'We Won't Ban Castrating Pervs Despite What Europe Might Think!': Czech Medical Sexology and the Practice of Therapeutic Castration.

The Czech Republic holds one of the highest numbers of men labelled as sexual delinquents worldwide who have undergone the irreversible process of surgical castration - a policy that has elicited strong international criticism. Nevertheless, Czech sexology has not changed its attitude towards 'therapeutic castration', which remains widely accepted and practised. In this paper, we analyse the negotiation of expertise supporting castration and demonstrate how the changes in institutional matrices and networks of experts (Eyal 2013) have impacted the categorisation of patients and the methods of treatment. Our research shows the great importance of historical development that tied Czech sexology with the state. Indeed, Czech sexology has been profoundly institutionalised since the early 1970s. In accordance with the state politics of that era, officially named Normalisation, sexology focused on sexual deviants and began creating a treatment programme that included therapeutic castration. This practice, the aim of which is to protect society from sex offenders, has changed little since. We argue that it is the expert-state alliance that enables Czech sexologists to preserve the status quo in the treatment of sexual delinquents despite international pressure. Our research underscores the continuity in medical practice despite the regime change in 1989. With regard to previous scholarship on state-socialist Czechoslovakia, we argue that it was the medical mainstream that developed and sustained disciplining and punitive features.

ENDOCRINE HISTORY: The history of discovery, synthesis and development of testosterone for clinical use.

As the most important male hormone, testosterone has an impact on almost all organs and body functions. The biological effects of testosterone and the testes have been known since antiquity, long before testosterone was identified as the active agent. Practical applications of this knowledge were castration of males to produce obedient servants, for punishment, for preservation of the prepubertal soprano voice and even for treatment of diseases. Testes were used in organotherapy and transplanted as treatment for symptoms of hypogonadism on a large scale, although these practices had only placebo effects. In reaction to such malpractice in the first half of the 20th century science and the young pharmaceutical industry initiated the search for the male hormone. After several detours together with their teams in 1935, Ernst Laqueur (Amsterdam) isolated and Adolf Butenandt (Gdansk) as well as Leopold Ruzicka (Zürich) synthesized testosterone. Since then testosterone has been available for clinical use. However, when given orally, testosterone is inactivated in the liver, so that parenteral forms of administration or modifications of the molecule had to be found. Over 85 years the testosterone preparations have been slowly improved so that now physiological serum levels can be achieved.

From bench to bedside: bipolar androgen therapy in a pilot clinical study.

Prostate cancer remains a leading cause of cancer death in Europe and the United States and is an emerging problem in Asia despite significant improvements in available treatments over the last few decades. Androgen deprivation therapy (ADT) has been the core treatment of advance-staged disease since the discovery of prostate cancer's androgen dependence in 1941 by Huggins et al. [1] Options for initial medical treatment include gonadotropin-releasing hormone analogues such as leuprolide (LHRH agonist) and degarelix (LHRH antagonist) and androgen receptor (AR) binding agents such as bicalutamide. Although most patients will initially respond to either surgical or medical castration, there is almost always progression to castration-resistant prostate cancer (CRPC) necessitating treatment with more novel agents. [2] However, even drugs such as abiraterone and enzalutamide, two next-generation agents used commonly in metastatic CRPC, have failed to demonstrate persistent efficacy in most patients. [3] ,[4].

Pain and Surgery in England, circa 1620-circa 1740.

The scholarship on the discussion and role of pain in early modern English surgery is limited. Scholars have given little consideration to how surgeons described and comprehended pain in their patients' bodies in early modern England, including how these understandings connected to notions of the humours, nerves and sex difference. This article focuses on the attention that surgeons paid to pain in their published and manuscript casebooks and manuals available in English, circa 1620-circa 1740. Pain was an important component of surgery in early modern England, influencing diagnosis, treatment and technique. Surgeons portrayed a complex and multi-dimensional understanding of their patients' bodies in pain, which was further connected to their portrayals of their professional ability.

Voluntary and therapeutic castration of sex offenders in The Netherlands (1938­1968).

