Exposing himself had become a way to reassure himself

which he felt humiliated or emasculated. Exposing himself had
become a way to reassure himself that he “had the guts” to be
successful as a man. Rick discovered that his vulnerability to
feeling very easily humiliated did indeed stem from his child-
hood experience of abuse, and his family’s shame and silence
about it. By gradually learning to understand these urges, Rick
was eventually able to keep himself from acting on them though
he still felt a strong desire to do so.
CASE DISCUSSION
●
Exhibitionism
Rick 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’s
denial 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 for
most men with exhibitionism.
Phil
●
Gender Identity Disorder
Phil (the 35-year-old anthropology professor) consulted with a
psychologist who was experienced in working with GID and af-
filiated with a sexual disorders clinic. The psychologist explained
to 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 more
convinced that he wanted to proceed with a sex change. He felt
that he could only be happy living as the woman he felt he was,
sharing “girl talk” with close female friends, and having a male
sexual 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 living
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CHAPTER TEN
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Sex, Gender, and the Sexual Disorders
as a woman for a year. The psychological evaluation indicated
that Phil was emotionally stable and realistically motivated to
pursue a sex change.
Phil found this first year “liberating.” It began with telling
his friends, family, and colleagues about his decision, and most
were quite accepting. Phil began female hormone treatment; with
daily estrogen doses, he developed breasts, his muscles and skin
softened, and he reported that he “felt womanly.” Phil met with
a team of speech and physical therapists who helped him to learn
to talk and move like the woman he was becoming. Electrolysis
allowed him to remove his unwanted facial and body hair. By
now, Phil easily passed as a woman, yet he felt his change was
not complete as long as he had a penis instead of a vagina. He
wanted to feel like “a complete, genuine woman able to have a
full relationship with a man.” Since everything had proceeded
well up to this point, Phil was scheduled for sex-change surgery.