Four Main Types of Autogynephilia
Blanchard (
1991
) described four distinct types or categories of autogynephilic fantasies and behaviors: transvestic
(involving wearing women’s apparel), anatomic
(involving possessing female anatomic features), physiologic
(involving having female physiologic functions), and behavioral
(involving engaging in stereotypically feminine behavior). Yet another type is partial
autogynephilia (Blanchard,
1993a
,
1993b
)—more precisely, partial anatomic
autogynephilia—in which individuals desire to have only partial, not complete, female anatomy. The most prevalent type of partial autogynephilia involves the desire to have women’s breasts but no desire to have female genitals. It is debatable whether individuals who experience this type of partial autogynephilia should be considered transsexual; for purposes of this study, I have chosen to categorize them as nontranssexual.
Chapter 11
includes several narrative excerpts by informants who experienced partial autogynephilia.
The four types of autogynephilia that Blanchard described are conceptually useful but are not mutually exclusive. Some autogynephilic fantasies and behaviors could easily be classified under more than one category; for example, wearing a menstrual pad could be considered a manifestation of transvestic, behavioral, or physiologic autogynephilia, depending on its meaning to the person wearing it. The various types of autogynephilia also tend to co-occur; in particular, most individuals who experience anatomic autogynephilia also experience transvestic and behavioral autogynephilia. There are some notable exceptions to this pattern, however: A few informants who reported anatomic autogynephilia denied any desire to engage in female-typical behaviors or to live in a female-typical gender role.
One particular type of behavioral autogynephilia, the act or fantasy of engaging in sexual activity with a man as a woman (a manifestation of autogynephilic interpersonal fantasy;
Blanchard,
1989b
) is both highly prevalent and of particular theoretical and clinical significance; it will be considered separately in
chap. 8
.
Transvestic Autogynephilia
Transvestic autogynephilia is the most prevalent type of autogynephilia; almost all autogynephilic males probably experience it. Most informants acknowledged or alluded to transvestic autogynephilia in their narratives. The narrative excerpts in this section illustrate important general principles about transvestic autogynephilia, are noteworthy or unusual, or emphasize fetishistic elements not generally associated with MtF transsexualism.
Several informants reported that they favored the kinds of apparel—lingerie, short skirts, high heels, etc.—that men generally find sexually alluring when worn by women and that are stereotypically associated with transvestic fetishism. Here are three representative accounts:
I am a transgender woman currently undergoing estrogen treatment. The fact that my body is feminizing is both a source of arousal and joy. My earlier “closet” phase involved the ritual of dressing as a normal woman: lingerie, nylons, dresses, shoes, etc., and applying full makeup and perfume and becoming so turned-on by my femme image in the mirror that the ritual often terminated in masturbation. (140)
I am 58 years old and a preoperative MtF transsexual. I began crossdressing when I was about age 7. I was especially sexually aroused wearing girdles and nylon stockings. By my mid-20s, I had very strong desires to dress as a female on a full-time basis and to attract attention as a sexy, feminine woman. I have worn sexy feminine fashions, especially bras, lingerie, pantyhose, short dresses, lace fashions, mini-skirts, high heels, etc., at home since my mid-20s. Wearing sexy lingerie, a bra, a girdle with nylon stockings or sensuous sheer pantyhose, and high heels, imagining myself as a female, still often sexually arouses me, leading to an erection, masturbation, and orgasm. (141)
I am a 44-year-old male. My counselor classifies me as a transsexual and has offered to refer me for hormone therapy. In high school, I cross-dressed in my mom’s clothes and can’t deny the arousal. In college and law school, under the guise of being a hippie, I wore long hair, women’s jeans, and women’s T-shirts. I married, and my cross-dressing became the secretive wearing of my wife’s clothes, always in front of a mirror. It was arousing. Presently I cross-dress on a limited basis, and it’s still arousing. When I am aroused by a woman, it feels good. But cross-dressing adds so much more: In front of a mirror, it gives the visual image of a woman in my presence, the touch of silk fabrics and feminine underclothes, the touch of smooth skin, the smell of cosmetics, etc. It just feels so good to be dressed and acting as a woman that nothing else compares. (142)
Note that the last two informants mentioned not only the appeal of the clothing itself but also the way in which wearing the clothing allowed them to see or imagine themselves as being female. This illustrates why it is useful to think of transvestism as “transvestic autogynephilia”: cross-dressing that facilitates the thought or image of oneself as a female. Blanchard (
1991
) explained:
The rationale for subsuming transvestism under the heading of autogynephilia is that the transvestite’s excitement results from making himself, in some sense, more like a woman …. In fact, most transvestites do fantasize themselves as females when they are cross-dressing and may also act this out in their behavior. (pp. 237–238)
One informant described this type of anatomic visualization as the rationale for her transvestism:
In the case of cross-dressing, it was using the prop of the clothing to imagine a female body underneath that turned me on, not the clothing itself. (087)
Another informant made the same point more explicitly, explaining that the greatest excitement associated with wearing women’s attire arose from the imagined anatomic features that certain items of women’s clothing implied (note: this informant had not undergone SRS):
My interest is not in underwear and outerwear that are deemed by some to be sexually provocative (six inch heels, nylons and garter belts, low-cut blouses, etc.). No, it is the “form follows function” aspect of women’s clothes that excites me most. Thus “having” to wear a bra for supporting my breasts, or “having” to wear panties that have a closed crotch, in recognition of the fact that my penis has been removed and that I now have the external genitalia of a female. (143)
Clinicians other than Blanchard have also observed that the associated mental image of oneself as a female is an essential aspect of transvestism. Levine (
1993
) commented that
I cannot ever recall speaking to or hearing about an adult cross-dresser who did not have a fantasy of himself as a female. I now assume that the cross-dressing and the autogynephilic fantasy are the external and internal manifestations of the same phenomenon. (p. 135)
Money (
1988
) similarly explained that “Wearing women’s garments is, however, in all likelihood only a partial manifestation of a more extensive gender crosscoding from male to female that includes also the body image.” (p. 94).
