MultiO Studies

A Boy Discovers his Penis
by James Allen Kleeman, M.D.¹
(Excerpts from: A Boy Discovers his Penis. 1965.
Genital Self-Discovery During a Boy's Second Year — A Follow-Up. 1966.
Genital Self-Stimulation in Infant and Toddler Girls. 1975.)

¹ Associate Clinical Professor of Psychiatry, Yale University.
Faculty, Western New England Institute for Psychoanalysis.

The subject of masturbation in very young children presents a paradox. On one hand, a great deal has been written about it; on the other hand, there are some large gaps in our knowledge concerning the beginnings or precursors of masturbation. We have five types of sources for what we know:
       (1) reconstructions from the psychoanalytic treatment of adults and children;
       (2) case reports of individual children where histories from parents and observations of the child by the treating therapist furnish the data;
       (3) reports from pediatricians (e.g., Levine, 1951);
       (4) observations of institutionalized children by trained observers with some comparison data of children in their natural home setting by the same observers (e.g.. Spitz and Wolf, 1949; A. Freud and Burlingham, 1944; Provence and Lipton, 1962);
       (5) observations by trained observers of children in a clinic or nursery setting away from their homes (e.g., Roiphe, 1968; Sperling, 1970).
       Many authors have specified the need for more detailed data on normal children observed longitudinally on a 24-hour-a-day basis. In general, the parents of a child are the only adults having access to this kind of data. The dependability of observations recorded by parents can be questioned on several scores. Yet, taken together with what we learn from the other five sources, this information can be useful. Such data are the basis of this study.

I have been collecting observations of this kind for about 25 years. I started with observations of my own children and the children in families in Edith Jackson's Rooming-In Project (Olmsted, Svibergson, and Kleeman, 1949). Subsequently, my study included the children of colleagues, friends, research-assistant employees, and parents who learned of my interest by word of mouth. The parents' written and verbal data were supplemented by my own periodic observations of the children in my office and their homes. The number of children studied at any given time is small, e.g., six families at this writing.

This report is based largely on longitudinal observations of one boy and five girls from different families. I shall report on one of these children in detail. My discussion and conclusions are based on these six children, many others about whom I have less material, and on articles listed in the reference section.

Most writers agree that pleasurable genital self-stimulation should not be labelled masturbation before the child is two and a half (Marcus, see Panel, 1962). Psychoanalytic theory has established that the fantasy associated with the stimulation is crucial to the concept of masturbation. The observations in this paper report the external behavior and not the psychic content, which rules against calling the behavior masturbation. However, for descriptive purposes I am arbitrarily using my own definition of masturbation. Whenever masturbation or masturbatory is used in this article I am referring to: Stimulation of the genital zone with the qualities of self-absorption, consciously intended self-arousal, mounting excitement, and with a climax type of rhythm (though not necessarily resulting in orgasm) rather than lulling, and where seeking pleasure predominates over exploring and acquiring knowledge.

William

The drama implied in the title is in the mind of the adult* and the title actually refers to a rather undramatic moment in the first year of the male child. This boy, William W., was nursed by his mother throughout the first year (weaning from the breast was completed late in his sixteenth month). Since he did not drink milk from a bottle or cup and was nursing three times a day at eleven months and two times a day at one year, his mother was out of the home without him at most only a few hours at a time throughout this year. Furthermore, since he was in diapers and rubber pants except during his bath and since the mother exclusively gave him his baths, we have available as complete a record of his exploration of his genitals as one could hope to obtain in a home setting. Mrs. W. was a sensitive observer of people, which enhanced the value of the material. Thus this method of data collection not only permits an exact dating of the first time William discovered his penis but also offers a record of essentially every time he did so during his first twenty four months.
       * Cf. Freud (1905): "Among the erotogenic zones that form part of the child's body there is one which certainly does not play the opening part, and which cannot be the vehicle of the oldest sexual impulses, but which is destined to great things in the future" (p. 187).

Mrs. W. was a well-educated woman. She and her husband were agreed that William's interest in all parts of his body was a normal evolution. She neither encouraged nor discouraged his genital manipulations and visual interest, but just observed their unfolding (with the exception of distracting his handling himself when he was being cleaned after a bowel movement).

In his first year, William was a healthy, large (9 lbs. at birth), alert, vigorous, unusually active infant, advanced in social responsiveness, affectionate behavior, gross motor activity (he walked effectively at eleven months), and language development (in addition to mama and dada, at eleven months his vocabulary included sounds used meaningfully for no, yes, nice, car, bye, baby, ball, kitty, and thank you). 

