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Correspondence

Dr B Amichai
Department of
Dermatology
Soroka Medical Center
PO Box 151
Beer-Sheva
Israel

Masturbation in prepubescent children: a case


report and review off the literature
E Finkelstein, B Amichai, S Jaworowski* and M Mukamel
Day Care Unit, Children's Medical Center of Israel, Petah-Tiqva and 'Department of Psychiatry,
Soroka Medical Center, Beer-Sheva, Israel

Accepted for publication 3 June 1996

Summary
A 10-year-old girl observed to have episodes of flushing, pallor and weakness,
was referred for investigation of possible carcinoid syndrome. The cause of these
episodes was masturbation. Masturbation occurs at aii ages and in most cases
is considered normal behaviour. Laci( of recognition of this phenomenon in
children may lead to unnecessary investigations and treatment.
Keywords: masturbation, children

Case report

Child: care, health


and development
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NUMBER 5

1996

A io-year-old girl was referred by a paediatrician for investigation of suspected


carcinoid syndrome. The girl, a new immigrant from the former USSR had been
healthy until 3 months previously when her parents and teacher noted episodes
of flushing, followed by mydriases, pallor and generalized weakness. The girl
added that the 'attacks' occurred a few times a day, were accompanied by
palpitations and lasted for a few minutes only. On one occasion she stated that
her underpants became damp during the episodes, which was suggestive of
episodes of masturbation and orgasm.
Further questioning revealed that in order to bring on these episodes she
would rhythmically press her thighs together and that it made her feel more
relaxed.

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The child and her family were referred to a multidisciplinary child abuse team
attached to a large teaching hospital, in order to exclude a diagnosis of child
sexual abuse. The assessment involved a physical examination of the girl by a
physician, and separate interviews of the child and her parents by the team
psychologist. On the basis of their assessment, they concluded that there was no
evidence of child sexual abuse.
The girl told the psychologist that since her family had emigrated from the
former USSR she had been very stressed. Her parents worked very long hours,
arriving home late in the evening. Her two older brothers, aged 20 and 22, were
also rarely home and provided her with little support. She did not feel integrated
into her class and had few friends. While she had previously been a competitive
student, her poor language abilities had silenced her in the classroom.
She described how one evening, when she was at home alone she became
frightened and pressed her thighs together. She noted that this caused sweating
and palpitations followed by weakness. She described the experience as being
pleasant. Since then when she felt tense, either at home or in the classroom, she
would repeat the self-stimulation.
Since these episodes caused considerable concern to her parents and teacher,
she used the episodes to be excused from helping around the house and doing
tests at school.
Following the diagnosis, the nature of the self-stimulatory behaviour was
explained to the girl and her parents. The parents accepted the need to spend
more time with their daughter, particularly during the evening, and the girl was
helped to cope with her schooling and peer relationship difSculties.

Discussion

Child: care, health


and development
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NUMBER 5
1996

Masturbation in children is a imiversal phenomenon, and as long as it is not


carried out excessively or in public, it is considered to be normal behaviour
(Leung & Robson 1993).
Masturbation occurs in all ages and has even been observed in utero (Meizner
1987). A number of authors cite cases where masturbation in public has led to
the mistaken diagnosis of epilepsy or abdominal pain (Livingston et al. 1975;
Bradley 1985; Fleisher & Morrison 1990). It is easy to understand the mistaken
diagnosis when parents describe that their young child develops a glassy stare,
becomes rigid or starts shaking as well as becoming pale and then drowsy.
In reported cases of prepubertal masturbation presenting as physical illness,
the children were all females, aged between 2 months and 5 years, and all used

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Child: care, health


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1996

masturbatory posturing or rocking movements to achieve orgasms. None


manually stimulated the genitalia. Fleisher and Morrison in 1990 described that
in their patients pressure was also applied to the pubic or suprapubic region. In
all cases there was no alteration of consciousness. The physical examination was
either normal or there was mild perineal irritation.
In all cases, with the passage of time 'episodes' of masturbation stopped
occurring in public, the only treatment being the reassurance of parents.
It has been noted that emotional deprivation, perhaps during a time of family
stress may lead to more self-stimulation. Parental absence, divorce, death and
the birth of a new sibling, have all been cited as possible family stresses (McCray
1978).
Perineal discomfort such as pinworms or diaper rash, might intensify the
child's sensation (Kleeman 1975) and these irritations may make it more likely
for the child to 'discover' her genitalia. Child abuse has also been cited as a cause
which must be excluded (Sauzier 1989).
In this case, the child initially used masturbation to deal with emotional stress,
subsequently using it to draw her parents' and her teacher's attention to her
distress.
It is noteworthy that cases of infantile or childhood masturbation reported in
the literature involve only girls, apart from the case of 'in utero masturbation'
(Meizner 1987).
The authors consider that boys' masturbation is more evident since penile
erections are easily recognized; there is also a greater awareness of early
childhood masturbation in boys because of the frequency of spontaneous
erections.
While the 'diagnosis' of masturbation in young boys is rarely difficult, some
of the posturing and movements of young girls in order to bring about
self-stimulation are more unusual and therefore it is much easier to miss the
diagnosis.
Parents may also manifest greater anxiety in relation to masturbation in young
girls as compared to boys, thereby reinforcing the possible confusion with other
conditions.
Failure to recognize this phenomenon has led to unnecessary abdominal
operations and treatment with anticonvulsant medication (Livingston et al.
19755 Fleisher & Morrison 1990). Once the diagnosis of masturbation is
made, and the possibility of child sexual abuse is excluded, reassurance of
both the parents and the child is usually the only treatment that is necessary,
although attention must be given to any co-existing emotional deprivation or
disorder.

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References
Bradley S.J. (1985) Childhood female masturbation. Canadian Medical Association Journal
32, 1165-1166.
Fleisher D.R. & Morrison A. (1990) Masturbation mimicking abdominal pain or seizures
in young girls. Journal of Pediatria, 116, 810-814.
Kleeman J.A. (1975) Genital stimulation in infant and toddler girls. In: Masturbation from
Infancy to Senescence (eds I.M. Marcus & J.J. Francis), International Universities Press,
New York, pp. 79-106.
Leung A.K.C. & Robson W.L. (1993) Childhood masturbation. Clinical Pediatrics, 32,
238-241.
Livingston S., Berman W. & Pauli L.L. (1975) Masturbation stimulating epilepsy. Clinical
Pediatrics, 14, 232-234.
McCray G.M. (1978) Excessive masturbation of childhood: a symptom of tactile
deprivation? Pediatrics, 62, 27'j-2J9.
Meizner I. (1987) Sonographic observation of in utero fetal 'masturbation'. Journal of
Ultrasound Medicine, 6, i i i .
Sauzier M. (1989) Disclosure of child sexual abuse. For bener or for worse. Psychiatric
Clinics of North America, 12, 455-469.

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and development
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1996
PAGES 323-326

1996 Blackwell Science Ltd