Between 1938 and 1968 some 400 sex offenders in the Netherlands who by court orders had been put at 'the discretion of the government' and were incarcerated in asylums for the criminally insane, 'voluntarily' submitted themselves to 'therapeutic' castration, the surgical removal of their testes. Prior to 1938, inspired by a Danish castration act from 1929, and urged by asylums that were overcrowded by sex offenders, the ethics of the surgery had been discussed for nearly a decade amongst theologians, (forensic) psychiatrists, jurists and politicians, mostly in the context of eugenic sterilization. Discussions of conflicting Catholic, Protestant and non-denominational points of view vis-à-vis eugenics resulted in consensus about 'therapeutic' and 'voluntary' castration. Sexual deviancy, according to some, was like a tumor located in the testes, which could therefore be removed without moral objections and the person was thus cured of his disease. Although obviously related to forensic psychiatry and concerned with issues like protection of society and treatment of offenders, discussions were never held in a strictly forensic context. Unlike in other countries in which castration policies were enforced, in The Netherlands the surgery was never embodied in law but subject to an informal protocol that covered political accountability. To satisfy Catholic objections references to eugenic aims were omitted from the documents, as were references to castration as a penalty.Based on international and Dutch literature (from both before and after 1938) as well as case histories, this article will show that the compromise about the therapeutic value of castration had no basis in medical knowledge, while 'voluntariness' (as elsewhere) was an acknowledged fallacy once surgeries had started. It was also acknowledged that castration did not really cure deviancy, but curbed libido and helped the castrate to suppress his urges. Nonetheless, because of the eugenic origins of discussions, associated with persistent confusion about the difference between castration and sterilization, it never became fully clear whether the surgery was meant to curb libido or to prevent the offenders from begetting inferior progeny.

Castrati singers: surgery for religion and art.

The act of castration was practiced from ancient times. In countries of Middle and Far East, castration was often done to provide eunuchs as guardians of the harems. In Europe and especially in Italy, it was carried out to preserve the male voice unbroken into adult life. From 16th century till the end of 18th century, castrati singers dominated opera with their supernatural voices. Boys were castrated mainly before the age of 9 years and when they grew up they had feminine characteristics, such as smooth, hairless bodies, breasts, infantile penis. The training procedure to become a castrato singer was very intense and lasted up to ten years. The most common surgical technique was either to sever the spermatic cords or crush the testis with the fingers. The voice of a castrato was the outcome of a larynx the size of a child's combined with the lung volume of an adult male. The castrati singers became superstars who dominated opera, singing both male and female roles for more than 200 years. Castrated for art, the beauty, range and flexibility of their voices raised them to mythical status.

Castrati singers--all for fame.

INTRODUCTION: The phenomenon of castration is very closely associated with the baroque era. In a period that placed emphasis on pure sensual pleasure, castrati singers, with their angelic voices, were a perverted outcome of this ambition. It was the intention that these castrato voices with their supernatural sound would mesmerize audiences. At that time, it could be said that within certain society circles, an addiction to these voices existed. Equally, they were oblivious to the spiritual side of the lives of the castrati. Farinelli, Caffarelli, and Senesino, three of the most famous castrati, were the first musical superstars of the 18th century. Their voices moved decadent audiences to tears and standing ovations. The price for this fame was, however, high. AIM: The aim of this review is to provide an overview of castrati singers, especially in the baroque era, their sexuality and the effects of castration on their physical development. METHODS: A literature search of relevant databases, books, and articles in journals was performed and compared with current data concerning androgen suppression and endocrine aspects of male sexual dysfunction. RESULTS: The effects of castration on physical development were notoriously erratic. Much depended on the timing of the operation: boys pruned before the age of 10 or so very often grew up with feminine features; smooth, hairless bodies, incipient breasts, infantile penis, and often a complete lack of sex drive. CONCLUSION: The peak success of the castrati ended with the end of the 18th century. The last castrato was Alessandro Moreschi, a solo singer in the choir of the Sistine Chapel of the Vatican. Following the ban on castration, Pope Pius X sent him into retirement in 1912, thus putting an end to a very impressive part of the history of music.

Hyperostosis frontalis interna (HFI) and castration: the case of the famous singer Farinelli (1705-1782).

The famous castrato singer Farinelli (1705-1782) was exhumed by our research group in July 2006 for the purpose of gaining some insight into his biological profile through a study of his skeletal remains. Farinelli was castrated before puberty to preserve the treble pitch of the boy's voice into adult life. His powerful and sweet voice became legendary. In spite of its bad preservation state, the skeleton displayed some interesting characteristics that are probably related to the effects of castration, including long limb-bones, persistence of epiphyseal lines and osteoporosis. In particular, the frontal bone was affected by severe hyperostosis frontalis interna (HFI). This condition consists in a symmetrical thickening of the inner table of the bone. The epidemiology of HFI shows that it is relatively common in postmenopausal women but very rare in men. Men affected by this pathology suffer from diseases, syndromes or treatments causing androgen deficiency. In the case of Farinelli, castration was probably responsible for the onset and development of this lesion.

[Voices from the past: castrate singers]. / Stemmen uit het verleden: castraatzang.