At two weeks of age he was found to have a prominent communicating hydrocele, which persisted for about six months; a severe excoriation of the scrotal sac and tip of the penis of unknown origin developed at the same time. Both of these caused increased manipulation of and attention to his genitalia by the mother and pediatrician. The skin rash lasted three weeks, was quite painful to the infant for about one week, being irritated by urine and bowel movements, and required frequent wet dressings and the application of ointments. Frequent warm baths, the treatment which seemed to offer the baby maximal relief through relaxing him, were not specifically zonally directed. There was no evidence that the pain or extra manipulation affected the normal emergence of his genital self-stimulation late in the first year. It is evident from the Observation 20  that, because of the augmented genital sensitivity and conscious awareness of it, the same genital attention at fourteen months (1;2 + 5) would have had a markedly different impact.

William was highly sensitive perceptually, and subject to an extraordinary kinesthetic experience when nursing at the breast (moments of intense and usually pleasurable interaction). Because of a peculiar gastrointestinal intolerance, he was subject to much distress during the day. He was able to tolerate very little solid food and would interrupt nursing with crying, pulling away, and burps. The pediatrician, noting William's healthy appearance and development, approved the mother's trial-and-error method of diet selection in order to permit the baby the least fretful day. She gradually evolved a solid diet largely of bananas (in the form of banana flakes), supplemented by small amounts of applesauce, strained pears, oatmeal or cream of wheat in addition to nursing. Any attempt to expand this basic diet would result in what the mother described as a tense and bloated abdomen, fast thoracic breathing protective of the abdominal area, writhing, twisting, and disturbed naptimes and night sleep. She said, "His burps were more like the belches of an adult who has overeaten than like those of a baby having taken in air."

Extreme were his responses to animal proteins, including cow's milk. Thus, the nutritional aspect of nursing encouraged the mother to continue beyond ten months, although she was prepared and hopeful to begin weaning by that time. Mrs. W. describes another factor as follows, which she felt was prime in causing her to continue: "Although William showed only moderate interest in the breast, nursing seemed to offer a prolonged and intense positive relationship outside the baby that I had wished would counteract the prolonged and intense negative inner frustration, and hopefully secure for him a foundation of trust. I reduced his nursing one feeding at a time until we were down to one a day at thirteen months (which marked his beginning tolerance of whole cow's milk). When I weaned him completely at sixteen months, it was because he showed a greater tolerance for more foods and because, in a number of ways, he exhibited a new kind of separateness from me implying characteristics of an inner security I had wanted for him. I then felt satisfied that Billy was really beginning to know where Billy (cramps and all) ended and where mommy began."

His mother gradually found that motion seemed to relax him. It would keep him nursing at the breast with diminished discomfort. She provided this by remaining standing, while nursing, so that she was able to walk, sway, hop, or dance to radio music. She would sometimes bump his buttocks against the wall lightly and rhythmically which enabled him, on occasion, to relieve himself of rectal gas. This truly exhausting procedure for the mother for a 15-20 minute nursing was greatly preferred to the interrupted feeding, crying, gastrointestinal distress, and frustration for mother and child that was frequent without it. This went on between four and eight months. When William was eight months, I made the prediction that at about one year, it would find expression in some rhythmic autoerotic activity. However, this did not occur, possibly because nursing continued through this period (much less kinesthetic activity was needed). William rocked some in his crib around nine months, but the dominant mode of self-stimulation was thumb sucking, sometimes with a soft diaper pressed against his face. There was occasional playful head banging at a year, but no significant rocking, head banging or other major rhythmic activity. Escalona anticipated the complexity of such a prediction. In conjunction with point 3 quoted above she added: "In this area, too, the facts are such that knowing how the mother tends to stimulate her infant does not predict the preferred modality for autoerotic activity in the baby. Nor is there a consistent relationship between that modality to which the infant proves most reactive and the modality he chooses for conspicuous self-stimulation" (p. 241f.). Retrospectively, it is not difficult to understand why this infant utilized thumb sucking and a soft diaper pressed against the face as his preferred modes of self-stimulation, expressing his experience (his innate characteristics and his mother's style of caring for him). In addition to the kinesthetic stimulation offered him, the mother was richly oral herself. She kissed him a lot, talked to him with the use of a variety of facial expressions, sang freely, and offered him the breast to satiety. She also exposed him to much tactile pleasure.

