Childhood female masturbation

other playmates and start "leaning". surable, not painful, feelings. The Susan J. Bradley,* MD When her language skills increased child's grandmother and teacher had she would say to anyone attempting both suggested that she was mastur- to distract her "Wait a minute: I am bating. The treatment intervention Masturbation is not uncommon in not finished." was to consistently discourage the young children. However, it is not When the child was about 2 years child from exhibiting this behaviour usually noticed in children under 3 old her family physician referred her in public. years old. In this paper I describe a to the Gastroenterology Clinic of One year later the frequency of child who had started to masturbate our hospital for assessment of the the episodes had decreased and they at 5 months of age but in whom the leaning episodes and her delayed were seldom seen to occur at school; diagnosis was not made until 5 years growth (she had dropped from the the parents were aware that she was later. 50th to the 10th percentile in 2 still masturbating in private, but years). Although the notes on the they were now more tolerant of her Case report child's chart stated that the episodes behaviour. were not accompanied by pain, the A 51/2-year-old girl was referred presenting complaint continued to Discussion to the Department of Psychiatry, be listed as painful episodes. The Hospital for Sick Children, Toronto, nursing staff who observed the epi- Although the genitals are usually for "leaning episodes" lasting from a sodes described them as being "well discovered in the latter half of the few minutes to several hours. During within the range of normal behav- first year, masturbation, the rhyth- these episodes the child would lean iour". mic manipulation of the genitals forward, often over a table or a The results of physical, hemato- accompanied by mounting excite- ledge, and look flushed and preoccu- logic and extensive gastroenterologic ment and what appears to be an pied. This could happen several examinations, which included a orgasm, does not typically occur in times a day or as infrequently as a small-bowel biopsy, were unremark- children less than 21/2 years old,"2 few times a week. able. although in some children the same The leaning episodes had begun When the child was 5 years old effects may be attained at a much when the child was 5 months of age she was referred for allergy testing. earlier age with rocking.3 and were accompanied by infrequent The results were negative. Two It has been shown that genital and brief bouts of crying and leg months later, at a follow-up visit to play during the first year of life is and arm flexion. Later the crying the Gastroenterology Clinic, the related to a positive mother-child stopped but the child's breathing child pointed to her pudendum and relationship.4 However, the factors became laboured during the leaning vulva as the source of concern. She that elicit masturbation have been episodes. then underwent an extensive genito- less well studied. Tension, excite- During the first 2 years her par- urinary evaluation, including intra- ment,2 boredom or lack of stimula- ents had tried different methods of venous pyelography, voiding cysto- tion may be contributing factors. dealing with her behaviour, includ- urethrography, abdominal ul- Sauzier,5 in an uncontrolled study of ing distraction, placation and at trasonography and culture of urine preschool-aged children, found that times anger. However, the frequency specimens. All the results were nor- masturbation was excessive in chil- of the episodes increased, and they mal. dren who had been sexually abused. could last from several minutes to A month later the parents Other related factors included infec- several hours. Although the leaning brought in a film of the child's tions of the genital system and rash- episodes most often occurred at leaning episodes. A gynecology fel- es on the vulva or perineum.2 Such home they also occurred in public low and a neurologist, both female, rashes were at times thought to be places. They did not seem to be assessed the child. In view of the the effect as well as the cause. related to boredom since the child negative results of their investiga- Balk and colleagues6 showed that would sometimes interrupt appar- tions and the evidence from the film in routine health examinations of ently pleasurable activities with they both diagnosed masturbation. children by pediatric house staff the Psychiatric assessment revealed female genitalia were examined half *Clinical director, Department of Psychiatry, that the child had been inhibiting as frequently as the male genitalia. Hospital for Sick Children, Toronto; asso- more than 3 the child I ciate professor, Department of Psychiatry, her behaviour at school at the teach- Over years University of Toronto er's request. The child described have described underwent several being able to reproduce the same unnecessary and expensive investiga- Reprint requests to: Dr. Susan J. Bradley, common and Department of Psychiatry, Hospital for Sick feeling she had during the leaning tions of a relatively Children, 555 University Ave., Toronto, Ont. episodes by rubbing her genital area benign behaviour. There may be M5G lX8 and reported that it produced plea- several reasons why the diagnosis CAN MED ASSOC J, VOL. 132, MAY 15, 1985 1165 was not made earlier. The mastur- correct diagnosis, which was made uality. J Am Psychoanal Assoc 1956; 4: bation began at an unusually early by the child's grandmother and 453-476 age, 5 months. The child was not teacher. 4. Spitz RA, Wolf KM: Autoerotism: some seen by a female physician until empirical findings and hypotheses on three after the diagnosis was made. Per- References of its manifestations in the first year of haps pediatricians, especially males, life. In Emde RN (ed): Rene A. Spitz: 1. Kleeman JA: Genital self-stimulation in Dialogues from Infancy, Selected Papers, are not likely to think of masturba- infant and toddler girls. In Marcus 1, Intl Univs Pr, New York, 1983 tion occurring in young girls. The Francis JJ (eds): Masturbation from In- 5. Sauzier M: Sexual abuse of children and nursing staff who felt that the fancy to Senesence, Intl Univs Pr, New adolescents. Audio Dig Psychiatr 1984; child's behaviour was normal did not York, 1975 13: no 17 communicate their impression to the 2. Levine Ml: Pediatric observations on mas- other medical staff. Finally, the turbation in children. Psychoanal Study 6. Balk SJ, Dreyfus NG, Harris P: Exami- Child 1951; 6: 117-124 nation of genitalia in children: "the re- child's retarded growth may have maining taboo". Pediatrics 1982; 70: distracted the physicians from the 3. Kestenberg JS: Vicissitudes of female sex- 75 1-753

