10 Unusual Sexual Conditions

Exactly what is "normal" when it comes to sex?
Exactly what is "normal" when it comes to sex?
© iStockphoto.com/Yuri_Arcurs

When it comes to most things sexual, "normal" spans a wide range. Yet, many of us tend to spend a lot of time unnecessarily worrying about whether we're normal or not, whether we're thinking about our sex drives or how our bodies look. It doesn't help that there can be a big stigma associated with talking about sex, so you can't always compare notes with your peers.

Unusual sexual conditions, though, put some people clearly outside the norm. Most of these conditions are rare, but that doesn't matter much to you if you have one. It can be a huge source of physical and emotional pain, shame and embarrassment. In some cases, it's so difficult to deal with that the person's entire life revolves around it. There's not usually an easy fix or "cure," either.



Some unusual sexual conditions are present at birth, while others take time to emerge. We'll kick off this list of 10 unusual sexual conditions by looking at one of the latter, which might sound kind of fun at first: persistent genital arousal disorder (PGAD).


Persistent Genital Arousal Disorder (PGAD)

People with persistent genital arousal disorder, or PGAD, are constantly in a state of sexual arousal. Actual symptoms of PGAD can vary. Women often experience the physical signs of arousal, including engorgement in their genitals, without even thinking about sex. They can also have such sensitive genital areas that driving or wearing certain types of clothing can cause arousal.

People with PGAD sometimes have spontaneous orgasms, which can number in the dozens each day, or they may have to self-stimulate to find relief. But this relief doesn't last long. The arousal may return within hours, minutes or even seconds, and it can last for days, weeks or months at a time.



Initially, having (or needing to have) orgasms so often might not sound like a bad thing. But for women with PGAD, it's not enjoyable -- it's debilitating, preventing them from sleeping, working or even getting through a family meal. Some women claim to have had PGAD since childhood, while for others it began during a pregnancy or post-menopause. People with the condition often feel ashamed and wait years to seek medical help.

Medical literature only recognized PGAD within the last decade, and doctors are unsure of its cause. It may be due to malfunctioning or damaged sensory nerves. Some patients have been successfully treated with medication such as antidepressants or Chantix (initially used to curb nicotine addiction). Others try to just live with it, thankful that they at least have a name for their mysterious disorder.

Next, we'll look at a condition that's similar in some ways to PGAD: priapism.



Priapism involves one basic symptom: a painful engorgement of erectile tissues that lasts for more than four hours. It occurs when blood becomes trapped in the genital area and does not circulate back into the rest of the body. While women can have priapism, it's more common in men, and men and women require different treatments for the condition.

Priapism can happen spontaneously, but it can also be caused by some medications, diseases or conditions. It's a potential side effect of medications used to treat erectile dysfunction, as well as some antidepressants and recreational drugs like cocaine. Men with sickle-cell anemia often develop priapism -- it occurs in about 40 percent of males with the disease [Source: Cleveland Clinic]. Finally, some cancers and injuries to the scrotum or penis can cause priapism.



Given the large amount of blood trapped in the genitals, priapism in males is a medical emergency. It can cause vessel damage, scarring, a loss of function or even gangrene if left untreated. The earlier people seek attention, the better their chances of a full recovery. An injection of decongestant medications at a doctor's office or hospital can usually get the blood flowing out again. If the patient has had an erection for longer than four hours, he may need a surgical shunt to redirect blood flow or have the blood removed from the penis with a needle.

While priapism isn't an emergency in women, it's still very painful. Treatments include ice packs and anti-inflammatory medication, which usually relieves the tenderness and swelling.

Now, let's look at a condition that's all about wanting sex ... all of the time.



Hypersexuality, or having an excessively overactive sex drive, is classified as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM). People with this diagnosis also have lowered sexual inhibitions and are generally obsessed with sex to the point that their lives are deeply affected.

People with hypersexuality often engage in risky sexual behaviors, like sex with prostitutes and unprotected sex with numerous strangers, which can put them at risk for sexually transmitted infections. Those who are in monogamous relationships may not be able to be faithful to their partners. In extreme cases, hypersexual people may be sexually abusive to others. As with many other sexual conditions, people who are hypersexual don't always seek help. They may not view their impulses or behavior as problematic, instead seeing their sexual prowess as a source of pride.



Hypersexuality can also occur in people with other disorders. People with bipolar or schizoaffective disorder sometimes experience hypersexuality as part of their mania. Patients with neurological disorders such as Alzheimer's disease or traumatic brain injuries sometimes experience it as well. Some medications may even cause hypersexuality, such as the drugs used to treat Parkinson's disease.

