Infantile masturbation: Pitfalls in diagnosis and possible solutions

Sir,

Masturbation or self stimulation of genitalia is a common human behavior and is believed to occur in 90 - 94% of males and 50 – 60% of females at some point during their life time.[1] The concept of infantile masturbation (IM) was suggested by Still in the early part of 20^th century and has been widely recognized since then by the medical fraternity.[2] Although in utero cases of masturbation have been reported, IM usually starts by 2 months of age and progressively increases and peaks at 4 years of age.[3] Secondary peaking occurs during adolescence in both sexes. The frequency of events varies from 1/week to 12/day (mean: 16/week) and the duration ranges from 30 seconds to 2 hours (mean: 9 minutes).[4] Unlike masturbation in older children and adults, IM involves little or no genital stimulation. This is the single most reason why making a diagnosis of IM is difficult. Moreover, it can manifest with various behavioral patterns including clonic movements, tonic posturing, grunting, rocking, facial flushing, sweating, etc. Children tend to get fatigue after the episode and fall asleep. Since IM often mimics seizures, dystonia and abdominal pain, it has a higher propensity to get misdiagnosed. This can lead to unnecessary investigations and drug therapy. Nechay et al reviewed 31 cases of IM and found out that 21 of them were diagnosed and referred as seizures.[4]

Knowledge about the various manifestations of IM and high index of suspicion are the prerequisites for a successful diagnosis. Carefully taken history can clinch the diagnosis in most of the cases. Symptoms tend to occur in a particular setting like in car seat, during boredom, sleep, etc. and can be reproducible at times which is in sharp contrast with seizures. Symptoms can be abruptly stopped during an episode by distracting the child, but in some cases can lead to anger, frustration and crying episodes. A simple act of taking a home video recording during the episode with a mobile phone camera can be very helpful in establishing the diagnosis. Physicians should encourage the parents to do so in all suspected cases. Possibility of child abuse should always be suspected and ruled out. As this is a normal human behavior, it needs nothing more than reassurance to the anxious parents. It is highly preferable to use the term gratification disorder instead of IM in view of the social stigma attached to this term and to alleviate parental anxiety.