[39] Unal, F. (2000a) Predisposing factors in childhood masturbation in Turkey, Eur J Pediatr 159:338-42; Unal, F. (2000b) [The clinical outcome of childhood masturbation], [Turk J Pediatr] 42,4:304-7

[40] Mikirtumov, B. E. (1980) [Clinical manifestations and the treatment of masturbation in infants and preschool children], Vopr Okhr Materin Det 25,3:47-51; Fainberg, S. G. (1964) O Preduprezhdenii Det-Skikh Zabolevanii [On the prevention of nervous disease in children]. A manual for the prophylaxis and cure of neuroses, behavior problems, and masturbation in children; Atarov, T S. (1959) Voprosy Polovogo Vospitaniia [Problems in Sex Education]. Masturbation, which "under Soviet conditions is no longer a mass phenomenon", is viewed as harmful. Cf. Hungary: Frankl, S. (1936) Az Idegbajos Gyermek [The Neuropathic Child]. Including masturbation.

[41] Essa,. E. L. & Murray, C. I. (1999) Sexual Play: When Should You Be Concerned? Childhood Educ 75,4:231-4

[42] Cantwell, H. B. (1989) Child Sexual Abuse: Very Young Perpetrators, Child Abuse & Neglect 12,4:579-82

[43] Kellogg, N. D. & Hoffman, Th. J. (1995) Unwanted and illegal sexual experiences in childhood and adolescence, Child Abuse & Neglect 19,12:1457-68

[44] This term was traced back to 1991.