One informant who was especially aroused by wearing women’s panties early in her cross-dressing career reported that the scope of her erotic cross-dressing subsequently broadened to include other items of women’s attire:
I have always found crossdressing extremely erotic and very sexually satisfying. It all started at age 15, when I discovered my mom’s panties. That was when I had my first sexual experience. I never developed any type of normal sexual relationships with girls in my teens. I was more interested in what style of panties they were wearing or what I was going to wear when I got home from school. Panties were my obsession. By age 20, I probably had collected over 200 pairs of women’s panties. In my twenties, I began to acquire bras, nightgowns, nylons, and other types of lingerie. Next was women’s clothes, wigs, makeup, and heels. Every dress-up session always ended in a very intense masturbation session. It was like clockwork. I now have a huge collection of women’s clothing, makeup, lingerie, and jewelry. I am usually completely dressed in women’s clothes while I am at home. (080)
Wearing specific kinds of women’s footwear was a prominent element of transvestic autogynephilia for some informants. Two individuals favored high-heeled shoes:
Your article on autogynephilia very accurately characterized the core experience of my life. As a 16-year-old, I tried on a tight shirtdress of my mother’s. The sexual excitement that resulted permanently altered my sexuality. My earliest fantasies simply involved being a cute little female with large breasts. This evolved over time into enormously detailed fantasies, which included taking showers as a woman (but wearing high heels) and different sorts of sexual intercourse. In my fantasies, I imagine the sensation of a man’s hands on my hips, pulling me down to make penetration deeper. I find it hard to imagine sex any other way, with one exception—standing up, my skirt around my waist—and in both cases, with heels on. For quite some time, sex with women has required me to pretend that I’m the female being penetrated to achieve orgasm. I press my legs together and arch my feet as if I’ve got heels on. Frankly, I wish I were in her shoes—literally. (144)
I feel so sexy in my high-heeled boots and skirt with my long red hair. I loved putting on makeup, doing my hair, and getting dressed. I just love heels. I am 6 feet tall, like all the runway models, with a size 9-1/2 women’s pump, and open toe strappy sandals are my favorite. Even though my age should call for a cooled-down version of attire, I much prefer the hotter, younger styles. I have been playing ice hockey for years, and my behind and long legs are really something to see. (145)
The latter informant’s preference for “younger, hotter styles” rather than more age-appropriate attire is not unusual. Autogynephilic transsexuals are theorized to want to become facsimiles of the kinds of women to whom they are sexually attracted, so it is not surprising that most would prefer to resemble young, sexually desirable women and would be drawn to the attire that young women who wish to project a sexy image stereotypically favor.
One informant had a special fondness for another particular type of women’s footwear, Keds tennis shoes:
I remember finding my mother’s stockings and garters sometime around age 8 or 9, and that is when I started trying women’s clothes on. I found it to be exciting and sexually arousing. My wife understands that I wish that I was female and lets me buy and wear women’s clothing; for the most part I do it when I am alone. Sometimes it is a sexual thing and other times it is just because it feels good. I wear things like women’s sandals, Keds tennis shoes (I have found Keds very sexy since I was in third grade), panties, tops, pants, shorts, and bathing suits. (146)
Other informants emphasized that wearing women’s clothing was not so much arousing for its own sake, or even for the female anatomy it implied, as for its ability to facilitate or necessitate female-typical behavior. Their reports could be interpreted as describing transvestic autogynephilia that occurred “in the service of” behavioral autogynephilia. The following narratives are illustrative:
I began cross-dressing shortly after puberty in my older sister’s clothes. Later, I would occasionally borrow one of my wife’s dresses when she was out of town. I would always fantasize about women and assuming the role myself when dressed. And it was always an erotic experience. I have come to realize that for me, being a cross-dresser has not merely been the activity of a transvestite, but of a transsexual. The clothes themselves are but an adornment that allow me to take on the intended role. Just as “clothes make the man,” I feel they make the woman as well. A skirt or dress, because of its very construction, makes a woman vulnerable, which is a female attribute. (020)
The restrictions imposed on me by wearing female clothes are also tremendously exciting—having to sit with my legs together when wearing a skirt. Trying to keep hold of the hem of a skirt or dress on a windy day. Trying to avoid a neighbor’s excitable little terrier causing a run in my pantyhose when he runs to greet me. (143)
Here again, the point that comes through clearly is that transvestism represents transvestic autogynephilia: cross-dressing that contributes to or facilitates the thought or image of oneself as a woman.
