What is nymphomania?

August 22, 2003

Dear Cecil:

Is nymphomania a recognized medical condition, and, if so, what is its definition?

Much of this column's male readership is now thinking: Gosh, Unca Cecil, can I help with the research? Down, boys. The nymphomaniac of legend was probably best defined by sex research pioneer Alfred Kinsey: "someone who has more sex than you do."

Although wacky theories about female sexuality have circulated since ancient times, as a medical diagnosis nymphomania is only a couple centuries old. According to Carol Groneman, author of Nymphomania: A History (2000), the concept of nymphomania was first laid out by the French physician Bienville in his 1771 treatise, Nymphomania, or a Dissertation Concerning the Furor Uterinus.  Among the behaviors Bienvillle cited as conducive to or symptomatic of nymphomania: dwelling on impure thoughts, reading novels, and eating too much chocolate. Oh, and indulging in "secret pollutions" (masturbation).

Scientific thought on the subject didn't advance much for the next 175 years. Victorian medical literature is peppered with anecdotes about female patients exhibiting what we would regard as simple horniness but which back then could be a ticket to the insane asylum, especially if accompanied by physical symptoms like an "overheated" vagina or an enlarged clitoris or uterus. Treatments ranged from the comical to the downright criminal: cold baths and enemas, leeches applied to the perineum (the area between the vagina and rectum), and clitoridectomy (surgical removal of the clitoris).

Freud and his followers injected new crackpot ideas into the discussion with their pseudoscientific theories about female sexuality. Freud drew a distinction (later dismissed) between clitoral and vaginal orgasms--in his view, the former was the mark of immature women, the latter a characteristic of mature ones. (In fairness to Freud, he was probably just trying to explain why some women routinely have orgasms during intercourse while others must resort to different forms of stimulation.) Building on this idea, Freud's disciples claimed that, far from being a sign of excessive carnality, nymphomania really sprang from frigidity. The sexually immature woman, they argued, was unable to have orgasms during intercourse and so took frequent lovers in a futile quest for satisfaction.

Kinsey introduced an element of realism to the subject with the publication of his landmark studies of male and female sexuality, in 1948 and 1953 respectively. Although his work has since been criticized on methodological grounds, Kinsey made a serious attempt to ascertain the frequency of "sexual outlet" in both sexes using surveys and other research tools. Among his conclusions: terms like nymphomania, hypersexuality, and so on had no scientific basis. Rates of sexual activity varied widely among individuals and there was no readily distinguishable point past which the frequency (or infrequency) of sex became pathological.

Even so, talk of nymphomania persisted until surprisingly recently. Lawyers helped keep the concept in circulation because it was useful in defending accused rapists (although in a widely publicized case in 1970 a woman successfully sued the San Francisco transit authority, claiming that a cable car accident triggered her subsequent hypersexuality). By the 1970s, most sex researchers were willing to concede that some women enjoyed frequent sex with multiple partners and that there was nothing inherently abnormal about this. But a few still felt justified in attaching the term nymphomania to joyless, compulsive sex.

Evolving views of nymphomania were reflected in the successive editions of the American Psychiatric Association's official guide to madness, the Diagnostic and Statistical Manual of Mental Disorders. Nymphomania was listed as a "sexual deviation" in the first DSM, published in 1951; by DSM-III (1980) it had become a "psychosexual disorder," albeit a vaguely defined one. Sensing the winds of change, or maybe just having watched a few talk shows, the editors of DSM-III-R (revised third edition, 1987) dropped nymphomania and its equally quaint male counterpart, Don Juanism, and replaced them with "distress about a pattern of repeated sexual conquests or other forms of nonparaphilic [nondeviant] sexual addiction." In DSM-IV (1994) even sexual addiction was abandoned, perhaps because the non-gender-specific nature of the term laid bare the speciousness of the whole project: If men as well as women can be sex addicts, and if many male victims (Bill Clinton, Joe Namath) are successful, admired, and largely unrepentant, it seems stupid to characterize as an illness what a lot of people would consider an accomplishment.

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