Because the following Observations are of necessity condensed and selective, some readers may infer that Mrs. W.'s focusing on William's genital and anal anatomy and functioning was excessive and seductive. Admittedly the dividing line between what is to little or too much is a delicate one. In general, Mrs. W.'s combination of psychological sophistication, sensitive observation, empathy with the small child's need to talk frankly without pretense or shame, her assessment of his anxiety level, her interest in educating, whetting curiosity, and anticipating the boy's next developmental readiness (which included cognitive advance and potentiality to be overstimulated) resulted in a reasonable balance for William.

Observation 1 (0;8 + 0): He was just eight months to the day. There he sat in the bathtub playing with the rubber mat beneath himself as the water ran out the tub. Looking down, he spied a small object between his chunky, little thighs. He reached down and gently felt it in his fingers (his initial approach to anything new was usually a gentle one). He moved it and squeezed it with interest several times. He released his hand and reached again for the bathmat and then for the drain plug and, as if he were suddenly reminded, once again he lowered his eyes and put his hand down to discover anew his penis. Until Observation 2, William did not again direct attention to his unclothed genitalia.

The age of onset of genital self-stimulation could be precisely stated. Two points are of interest, knowledge of the exact age of onset and the prolonged interval before it was resumed more consistently. The first genital touching occurred on the day he was eight months old. This was not repeated until he reached ten months nine days.

Spitz shows a chart of the age of onset in the twenty-one "institution" infants who showed "genital play," one beginning at six months and over 60 per cent starting after ten months. In children reared in families with "excellent" mother-child relations Spitz found that sixteen out of seventeen infants studied manifested genital play within the first year, at ages which were on the average two months earlier than those observed in the institution (Spitz and Wolf, 1949, p. 95). Bender (1939) declares genital play begins between the eighth and ninth month in normal children. The infant reported by Loewenstein (1950) was ten months old and so was the boy described by Casuso (1957). Bornstein (1953) states that pleasurable self-manipulation may occur in the fifth or sixth month. Levine (1951) reports that between five and six months an infant rarely finds his genitals, but the fingering is not purposeful or continuous. After six months the fingering of genitals begins to occur with greater frequency. Bell (1961) notes an infant, at about six months, who, making random movements toward the genital, manipulated the scrotal sac as his first encounter with his genitalia; only later, when more directed movements had developed, did he reach for the penis. Her observation and the following one from Halverson (1940) are of a different order from the "discovery" at eight months by William and the genital play reported by Spitz; the latter involve coordination of purposeful hand and finger movements and visual focus. Halverson describes a fifteen-week-old infant: "M's tumescences were usually of long duration and the cause of considerable annoyance to him. He repeatedly reached for his penis and scrotum and grasped or clawed them violently."

Observation 2 (0;8 + 30):5 After his bath William was sitting undressed on his mother's knee facing a mirror as his mother was putting on his shirt. He saw his penis in the mirror and looked intently at it. He made no movement to reach for it or touch it but stared with interest for about ninety seconds.

It seems reasonable to assume that William had essentially no established mental representation of his genitalia at this time. In contrast, he had a developed mental part image of his thumb, which he sucked vigorously to ease distress (withdrawing interest from the outer world and soothing himself in preparation for sleep). Often the put his toes in his mouth and sucked them, "knowing" them, at least, as appendages. This was a baby who at a very young age was observed to be remarkably aware of form: he reached with his mouth for nipples, toys, mother's nose, fingers, breast, etc. When he began to utilize his hand at eleven and a half weeks, he then reached with his hand as well as his mouth for these positive forms. He would regularly grasp his mother's facial features and fingers.

Between eight and ten months William was making a good start at self-sufficiency. In his bath he would suck on the rubber mat or a washcloth, splash, and "swim." His forefinger-thumb coordination had enabled him for some time to feed himself pieces of bread and other food skillfully; he could with great fascination open and close a doll's eye with his forefinger. At nine months he was a real explorer with curiosity and intrusiveness and a special mechanical bent. He made wheels spin and examined various protuberances — light switches, radio and phonograph knobs. He pulled out drawers, turned on radios, flushed toilets, and unscrewed tops of jars.

