Childhood Masturbation

Alexander K.C. Leung, M.B.B.S., F.R.C.P.C., F.A.A.P., F.R.C.P. (Edin), F.R.C.P. (Glasg), F.R.C.P.I.
Wm. Lane M. Robson, M.D., F.R.C.P.C.

Introduction Child-care providers are in a Etiology

unique position to educate chil-
asturbation is a topic dren and parents about normal Sexual arousal occurs early in
that has long perplexed sexual development and to help life. Penile erections in neonates
~ V and interested physicianss prevent or correct any misconcep- occur spontaneously during sleep
and laypeople alike. &dquo;Masturba- tions regarding masturbation. In and in response to genital manipu-
tion&dquo; refers to the self-stimulation spite of the prevalence of mastur- lation.’ Similarly, vaginal secre-
of the genitalia, often to achieve an bation, there is little written in the tions in response to stimulation
orgasm. The term &dquo;masturbation&dquo; pediatric literaturethis topic.
on have been observed in female in-
is derived from the Latin words The purpose of this article is to fants.’ In one study, a majority of
manus, meaning &dquo;hand,&dquo; and stu- familiarize the reader with the sub- male infants less than 20 weeks of
pratio, meaning &dquo;defilement.&dquo; Pre- ject and to recommend an ap- age were noted to have 5 to 40
sumably, the derivation stems proach to counseling parents and penile erections per day.9
from the observation that mastur- children on masturbation. Early random touching of the
bation is the stimulation of the genitalia results from the general
genitalia by the hand of an indi- exploration of the body by the in-
vidual for the purpose of sexual Epidemiology fant. Masturbatory activity is gener-
gratification and is a practice that ally initiated as a response to the
historically has been considered Approximately 90% to 94% of learned pleasure associated with
to be unhealthy. males and 50% to 60% of females such touching of the genitalia. The
Masturbation in children is an masturbate at some point in their interest in the genitalia may disap-
almost universal phenomenon. As lives. 1-4 pear as other aspects of the infant’s
long as it is not excessive and is Masturbation is practiced at all environment are discovered.
performed in private, masturba- ages and has been observed in About the age of 3 to 4 years,
tion is considered to be a normal utero.&dquo; It is most common at about the child learns that stimulation of
and healthy activity. Masturbation 4 years of age and again in adoles- the genitalia will consistently pro-
is often a concern for parents be- cence. The highest incidence is vide a pleasurable sensation. Mas-
cause of the long history of associ- among males between 16 and 20 turbation may then continue as a
ated religious and cultural taboos. years of age, of whom 88% mastur- lifelong pleasurable experience
Parental misconceptions about bate.6 In males, the incidence de- unless the individual is otherwise
masturbation and inappropriate creases after the age of 20 years, distracted or the activity is sup-
reactions to this activity may lead whereas in females the incidence pressed. Masturbatory activity is in-
to unnecessary anxiety and guilty increases until middle a~e.77 tensified during adolescence, a
feelings in children and parents. Masturbation is less common in period usually associated with an
individuals with lower educational increased sex drive.
backgrounds’ and in those with 3
Excessive masturbation may be a
Department of Pediatrics strong religious beliefs.3 symptom of emotional deprivation
University of Calgary The frequency of masturbation and may develop subsequent to ac-
Alberta Children’s Hospital varies considerably. Some individu- tual or perceived withdrawal of pa-
Calgary, Alberta, Canada als masturbate only occasionally, rental affection.l° Masturbation has
no more than a few times a year, been noted subsequent to parental
Address correspondence to: Alexander K.C.
Leung, M.D., Alberta Children’s Hospital, whereas others masturbate several absence, divorce, and death, as well
1820 Richmond Road SW, Calgary, Alberta, times a week.4 In general, females as following the birth of a new sib-
Canada T2T 5C7 masturbate less often than males.’ ling.l° Masturbation may be used to

