Mental health articles

sexual fantasizing in males and females Sexual fantasizing, especially during masturbation, is widespread and is an
important tool for gaining insight into sexual preferences, rehearsing anticipated
sexual behavior, and developing a sexual identity. For some, though,
fantasies reveal disturbing aspects of themselves. When students conceal fantasies
they consider shameful, they fail to properly contextualize their needs
and erroneously conclude that they are disturbingly unique. Some anxietyprovoking
and confusing sexual longings may be deemed inappropriate—
close friends, disliked peers, family members, and individuals of particular
races and ethnicities. Still more worrisome to some are homoerotic and
fantasies of bondage/discipline/sadomasochism (BDSM). Anticipating such
confl icts and preemptively alluding to or directly inquiring about them may
yield an outpouring of admissions and attenuated dysphoria. Similar to
other aspects of sexuality, gender diff erentiates; male college students are
more likely to be aroused by BDSM fantasies and behaviors (Donnelly &
Fraser, 1998). Males are also the vast majority of those who meet criteria in
the Diagnostic and Statistical Manual of Mental Disorders, fourth edition
(DSM-IV), for sexual masochism and sexual sadism (American Psychiatric
Association, 1994).
It is clinically useful to consider the desire to be sexually dominant
or submissive (D/S) an ingrained orientation akin to sexual orientation.
Although researchers remain uncertain about its etiology, a D/S orientation
oft en surfaces during childhood or early adolescence and is highly resistant
to change. For some, during times of stress the desire to relinquish power
(submissives) or assume it (dominants) increasingly dominates sexual fantasies
and/or behaviors.
Many young people enjoy their occasional D/S fantasies (bondage, masterslave,
biting, scratching), but for others these fantasies troublingly confl ict with
sex-role expectations or gender politics. Several males I treated found their
desires for physical restraint, servitude, or humiliation particularly shameful,
interpreting them as unmanly or, “worse,” womanly. Similarly, some women
who identifi ed with feminism interpreted their fantasies of servitude as betrayals
of their political sensibilities and refl ections of male fantasies of female
domination. As with other manifestations of sexuality, however, attempts at
denial or suppression frequently lead to amplifi ed preoccupation, longing, and
discontent.
For subclinical levels of BDSM, a therapist can reduce dysphoria with
combined psychosexual education and exploration of underlying dynamics
that currently fuel the fantasies. (Discovering the genesis of the fantasies is
a more nebulous task.) Insight and normalization may produce acceptance
even though the fantasies themselves are usually unremitting. Given that D/S
needs are usually harmless, therapy can help a client explore ways to request
specifi c behaviors from sexual partners.

Th erapists commonly experience initial discomfort with these issues and
wish to prevent students from enacting them. Th ey, like their clients, should
challenge stereotypes and uneasiness by reading popular BDSM literature
(Brame, Brame, & Jacobs, 1996) and learning community guidelines that
emphasize the canon “safe, sane, and consensual.”
More problematic is when BDSM fantasies are obsessional or distressing,
interfering with daily functioning, or when fantasies if expressed are
potentially dangerous, such as anonymous sexual encounters, extreme verbal
and psychological humiliation, or severe bodily injury (beating, cutting,
mutilating, branding, strangulating) and physical restraint (physical bondage,
especially over long periods). Hypoxyphilia, obtaining sexual arousal
by oxygen deprivation (by a noose, plastic bag, mask, or chemical), is particularly
dangerous and can be fatal, especially when practiced alone during
masturbation. Clients who approach DSM-IV criteria for sexual masochism
or sexual sadism are best referred to a specialist.
Paraphilias such as exhibitionism, voyeurism, and fetishism are common,
especially among males, and not necessarily cause for concern, especially
when they do not generate personal discomfort or infringe on the rights of
others. Examples are deriving pleasure from collecting someone’s worn garments,
washing someone’s feet, or viewing or being viewed showering. Provided
that these behaviors are consensual, don’t interfere with functioning,
and aren’t dangerous to self or others, they can be expressed, explored, and
embraced.