Observation 3 (0;10 + 6):7 After nursing at the first breast and before starting at the other, William explored the nipple of his mother's breast with great interest. He held it between his forefinger and thumb and squeezed it several times. The quality of this fingering, its intensity, and his facial expression were reminiscent of his "discovery" and examination of his penis at eight months. In contrast to his other two nursings, which preceded sleep, the initial nursing of the day was carried out in the light. The mother, hoping this might enhance a feeling of separateness and encourage weaning, permitted William to examine her breast sometimes at this feeding.

Lustman (1956) described an experimental evaluation of sensitivity of erogenous zones in neonates. Though the lips represented the most sensitive erogenous zone, this was a relative, not an absolute primacy. There were striking individual differences in sensitivity among the babies, and there were infants who hyperreacted in all zones stimulated (including the genital), even though the lips were the most sensitive zone. This work has not been carried out by Lustman or others on older infants. Various data suggest to me that at one year the oral area is still the most sensitive zone for a majority of healthy infants represented by William, but certainly not for all (see the infant Sybil at twenty-eight weeks in Escalona, 1963), and certain infants at one year show marked genital sensitivity compared with other infants of the same age.

Observation 4 (0;10 + 9): William played with his genitals again, for the first time in two months. It also occurred this time in the bath. He had an erection. I am not certain whether this preceded, or was the result of, his manipulation. He played with one hand and then with both, talking in a quiet jabber as he did. He then got on all fours and "peeked" as if to check if his penis was still there, but his pendulous belly made viewing difficult. He sat down and checked. He felt himself a little more. That was that!

This second occurrence of tactile genital self-stimulation was two months and nine days after the first. In the interval there was the single instance of visual interest in the mirror and a few occasions when he would clutch his genital area through his diapers, usually when they were wet or contained a bowel movement. Following this date, visual and tactile interest in his genitals was regular and frequent, though not daily.

Observation 5 (0;10 + 10): In the tub on this day William touched his penis with his forefinger. He rubbed his thighs together, which appeared stimulating to the genitals. He had an erection part of the time.

How erotic is genital self-stimulation in the first year? A number of analysts attach great erotic significance to the "genital play," masturbation, or genital self-stimulation in the first year of life. An example of this point of view is from A. Balint (1954): "We know that genital erotism manifests itself even in babyhood, in infantile masturbation… We may conclude that from the very beginning the genitals have this property of affording sensuous pleasure… Infantile masturbation should be regarded in the same way as, for example, thumb-sucking. At this age it has no more, but also no less significance."

At the other extreme is the belief that the genital touching and stimulation in the first year are the equivalent of the discovery and play with a toe or knee. Spock (1946) records: "Babies in the last half of the first year discover their genitals the way they discover their fingers and toes, and handle them the same way, too."

My own experience favors a position midway between these. Several of the qualities which may characterize an erotic activity are an absorption of the attention by it and a mounting excitation. Mild pleasure rather than the prominence of these other two qualities marked William's tactile stimulation of his genitals in the first year. Among the writers espousing this point of view are Bender (1939), Engel (1962), Levine (1951), Murphy (1964), Provence and Lipton (1962), Ribble (1955), Spitz and Wolf (1949, p. 102), and Stone and Church (1957).

However, under certain circumstances a greater degree of genital sensitivity in the first year exists in individual infants: (1) One of the babies tested by Lustman (1956, p. 94) showed a hyperresponse to air stimulation of the genitalia at three to four days after birth, indicating an innate characteristic. (2) In some cultures mothers actively stimulate the children's genitalia either to soothe them or teach them to masturbate (Sears, Maccoby, and Levin, 1957). (3) In the case described by Sylvester (1947) excessive masturbation was a clinical symptom of an eleven-month-old boy. Maternal care consisted of nearly uninterrupted attention to and manipulation of him. Masturbation ensued whenever attention was discontinued, even briefly. It would seem that either innate or especially environmental factors can lead to heightened genital sensitivity in the first year.

Observation 6 (0;10 + 11): Today in the bath, William did not touch his genitals. At one point he was on all fours looking back at himself. This was the third consecutive day he had an erection in the bath. It was clear this time it occurred spontaneously. He also paid special attention to his knee, touching and rubbing it. The intensity of the interest in the knee seemed about equivalent to that shown for the genitalia or for certain external objects at this time and represented his increasing awareness of this sector of his body.

Observation 7 (0;10 + 14): William showed tumescence throughout the bath. He examined his penis with his forefinger and then stroked it with his forefinger and thumb back and forth four times.