Transvestism as a Relaxing or Comfortable Activity
Heterosexual transvestites, who resemble autogynephilic transsexuals in many respects, often report that cross-dressing makes them feel relaxed or comfortable. In a survey of 33 heterosexual cross-dressers, Buhrich (
1978
) found that the most prevalent feelings his subjects described during cross-dressing were “comfortable, relaxed, at ease” (p. 147). Buhrich’s subjects reported that during adolescence, these feelings had been slightly more prevalent than sexual arousal; in later adulthood they were much more prevalent than sexual arousal. In the current study, several transsexual informants similarly reported that cross-dressing was not only sexually arousing but also made them feel comfortable or relaxed. Here are some representative narrative excerpts:
When I reached adolescence, I started cross-dressing discretely and would get aroused and masturbate. After the sexual part of the experience, I would remain dressed as long as was safe and would feel comfortable and cozy. (056)
I had a persistent desire to cross-dress and did so from as early as I can remember. It was interesting that, although I was excited to get dressed in female clothing, once dressed, I was always very relaxed and any emotional excitement subsided. (147)
Since I told my wife that I cross-dress, it has stopped being sexually exciting. I still dress, but it is more a stress reliever now than a form of sexual arousal. To me it feels nice, relaxing, maybe thrilling, but not sexually so. (148)
How should one interpret such reports of relaxation and comfort associated with cross-dressing? Blanchard was quoted (in Bloom,
2002
) as expressing skepticism that nonhomosexual cross-dressing is genuinely relaxing:
“Of course it’s not relaxing,” Blanchard says, with some heat. “Heels and makeup and a wig and a corset? It’s preposterous. Even women don’t find that relaxing. Relaxing is a pair of sweatpants, clothing that doesn’t even feel like clothing. Crossdressers want to normalize this, to have it seen as relaxation.” (pp. 66–67)
Docter (
1988
) was also skeptical of reports by heterosexual cross-dressers that habitual cross-dressing (e.g., underneath male clothing) is eventually experienced as relaxing or calming rather than sexually arousing:
The experience most often reported by those who wear women’s clothing beneath their male clothes for extended periods of time is that of a calming effect. It may be that the experience of relaxation or calmness is a major reinforcer which reduces sexual tensions, thereby becoming reinforcing. The mediating events for such a response pattern are not understood if, in fact, this is what takes place. Another hypothesis would be that the mild sexual arousal that may accompany concealed fetishistic cross dressing is subjectively interpreted as calming despite what may be mild physiological arousal. (p. 117)
Docter’s hypothesis is consistent with the observation by Blanchard et al. (
1986
) that nonhomosexual cross-dressing men who deny experiencing sexual arousal in association with cross-dressing nevertheless display physiological genital arousal when they listen to audio recordings describing cross-dressing scenarios.
Yet another explanation of cross-dressing being experienced as comfortable or relaxing is suggested by Blanchard’s (
1991
) observation that “many men, after years of marriage, are less excited by their wives than they were initially but continue to be deeply attached to them” (p. 248). One can imagine such men saying—to recast the ideas expressed by the informants above—“Early in my marriage, I was very turned-on by my wife; nowadays I just feel relaxed and comfortable around her.” Longstanding romantic relationships with other people can be sources of relaxation and comfort after associated erotic excitement has diminished or disappeared; perhaps longstanding “relationships” with activities like cross-dressing or with one’s own feminized body can also be sources of relaxation and comfort after associated erotic excitement has declined or become less important.
Anatomic Autogynephilia
Blanchard (
1993a
,
1993c
) observed that anatomic autogynephilia, especially sexual arousal to the thought or image of having female genitals, was the type of autogynephilia most closely associated with gender dysphoria and the desire for SRS. Several informants described feeling aroused by the fantasy or reality of having a feminized body or specific elements thereof:
Autogynephilia describes my sexual life. My sexual arousal and fantasies have always been about being transformed into a female. When I see a beautiful woman, I wish I had such a body. As I’ve grown older, the feeling has only gotten stronger. (149)
It is self-sexual desire that has driven my fantasies and my desire to change my body. As my body has become more curvy, with breast development, redistribution of fat on my ass, and a noticeable feminization of my facial features, I have become more aroused daily. (076)
Visualizing my body as having a female form is a primary source of sexual excitation. Viewing my flat pubic area and bra is a regular part of sexual foreplay. For years I have applied various forms of pressure and wraps on the penis that limited erections and have contributed to a tiny flaccid shaft. It is now usually inverted into my body and held in place with moderate pressure from support-style panties. (150)
Some informants emphasized that cross-dressing per se was less important than having female anatomic features:
My first experiences at age 13 involved masturbation. I was slightly fat at the time and would imagine myself to have larger breasts and push my penis up into my body cavity. Much later in my teens, I would masturbate while wearing women’s clothing, makeup, and other aids, while looking into the mirror and fantasizing about having a female body. In the case of cross-dressing, it was using the prop of the clothing to imagine a female body underneath that turned me on, not the clothing itself. Overall in my transition, the idea of changing has been incredibly exciting. The first 6 months when my breasts were developing were great. I’d look in the mirror and it wouldn’t matter how small the change was, it’d cheer me up. And while I still could, I’d jerk off to my own naked reflection. A standard masturbation technique was to squat in front of the dresser mirror so that my penis was not visible in the reflection. Then I’d concentrate on that while I touched myself. It worked, and I liked the idea of finding my own body to be sexy. (087)
I am a 35-year-old biological male who has undergone therapy for gender dysphoria over the past 2 years. My fantasies are almost purely based on the physical elements of being female: having breasts, a curvy body, a big butt, a vagina, a pretty face, long hair, etc., and not so much based on clothing or activities. Once puberty hit and I was aroused by females, I always wanted to be like them. The thought of being like them was always very arousing. I remember when I began masturbating, using porn magazines or videos, I would find myself thinking things about the women, like “I wish I were you. I wish my body was like yours.” And the more vividly I imagined that and the more I imagined myself as a woman, the more excited I became. That behavior has never left. (066)
