Nymphomania

by  Dr  Ruwan M Jayatunge and Dr Laurent Karila, of Paul Brousse University Hospital, Villejuif, France

Problematic sexual behaviors have been identified for centuries and Nymphomania has become a controversial subject among the clinicians. Nymphomania is considered as an organic disease, psychological disorder and a legal construct (Groneman, 2001). The term nymphomania resonates with a sense of the insatiable sexuality of women, devouring, depraved, and diseased. It conjures up an aggressively sexual female who both terrifies and titillates men (Groneman, 1994).

In general notion nymphomania is defined as a neurotic condition in women in which the symptoms are a compulsion to have sexual intercourse with as many men as possible and an inability to have lasting relationships with them. Hypersexuality in males sometimes known as Don-Juanism (Shainess, 1972).

Nymphomania is a compulsive sexual behaviours which include conventional behaviours that are taken to such obsessive extremes that they interfere with everyday life. Nymphomania shows a symptom-profile similar to the current notion of ‘sexual addiction’ (Goodman, 1998; Berrios&Rivière, 2006). Since  the  appearance  of  sexual  addiction  in  the clinical literature, various  terms have been used to name the  condition,  including  nymphomania,  Don  Juanism,  satyriasis , sexual compulsivity,  sexual  impulsivity ,  out-of-control  sexual  behavior , sexual  addiction,  and  hypersexual  behaviour  (Karila et al., 2014).  

The term nymphomania was inspired by Greek mythology: nymphs are minor deities represented as beautiful maidens. The nymph was a female character who could either resist male desire, or could be sexually promiscuous herself, to the point of aggression (Cohen, 2014).

Hippocrates (460 BC) wrote uncontrolled sexual behaviours in young girls (under the term of melancholy madness) and recommended marriage as the cure (King, 1998).  For centuries it was named as madness from the womb. In some cultures clitoridectomy was performed as a treatment measure. According to Brooten (1996) clitoridectomy was the suggested remedy for women with an overly large clitoris or “masculine desires”. This concept of “masculine desires” in women may also have included the act of being “sexually aggressive” towards men. Furthermore as conservative management hemp seed emulsion was used to treat furor uterinus or nymphomania (Russo, 2002).

The treatment of nymphomaniawas discussed in the Aurvedic Medicine (Rao, 2003).The origin of Ayurveda is attributed to Atharva Veda where mention is made several diseases with their treatments. Later, from the 6^th Century BC to 7^th Century AD (Narayanaswamy, 1981).The Ayurvedic medicine recommended herbal treatmentfor impulse-control disorders such as   hypersexuality (Jansen et al., 2014).

Health care in Ancient Sri Lanka would go back about 5000 years (De Silva, 2015). The ancient Sri Lankan physicians identified extreme sexual behaviour in women and named it as Kinnara Umathuwa or Narikaunmadaya. For the affected subjects healing rituals were performed. These rituals constitute behavioral treatments (Bartlett, 1989).

The Buddhist Jātaka stories that were compiled from the 3rd Century B.C. to the 5th Century A.D. narrates about a princess named Krishna (in Maha Kunala Jātakaya) who had suggestive features of Nymphomania or sexual addiction (Jayatunge, 2015).

History recounts several infamous women with extraordinary sexual libido. The Empress Messalina (born in around 20 AD) who was the third wife of the emperor Claudius had an enormous sexual disinhibition. To quench her sexual thrust Messalina incognito used to go to brothels frequently.    

The queen Anuladevi of Sri Lanka reigned from 47 BC –to 42 BC and became famous for her promiscuous behavior. She poisoned her husband the King Chora- Naga and came in to power. Anuladevi became the first queen in Sri Lankan history who had meaningful power and authority.  

According to the historical reports Anuladevi had sexual sensation seeking behaviour. She was fond of men and had a number of affairs with the commoners. Ironically she used to poison her lovers after her erotic desires had been satisfied. She had extreme desire for sex and power.   As described in the Mahavamsa - the Great Chronicle of Sri Lanka in her last four months in power Queen Anuladevi had sexual relationships with 30 young men. Finally as a result of a coup she lost her power and her opponents set fire to her palace. The queen Anuladevi was burnt alive.   

The Italian physician Girolamo Mercuriale(1530- 1606) believed that  immoderate burning in the genital area of the female, caused by the surging of hot vapour, bringing about an erection of the clitoris and causing hyper sexuality in them (Jung,  ‎2011). In 1769 a Scottish medical book published the term ‘nymphomania and the French physician de Bienville, used this term in the medical context in 1771. From the 1880s to the 1930s,   nymphomania began to be transformed from an organic illness with both mental and physical symptoms to a mental disorder caused by psychological factors (Groneman, 1995).  

