Masturbación compulsiva en adolescente / Compulsive Masturbation in Adolescents

Introducción: La masturbación compulsiva provoca una cascada de sentimientos y emociones que pueden recorrer desde la culpabilidad y el rechazo a la satisfacción hasta el bienestar más placentero y deseado. Objetivo: Exponer una forma de presentación poco frecuente de un adolescente con masturbación compulsiva. Presentación del caso: Adolescente masculino de 14 años de edad, de procedencia rural y antecedentes de salud física. Evaluado en consulta de psiquiatría infanto - juvenil por realizar masturbaciones en sitios públicos, que resultaban cada vez más frecuentes, y al final de esta se producía expulsión de materia fecal. Los estudios clínicos y psicométricos confirmaron el diagnóstico de masturbación compulsiva. Conclusiones: El tratamiento se basó en el modelo cognitivo-conductual y farmacológico con imipramina. Se disminuyó la frecuencia e intensidad, así como la duración de la conducta problema. El caso clínico expuesto resulta de interés por ser poco frecuente la presencia de este trastorno dentro de la población adolescente(AU)

Introduction: Compulsive masturbation provokes a cascade of feelings and emotions that can range from guilt and refusal to satisfaction to the most pleasurable and desired well-being. Aim: To present a rare presentation of an adolescent with compulsive masturbation. Case presentation: 14-year-old male adolescent from a rural area with a history of previous physical health. He was evaluated in a child and adolescent psychiatry clinic for masturbation in public places, which became increasingly frequent and ended with the expulsion of fecal matter. Clinical and psychometric studies confirmed the diagnosis of compulsive masturbation. Conclusions: Treatment was based on the cognitive-behavioral and pharmacological model with imipramine. The frequency and intensity, as well as the duration of the problem behavior was reduced. The clinical case presented was of interest due to the infrequent presence of this disorder in the adolescent population(AU)

Presentation Of Children With Masturbation.

Childhood masturbations (CM) is stimulation of genital by pre-adolescent children with accompanying symptoms including sweating, tachycardia, blushing, muscle contraction and increase rate of breathing. We are presenting case series of three patients, who presented with history of vague symptoms and ultimately diagnosed and managed as case of CM. A 2 years old girl presented with history of to and fro movements. A 3 years old girl presented with history of rubbing of inner thighs and 3 years old boy presented with history of holding and rubbing genitalia with forward bending and symptoms of increase breathing, flushing and sweating. Video recording was available with two patients, which helped in making final diagnosis. Parents were counselled and patients referred for behavioural therapy. Conclusion: In young child CM should be considered in differential diagnosis whenever history is not fully suggestive of seizures.

Paroxysmal non-epileptic events in infants and toddlers: A phenomenologic analysis.

AIM: The aim of this study was to analyze in detail the clinical phenomenology of paroxysmal non-epileptic events (PNEE) in infants and toddlers. METHODS: We studied all children aged ≤2 years who were diagnosed with PNEE based on video-electroencephalographic (VEEG) recordings. We analyzed the following four clinical domains of each clinical event: (i) motor manifestations (body/limb jerking, complex motor, and asymmetric limb posturing); (ii) oral/vocal (crying, vocalization, sighing); (iii) behavioral change (arrest of activity, staring); (iv) and autonomic (facial flushing, breath holding). RESULTS: Thirty-one of 81 (38.3%) infants and toddlers had 38 PNEE recorded during the study period (12 girls and 19 boys, mean age 10.5 months). The predominant clinical features were as follows: motor in 26/38 events, oral/verbal in 14/38 events, behavioral in 11/38 events, and autonomic in 8/38 events. Epileptic seizures and PNEE coexisted in four children (12.9%). Seventeen children (54.8%) had one or more risk factors suggestive of epilepsy. Twelve children (38.7%) had a normal neurologic examination, 10 (32.3%) had developmental delay, and eight (25.8%) had a family history of epilepsy or seizures. CONCLUSION: VEEG recorded PNEE in nearly 40% of 81 infants and toddlers referred for unclear paroxysmal events in our cohort. Non-epileptic staring spells and benign sleep myoclonus were the most common events recorded, followed by shuddering attacks and infantile masturbation. In addition, greater than one-half of the infants and toddlers had risk factors, raising a concern for epilepsy in the family and prompting the VEEG evaluation, suggesting that paroxysmal non-epileptic seizures may frequently coexist in young children with epilepsy.

Girls who masturbate in early infancy: diagnostics, natural course and a long-term follow-up.