This kind of tactile genital self-stimulation was rather characteristic of what was observed during his eleventh month. It also resembled his behavior at this time with the nipple of his mother's breast. The mother felt that the nipple was similar to the penis in color, temperature, erectile tissue, and, to the baby boy, similar in size. The day following this observation William began walking unaided. The mother thought prolonged tumescence might indicate a full bladder. She stated that when changing him as a newborn, she would wait before putting on a dry diaper (but would keep him covered) when he had an erection. She said he usually would urinate if she waited a few minutes, and the erection was her clue.

Observation 8 (0;10 + 18): On the three previous days there was no genital touching in the bath. This evening William showed interest in his penis as soon as he was in the tub and remained interested throughout the bath. While sitting, he bent over trying to look at himself. He touched his penis with the thumb of one hand. Then with the other hand he held the penis with his forefinger and thumb. After additional clutching of the whole genitalia and squeezing of the penis, William started to get an erection. Near the end of the bath he was holding the penis between his thumb and forefinger. He began tugging at it back and forth in a more vigorous fashion than had previously been observed. After he stopped, he bent over again and tried to see.

The visual component of William's genital exploration not only was important, but actually tended to supersede the tactile in later observations. Because of their location, the genitals and back are the last major external areas of the body discovered. Apprehending any object (external or body part) simultaneously in various modalities, such as touching or manipulating it while also looking at it, promotes a more distinct awareness of the thing or its properties than is possible through a single modality (Escalona, 1963, p. 221).22 In the case of a body part there is the additional sensation created by the stimulation in the part itself. Greenacre (1958), (1960) has written extensively about the role of vision in developing a sense of identity, as an indispensable adjunct in establishing the confluence of the body surface, delimiting the self from the nonself, and integrating body parts into an organized central image. She points out that for a girl touch and vision play less of a part in forming the image of her own genitals than they do for a male.

Observation 9 (0;10 + 27): In the bath William approached his genitals with an open hand and partly enveloped his scrotal sac and penis together. Bending over, he looked at his penis, tugged on it, and continued to look at it off and on throughout the bath. While holding his penis, he looked up at his mother's face with a facial expression she interpreted as "Isn't it wonderful!" She responded, "That is your penis; you like that?"

In diapering William afterward the mother retracted the remnant of his circumcised foreskin to clean the area. He giggled as she did this. It is fairly apparent that by this time the genital area had sensation of a special quality. However, it was not yet clear whether the degree of sensation was markedly different from the sensation that produced laughter when he was "tickled" in other sensitive parts of his body.

There are two facts of life about male infants which distinctly make stimulation of the genitals different from stimulating the knee, for example, and certainly suggest a greater erotic quality than knee stimulation: (1) tumescence and (2) reflex movement of the testicles.

Relatively little has been written about the erections of boy infants in the first year (Halverson, 1938), (1940); (Greenacre, 1941); (and Casuso, 1957). The observations of William in this area of tumescence are suggestive but are difficult to interpret because of the problem of accurate observation. Noting the degree of erection in an active little boy through soapy bath water, without being too obvious about the observing, presents obstacles, which are less in a younger child lying nude in his crib. However, it can be said that erections and partial erections were frequent (they could be seen either at diaper changing or in the bath almost daily); more arose reflexly than through genital stimulation. As Halverson (1940) pointed out, there was often an association with micturition; i.e., tumescence would occur as the bladder was full and detumescence followed quickly after urination. On rare occasions the tumescence would draw William's attention to his genitalia. His mother's cleaning the area or his own touching would stimulate an erection more commonly later in the period reported than earlier (see Casuso, 1957). By fourteen months it was very common.

We do not know how testicular movement feels to a one-year-old. It occurs frequently during diapering, cleansing, and bathing, and it seems reasonable to assume that some awareness of this is present on some level and that the testicular movement confers on genital stimulation an additional quality of sensation unlike any other body part (see A. Bell, 1961).

Observation 10 (0;10 + 28): As warm water came flowing in around William sitting in the bath, both testicles retracted upward and the penis seemed to bob up and become partially erect. At this point William grasped his penis in his fingers. The penis remained erect. He bent over, presumably to look at it. Earlier the same day William and again fingered the mother's nipple during the nursing period in a way very similar to the above fingering of his penis. Though I have assumed that his bending over was always to look at his penis, the breast-penis equation here leaves open the possibility that bending over also involved a wish to suck on the penis.

