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Sexual Health & Intimacy

Sex With Oneself

Heather Hoffmann, PhD

Masturbation has yet to fully recover from its undeserved reputation. Most people realize that autoeroticism does not usually compromise physical or mental health, but many individuals, particularly women, are still uncomfortable masturbating and/or talking about it. Also, perhaps due to our squeamishness, it has been a neglected topic in sex research.

WHY THE NEGATIVE ATTITUDE?

Thomas Laqueur chronicles the changing social attitudes toward sex with oneself in his 2003 book, Solitary sex: A cultural history of masturbation.¹ The brief summary below only scratches the surface of what I learned from this text. I highly recommend reading it for a fuller understanding of current beliefs about autonomous sexual behavior.

Prior to the 1700s, masturbation appeared not to be mentioned much, even by clergy or physicians. However, condemnation from both parties began to grow in the 18^th century. In 1712, the publication of an 88-page text entitled Onania by a "profit-seeking quack doctor cum pornographer" created the new "disease" of self pollution. Larger sociopolitical changes—in particular, changes in what it meant to be an individual in modern society—were at the root of this publication’s success. Masturbation was seen as being too self-centered and pleasure-based to be consistent with being a good citizen. Others have proposed a similar thesis.² Further, the practice lacks the normal boundaries of other "luxuries," ie, it is always readily available at no (monetary) cost. Hence, there needed to be other "costs." Masturbation’s original symptoms were physically based but with the advent of germ theory, the maladies changed to psychological ones (eg, degeneracy, insanity). Masturbation was recognized to occur in both men and women, but it was seen as being particularly problematic in women.

Attitudes about masturbation became less negative in the mid-1900s. Changes in psychological theory; the development of sexual science, including publication of the Kinsey reports indicating that masturbation was (still) quite common; and the advocacy of self-stimulation by sex therapists and feminists all probably played a role. Nonetheless, the negative legacy remains. And even though Laqueur describes masturbation as having been "rehabilitated" in the 20^th century, he concludes with the line, "It remains poised between self-discovery and self- absorption, desire and excess, privacy and loneliness, and innocence and guilt as does no other sexuality in our era."¹

WHO DOES IT AND HOW DO THEY FEEL ABOUT IT?

Although masturbation is the most common sexual behavior in humans, there is relatively little research focusing on autoeroticism. A MEDLINE search yields approximately 9,000 studies mentioning sexual intercourse or coitus but only approximately 1,000 mentioning masturbation. The number of studies actually about masturbation is even fewer. Available information includes rates of incidence, some demographics, and how people feel about engaging in erotic self- stimulation.

Approximately 50 years ago, Kinsey^3,4 reported the lifetime incidence of masturbation (meaning the
number of people who have ever tried it) to be 93% for men and 62% for women. However, a more recent national survey, the National Health and Social Life Survey (NHSLS)⁵ done in the early 1990s, reported lower rates, at 63% for men and 42% for women. It could be that masturbation has declined over this period but other explanations seem more viable. For example, the NHSLS employed a more representative sample than Kinsey. Also, Kinsey asked about masturbatory practices in the context of an interview, whereas, although the bulk of the information gathered in the NHSLS study was from an interview, a few items (eg, household income and masturbatory practices) were reported on a questionnaire. This change in format potentially inhibited accurate reporting, as it seemed to indicate that sex with oneself was something that couldn’t be discussed openly and therefore, was potentially something one should not do.

The NHSLS and other studies reveal that masturbation occurs at all age ranges, and those who masturbate tend to be more educated, have regular partners, and also engage in a wide range of other sexual behavior than those who do not masturbate. Other studies have found that married women who masturbate report greater marital and sexual satisfaction than those who do not.⁶ The NHSLS also found that even though a fair number of people masturbate, they often report feeling guilty about it. In fact, at least for men who masturbate, about half report feeling guilty about their behavior. For women who masturbate, the rates of experiencing guilt were somewhat higher. One group experiencing the least guilt (at just under 40%) was black women. Masturbatory guilt has been associated with decreased levels of physiological and psychological pleasure derived from masturbation and from foreplay, as well as other negative sexual behaviors and beliefs.⁷

WHY THE GENDER DIFFERENCES?