Freud believed the unconscious was filled with sexual and erotic desire and the true cause of nymphomania was women's failure to have vaginal rather than clitoral orgasms. According to Freudian theory, nymphomania grew out of a psychological condition he called frigidity, in which affected, or sexually immature, women were unable to achieve orgasm during sexual intercourse.As a result of their inability to be sexually satisfied, these women sought frequent sexual encounters as a means of gratifying their sexual needs (Cavendish, 2010).  

The German sexologist Richard Freiherr von Krafft-Ebingdescribed several cases of extreme sexual behaviours in women which he called “insatiable succession of sexual enjoyments”In one of the cases Krafft-Ebing decribes a woman diagnosed with Nymphomania and her  incestuous desire for her own son.  

The American Psychologist Albert Ellis became one of the founders of the American sexual revolution. His early work focused on nymphomania and he described a several cases of oversexed women.  

The word 'nymphomania', the concept of 'madness from the womb' and the belief in the existence of a behaviour consisting in an abnormally high female sexual drive converged during the second half of the seventeenth century to give rise to a new clinical category which, with minor changes, has survived until the present (e.g., in ICD-10) (Berrios &Rivière ,2006). Nymphomania was listed as a "sexual deviation" in the first DSM (Diagnosticand Statistical Manual of Mental Disorders) published in 1951. 

The International Classification of Diseases or ICD-10, includes "Excessive sexual drive" as a diagnosis (code F52.7), subdividing it into satyriasis (for males) and nymphomania (for females). However Hypersexual Disorder was proposed as a new psychiatric disorder for consideration in the Sexual Disorders section for DSM-V.  But it failed and the highly relevant clinical concept 'hypersexuality' has still not been incorporated as a separate category (Goethals &Cosyns, 2014). 

Nymphomania is a form of Compulsive sexual behavior. Compulsive sexual behavior (CSB) is a disorder featuring repetitive, intrusive and distressing sexual thoughts, urges and behaviors that negatively affect many aspects of an individual's life (Derbyshire & Grant  2015). Nymphomania can co-occurr with psychiatric disorders and traumatic experiences. 

There is a stark contrast between the widespread myth of nymphomania and women who actually experience disruptive increases in sexual desire. Nymphomania can be defined in terms of three distinct elements: marked increase in sexual drive; extremely frequent partner sexual behavior; promiscuity (Levine, 1982).  

Some describe of female compulsive sexual behavior in association with obsessive-compulsive disorder (OCD). Mulligan et al (2002) provide several case studies of female compulsive sexual behavior in association with obsessive-compulsive disorder. Some researchers believe that compulsive sexual behavior is a coping strategy to deal with serious stress or anxiety.  

There are strong counter-arguments against the diagnostic entity –nymphomania.   Sexual desire is the subjective experience of being interested in sexual objects or activities or wishing to engage in sexual activities (Regan &Berscheid, 1999; Peplau, 2003). Therefore some Feminists argue that the diagnosis “nemphomania” has been used as a   cultural suppression of female sexuality.  

According to Groneman (1994) the medical diagnosis of nymphomania in the nineteenth century, constructed within a social and cultural context as well as within a scientific one, reflected and reproduced prevailing attitudes about appropriate behavior. Physicians, however, did not speak with a single voice: they did not agree on the nature of the disease, its extent, its treatment, or even what constituted normal female sexuality.Futhermore some feminists have argued that  diagnosesuch as nymphomania has served to enforce conformity to norms of female domesticity, subordination, and subservience to men's sexual needs; at times diagnoses have reaffirmed class distinctions as well” (Marecek, 1993, )As indicated by Eriksen and  Kress (2005) feminist theorists believe that women's anger, depression, and discontent have been reframed as medical or psychiatric symptoms, and that, as a result, the often difficult and distressing life circumstances of women have been disregarded. 

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Dr Laurent Karila, MD, PhD Paul Brousse University Hospital, Villejuif, France

 Born in Paris in 1973, Laurent Karila obtained his medical degree in 1999. He performed his internship in psychiatry at the Universitary Regional Hospital Center of Lille (France) from 1999 to 2004. In 2004 , he joined the psychiatry and addiction medicine department of the hospital Paul Brousse in Villejuif (France). He obtained his PhD in 2012 in Paris 6 University (brain imaging and pharmacological treatment of cocaine addiction). His areas of work are substance use disorder and behavioral addiction treatment : cocaine, new psychoactive substances (cathinone, cannabinoids..), methamphetamine, amphetamines, internet and sex. Laurent Karila participated in numerous books and scientific publications in the field of psychiatry and addiction medicine . He also participated in many addiction prevention projects.