encephalitis in New Bruns

zures. On the fifth day of the illness In addition, a hemagglutination in- J.A. Embil,*tt MD, PhD, FRCPC, his temperature rose to 40°C, and hibition test showed antibodies to FACTM he had a brief generalized tonic- SSH antigen in the IgM fraction of P.R. Camfield,t MD, FRCPC clonic seizure. The fever, accompa- serum fractionated by the sucrose- H. Artsob,§ PhD nied by lethargy and vomiting, per- gradient method. sisted for another 5 days, after which the boy recovered. Comment California (CAL) serogroup virus A lumbar puncture performed on activity has been documented the fifth day showed a lymphocyte Antibodies to CAL serogroup vi- throughout Canada, but human dis- count of 37 X 106/L in the cerebro- ruses (SSH and JC) have previously ease due to these viruses has been spinal fluid, and a puncture per- been found in New Brunswick in the recognized in only three provinces: formed on the eighth day showed a white-tailed deer (Odocoileus vir- Quebec, Ontario and Nova Scotia.' leukocyte count of 340 X 106/L, ginianus), moose (Alces alces amer- We report the first recognized case with 74% monocytes and 26% neu- icana Clinton) and horse popula- of disease due to a CAL serogroup trophils, a protein level of 1.04 g/L tions.2 In Northumberland County, virus (snowshoe hare [SSH] sero- and a glucose level of 3.8 mmol/L. where this patient lives, 18 of 20 type) in New Brunswick. Computed tomography of the head samples of moose blood collected gave normal results, and an electro- during 1979 were found by neutral- Case report encephalogram showed diffuse slow- ization tests to contain antibodies to ing compatible with encephalitis. SSH, and 2 of 2 samples of horse In August 1984 an illness charac- The boy made an uneventful re- blood collected during 1977 were terized by headache and malaise covery and 1 month later was well. found by hemagglutination inhibi- developed in an 11-year-old boy. He He had not travelled away from tion tests to contain the same type of had a history of eight febrile sei- Chatham, Northumberland County, antibodies.2 New Brunswick for at least a month From the departments of *Microbiology, before his illness. References tPediatrics and tCommunity Health and Ep- Hemagglutination inhibition and idemiology, Dalhousie University and Izaak neutralization tests of serum ob- 1. Artsob H: Distribution of California Walton Killam Hospital for Children, Hali- tained Aug. 17 and 20 showed a serogroup viruses and virus infections in fax, and §the National Arbovirus Reference twofold and a Canada. Prog Clin Biol Res 1983; 123: Service, Department of Microbiology, Uni- fourfold increase re- 277-290 versity of Toronto spectively in the titre of antibody to SSH antigen as well as lower titres 2. McFarlane BL, Embree JE, Embil JA et Reprint requests to: Dr. J.A. Embil, Infection al: Antibodies to the California group of and Immunology Research Laboratory, Izaak of antibody to three related CAL arboviruses in animal populations of New Walton Killam Hospital for Children, 5850 serogroup viruses: Jamestown Can- Brunswick. Can J Microbiol 1982; 28: University Ave., Halifax, NS B3J 3G9 yon (JC), trivittatus and LaCrosse. 200-204 1166 CAN MED ASSOC J, VOL. 132, MAY 15, 1985