238
release anxiety or tension, particu- the age of 21i2years. During mastur- bate.12 Both sexes may develop their
larly regarding conflicting feelings bation, the child may appear to be own fantasies, or they may rely on

toward parents. Some children will in a trance, with a flushed face, erotic books, pictures, or films.
masturbate to comfort themselves glassy stare, and audible breathing. Most masturbatory activity is
when they are frightened.&dquo; Frus- If an orgasm develops, it may be carried out in private. Less com-
tration, boredom, loneliness, followed by general relaxation, pal- monly, males masturbate in front
poor self-esteem, lack of peer re- lor, and sweating. 14 In some cases, of friends. Mutual masturbation
lationships, conflict with parents, the child may appear exhausted may be practiced by sexually expe-
and too much pressure in school and fall asleep.14,17 Orgasms due to rienced individuals.
are common causes of stress which masturbation are rare in children
older children and adolescents may less than 2~- years of age.3,lS
try to relieve through masturba- In older children, adolescents, Laboratory Findings
tion.12
Compulsive masturbation or and adults, manual stimulation of
masturbation in public usually sug- the genitalia is the most common Plasma levels of pregnenolone,
gests a serious emotional
more technique of masturbation for dehydroepiandrosterone, andro-
problem. However, some children both sexes. Most males masturbate stenedione, testosterone, and dihy-
may unknowingly masturbate in by holding the penis in their hand drotestosterone are significantly
public when they are preoccupied and then stroking the penis up and elevated in males immediately fol-
or are daydreaming.&dquo; down or in a &dquo;milking&dquo; motion. 15 lowing masturbation. The most
In a small number of cases, local Most females masturbate by rub- marked changes are observed in the
genital irritation is a contributing bing or massaging the clitoris or plasma levels of pregnenolone and
or indirect cause of masturbation labia with one or more fingers. dehydroepiandrosterone.22 The
in preschool children, especially in Digital stimulation of the vagina is plasma luteinizing hormone level re-
girls. 13,14 Local genital irritation practiced by approximately 20% of mains unchanged before and after
may result from tight clothes, vulvo- females.’5 The breast and nipples masturbation.22
vaginitis, balanitis, diaper rash, phi- may be stimulated simultaneoUSly.4 Increased vaginal vasoconges-
mosis, or parasitic infestation.14,15 In both sexes, anal masturbation is tion, as measured by both vaginal
an uncommon form of sexual stimu- pressure pulse and pooled blood
lation.19 Masturbation in children volume, has been demonstrated in
Clinical Manifestations can be achieved by genital stimula- females during masturbation.23
tion against objects, such as by rub- Nonspecific electrocardiographic
The most forms of
common bing or pushing against a pillow, changes may be observed, such as in-
masturbation are manual stimula- mattress, towel, or bed cover. creases in the amplitudes of the QRS

tion, genital stimulation against Individuals who masturbate ex- complex, T wave, and ST segment
objects, muscular tension, and, in perience sexual excitement and There are no significant or specific
adolescents and adults, genital pleasure. In the male, this is mani- changes in the electroencephalo-
stimulation with the use of special fested as penile erection, and in gram (EEG) during masturbation.25
devices. 14 These methods are not the female, as vaginal vasoconges- Some authors report low-voltage
mutually exclusive. The primary tion and secretion and breast and rapid activity during the early
site of genital stimulation for the vulval engorgement. The sexual ex- stages of arousal, followed during
majority of males is the penis and citement may be accompanied by orgasm by high-voltage paroxys-
for the majority of females is the tachycardia, tachypnea, skin flush- mal, three-per-second waves which
glans clitoris ing, mydriasis, and increased blood are mixed with rhythmic muscular