I’m 44 and scheduled for sex reassignment surgery in 3 months. I never really got into cross-dressing. I did, however, from an early age fantasize about having breasts and a vagina and being accepted among women as a woman. I will admit that my initial transition did have a component of sexual desire, but it has faded, along with everything else sexual. My basic goal is to be able to fit right into tight clothing and swimwear. And, I admit, urinating in the female manner is a major goal of my upcoming sex reassignment surgery. (151)
I am anatomically autogynephilic. Since the age of 5 or 6, I have had dreams and fantasies of being turned into a girl. Occasionally, I would get off by putting on my mom’s, and later my ex-wife’s, nylons; but I never had any other thoughts of cross-dressing. I am considering surgery and have begun talking to my therapist and psychiatrist about it. (152)
It was not unusual for informants to report that their most intense source of sexual arousal was imagining themselves having female genitals:
I feel more asexual than anything, but I still must admit my greatest arousal comes from fantasizing or imitating having female genitalia. Even dressed to the hilt, if I cannot see or feel myself as a woman, with a woman’s anatomy, I feel more sad than aroused. (124)
I have always felt vulva envy. To me, being a woman is to be [sic] a vulva between the thighs—nothing more, nothing less. The beauty of being a woman comes from the vulva and is in the vulva and only there. To wear the most beautiful clothes, to have a pretty face, to have breasts, round hips, can mean nothing to me in the absence of the vulva. When I have my vulva, I will feel beautiful enough to me, and to wear feminine clothes in public will be just a consequence of that. (153)
Some informants reported that they experienced sexual arousal to the fantasy or reality of undergoing orchiectomy, penectomy, or complete SRS. In other words, the process of physical feminization was sexually arousing, not just the outcome of that process:
I’ve always been turned on sexually by the idea of having a woman’s body. Finally my compulsion drove me to have an orchiectomy, which was perhaps the greatest thrill of my life. A girlfriend who is a medical student came with me to the procedure. I can’t tell you how thrilled and amazed I was when my testicles were removed and the process was described by my friend. It was sort of the ultimate forced feminization. (154)
I remember reading, many years ago, about the case of the twin who lost his penis during circumcision and being tremendously envious and sexually excited. (155)
I have always had highly charged erotic feelings associated with the development of female sex characteristics. I will have my sex reassignment surgery in about 6 months. At the moment I even have erotic fantasies derived from finally having my penis removed. (077)
I have several fantasies I use to achieve orgasm. All are autogynephilic in one way or another. In one, I re-live my orchiectomy, albeit somewhat embellished by a more dominant group of women being the ones castrating me. My actual surgeon obliged that fantasy somewhat by acquiescing to my request that his female surgical assistant cut my spermatic cords. (156)
The sexual stimulation of thinking of myself as a woman—that is me in a nutshell. Some of the sex games with the spouse involved pretend castration and forced feminization. The real desire, to have a vulva, is overpowering. Even the idea of the surgery process can arouse me. (157)
When I was 14, I imagined lying down on the operating room table for my sex reassignment surgery. I also imagined, with horror, that I would become sexually aroused. How would I explain this? How could I even understand it myself? I didn’t know why, when I thought those thoughts, I became excited. (123)
Two of the above informants mentioned forced feminization fantasies, which are extremely common in autogynephilic transsexuals. I will discuss these fantasies in
chap. 9
.
Other informants described the intense excitement they felt at seeing their bodies being feminized by hormone therapy:
I’ve had all of the feelings associated with autogynephilia, from early childhood to today. I feel that I’m addicted to feminizing myself with hormones. I can’t seem to stop, because of the feelings I get from seeing myself change to a more female-looking body. I wish that I could stop at times, but the high I get from seeing the change is never ending. (158)
I’ve been on hormones for 4 years now and have the usual physical developments, which I dearly love. My endocrinologist gives me my prescriptions and I love her performing physicals on my developing breasts and atrophying testicles and male organ. She always measures me, and I love to hear of the developments since my last visit with her. I am so mentally aroused as my breasts are measured. (159)
As I observed in
chap. 1
, cross-gender identity and gender dysphoria seem to operate as two sides of the same coin in many or most autogynephilic transsexuals. The autogynephilic erotic wish to have female-appearing genitals (a manifestation of cross-gender identity) is not uncommonly accompanied by dislike or disgust for one’s male genitals (a manifestation of gender dysphoria). Some informants reported that they had tried to damage or anesthetize their genitals or had attempted to castrate themselves because they disliked their male anatomy; sometimes these attempts were explicitly linked to an erotic desire to have female genitals:
Changing into a woman was the dominant fantasy that I had even at early childhood. When I started to hear about sex change operations, I wanted one. I’d heard about horses being castrated by slowly tightening a strap of leather around their testicles. I tried to duplicate the effect. I gathered together rubber bands and wrapped them tightly around my testicles and penis. I even tried to hang myself by my genitals. (122)
I remember wearing my older sister’s panties and being very disappointed that they didn’t seem to fit me properly because of my genitals. I hate my male genitals. A couple of years ago, I tried to modify my genitals, but I had to stop and take myself to the hospital because of the bleeding. If I didn’t fear bleeding to death, I think that I would have removed my genitals before now. (160)
I have always felt aroused by the fantasy of having a female body, with or without a partner. I find clothes are of little help in the arousal if I cannot disassociate myself from the penis. Experimentation in desperation has made me find ways to numb and damage my penis over the years. I confess that sex reassignment surgery to me is as much a sexual high as it is a completion of reality for my own identity physically. (161)
Note that the last informant made an explicit connection between anatomic autogynephilic arousal and her attempts to damage her penis.