Observation 11 (0;11 + 1): At the outset of his bath William looked down at the genital area, took his penis in his fingers several times, briefly, for not more than thirty seconds and then did not touch his penis the rest of the bath despite the fact that the penis was erect most of it. After his mother washed his legs, there was soap left on the right knee and leg. With his right hand he made a washing movement over the knee and part of the thigh and leg as the mother had done. It apparently felt good or he enjoyed doing it, for he smiled; he then repeated the stroking of the right knee, making six rotations. At the end of the bath when the soap had been rinsed away, he again carried out the motion over the right knee.

Though the recorded observations focus on the genital self-stimulation and activities, it is important to emphasize that they represent a very small fraction of his total daily interest in himself and his surroundings. In the bath itself the great majority of time was spent otherwise, getting up and down, splashing, trying to drink bathwater, patting the wall, opening and closing the drain, holding something, sucking on a washcloth, etc. He almost always wished to hold something in his hand during his bath, such as a washcloth, toothbrush, plastic bottle, or ball.

During the twenty-four days following his second genital self-stimulation there was some tactile self-stimulation of his genitals on fourteen days.

Observation 12 (0;11 + 8): William walked unclothed from his room to the tub. He touched his penis as he entered the bathroom (possibly in response to his mother's looking at his genital area momentarily). During most of the bath he played with a washcloth. As the water was draining out, William grabbed at his penis and held it with one hand. He released the penis shortly thereafter, and pressed his genitalia with a plastic bottle he was holding in the other hand. He rubbed the bottle against his penis. He again put his free hand back on his penis and pulled back and forth on the foreskin, in fine movements with his fingers. He squeezed the penis and testicles together and moved them around. The penis became erect. The mother (who frankly acknowledged her interest in his budding masculinity) said, "Do you like it, Billy?" Shortly he let go; the mother did not focus any more attention on his genitalia. The erection gradually subsided.

This incident had the quality of intent to excite by self-stimulation (in contrast to the wish to explore, with stimulation the inevitable result). There was nothing one could characterize as an orgasm.

Greenacre (see Kris et al., 1954) reports that situations of stress can lead to inappropriately precocious development resulting in genital orgasm in the first year, from about the eighth month on (see Townsend, 1896). Isaacs (1935) also makes a claim for genital orgasm in the first year. Spitz's impressive experience certainly makes the occurrence of orgasm in this age group sound rare indeed: "In all the series of over a thousand children I have seen and observed, of these four hundred long-term and continuously, I have never in the first year seen an orgasm stemming from genital stimulation" (see Kris et al., 1954, p. 54). Spitz's thorough review of the literature also left him suspicious of the reports of orgasm in the first two years. There was nothing in the observations of William approaching the excitement of orgasm or even the "acme" reported by Lampl-de Groot (1950).

Observation 13 (0;11 + 12): As the water came in, William was sitting on the rubber mat, mouthing a small ball. He had a spontaneous partial erection without touching or gazing at his genitals. When his mother washed the genital area and, on this occasion, retracted the foreskin, he immediately reached with his right hand to his penis and "washed" it in three rubbing motions. He looked as he did. He did not touch his genitals again during the bath, though a partial erection remained for awhile.

This seemed a clear-cut example of an active self-stimulation following the passive receipt of stimulation from his mother, although there were many occasions when her ministrations did not evoke such a response.

What is the genesis of genital self-stimulation? What factors contribute to its presence or absence? It is clear that maturational factors, such as a certain level of purposeful motor coordination and skill and of functional use of the visual apparatus, are essential. As discussed, innate variability of erogenous zone sensitivity might affect timing, preferred modes of self-stimulation, and interaction with the environment. Controversial is the degree to which mechanical stimulation, such as cleansing, powdering, and bathing by the mother, contributes to self-stimulation. Provence and Lipton (1962) list three key factors of adequate maternal care leading to optimal development of the body scheme: (1) the "dosage" of stimuli (particularly the tactile and kinesthetic); (2) the maturational phase in which the stimulation occurs; and (3) the emotional environment. They emphasize that ministrations of the mother are essential to the infant's awareness of his own body. Spitz and Wolf (1949) stress: "'a close and balanced' mother-child relationship is an important prerequisite for the development of genital play during the first year of life" (p. 99). The observations of William do not conflict with this finding.