Treatment for hypersexuality varies depending on whether it's tied to another disorder. Mood-stabilizing drugs like lithium can lower sex drives overall, and drugs that reduce testosterone levels have been helpful for some patients. Talk therapy can also help people recognize their behavior and work to curb their impulses.

What about people who want a lot of sex ... but only in their sleep? Next, we'll look at sexsomnia.



People with sexsomnia triggered by sleep apnea often find relief when they use a CPAP machine.
People with sexsomnia triggered by sleep apnea often find relief when they use a CPAP machine.
© iStockphoto.com/Yuri_Arcurs

People with sexsomnia have sex while they're asleep. Usually, they have no idea what they've done until confronted by evidence or by another person. Behaviors may range from masturbation to having sexual intercourse while sleeping. Sexsomniacs have been known to sleepwalk from their homes and have sex with strangers. There have even been cases in which a person with sexsomnia committed a sexual assault or rape while asleep [source: Cline].

Sexsomnia is a non-rapid-eye-moment (REM) parasomnia, a sleep disorder that occurs in the periods between deep sleep and wakefulness. Other disorders in this category include sleepwalking, sleep eating, sleep talking, night terrors and teeth grinding. People with sexsomnia typically have one or more of these other parasomnias as well.



While people can simply develop the disorder, factors that disrupt sleep, such as stress, sleep deprivation, apnea, or drug and alcohol use, can also trigger it. Sexsomniacs typically feel ashamed and embarrassed by their behavior, and it can damage their relationships. But the stakes can be even higher. Several men have been charged with rape after episodes of sexsomnia, often with an official diagnosis leading to acquittal. A case in Toronto in 2005 marked the first time that many people had heard of sexsomnia [source: BBC].

Treating sexsomnia can be as simple as treating the underlying cause. For example, use of a CPAP (continuous positive airway pressure) machine to treat sleep apnea has also reduced or eliminated sexsomniac behaviors in people with both conditions. Other sexsomniacs have been successfully treated with Klonopin (clonazepam), an anti-anxiety drug that has also been used to treat other parasomnias.



Many people consider sexuality to be part of who they are and a necessary aspect of romantic relationships. But sex holds no significance whatsoever in the lives of a small number of people. Asexuals have no sex drive or sexual attraction to others. This is different from celibacy, in which people choose not to engage in sexual activities. Asexuals aren't sexually dysfunctional. They're physically able to have sex but prefer not to. They're not bothered by the lack of a sex drive and don't believe there's anything "wrong" with them.

People who are asexual can have romantic relationships and may get married. They often describe their sexual orientation in terms of the people they are attracted to emotionally rather than physically. Asexuals' attitudes towards sex may also range from complete repulsion to willing participation for the benefit of another person. Some asexuals say that they masturbate but consider it a part of their bodily functions, not part of their sexuality.



Studying asexuality in the past has been challenging, especially since many sex researchers haven't included it as an option in surveys about sexual orientation and practices. In recent years, however, asexuals have become more outspoken, formed communities and sought to educate others about asexuality.

The mere existence of asexuality can be controversial, but the controversy associated with our next unusual sexual condition is even more extreme. Read on to find out why.



If asked to name a sexual condition they considered "unusual," many people would probably point to fetishes -- known as paraphilias in the psychiatric community. As defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), paraphilias are mental disorders "characterized by sexual fantasies, urges, or behaviors involving non-human objects, suffering or humiliation, or non-consenting persons." Generally, paraphilias are extreme and fall well outside of the norm, and paraphiliacs typically can't find sexual gratification without a particular object or act involved. Particularly when they focus on something dangerous or illegal, these conditions can be severely damaging.

The controversy is whether some paraphilias should really be classified as mental disorders. For example, some argue that a paraphilia involving consenting adults that doesn't cause distress to the paraphiliac or other people isn't really a mental disorder. Transvestic fetishism, in which a man is sexually aroused by wearing women's clothing, is often cited as an example.



Researchers aren't sure what causes paraphilias; they may stem from behaviors or associations made early in life. Many people with paraphilias don't get any kind of help with their condition until it's discovered by other people. Along with behavioral and cognitive therapy, counseling has helped some people stop acting on their paraphilias, and so have medications such as Ritalin. Generally, though, paraphilias are very difficult to treat.


Sex Chromosome Abnormalities

Sex chromosome abnormalities occur when there's a problem during egg or sperm production. In people, typical eggs and sperm cells have 23 chromosomes. Sex chromosome abnormalities occur when an egg or sperm has too few or too many. Regardless of which cell has the wrong number, the resulting embryo has more or fewer than 46 chromosomes total, leading to a range of physical and developmental problems. Sometimes these syndromes are basically asymptomatic, but others can have severe effects including developmental disabilities, emotional problems, sterility, organ problems and physical abnormalities.