Anatomic Autogynephilia Without the Desire to Live in Cross-Gender Role
As I discussed in
chap. 3
, some informants reported a desire to have female genitals—and usually other female anatomic features as well—but no strong inclination to live in a female-typical gender role. Conceptually, this could represent anatomic autogynephilia unaccompanied by significant transvestic or behavioral autogynephilia. Blanchard (
1991
) described this pattern in the case history of Philip, a patient who experienced anatomic autogynephilia but had never cross-dressed as an adult. Alternatively, persons who give such histories might actually experience significant transvestic and behavioral autogynephilia and prefer to live as women in an ideal world but conclude that cross-living would be unfeasible in their particular circumstances. Consequently, they might decide not only to forego cross-living but to disavow any desire for it. Instead, they might seek SRS (and sometimes additional physical feminization) but continue to live as men as a compromise solution.
Based on the reports of several informants, the phenomenon of anatomic autogynephilia unaccompanied by the desire to live in a cross-gender role may be more prevalent than is generally assumed. Here are some representative narratives:
I am a 30-year-old man, currently in therapy regarding my desires to become a female and on a hormonal regimen. My problem is that I want to go through the process, up to and including SRS, but afterwards continue living my life as a male, in a male role. I feel that I would be more comfortable living in that role. I am trying to explain this to my counselor, but I fear that she would reject me for the SRS part of transition if she really knew my goal. I don’t want any surgical enhancements to my body other than SRS. I would not want to transition fully, as I have no desire to live as a female. (162)
I am 20 years old and in college. As long as I have been sexually aware, I have been aroused exclusively by the thought of myself having a female body—specifically, a vulva and large breasts. My thoughts have been consumed by the possibility of having SRS and breast augmentation but continuing to live as a heterosexual male. It seems like the only way I could satisfy the only sexual feelings I have ever known. Since middle school, I have thought I might be a candidate for a sex change operation, but the thought of becoming a girl seemed both socially impossible and not necessarily desired. Unlike a number of autogynephiles, I have no history of cross-dressing. My arousal seems to be focused on having female anatomy. (014)
I am 47 years old. For many years, I have wanted to have a female body, particularly breasts and a vulva. But I don’t want a female face, I don’t want to wear female clothes, and I don’t want to have a female lifestyle. Moreover, although I want a vulva with a clitoris and outer and inner labia, I don’t want a vaginal canal or to have sexual intercourse like a woman. (163)
I want genital modifications but don’t want to become a woman. After the modifications, I want to continue to live socially as a man. I do not like to use my penis to urinate, because I do not like to touch it and see it. I like to look at a woman urinating, with the secret hope to be able to urinate like that one day myself. During masturbation, I take pleasure from imagining that I no longer have a penis but a pretty vulva. For me, my penis is useless and I want to remove it and the testicles and to replace them with a vulva. But I do not want to become a woman or live like a woman. (164)
I have wanted to be female all the way back to the age of 6 or 7. I am 6′4″ and 265 lbs., a little large to pass as a female. I love my job and could not transition without giving it up. I am also in a wonderful relationship with a woman, so I will probably do nothing more than cross-dress and continue the hormones I have been on for 12 years. But if she should pass before me, I do intend to seek SRS. The inflexibility of the Standards of Care on this issue is unreasonable. They cannot see that, at least in my case, being a female living as a male makes sense. It would hurt no one, and yet it would complete me. As a result, if that day ever comes, I will be forced to go underground and find a surgeon overseas and probably not one who will do the best job of SRS. (165)
I feel arousal at the thought of having female genitalia. Since I was a child, I have had dreams about becoming female from the waist down. I try to will those thoughts away, but they keep resurfacing. I don’t want to live in the female role, and I am not attracted to men. I actually fantasize about lesbian sex with my wife. If it were possible, I would probably have genital surgery, but nothing else. Most men would feel sick at the thought of losing their penis and testicles, but I would actually feel a sense of relief. I hope the Standards of Care will change to allow for genital surgery based on a diagnosis of autogynephilia. (166)
The last two informants were referring to the Standards of Care for Gender Identity Disorders
(Meyer et al.,
2001
)—recently renamed the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People
(World Professional Association for Transgender Health [WPATH],
2011
)—which are widely viewed as authoritative. The Standards of Care specify that having “lived continuously for at least 12 months in the gender role that is congruent with [one’s] gender identity” (WPATH,
2011
, p. 21; the language in Meyer et al.,
2001
, p. 25, is almost identical)—the so-called “real-life experience”—is a prerequisite for SRS. For persons who want to obtain female-appearing genitals through SRS, the gender role that is congruent with one’s gender identity is usually assumed to be something resembling a female-typical gender role, although the Standards of Care are not explicit on this point.
A few informants reported, however, that they had managed to obtain SRS with little or no real-life experience in a female-typical gender role:
I am a 28-year-old postoperative MtF transsexual. However, unlike the vast majority of postoperative transsexuals, I do not live in a full-time female role. I first remember wanting to be female at a very early age, and the desire to become female continued as an obsession throughout my life. By my 20s, I was living a successful life as a male, with a profession and a well-paid career. My strong desire to become a woman continued, but the practical consequences of taking the conventional route for obtaining gender reassignment surgery would have been huge. I would have lost my job and would have found it hard to reestablish myself in my profession. Furthermore, there were some aspects of my male life (certain social interests, networks, etc.) that I preferred to retain. My overriding goal was not so much to live full-time as a female, but rather to acquire the physical characteristics of a female. Looking at the practical consequences, I felt that I should try to achieve my desire of undergoing physical feminization through a female hormone regimen and sex reassignment surgery. I achieved this goal without substantial difficulty. (167)
I underwent SRS in Thailand 4 months ago. I had a referral letter from my therapist for SRS, but there was something of an unspoken agreement that I had performed a full 1-year real-life experience, when in reality I did nothing more than dress in an androgynous manner for 3 or 4 months prior to SRS. My sexual fantasies and desires have always centered around having a vulva; I don’t recall any instances of female clothing ever arousing me. I never actively lived my life as a female. I remain “male” even now. I have a gender-neutral name. I am not taking testosterone or estrogen, and I live day-to-day as a male, although I am postoperative. I’ve been in contact with some other people who live as I do, but we are admittedly rare. I’ve found a small network of six post-op “male-to-female” persons who remain living as men postoperatively. (168)
I will have more to say in
chap. 12
about men who experience severe gender dysphoria as a result of anatomic autogynephilia but do not want to live as women or do not feel that doing so would be feasible.