AIM: To evaluate the natural course, onset, diagnostics and long-term follow-up masturbation in infant girls, which up to now has only been described in case reports. METHODS: Nineteen consecutive healthy, masturbating girls, diagnosed in early infancy between three and 15 months, were followed up for an average of 8 years. All were diagnosed in the same Swedish hospital between May 1996 and June 2010. Ten girls were videotaped and/or directly observed while masturbating. RESULTS: Mean age at onset of masturbation was 10.4 months. The diagnosis was based on history taking and clinical observation. Parents reported that masturbation ranged from a few times a week to two-to-fifty episodes a day. Twelve girls had stopped masturbating when this study was written, after a mean duration of 66 months. Their symptoms and diagnostics are described in detail. CONCLUSION: This is the first follow-up study of girls who started masturbating in early infancy, with a mean duration of five-and-a-half years. Diagnosis may be difficult, but with awareness and knowledge of the condition, a normal physical and neurological examination, a detailed history from the parents and, in particular, video documentation, it can be settled without extensive investigations and the parents reassured.

Infantile and early childhood masturbation: Sex hormones and clinical profile.

BACKGROUND AND OBJECTIVES: Few studies have explored the hormonal triggers for masturbation in infants and young children. Thus, we aimed to study the sex hormones and clinical profiles of masturbating infants and young children. METHODS: This case-control study involved infants and young children who masturbate and were referred to three pediatric neurology clinics between September 2004 and 2006 (n=13), and a similar control group. All children underwent basic laboratory investigations prior to referral. Other tests included electroencephalography (n=8) and brain neuroimaging (n=9). We measured dehydroepiandrosterone sulfate, 17-hydroxyprogesterone, free testosterone, estradiol, dehydroepiandrosterone, sex hormone-binding globulin (SHBG), and androstenedione in all participants. RESULT: The median age at the first incident was 19.5 months (range, 4-36 months); the median masturbation frequency, 4 times/day; and the median duration of each event, 3.9 min. The subjects masturbated in both prone (n=10) and supine positions (n=3); two subjects used the knee-chest position. All subjects showed facial flushing; 6, friction between the thighs; 5, sweating; 9, sleeping after the event; and 12, disturbance on interruption. EEG was abnormal in one of eight subjects tested, and neuroimages were normal in all of nine subjects examined. The case and control groups had comparable levels of all sex hormones, except estradiol, which showed significantly lower levels in the case group (P=.02). CONCLUSION: Masturbation in children seems to be associated with reduced estradiol levels, but not with other sex hormones. Further studies are needed to confirm our findings.

Diagnosis, assessment, and treatment of hypersexuality.

This article reviews the current evidence base for the diagnosis, assessment, and treatment of hypersexual conditions. Controversy concerning this diagnosis is discussed. Terminology and diagnostic criteria, as well as psychological, psychopharmacological, and other treatment approaches, are presented.

Hand activities in infantile masturbation: a video analysis of 13 cases.

BACKGROUND: Infantile masturbation is considered a variant of normal behaviour. The abrupt and spontaneous onset, altered sensorium and autonomic phenomena during episodes may suggest an epileptic fit. Therefore, children with infantile masturbation are often admitted to hospital and undergo unnecessary tests. The purpose of the present study was to provide a detailed description of hand activities in infantile masturbation. METHODS: The authors reviewed video recordings of 2 boys and 11 girls with infantile masturbation. Position, movements and activities of hands and fingers during episodes were registered. RESULTS: Five patterns of hand activities were registered: Fisting (four infants), grasping of toys, furniture or clothing (ten infants), chorea-like "piano playing" hand movements (two infants), pressure over the diaper/genital region (one infant) and bimanual manipulation of items (four infants). Fisting was primarily observed in the younger infants, and bimanual manipulation was primarily seen in the older infants. CONCLUSIONS: Recognizing one or more of the five distinct patterns of hand activities in infantile masturbation may help establishing the diagnosis.

Infantile masturbation in an African female: is this a justification for female genital cutting?

