'We Won't Ban Castrating Pervs Despite What Europe Might Think!': Czech Medical Sexology and the Practice of Therapeutic Castration.

The Czech Republic holds one of the highest numbers of men labelled as sexual delinquents worldwide who have undergone the irreversible process of surgical castration - a policy that has elicited strong international criticism. Nevertheless, Czech sexology has not changed its attitude towards 'therapeutic castration', which remains widely accepted and practised. In this paper, we analyse the negotiation of expertise supporting castration and demonstrate how the changes in institutional matrices and networks of experts (Eyal 2013) have impacted the categorisation of patients and the methods of treatment. Our research shows the great importance of historical development that tied Czech sexology with the state. Indeed, Czech sexology has been profoundly institutionalised since the early 1970s. In accordance with the state politics of that era, officially named Normalisation, sexology focused on sexual deviants and began creating a treatment programme that included therapeutic castration. This practice, the aim of which is to protect society from sex offenders, has changed little since. We argue that it is the expert-state alliance that enables Czech sexologists to preserve the status quo in the treatment of sexual delinquents despite international pressure. Our research underscores the continuity in medical practice despite the regime change in 1989. With regard to previous scholarship on state-socialist Czechoslovakia, we argue that it was the medical mainstream that developed and sustained disciplining and punitive features.

[Sexual delinquency and surgical castration: a 'measure of last resort' in the Netherlands from 1920-1970]. / Zedendelinquentie en chirurgische castratie.

From the 1920s, surgical castration increasingly became an accepted 'therapy' for the treatment of sexual delinquents in the Netherlands. Though often seen as a measure of last resort ('ultimum remedium'), the number of castration cases would reach into the hundreds during the following decennia. Since castration was applied to sexual delinquents, it meant that this procedure was not just dependent on medical, but also broader societal concerns and ideas about sexually acceptable behaviour. For example, homosexuals frequently underwent such surgery, often within the context of the Dutch Entrustment Act ('Terbeschikkingstelling' or 'TBR', now called 'TBS'). By the late 1960s, due to changing cultural and medical views, surgical castration was abandoned.

Urofilias: aproximación clinicoterapéutica a propósito de un caso de una vela intravesical / Urophilias: Clinical and therapeutic approach a propos of an intravesical candle

Las parafilias son entidades patológicas de la esfera psiquiátrica que difieren de otros comportamientos sexuales por las serias implicaciones que suponen en la vida de los pacientes. Las urofilias son parafilias que implican al ámbito urológico. Estas presentan un amplio espectro de variaciones clínicas, llegando a poder tener serias consecuencias para la vida. La introducción de objetos en la uretra o en la vejiga es la urofilia que más frecuentemente requiere asistencia médica, ya sea por daño en la vía urinaria o por las implicaciones de alojar cuerpos extraños en ella. A raíz de la identificación de un insólito cuerpo extraño en la vejiga se ha realizado una revisión del tema desde la vertiente psiquiátrica y urológica de esta patología (AU)

Paraphilias are pathologies of the psychiatric field that differ from other sexual behavior because of the serious implications in the lives of the patients. Urophilias are paraphilias involving the urological setting. They have a wide spectrum of clinical variations and can have serious consequences for life. Insertion of objects into the urethra or bladder is the urophilia that most frequently requires medical care, either by damage to the urinary tract or due to the implications of hosting foreign bodies in it. Following the identification of an unusual foreign body in the bladder, a review of the subject from the psychiatric and urological side has been carried out (AU)

[Long-term results in patients with stereotaxic surgery for psychopathologic disorders]. / Dlhodobé výsledky 304 stereotakticky operovaných pacientov s psychopatologickými poruchami.

Long-term results (5-20 years) recorded in 304 patients operated on stereotactically for psychopathologic disorders are presented. The largest group of 260 surgically treated subjects represented aggressive patients. This group consisted of 150 patients with mental retardation, 70 with epilepsy, 20 with schizophrenia, and 20 patients with sexual deviations. Amygdalectomy for patients with normal intellect and posterior hypothalamotomy for those with reduced intellect proved to be the most effective procedure. Symmetrical operations were also effective. In some cases a combination of two target was necessary. In epileptics with aggressivity the combination of amygdalectomy and hippocampectomy yielded the best results. In aggressivity with sexual deviations anterior hypothalamotomy was the most effective operation. Favorable results in aggressivity therapy were recorded in 60% of patients. In patients with criminal sexual deviations, in drug addicts, and in alcoholics, anterior hypothalamotomy was found to be most effective, with favorable results in 50% of patients. In patients with depression, thalamotomy or stimulation of the limbic regions of the thalamus decreased the depression, with favorable results recorded in 66% of patients. The results of the surgically treated patients show that target-oriented stereotactic operations remove psychopathologic symptoms, improve the effectiveness of psychoactive drugs and the social adaptability of patients. (Ref. 15.)

Psychiatric and neuropsychological findings after stereotactic hypothalamotomy, in cases of extreme sexual aggressivity.

Report on 14 cases treated for aggressive sexual delinquency by unilateral ventromedial hypothalamotomy. Eight of them had a thorough psychiatric and psychological examination during follow-up. The following constant modifications were found: Decrease in the domination by sexual drive, increase in the fluency in semantic contexts, increase of rapidity of visual image formation and of coordinative perception processes, positive modifications in the scope of some personality dimensions (poise, openness, self-criticism), decreased colour perception, increased appetite. The structure of the patient's sexuality was not changed but the probability of a specific aggressive behaviour reduced, due to the diminished sexual drive thus allowing a positive consolidation of their social interactions with more harmonic relationships to the families or partners. These results give proof that the many prejudices and aversions against this type of therapy are not justified.

Psychosurgery on sex offenders and sexual "deviants" in West Germany.

About 70 men have undergone a stereotaxic hypothalamotomy in West Germany for sexual behaviors. In most cases the nucleus ventromedialis (Cajal) has been unilaterally destroyed. The question of whether this kind of psychosurgery shoudl be legally controlled is being discussed by both scientists and the public in West Germany. The justification for this psychosurgery is taken from a theoretical basis which is at least questionable and which stems from a biologically truncated and therefore limited perspective on human sexuality. An inspection of the published reports shows that the indication for surgery was based on questionable scientific and clinical grounds and practically excluded psychotherapeutic and sociotherapeutic aspects. In the authors' opinion stereotaxic hypothalamotomy can in no way be regarded as an unquestioned, applicable method of therapy. We consider it essential that this surgery be suspended at least as long as the possible therapeutic effectiveness and the possible adverse side effects remain unclear.