Physiologic Autogynephilia
Sexual arousal to the thought or image of having female physiologic functions (i.e., menstruation, pregnancy, or lactation) was first mentioned by Hirschfeld (
1918
), who described a case of “pregnancy transvestism” (“Schwangerschaftstransvestismus”; p. 168). Money (
1988
) also described transvestites for whom being a pregnant woman was a feminine ideal and who cross-dressed accordingly:
She [sic] may have dozens, if not hundreds of photographs of herself in many different poses and outfits, to suit each occasion, including pregnancy, that is construed as womanly in her idealized conception of womanhood. (p. 95)
Buhrich and McConaghy (
1977b
) described the prevalence of fantasies (albeit not necessarily erotic ones) involving pregnancy and menstruation in small samples of MtF transsexuals and heterosexual cross-dressers. Most of the transsexual patients were probably homosexual, so their data are of less interest; but 3 of 35 transvestites fantasized about pregnancy and 1 fantasized about menstruation.
Physiologic autogynephilia is probably the least prevalent type of autogynephilia, but several transsexual informants in the current study reported sexual fantasies involving all of these female physiologic functions:
I’m 31 years old. When I was age 12 or 13, I was sexually aroused by wearing my sister’s clothes and later by my mother’s. As I became older, I wanted to be a woman full-time. Now, with one year to go before sex reassignment surgery, I want more than that. I have fantasies of breast feeding and getting pregnant or menstruating. (169)
Wearing women’s clothing was about the least of my fantasies; being female and being made love to, made pregnant, and having children played prominent roles in my fantasies. (170)
I’ve been on hormones now for almost 7 years. I’ve experienced arousal from the fantasy of having a woman’s body. I’ve also fantasized about having periods and cycles. I’ve imagined being pregnant and carrying my child, created with my special other’s seed deeply implanted inside my womb. Breast-feeding from my breast would be so heavenly. (171)
Other informants emphasized particular aspects of female physiologic function; one informant was especially aroused by simulating menstruation:
Wearing women’s clothing and feminizing my body has always been sexually exciting for me. Also, it was and still is sexually exciting for me to have female body functions. Before my sex reassignment surgery, I would pretend to menstruate by urinating in sanitary pads. I particularly enjoyed wearing the old-fashioned belted pads with long tabs. (061)
Several informants were particularly aroused by the fantasy of being pregnant, with or without arousal to the fantasy of lactation or breastfeeding:
I am a 38-year-old male. I have felt that I should be a woman since I was about 12. I find the thought of having female genitalia very erotic. I have also fantasized about becoming pregnant. I used to do this by stuffing a pillow under a dress or pair of jeans when I was a teenager. (172)
I am transitioning at 46 and have been approved for sex reassignment surgery. I fantasized as a youth about being a teenage girl. I have been interested in breastfeeding and becoming pregnant and have been known to wear maternity clothing. I was never aroused by the idea of breastfeeding, just by the idea of becoming pregnant. (173)
I underwent sex reassignment surgery 22 years ago. Preoperatively, when I was fantasizing myself to be a woman with a vagina, I was strongly sexually aroused and got an orgasm. Sometimes I imagined being pregnant, also with sexual arousal. (137)
I consider myself a transsexual. Of my thousands of sexual experiences, both with women and masturbatory, probably 98% or more centered around autogynephilic themes. In one favorite fantasy, I am married to a feminist career woman. When she gets pregnant, we agree that we should split child care completely fairly. We also want the baby to be breast-fed. We decide that I should start taking the appropriate hormones so I will be able to lactate. Because of the pressure of her work, I eventually take over all the nursing. We find out that a procedure has been perfected whereby men can be made able to receive the couple’s fertilized egg, becoming pregnant. This is perfect for her career, and I willingly bear our second child. (174)
Since puberty, I have been filled with powerful sexual feelings by the thought of dressing as a woman, having a woman’s body, being pregnant and nursing my baby, and being made love to as a woman. When my longing to be a woman becomes more than I can bear, I resort to masturbation, accompanied by fantasies of being a nursing mother. (175)
Behavioral Autogynephilia
Behavioral autogynephilia—sexual arousal to the act or fantasy of engaging in stereotypically feminine behavior—was reported by many informants. The most prevalent behavioral autogynephilic fantasy of autogynephilic men is having sexual intercourse with a male partner as a woman (Blanchard,
1991
); I will address this topic separately in
chap. 8
. The following narrative examples involve other kinds of behavioral autogynephilia.