In infancy and early childhood, pressure. The majority of older chil- discharges.26 Other authors report
masturbation is usually practiced dren and adults can produce an or- finding interhemispheric asymme-
by rubbing the thighs together gasm through masturbation. 20 try in the parietal areas. 21
and, sometimes, by rocking the The first ejaculation of a male is
body against a pillow or another usually due to masturbation, rather
object 14 Rhythmic body move- than to a nocturnal ejaculation (wet Differential Diagnosis
ments and pelvic thrusts have been dream) or CoitUS.21
observed in older infants.&dquo; Rhyth- Masturbation is accompanied by Masturbatory activity in infancy
mic manipulation of the genitalia fantasies in about 75% of the males and early childhood may be mani-
by the hand rarely occurs before and 50% of the females who mastur- fested as an active stereotyped
j
239
 movement, stiffening of the body, Notwithstanding the prevalence to their children. This approach will
and staring appearance, followed in the developed world of a liberal foster a healthier attitude toward
by exhaustion and sleep. These fea- attitude toward sexuality, guilt over sexuality and will open the door to
tures may be mistaken for epi- masturbation still remains a signifi- discussions about other important
lepsy.14,l7,28 The following points help cant factor in the psychosexual de- topics, such as contraception1 and
to distinguish epilepsy from mas- velopment of many individuals.&dquo; sexually transmitted diseases.&dquo;
turbation : In epilepsy, the onset is In one study, over two thirds of Children should receive sexual
generally abrupt, spontaneous, and individuals with a history of mas- counseling appropriate for their age.
involuntary, whereas in masturba- turbation indicated that they felt Sexual education programs should
tion, the onset is volitionaJ.28 With guilty.32 If a child feels shame, fear, include information concerning
epilepsy, the child is unconscious, or guilt as a consequence of mas- masturbation. Children should be
whereas with masturbation, there turbation, this may adversely affect counseled that individuals who mas-
is no alteration of consciousness. future sexual adjustment.33 turbate are normal, as are those who
The rocking movement which is In general, masturbation in pri- choose not to masturbate.
characteristic of masturbation is vate is harmless. Excessive mastur- In a small number of cases, local
rarely observed during an epileptic bation, however, may interfere irritative factors, such as balanitis
seizure.28 An epileptic seizure may with regular activities and school or vulvovaginitis, may be a causa-
occur in any location, whereas mas- work and may lead to soft-tissue tive factor and should be treated.
turbatory activity is usually per- injury to the genital area.34 Excessive masturbation may be
formed in private .2’ Epilepsy and an indication of boredom, anxiety,

masturbation may coexist. Jacome frustration, or emotional depriva-

and Risk029 reported a male patient Management tion and suggests a need for in-
with generalized epilepsy whose creased attention and other kinds of
automatisms during episodes of ab- Parents should be reassured stimulation. This should be man-
sence were manifested only as com- that masturbation is common in aged by providing additional oppor-
pulsive masturbation. children of both sexes and that tunity for social interaction and play
In infancy and early childhood, this activity is harmless. Masturba- and by giving the child adequate
masturbatory posturing may in- tion in private should be ignored love, affection, and attention.
volve stiffening of the lower ex- to prevent unnecessary anxiety. Masturbation in public is not ap-
tremities or mechanical pressure Scolding, threatening, and sham- propriate and suggests either a lack
applied to the suprapubic area, ing are not appropriate. Overreac- of parental guidance or a signifi-
and this may be mistaken for ab- tion or punishment may lead to cant behavioral disorder. Children
dominal pain.30 increased sexual preoccupation or should be taught that masturbation
regression. If feelings of guilt or in public is unacceptable behavior.
shame develop, they may carry Repeated masturbation in public
Complications over into adult life and affect fu- suggests the need for consultation
ture sexual adjustment. with a child psychologist.
There is no scientific basis for Some parents may have religious
the myths that masturbation may or moral beliefs that do not tolerate

lead to acne, warts, hair on the masturbation. These parents should Conclusion
palm, poor physical health, physi- be advised not to shame, frighten, or
cal deformities, deafness, blind- threaten their children about mas- Masturbation in children is an
ness, insanity, mental retardation, turbation. These approaches may almost universal phenomenon.
epilepsy, impotence, sterility, sex-1 lead to permanent emotional and Masturbation that is not excessive
ual perversion, or homosexuality. 1 sexual difficulties. Rather, these par- and that is performed in private is
Masturbation does not interfere ents should employ mild types of a normal and healthy activity.

with contemporary or later sexual inhibition, such as advising their

responsiveness. There is clinical children that their family does not
evidence that adolescents of both believe in such activity.ll Whatever Acknowledgments
sexes who repress their sexual feel- the religious or moral beliefs of the
ings and who never masturbate parents, it is important for the par- The authors would like to thank
may have subsequent difficulty ents to talk openly about masturba- Ms. Kathy Campbell-Brown and
adapting to adult sexuality.9’ tion and other aspects of sexuality Mrs. Paula Pang for their expert

240
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Chopra of the University of Cal-
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11. Spock B, Rottenberg MB. Baby and Child graphic study of the effect of masturba-
Care. New York, NY Simon and Schuster tion in normal individuals. Indian J
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Inc; 1992:502-506. Physiol Pharmacol. 1976;20:226-230.
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241