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Exhibitionism

(Exhibitionistic Disorder)

By George R. Brown, MD, Mountain home VAMC, Johnson City, TN;East Tennessee State University

Exhibitionism involves exposing the genitals to become sexually excited or having a strong desire to be observed by other people during sexual activity. Exhibitionistic disorder involves acting on exhibitionistic urges or fantasies or being distressed by or unable to function because of those urges and fantasies.

Exhibitionism is a form of paraphilia.

Exhibitionists (usually males) expose their genitals, usually to unsuspecting strangers, and become sexually excited when doing so. They may be aware of their need to surprise, shock, or impress the unwilling observer. The victim is almost always a woman or a child of either sex. Actual sexual contact is almost never sought, so exhibitionists rarely commit rape.

Exhibitionism usually starts during adolescence. Most exhibitionists are married, but the marriage is often troubled.

About 30% of male sex offenders who are arrested are exhibitionists. They tend to persist in their behavior. About 20 to 50% are re-arrested.

Exposure of genitals to unsuspecting strangers for sexual excitement is rare among women. Women have other venues to expose themselves: dressing provocatively (which is increasingly accepted as normal) and appearing in various media and entertainment venues. Participation in these venues of itself does not constitute a mental health disorder.

For some people, exhibitionism is expressed as a strong desire to have other people watch their sexual acts. Such people want to be seen by a consenting audience, rather than to surprise people. People with this form of exhibitionism may make pornographic films or become adult entertainers. They are rarely troubled by their desire and thus may not have a mental health disorder.

Most people with exhibitionistic tendencies do not have a disorder.

Treatment

  • Psychotherapy, support groups, and certain antidepressants

  • Sometimes other drugs

Treatment usually begins after exhibitionists are arrested. It includes psychotherapy, support groups, and antidepressants called selective serotonin reuptake inhibitors (SSRIs).

If these drugs are ineffective, drugs that alter the sex drive and reduce testosterone levels may be used. These drugs include leuprolide and medroxyprogesterone acetate. People must give their informed consent to the use of these drugs, and doctors periodically do blood tests to monitor the drug’s effects on liver function, as well as other tests (including bone density tests and blood tests to measure testosterone levels.

* This is the Consumer Version. *