Sex chromosome abnormalities may be detected during pregnancy via chorionic villi sampling (CVS) or amniocentesis. Depending on the abnormality, some of these pregnancies may result in miscarriage or stillbirths. Girls born with Turner syndrome have distinctive physical characteristics, but other abnormalities must be diagnosed via genetic testing. Treatment of these abnormalities may include estrogen or testosterone replacement therapy, growth hormone therapy, surgery to correct physical defects, and intervention to assist with behavioral and learning difficulties.



We'll look at another biological unusual sexual condition next.



Although people have long used the word "hermaphrodite" to describe those with both male and female anatomical characteristics, it's a misleading idea. Today, the term for people with this condition is intersexed. Intersexed people don't have both male and female genitalia, but typically have some features of each. There is a wide range of variations among intersexed people.

Some intersexed people are known as true gonadal intersexed. They might be genetically male (XY) or female (XX) but have one ovary and one testicle or a single gonad with both testicular and ovarian tissue in it. Externally, these people might have clearly male genitalia, clearly female genitalia or ambiguous genitalia. The cause of this type of intersex is unknown.



XY intersex describes a person who has male chromosomes but genitalia that is atypical, ambiguous or female. Testes may be present, missing or abnormal. The most common cause of XY intersex is a problem with processing male hormones, known as androgen insensitivity syndrome (AIS).

A person who is XX intersexed usually has the internal genitalia of a female, but the external genitalia appears to be male. She may have a large, penis-like clitoris and fused labia. Most people with this condition have congenital adrenal hyperplasia, a disorder in which the adrenal gland doesn't produce cortisol or aldosterone, resulting in higher levels of the male hormone androgen. People with this condition may have been exposed to high levels of male hormones while in the womb or may be deficient in aromatase, an enzyme that converts male hormones to female hormones. XX children with the latter may start to take on more male characteristics at puberty.

In the next section, we'll look at a condition that is sometimes related to intersex: micropenis.



According to a 1979 study by Kinsey Institute researchers Gebhard and Johnson, the average erect penis length is between 5 and 6 ½ inches, with a circumference between 4 and 5 inches [Source: Kinsey Institute]. About 0.6 percent of men have a condition called micropenis, defined as having an erect penis length of less than 2 inches (or 2.5 standard deviations below the mean).

Some of the conditions that cause micropenis are the same as those that cause XY intersex, such as androgen insensitivity syndrome (AIS). However, men with micropenises generally don't have genital ambiguity. Micropenis can also be caused by other genetic problems such as growth-hormone deficiency. If the condition is detected in childhood, hormone therapy can lead to some growth. However, it's unlikely that the penis will ever reach average size. Medications and supplements meant to enlarge the penis usually don't do so permanently, but some men have had success with surgical enlargement.



Micropenis can cause both social and psychological problems in men. Men may also have difficulty having sexual intercourse. In the 1960s and 1970s, some doctors advocated reassigning the gender of boys with micropenis to girls, with the belief was that gender identity is learned. Some researchers still advocate raising these boys as girls, but men who underwent reassignment as children have since spoken out against it.

In the last section, we'll examine one final unusual sexual condition: supernumerary sex organs.


Supernumerary Sex Organs

While some people have missing or atypical sex organs, others have more than what's considered normal: extra, or supernumerary, sex organs. Males born with a condition known as diphallia or penile duplication have two penises. This condition is extremely rare; less than 100 have been reported in medical literature. It is thought to occur due to a problem during the stage of fetal development when the rectum and penis are forming. Often, one penis is smaller than the other. Men with diphallia may urinate out of one or both penises, and may or may not be able to have sexual intercourse with both. They typically have defects in the kidneys, spine, colon, anus or rectum. Diphallic men may also be sterile. In at least one case, a man with diphallia asked to have one penis removed [source: Reuters].

Women who are born with an additional uterus, known as uterus didelphys, are more common. This occurs in about 1 in 1,000 women, who may also have two cervixes and two vaginas. This happens when the mullerian ducts, two tubes that eventually fuse into a single uterus in female embryos, remain separate during gestation. Often, women don't know they have two uteruses and have normal periods and pregnancies. Some women have symptoms such as heavy menstrual bleeding, unexplained pelvic pain, infertility or miscarriages. The condition is confirmed via ultrasound or MRI.



Rarely, women with uterus didelphys have had surgery to create a single, larger uterus. Women with this condition who do become pregnant are considered high risk.


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