Some informants reported that they found a wide range of stereotypically feminine behaviors arousing or appealing:
I’m 53 and am confessing to what I have told so many fellow transsexuals: I am obsessed with the desire to be female. I have been sexually aroused by imagining using a feminine voice, a feminine name, a feminine walk, tossing my hair, and opening my legs. My greatest moments of joy would be being told I am a true born woman, being told I am indeed one of the girls, or shopping for earrings or makeup in a shop where salesladies treated me as a normal woman. I love the idea of being accepted in women’s locker rooms, wearing a towel like a dress, wearing tampons, and urinating sitting down always. I dream of feeling and getting wet under panties or sometimes having hot waves or itching in this area. (176)
Although I have not yet transitioned, the thought that I will someday do so is extremely exciting to me. My mind is constantly filled with sexually exciting thoughts of living a regular daily life as a woman: getting up in the morning and putting on women’s underwear and clothing; going to work at a traditional woman’s job; and having everyone who interacts with me believe I am a woman. (104)
I am 58 years old and a preoperative MtF transsexual. By my mid-20s, I had very strong desires to dress as a female on a full-time basis. I use a variety of feminine hygiene products; these include panty-liners, maxi-pads, vaginal creams, tampons, etc. I have often wished I could have been a saleslady, selling feminine fashions at a Victoria’s Secret store, dressed as a woman and appearing to be a female at my job and in public. As a male, I have always been reluctant to make sexual advances; but, imagining myself as a female, I have wanted to be seductive, wear sexy, feminine fashions, and initiate physical intimacy, especially with other women. (141)
Other informants reported that they found certain specific feminine behaviors particularly arousing. Being obliged to sit to urinate or experiencing the inconvenience associated with seated urination was sometimes experienced as sexually arousing:
I always wanted to have to sit on a toilet just like a woman. For years I would wear arrangements (so as not to touch or direct my penis) to simulate female urination. For example, I would wear the old-fashioned sanitary belt and pad, with the inner pad removed from the outer covering. The mesh covering would hold my penis in a downward position and produce a feminine stream. Also, I would void through pantyhose, or glue or tape my penis in a downward direction. For me, the greatest joy of my sex reassignment surgery is the constant reminder, every time I use the bathroom, that my maleness is gone. I am still sexually excited knowing that my urination process is just like a woman’s. (061)
I find the thought of becoming a woman and “having” to urinate as women do incredibly arousing. I thought that I was completely alone in finding this so arousing. (143)
I empathize with the other writers who expressed excitement at going to the bathroom as a female. It’s intensely exciting to think of having no choice but to squat to urinate, and I’m very envious of those transsexuals who have attained the ability to experience female urination. In fact, I go out of my way to make sure I always use a stall to pee, even when it’s very inconvenient to do so. I consider this good practice for what I will have no choice but to do once I am female. (104)
Some informants described even seemingly trivial female-typical activities and behaviors as having been sexually exciting:
The idea of owning a girl’s bike has aroused me. (174)
I definitely have that erotic turn-on from thoughts of myself as a female, sometimes doing ordinary things: When I’m alone or driving, I sometimes fancy myself a middle-aged, attractive woman with a husband. (177)
I had my first experience at 15 with a 16-year-old girlfriend. Later with the same girlfriend I did some amateur feminization, including makeup and nails and the most amazing part: I got to take the non-hormone reminder pills from her birth control pills a few times. (178)
Others were sexually excited by the idea of being with other women in a gym or locker room and feeling as though they genuinely belonged or deserved to be there. Here are two representative examples:
I started hormones about 6 months ago and am awaiting approval for sex reassignment surgery. The most sexually exciting thing about being a woman is fitting in as a woman and finally feeling I have a place to belong. I often fantasize being postoperative and being able to go to the gym and finally being able to shower with other women after having a nice workout. I am really turned on by the idea of going into the women’s shower and being surrounded by femaleness and of just being able to legally belong in the women’s restroom. What I’m saying is that to truly fit in as another woman in these places means a great deal sexually to me. (089)
After reading about autogynephilia, I think that I have come a long way in understanding myself and my motivations and desires. Most of my early masturbatory fantasies involved being transformed into a woman and living as a woman. I don’t really care about the clothes. It is about being able to see myself as a woman or at least with feminine qualities. My most enjoyable moments are imagining experiencing the more tame parts of life as a woman (e.g., playing golf, going to the women’s room or locker room, being able to shop for feminine clothes and shoes, and being seen as a woman.) The few times I have been in a women’s locker room have been overwhelming. The smell is so inspiring and alluring and the idea of being able to go there and be accepted as a woman—I certainly can understand why people go completely through the surgery. (107)
It is important to emphasize that the narratives that mentioned wanting to be with other women in a gym or locker room never carried overtly voyeuristic overtones. What was arousing to the informants was being accepted as a woman by other women, not the opportunity to view nude or scantily clothed female bodies. In fact, one informant explained that experiencing the absence
of male-typical feelings was what made the locker room scenario arousing:
I am deeply aroused by the idea of being in a locker room with other women and having no male sexual feelings. (179)
Another informant reported that shopping for women’s clothing was arousing primarily because it is something that only women normally do:
I’ve often become aroused by wearing women’s clothing or thinking about having a woman’s body. The desire to become a woman or more like a woman has encouraged me to just walk right into a department store and into the women’s department and go right up to the lingerie counter and ask for what I want. Often when I’ve done this I’ve had a mixture of guilt, shame, and embarrassment and at the same time felt excited, proud, relieved, and happy. There are also times when it feels exhilarating, because I’m doing something that normally only a woman would do and start to feel like a woman shopping for her personal needs. (180)
Yet another informant was especially sexually aroused by the fantasy of receiving a manicure in a beauty salon. She apparently found the actual event arousing, too—she implied that having undergone castration was all that prevented her from exhibiting an erection:
When I first read about autogynephilia, I knew instantly that it described me to a T. I was surprised that hormones and orchiectomy did not eliminate my sex drive. My erotic fantasies have evolved considerably over time. I have several fantasies I use to achieve orgasm. All are autogynephilic in one way or another. In one, I enjoy an afternoon being totally pampered at a beauty salon. The centerpiece is always a manicure. It’s kind of the sine qua non of feminine indulgence and is the one female affectation forbidden to men. Two months ago I felt confident enough to finally indulge my manicure fetish. I felt I had earned a set of acrylics. Had I not been castrated it could have been a very awkward moment. But instead it was anticlimactically but perfectly normal. My manicurist gave no indication that she suspected I was anything but a woman. (156)
The fantasy of being in a lesbian relationship with a woman was particularly appealing to another informant. She emphasized that what was exciting about this fantasy was not the opportunity to have sex with a woman but the opportunity to enact the role of a lesbian.