Kris (1951) directs himself to this very point: "The transfer from general affection to the genital zone itself is a complex process; it need not only come about by the direct contact of the mother with the genital region of the child during her ministrations, an experience the child would repeat by self-stimulation. It may also arise as consequence of the general bodily closeness to which, we assume, the child tends to react with sensation in the genital region. The genital self-stimulation could then replace the more general stimulation which had produced the pleasurable sensation in the genital region" (p. 100f.).

Based partly on observations not included here, I suggest adding to Kris's formulation that an early identification process is involved in the one-year-old's self-stimulation. His behavior toward his own body reflects in part his mother's behavior toward him. By acting himself in the mother's place, he simulates the whole experience with the mother, inclusive of the sensation she stimulated. Theoretically, after perceiving, representing, and organizing the mother's care, the one-year-old can then discharge maturational drive representatives in the activity of self-stimulation (see Lipin, 1963).

Observation 14 (0;11 + 16): During this bath William neither looked at nor touched his genitals; however, a variety of tumescences and detumescences and testicular movements were observed. The first tumescence occurred as William sat with his right foot tucked under his buttocks and genitalia. The added pressure of his foot against the genitalia as he moved his body or his foot seemed responsible for the erection.

Observation 15 (0;11 + 27): In changing his diapers, Mrs. W. noted that his knee was bent so that the heel of one foot was pressing his genitals. He rubbed the heel against the genitalia four times with a resulting increase of erection. At two other diaper changes, when his diapers were removed, William extended his legs and squeezed them together exhibiting total body tension. (It also seemed to involve genital stimulation via thigh pressure.) In the bath the degree of genital stimulation was greater than had been seen recently. At the outset, he lightly touched the tip of his penis with a forefinger. He explored his genitalia with his hand, squeezing and looking and stroking, all briefly, and then shifted the activity to the knee. His mother's washing did not renew the genital touching. As the water went out, he made his most active approach to his genitals. He looked down at his partially erect phallus, squeezed it, rubbed it back and forth, squeezed again, and tugged on the foreskin, lasting about fifteen seconds in all. He shifted his interest to the drain handle, and then got up on his feet and hands and looked backward at himself. As he was dried in his mother's lap, his thumb went into his mouth.

Observation 16 (0;11 + 29): At the beginning of his bath William grasped a toothbrush in his hand, and alternately banged it against the wall, sucked it or just held it. He had a 1+ (slight) erection at this moment. Several times he lightly put both hands to his lap, perhaps touching his genitals. He then held his penis between his thumb and forefinger, squeezing it gently, as the water came into the tub. Shortly thereafter, he was observed to have a 3+ (full) erection, and both hands dropped to his lap, one still holding the toothbrush. The hands lightly touched his erect penis but did not grasp it. (The movement seemed to be a response to the erection.) During the last part of the bath there was 0 (no) erection and no more touching of his phallus. He sucked his thumb actively in his mother's lap after the bath. She permitted him to play, unclothed, in his crib for a few minutes, which included his lying face down and rocking his pelvis on the crib sheet several times. This seemed pleasurable to him, though he did not reach for his genitals. In being diapered William squeezed his thighs together while extending his legs.

A number of times on his changing table William was observed stretching his legs and squeezing his thighs in a way stimulating to his genitalia. The pleasure he seemed to derive from this was moderate at most; it appeared to be a transitory and normal phenomenon in his total development. It was of about as much importance as his infrequent head tapping (part of his varied explorations and stimulations of his surroundings and himself).

This observation brings us to the end of William's first year. He touched his genitalia on seventeen of the previous twenty-nine days and looked, without touching, on two additional days. His genital self-stimulation at one year appeared more complex than a month earlier and was associated with an interesting cognitive development in another mental sphere; his capacity for organizing percepts was now such that he made connections between parts. A simple example concerned a small plastic bottle and snap-on top. He knew how the two went together. He could remove the top, and attempted to replace it. Failing this, he would hand them to his mother, vividly indicating that she should and could do it. The process was then repeated a number of times.

The observations continued throughout his thirteenth and fourteenth months. There was a definite increase in tactile self-stimulation and visual interest during the thirteenth month compared with the twelfth, but especially noteworthy was the prominence of bending over and looking at his genitalia, often with no touching. There were many more clear-cut occurrences where self-stimulation aroused an erection, although spontaneous tumescences were still in evidence. For this child the erections themselves were apparently not yet especially sexually exciting since they usually did not attract his attention when they arose spontaneously. Whereas in the eleventh month his approach was often to the whole genitalia, progressively in the twelfth and thirteenth months the penis was singled out, undoubtedly because of its special sensation, for focused attention.