Castration is a severely mutilating procedure. In Italy in the period around 1600-1850 even up to 4,000 yearly prepubescent boys per year underwent a bilateral orchidectomy to preserve their boyish high voice in order to become a 'castrato' singer. The operation was not without health risks and must have caused severe psychological problems, but some of the victims would become very famous, such as Carlo Broschi (1705-1782), better known as Farinelli. However, the majority of the castrati would remain unknown. Tradition has it that that the castrati were welcomed with euphoria by the general public. The last castrato at the Vatican, Alessandro Moreschi, died in 1922. The surviving recordings of the voice of this last official castrato give an impression of how the castrati's singing may have sounded. Several attempts have been made since to imitate the sound of the castrati, for example by digitally mixing soprano and countertenor voices.

[Salic law and punishment by castration]. / Salijski zakon i kazna kastracije.

Lex Salica was made at the end of the 5th century and it governed the Salian Franks. In those times, there were other so-called leges barbarorum, which together formed (as well as Lex Salica) important source of early feudal law in Western Europe. Lex Salica included common law of the Salian Franks which was adopted by the government and therefore had the effect of the law. Most provisions included punishment by whipping, and there were two cases of punishment by castration, although, the alternative to this punishment was a hefty fine that a slave could never pay. Punishment by castration in Lex Salica was intended only for male slaves (while it was strictly forbidden to punish free people in this way) in two cases: - A slave "had sexual relations" (presumably involuntary) with another master's female slave, if such act caused the death of said female slave. - A slave committed burglary (breaking and entering). The existing legal texts do not provide a clue as to who performed the castration of these slaves.

Guilt by association: a historical perspective on Huggins, testosterone therapy, and prostate cancer.

INTRODUCTION: A long-standing belief is that higher testosterone (T) will increase the risk of prostate cancer (PCa), yet recent studies do not support this view. AIM: To identify the key historical and scientific events leading to the establishment and persistence of the belief in a T-dependent model of PCa growth, despite evidence to the contrary. METHODS: Review of key historical scientific articles regarding T and PCa. RESULTS: The T-dependent model of PCa growth arose from the work of Huggins and coworkers, who in 1941 demonstrated dramatic responses to castration among men with advanced PCa. These authors and others also reported a rapid clinical progression with T administration. This led to the concept that T was like "food for a hungry tumor" for men with PCa. Fowler and Whitmore recognized in 1981 that the negative effect of T administration did not occur unless men had been previously castrated. However, this critical observation was either forgotten or dismissed amid major changes in PCa diagnosis and management during the 1980s. More recent studies have failed to provide clinical evidence supporting the belief that higher T represents a risk for PCa. Factors contributing to the persistence of the T-dependent model included dramatic effects of castration, continued use of androgen deprivation for treatment of PCa, an influential spokesperson (Huggins), groupthink (failure to acknowledge evidence inconsistent with the prevalent ideology), and an imprecise formulation of the model ("more T, more cancer growth"), making refutation difficult. CONCLUSIONS: The fear that higher T will increase PCa growth stems from a theory of T-dependent PCa growth that originated with observations in a special population (castrated men) that is not particularly relevant to T therapy in hypogonadal men. The negative view of T with regard to PCa should be recognized for what it is--guilt by association.

[A brief history of the inguinal hernia operation in adults]. / Een beknopte geschiedenis van de liesbreukoperatie bij volwassenen.

Late into the 19th century, treatment for inguinal hernias consisted of repositioning the hernia with trusses or using 'softening agents' such as warm herbal baths and moist bandages. Surgical resection or cauterisation, often combined with hemicastration, was only considered for cases ofstrangulated hernia that could not be repositioned. Bassini (1844-1924) is credited with developing the precursor to the modern inguinal hernia operation at the end of the 19th century. Bassini's essential discovery was that the transverse fascia plays a key role in the pathophysiology of inguinal hernias. Bassini's operation, consisting of complete incision of the transverse fascia and reconstruction of the inguinal floor, was considered the gold standard for nearly a century. One problem with the conventional Bassini operation was the tension applied to tissues, which led to a high rate of recurrence. Although Bassini's operation has now become obsolete, current surgical approaches still centre on fortification of the inguinal floor. This tension-free repair now uses synthetic mesh that is positioned using an open anterior approach, laparoscopic surgery, or a preperitoneal technique.

The sexuality and social performance of androgen-deprived (castrated) men throughout history: implications for modern day cancer patients.