I’m a 50-year-old MtF transsexual, in transition about 10 years. I fit into the behavioral autogynephilic pattern. I am currently and always have been attracted to females. My conscious memory of gender dysphoria really began at age 13 with dressing up, which was always connected with sexual arousal and orgasm. This early fantasy was of being a girl and being with a girl. I had a real interest in reading lesbian love story paperbacks, which aroused me. I started to go out with girls at age 15 or 16. From 16 on up, I never really had any great desire to have intercourse, but I was really interested in a lesbian relationship, usually with a clothes fantasy. My sex life with my girlfriend from ages 16 to 18 was what I fantasized as a lesbian relationship. We never had intercourse: She was trying to be moral and I had no real interest in intercourse. (181)
Another informant admitted to feeling aroused by having a female name and gender designation on her identity documents, because this carried implications of now being “forced” to live permanently in the female gender role, a theme that is a staple of transvestite and transsexual erotic fiction:
I will confess that officially changing my name and changing my driver’s license and ID over to “female” did sexually excite me, as I felt I had pushed myself to a point of no return. The notion of now being trapped in my new gender reminded me of all of the little pink storybooks of “forced transitions” I had bought and been stimulated by earlier. (182)
The anonymity provided by the Internet allowed some informants to enact their behavioral autogynephilic fantasies by posing as women and engaging in female-typical behavior in cyberspace:
I have lived as a woman in the cyber world for the last few years, taking on a woman’s name and identity. I spend a lot of my time on the net every night, living out my fantasy of being a woman. (183)
I really do wish I could be an attractive woman. But that is impossible, so I become one in cyberspace. When I first created a female identity on the Internet, I would become the attractive, 5′1″, 100 lbs., black-haired beauty who wears red lipstick and pearls. (109)
Perhaps the most unusual instance of behavioral autogynephilia involved a 61-year-old informant who aspired to be the “trophy wife” of a wealthy businessman or successful male professional:
I am a 61-year-old preoperative transsexual. I have had liposuction and will have an almost total facial package done within the next several months. My thing is not to have a female body, though I am definitely an anatomic autogynephiliac. My thing is to have a super-sexy female face and body. I want to be the woman that men look at and know that, unless they’re the CEO or extremely successful professionally, they can’t afford me. I feel like I’m an ideal candidate to be the wife of an extremely successful person. I’ve seen the male side of things and I’m going to have extraordinary empathy for his side. Even though I’ll be a sex-bomb, I won’t be an airhead. I’ll be the best combination of two worlds. (184)
Wealthy male CEOs and other professionals rarely choose 61-year-old natal women as trophy wives, even if the women in question are or were extremely beautiful, love men, and have decades of experience in pleasing and catering to their male partners. The idea that a wealthy male CEO or other professional might choose to marry a 61-year-old autogynephilic MtF transsexual strains credulity. This narrative illustrates the naiveté with which many autogynephilic MtF transsexuals approach the prospect of romantic or sexual relationships with male partners. I will examine this topic in greater detail in
chap. 8
.
Concluding Comments on the Diverse Manifestations of Autogynephilia
As these narrative excerpts demonstrate, the manifestations of autogynephilia are highly diverse. The key to understanding this diversity is the realization that autogynephilic transsexuals can envy and eroticize any aspect of femaleness or femininity, from the most fundamental and essential to the most trivial and mundane. Autogynephilic transsexuals can and do eroticize fundamental biological aspects of femaleness, such as having female anatomy and physiological functions. They almost invariably eroticize wearing women’s clothing—the most prevalent manifestation of autogynephilia. They can eroticize any aspect of female-typical behavior, from the cross-culturally universal to the most culturally specific. They can even eroticize aspects of women’s experience that most women dislike, such as societal expectations to conform to standards of dress or behavior that are restrictive, inconvenient, or uncomfortable. One of my clients even described being turned-on by the fantasy of experiencing sexism: having her opinions ignored or dismissed because she is a woman, or being treated as incompetent in technical subjects in which she had been expert while living as a man. Any aspect of women’s experience is seemingly fair game for an autogynephilic fantasy.
The unusual or quirky manifestations of autogynephilia are undeniably fascinating, in part for what they reveal about current cultural ideas concerning femaleness and femininity. It is important to remember, however, that autogynephilic transsexuals—whatever the nature of their erotic fantasies—experience real gender dysphoria, develop real cross-gender identities, and often transition to live as social women in a world where being somewhat recognizable as a woman makes one’s life easier, safer, and more rewarding. The aspects of female-typical appearance and behavior that autogynephilic transsexuals eroticize are, for the most part, the same aspects that they envy, admire, love, and want to emulate. Autogynephilic transsexuals who undergo sex reassignment and want to thrive in the real world are well advised to try, at least to some extent, to look like and act like natal women. If they find the prospect of doing this somewhat erotic, so much the better.
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