BACKGROUND: Masturbation is a taboo and not discussed openly in Africa. It is still worse when it occurs in an infant and will thus call for a visit to the traditional healers for 'spiritual intervention' and prompt female genital cutting/mutilation to reduce the child's libido and risk of sexual promiscuity as she gets older. Because of its peculiar presentation in children without manual genital stimulation, it is often misdiagnosed. A Medline search showed sparse information on infantile masturbation and none from Africa. METHODS: A 15-month-old female was brought into a clinic in Port Harcourt, Nigeria, with a history of unusual rocking with adduction of the thighs noticed since 3 months of age. At 10 months of age, the child would lean forward and rock continuously on a hard surface such as a chair or an adult's lap. Rocking was accompanied with lip smacking, eye rolling, shaking, "watching of television in the air", spasm and feeling of fatigue and then resumption of the motions unless she was distracted. The child had been spanked occasionally by both parents with no noticeable change in behavior. Older female relatives had suggested female genital cutting or circumcision, but her father resisted vehemently. RESULTS: Infantile masturbation was viewed by the pediatrician and a 10-minute video recording was taken to confirm the diagnosis. The mother was reassured, counseled about behavioral and environmental modification. There was a marked improvement when the baby was seen 6 weeks later. CONCLUSIONS: Infantile masturbation rarely diagnosed in our region is probably due to a low index of suspicion and because mothers are afraid of stigma. We suggest that infantile masturbation should always be considered as a differential diagnosis of strange movement mimicking epilepsy in infants, and when a diagnosis is made parents should be counseled against female genital cutting. A video recording is encouraged fora correct diagnosis.

Infantile masturbation and paroxysmal disorders.

A recurrent paroxysmal presentation in children leads to different diagnoses and among them are neurologic and cardiac etiologies. Infantile masturbation is not a well known entity and cannot be differentiated easily from other disorders. Aim of this study is to elucidate and differentiate this condition from epileptic seizures. We report 3 cases of 10 to 30 mth old girls of infantile masturbation that their symptoms initiated at 2, 3 and 8 mth of age. These present with contraction and extension of lower extremities, scissoring of legs, perspiration, changing face color. In 2 cases body rocking and legs rubbing initiated then there after. Masturbation is one of the paroxysmal non-epileptic conditions of early infancy and is in differential diagnosis of epileptic seizures.

Masturbation in infancy and early childhood presenting as a movement disorder: 12 cases and a review of the literature.

PURPOSE: Infantile masturbation (gratification behavior) is not commonly identified as a cause of recurrent paroxysmal movements. Extensive and fruitless investigations may be pursued before establishing this diagnosis. Sparse literature is available regarding masturbatory behavior as a whole, but literature available as case reports describes common features. The purpose of this case series is to describe consistent features in young children with posturing accompanying masturbation. METHODS: Twelve patients presenting to a pediatric movement disorders clinic with a suspected movement disorder were determined to have postures and movements associated with masturbation. We reviewed the clinical history, examination, and home videotapes of these patients. RESULTS: Our patients had several features in common: (1) onset after the age of 3 months and before 3 years; (2) stereotyped episodes of variable duration; (3) vocalizations with quiet grunting; (4) facial flushing with diaphoresis; (5) pressure on the perineum with characteristic posturing of the lower extremities; (6) no alteration of consciousness; (7) cessation with distraction; (8) normal examination; and (9) normal laboratory studies. CONCLUSIONS: The identification of these common features by primary care providers should assist in making this diagnosis and eliminate the need for extensive, unnecessary testing. Direct observation of the events is crucial, and the video camera is a useful tool that may help in the identification of masturbatory behavior.

Video reveals self-stimulation in infancy.

UNLABELLED: The medical literature on early childhood masturbation is sparse. Only 12 patients who presented with infantile self-stimulation under the age of 1 y are described. During the last 2 y, five girls under 1 y of age presented at our department with self-stimulating behaviour. The diagnosis of this behaviour was difficult, but could be made by watching a video of the attacks. Infantile self-stimulation is often misdiagnosed and unnecessary investigations and useless treatments are often prescribed. Video recording can be of great help to put forward the correct diagnosis. Masturbation is not so uncommon and treatment consists mostly in reassuring the parents. It can, however, be associated with behavioural problems. Few data are available on the clinical outcome of childhood masturbation, but most children seem to develop normally. CONCLUSION: Infantile self-stimulation should always be considered in the differential diagnosis of "strange episodes or attacks".

Gratification disorder ("infantile masturbation"): a review.

BACKGROUND: Little has been published on gratification disorder ("infantile masturbation") in early childhood. AIMS: To expand on the profile of patients diagnosed with this condition. METHODS: Retrospective case note review; Fraser of Allander Neurosciences Unit paediatric neurology outpatient department 1972-2002. RESULTS: Thirty one patients were diagnosed (11 males and 20 females). Twenty one were referred for evaluation of possible epileptic seizures or epilepsy. The median age at first symptoms was 10.5 months (range 3 months to 5 years 5 months). The median age at diagnosis was 24.5 months (range 5 months to 8 years). The median frequency of events was seven times per week, and the median length 2.5 minutes. Events occurred in any situation in 10 children, and in a car seat in 11. Types of behaviour manifested were dystonic posturing in 19, grunting in 10, rocking in 9, eidetic imagery in 7, and sweating in 6. Two children had been previously diagnosed as having definite epilepsy. In nine cases home video was invaluable in allowing confident diagnosis. CONCLUSION: Gratification disorder, otherwise called infantile masturbation, is an important consideration in the differential diagnosis of epilepsy and other paroxysmal events in early childhood. Home video recording of events often prevents unnecessary investigations and treatments.