Androgen-deprivation therapy (ADT) via either surgical or chemical castration is the standard treatment for advanced prostate cancer (PCa). In North America, it is estimated that more than 40,000 men start ADT each year. The side effects of this treatment are extensive and include gynecomastia, erectile dysfunction, and reduced libido. These changes strongly challenge patients' self-identity and sexuality. The historical term for a man who has been castrated is 'eunuch', now a pejorative term implying overall social and sexual impotence. In this paper, we review key historical features of eunuch social performance and sexuality from a variety of cultures in order to assess the validity of contemporary stereotypes of the androgen-deprived male. Data were taken from secondary sources on the history of Byzantium, Roman Antiquity, Early Islamic societies, the Ottoman Empire, Chinese Dynasties, and the Italian Castrati period. This cross-cultural survey shows that castrated men consistently held powerful social positions that yielded great political influence. Many eunuchs were recognized for their loyalty, managerial style, wisdom, and pedagogical skills. Furthermore, rather than being consistently asexual and celibate, they were often sexually active. In certain cultures, they were objects of sexual desire for males, or females, or both. Collectively, the historical accounts suggest that, given the right cultural setting and individual motivation, androgen deprivation may actually enhance rather than hinder both social and sexual performance. We conclude that eunuch history contradicts the presumption that androgen deprivation necessarily leads to social and sexual impotence. The capabilities and accomplishments of eunuchs in the past gives patients on ADT grounds for viewing themselves in a positive light, where they are neither socially impotent nor sexually chaste.

[How did the castratos sing? Historical observations]. / Wie sangen die Kastraten? Historische Betrachtungen.

Historical observations In Church music from the early beginnings to the 19th century, women were not allowed to sing, because of a wrongly interpreted quote of the Apostle Paul. Paul had ordered women to keep silence in ecclesia, it means: in the community and in the congregation, but he himself never mentioned a ban on singing in church. The castratos gradually replaced the men singing falsetto due to the latter's weaker singing performance from the 17th century onwards. They originated mostly from simple social backgrounds. Many poor families in Italy in the 17th and 18th centuries had up to 15 children and there was far too little work for the population. Some castratos were the stars of the opera. But as human beings they were discriminated. The castration took place mostly between the 7th and 12th years of their lives and many died as a result of the operation. The singing-lessons thereafter lasted 5-6 years. In the 18th century, the most famous castrato was Carlo Broschi, named Farinelli (1705-1782). Numerous arias sung by him are still in existence as scores, some are high quality concert pieces. There are modem versions on CD sung by a counter-tenor or a mezzo-soprano as soloists. Farinelli was able, during a visit to Spain, to improve with his singing the mood of two severely depressive kings. In the late 18th and in the 19th century, the castratos were increasingly replaced by tenors and women singers. The only historical sound recordings were sung by one of the last castratos, Alessandro Moreschi (1858-1922). The recordings were made in 1902 and 1904 in the Vatican. The arias are in the style of the end of the 19th century and contain no longer anything of the bravura arias so admired by the audiences in the 18th century. Since the end of World War II, the high male voices have experienced a renaissance.

[Risking more freedom? Cyproterone acetate, sexual offenders and the German "Law on voluntary castration and other methods of treatment", 1960-1975]. / Mehr Freiheit wagen? Cyproteronacetat, Sexualstraftäter und das "Gesetz über die freiwillige Kastration und andere Behandlungsmethoden" 1960 bis 1975.

Shortly after the fall of the National Socialist regime efforts were made in the Federal Republic of Germany to legislate anew on sterilisation and castration. For some experts, in particular sexologists and forensic psychiatrists in Hamburg, the question of the "treatment" of sexual offenders soon played a major role. In another research context an endocrinological substance showing anti-androgenic effects was synthesised in 1961 at the Schering AG in Berlin. In 1966 this substance, cyproterone acetate, was used for the first time to subdue the sexual drive. During parliamentary debates on a reintroduction of castration as a method of treatment for sexual deviations the advocates of cyproterone acetate succeeded in "inserting" their expertise into the "law on voluntary castration and other methods of treatment", which was adopted by the German Bundestag in January 1969. This paper discusses the interface between applied pharmacology, forensic psychiatry and sexology, and the politics leading to this law.

The impact of surgical castration on sexual recidivism risk among sexually violent predatory offenders.

The relationship of surgical castration to sexual recidivism in a sexually violent predator/sexually dangerous person (SVP/SDP) population is reviewed. A review of the literature on castrated sex offenders reveals a very low incidence of sexual recidivism. The low sexual recidivism rates reported are critiqued in light of the methodologic limitations of the studies. Better designed testicular/prostate cancer studies have demonstrated that, while sexual desire is reduced by orchiectomy, the capacity to develop an erection in response to sexually stimulating material is not eliminated. The relevance of this literature to SVP/SDP commitment decisions and ethics is discussed. Two vignettes of castrated, high-risk sex offenders illustrate how to address risk reduction. Two tables are presented: the first outlines individual case data from a difficult-to-obtain report, and the second summarizes the most frequently cited castration studies on sexual recidivism. Orchiectomy may have a role in risk assessments; however, other variables should be considered, particularly as the effects can be reversed by replacement testosterone.