Although women use more diverse techniques for masturbation than men,⁸ they report a lower rate of masturbation than males. The reason for this difference is not clear, but there are a number of hypotheses. Some believe it reflects a lower sex drive in women,⁹ as females also report lower rates of other sexual behaviors. Others claim that masturbation is simply more likely to happen in men because the penis is more conspicuous than the clitoris. Cross-culturally, men masturbate more than women, yet there are fluctuations in the magnitude of the differences between them.² Even within the US, we see less of a gap in rates of masturbation between black men and women.⁵ Further, Alexander and Fisher10 found that societal norms influence reporting of sexual behavior. In particular, they found that the gender difference in the rate of autoerotic behavior was greatest if subjects believed that their responses would not be confidential. This gender difference was lower if they believed their answers were anonymous and the gap was smallest (although it still existed) if they believed the veracity of their answers could be determined. Whatever the reason, gender differences in masturbatory frequency may have important consequences. For example, it may contribute to gender differences in comfort with one’s body, in sexual self-knowledge and in sexual self-esteem.¹¹ Interestingly, a fair number of college women do not masturbate because they believe it is improper use of time, it is abnormal, and/or contradictory to personal values; however, many of these women have unprotected intercourse and multiple sex partners.¹²

WHAT CAN PHYSICIANS DO?

As Laqueur reminds us, physicians were successful in dispensing negative information about masturbation, hence, they can be helpful in normalizing and promoting more positive attitudes about it. The advocacy of masturbation may be inconsistent with your or your patient’s personal/religious views, and it should not be forced on the unwilling. It would, however, be helpful to let patients know that it is common. In fact, masturbation is the most common sexual behavior in humans and also occurs in animals. It is seen in adults as well as children and in women as well as men. It is a "real" sexual behavior that does not have to be seen as a lesser alternative to partnered sexual activity. Many people in committed, healthy relationships continue to masturbate. Eli Colman, Director of the Program in Human Sexuality at the University of Minnesota Medical School, sees promoting masturbation as one of the most critical steps in promoting sexual health. He believes it provides an example of the diversity of normative sexual expression and challenges the common assumption that sex needs to be partnered and/or procreative. He advocates finding ways of enjoying the positive power that can enhance sexual enjoyment as well as one’s general self-esteem, and of minimizing the negative aspects.²

Heather Hoffmann, PhD, is professor of psychology, Knox College, Galesburg, Ill.

References

1. Laqueur T. Solitary Sex: A Cultural History of Masturbation. New York: Zone Books; 2003.
2. Colman E. Masturbation as a means of achieving sexual health. Journal of Psychology and Human Sexuality 2002; 14: 5-16.
3. Kinsey A, Pomeroy W, Martin C. Sexual Behavior in the Human Male. Philadelphia, Pa: W.B. Saunders Co.; 1948.
4. Kinsey A Sexual Behavior in the Human Female. Philadelphia, Pa: W.B. Saunders Co.; 1953.
5. Michael RT, Gagnon JH, Laumann EO, Kolata GB. Sex in America. Boston, Mass: Little, Brown & Company; 1994.
6. Hulburt D, Whittaker K .The role of masturbation in marital and sexual satisfaction: A comparative study of female masturbators and nonmasturbators. Journal of Sexual Education and Therapy, 1991; 17(4): 272-282.
7. Francouer RT, Koch PB, Weis DL. Sexuality in America. New York, NY: Continuum; 1999.
8. Masters WH, Johnson VE. Human Sexual Response. Boston, Mass: Little, Brown & Company; 1966.
9. Baumeister RF, Catanese KR, Vohs KD. Is there a gender difference in strength of sex drive? Theoretical views, conceptual distinctions, and a review of relevant evidence. Personality and Social Psychology Review 2001; 5(3):242-273.
10. Alexander MG, Fisher TD. Truth and consequences: Using the bogus pipeline to examine sex differences in self-reported sexuality. Journal of Sex Research 2003; 40 (1):27-35.
11. Schwartz P, Rutter V. The Gender of Sexuality. Thousand Oaks, CA: Pine Forge Press, 1998.
12. Davidson JK, Moore NB. Masturbation and premarital intercourse among college women: Making choices for sexual fulfillment. Journal of Sex and Marital Therapy 1994; 20(3):178-199.

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