Whose attitude about sex is "correct"?

This is something that came up in my DSM class very briefly last week, and it's been on my mind since then, mainly because we didn't get to have a thoughtful discussion about it. So, world, here are my thoughts:

In the DSM's section on paraphilias, which I presented in class last week, there is a notation that each of the paraphilias -- exhibitionism, voyeurism, sexual sadism, sexual masochism, fetishism, transvestic fetishism, etc., -- must be distinguised from the "nonpathological use of sexual fantasies, behaviors or objects as a stimulus for sexual excitement."

Nowhere in the DSM does it address what constitutes "nonpathological." I asked the good and kind professor about this, and she replied that it is a matter of "clinician's judgment," as is the case for several other diagnoses in the DSM.

That seems to be a pretty sticky thing, I told her. I mean, some client could go to a therapist and talk about how she's been going to sex clubs with a new boyfriend and watching other couples have sex and is, let's say, surprised by how much she enjoys doing that and that her sex life with this new guy totally rocks. Personally, I would say, "Well, if you like that, more power to ya."

The good and kind professor nods in agreement.

But, I said, there are *plenty* of people out there who would think that's horrible, who would pathologize that behavior. I mean, clinician's judgment on sex? Everyone has different attitudes about it, and they can be so extreme that the same person can be regarded by different therapists as either enjoying a healthy sex life or being diagnosably "sick."

"You're right. It happens all the time," said the good and kind professor. "As a matter of fact, I had a supervisee who had such strong religious beliefs that she was actually pathologizing..." (Hold on to your hats, folks!) "...premarital sex. She was diagnosing people with Sexual Disorder Not Otherwise Specified."

Not too long after I put my eyeballs back into my head, I got up and gave a lecture to the class about the paraphilias. I showed that infamous spanking scene in "Secretary," and I said to the class, One of the most important things in distinguishing paraphilias from healthy, albeit perhaps unusual, human sexuality is your clinical judgment. I'm certain there can be a lot of debate over whether this spanking scene qualifies as a paraphilia or not.

Because the verbal presentation required that we limit our information to what is in the DSM, I could not go into more detail at that point. I was hoping it would come up in the Q&A. But it didn't. Even for your's truly -- we could call me Not Especially Shy -- it was not the most comfortable thing to talk about masturbation and whatnot in front of the class. So I'm not surprised the questions tended to focus on Gender Identity Disorder rather than any of the paraphilias or problems with desire, arousal and orgasm.

There are several people in the class who I think could actually have a problem saying the word "orgasm," even among good friends and even whispering it. So I didn't really expect a lot of detailed questions. But I'm disappointed we didn't have a discussion about what's "nonpathological" because it's just *those people* who need most to wrap their minds around the idea that healthy sexuality can manifest in ways that would make them uncomfortable. But that doesn't mean it's wrong.

If you exclude the fact that I enjoy it when women bronco ride my face, I'm not especially kinky. But it wasn't so long ago that homosexuality was a sexual disorder, so I am rather sensitive to this business. I am also aware that there are plenty of uptight plebian therapists and religous freaks and other kinds of bumpkins out there who would still like to pathologize gay sex.

Of course, I suspect they would like to pathologize a lot more than that. Masturbating? Off to the asylum with you! Fantasizing about black men again? Paging electroshock, stat! You got tied up and fucked in a sex dungeon -- and you *liked* it? Let's just send you straight to the gallows and see how you like that! You want to get an enema, listen to Britney Spears and screw your wife at the same time?

OK, you're right. Listening to Britney Spears is going too far. And why would you want an enema, seeing as you should *already* be shitting if you like her music?

In case you're wondering, the use of enemas for sexual pleasure is called "klismaphilia." But, technically, liking Britney Spears is a "cultural issue" that can't be pathologized -- another one of the DSM's shortcomings.

But I digress.

Here's the thing: If you're going to counsel people in a way that helps them live a healthier, more fulfilling life, don't pathologize the *non-dangerous* sexual activities of consenting adults unless they tell you it's a problem for *them.* And even then, perhaps some of your most important work will be in helping them realize that some unusual sexual activities are just fine, so they can enjoy what excites them rather than eating themselves up over their fantasies, urges or behaviors.

Life is too short; people should get to enjoy a good fuck. Put *that* on my tombstone.