which he felt humiliated or emasculated. Exposing himself hadbecome a way to reassure himself that he “had the guts” to besuccessful as a man. Rick discovered that his vulnerability tofeeling very easily humiliated did indeed stem from his child-hood experience of abuse, and his family’s shame and silenceabout it. By gradually learning to understand these urges, Rickwas eventually able to keep himself from acting on them thoughhe still felt a strong desire to do so.CASE DISCUSSION●ExhibitionismRick was not highly motivated to change initially. Like many in-dividuals with paraphilias, he wanted to avoid the negative con-sequences of his behavior while continuing to pursue it.However, the group treatment was effective in confronting Rick’sdenial of the seriousness of his problem and increasing his mo-tivation to change. Further individual therapy allowed Rick to ad-dress the earlier sexual traumas that contributed to his exhibi-tionism, leading to a more favorable outcome than is the case formost men with exhibitionism.Phil●Gender Identity DisorderPhil (the 35-year-old anthropology professor) consulted with apsychologist who was experienced in working with GID and af-filiated with a sexual disorders clinic. The psychologist explainedto Phil what the sex-change process would entail, and encour-aged him to read more about it and to talk to others who had un-dergone a sex change. As he did so, Phil became even moreconvinced that he wanted to proceed with a sex change. He feltthat he could only be happy living as the woman he felt he was,sharing “girl talk” with close female friends, and having a malesexual partner. Phil applied to the sex-change treatment program.The program began with a psychological evaluation, counseling,and support for the first stage of the process—successfully livinghansell_c10_364-407hr 11/6/07 4:23 PM Page 405
406CHAPTER TEN■Sex, Gender, and the Sexual Disordersas a woman for a year. The psychological evaluation indicatedthat Phil was emotionally stable and realistically motivated topursue a sex change.Phil found this first year “liberating.” It began with tellinghis friends, family, and colleagues about his decision, and mostwere quite accepting. Phil began female hormone treatment; withdaily estrogen doses, he developed breasts, his muscles and skinsoftened, and he reported that he “felt womanly.” Phil met witha team of speech and physical therapists who helped him to learnto talk and move like the woman he was becoming. Electrolysisallowed him to remove his unwanted facial and body hair. Bynow, Phil easily passed as a woman, yet he felt his change wasnot complete as long as he had a penis instead of a vagina. Hewanted to feel like “a complete, genuine woman able to have afull relationship with a man.” Since everything had proceededwell up to this point, Phil was scheduled for sex-change surgery.