Masturbation mimicking seizure in an infant.

A 3.5-month-old boy was referred to our hospital with the diagnosis of infantile spasm. His developmental milestones and physical examination were normal. During the follow-up we recorded about six to nine attacks a day and the duration of attacks was changed between 15 seconds-1.5 minutes. During the episodic attacks he was flushed and had tonic posturing associated with crossing of thighs, without loss of consciousness and his eye movements were normal. Routine and long-term electroencephalogram (EEG) were normal during attack. The patient was diagnosed as masturbation according to the clinical and EEG findings. In conclusion, we would like to stress that masturbation should also be considered in infants who were admitted with complaint of seizure, and aside from EEG monitoring a detailed history and careful observation are very important factors in differential diagnosis of these two different conditions.

[A video-EEG description of non-epileptic paroxysmal seizures]. / Descripción vídeo-EEG de crisis paroxísticas no epilépticas.

INTRODUCTION: Paroxystic disorders, especially of motor type, mean that sometimes interpretation and classification as epileptic or non-epileptic is difficult. In these cases a recording of the episodes synchronized with an EEG may help diagnosis. DEVELOPMENT: By means of digital EEG and video we have recorded various episodes similar to epileptic seizures, in which lack of correlation between the absence of paroxysms on the recording and the clinical anomalies is well seen, and therefore this investigation is more than justified. In some cases it has allowed medication to be stopped in patients who were being treated as though they were epileptics when in fact they were not. In others, such as a case of syncope with subsequent convulsions, we showed that on the EEG there was slowing followed by reduction in the amplitude representing cortical extinction, far from paroxystic hypersynchrony. Hypnagogic nocturnal episodes are differentiated from true myoclonic epilepsies. We have shown pseudo-seizures which were very similar to the automatisms of epileptic complex partial crises, without electrical changes apart from the extracerebral artefacts due to the patient's movements. CONCLUSION: In every patient in whom there is reasonable doubt as to whether the motor disorders are of cerebral origin or not, a long duration synchronized video-EEG is essential, done both whilst awake and asleep.

Motivos sexuales de consulta en pediatría

Objetivo:presentar la experiencia con los pacientes queconsultan por motivos sexuales a un hospital universitario pediátrico. Método: se revisan los pacientes que consultaron sobre temas sexuales al Servicio de Psiquiatría del Hospital Pediátrico Universitario de la Misericordia, en el período 1991 a 1995. Los indicadores analizados fueron: quién indujo la consulta,a qué edad, las patologías asociadas o desencadenantes, el entorno familiar, escolar y social y el rendimiento escolar. Para el seguimiento las variables fueron: persistencia del motivo de consulta sexual, rendimiento escolar, relaciones sociales, juego, nuevas consultas médicas por la misma causa a otros médicos, peso y talla para la edad. Resultados: siete pacientes consultaron por masturbación y diez por conducta femenina. El grupo de masturbación son mayores de cinco años, con motivo de consulta impreciso, bajo rendimiento escolar, padecía trastorno específico del aprendizaje, retardo mental, ansiedad, epilepsia y disfunción familiar. El grupo con conducta femenina mostró bajo rendimiento escolar, el motivo de consulta fue formulado precisamente, eran rechazados por sus compañeros de estudio. Conclusiones: estos dos motivos de consulta están relacionados con alteraciones emocionales que deben diagnosticarse. Se presenta un método de abordaje y tratamiento.

Effective utilization of home-video recordings for the evaluation of paroxysmal events in pediatrics.

In young children, differentiating seizures from nonepileptic "spells" by history alone can be difficult, even for the specialist. Nonepileptic spells may be psychogenic (rare in the young child) or physiologic in origin. Physiologic spells misidentified as epileptic may be treated with antiepileptic medication where none is needed. Recording spells on video provides a potentially valuable supplement to the clinical history in arriving at a correct diagnosis. In practice, however, most home-video recordings prove difficult to interpret. Simple instructions to parents on the manner in which spells should be recorded will greatly increase the usefulness of home-video recordings. A systemic analysis of precipitating factors and the evolution and resolution of the spell will very often exclude seizures. The widespread availability of home-video recordings provides the pediatrician with an opportunity to visually examine a child's spells, often avoiding unnecessary investigations and referrals and allowing the physician to more confidently offer reassurance to the parents.