Self-stimulation through thigh pressure was frequent in the thirteenth month, but this and tactile self-stimulation decreased somewhat in the fourteenth month, possibly because of his focus upon apparent discomfort associated with prolonged upper respiratory infections. However, a good deal of bending and looking persisted in the bath. Four observations during these two months warrant special mention:

Observation 17 (1;0 + 15): The mother put her hand inside his diaper to see if it was wet; her hand touched his penis. His immediate response was to stroke her cheek and say "Ni" (making nice). This is a striking example of a passivity-activity connection and a reversal of the process whereby general affection from the mother leads to genital sensation.

Observation 18 (1;1 + 20): William had a 3+ (full) tumescence in his bath which was followed immediately by detumescence (0) after urination.

Observation 19 (1;1 + 21): William stood for quite awhile in his bath so that it was possible to observe without difficulty spontaneous tumescence and detumescence occurring without any tactile stimulation of the genitals.

Observation 20 (1;1 + 25): After bending over on all fours to look at his genitalia three separate times, William was sitting in the bath. His mother named body parts, which he knew, suggesting he wash his knee. As she pointed to the knee, he stroked it with the washcloth. She encouraged him to wash his belly, touching it as she pointed to it. He did not acknowledge her but instead reached for his penis and tugged at it. She again pointed to the belly and suggested he wash it, and he repeated the same behavior. This time his tugging aroused an full (3+) erection.

Observation 21 (1;2 + 5): William had a slight irritation around the urethral meatus. His mother applied ointment to the spot three times during the day, and on each occasion this minimal stimulation aroused an immediate (3+) erection. At one of these times he pushed his mother's hand away and stared quite intensely at her. At another he responded to the tumescence by squeezing his thighs together.

The observations point to an increasing interest in visual exploration and tactile self-stimulation of the genitalia as the first year progressed. There was a suggestion of increasing genital sensitivity, particularly in the way the phallus became singled out for special attention. If one compares William's genital sensitivity as seen in the observations early in the fifteenth month with those at eight months or one year, the increase is striking. Most authors writing on the subject describe a progressive interest, but as Casuso noted, it is an interest with discontinuities. For example, in William's fourteenth month, he would frequently stare at his genitalia and check on them visually, but tactile stimulation was decreased. Greenacre (1958) and others have pointed to the increase in genital feeling late in the second year and into the third (when masturbation really deserves the name).

Observation 22 (1;2 + 8): In his bath William tugged several times at his foreskin. His mother identified the part for him, "That's your penis, Billy." At that he patted his genitalia with the palm of his hand and a minute afterward repeated the patting a second time. A little later his mother tested him with the question: "Where is your penis, Billy?" He tugged at his foreskin in response.

Observation 23 (1;3 + 0): During the course of a bath he tugged at his penis several times without glancing at his genitalia and without much apparent stimulation.

Throughout William's fifteenth month there was a definite decrease in his touching and looking at his penis. During many baths he did neither. Mrs. W. believed he now really knew of the existence of his penis; therefore he no longer needed to check it visually and tactilely as often as he had done in the previous months.

At fifteen months William had the outer appearance of a robust, active, healthy, attractive boy, though inwardly he was still frequently distressed by his gastrointestinal sensitivity, manifested by abdominal tenseness, gas, apparent cramping with crying, and disturbed sleep whenever his extremely limited diet of banana, milk products, a few cereals, and two baby fruits was expanded. He was still nursing once a day at bedtime. William had a sleep problem related to his stomach difficulty; a parent needed to go to him for comforting or diaper change one night in two. He also had repeated upper respiratory infections and teething discomfort (he had four upper and two lower teeth).

William was doing well in his gross and fine motor skills. For example, he would insert a stick into the hole of a Cheerio and lift it to his mouth to eat it; he walked and ran effectively (walked up-stairs alone holding the banister or the hand of an adult), and fed himself with a spoon; he was fascinated with various mechanical devices. He was socially responsive and deeply devoted to his mother, but he could tolerate separation from her for short periods without difficulty. He was advanced in communication, language, and concept formation. For example, he comprehended the concept of "light" whether it be a street light, a ceiling light, an automobile tail-light even unlighted, or a wall light switch; after Mrs. W. taught him that the point of a safety pin was "sharp," he demonstrated to her that a pencil point and his own fingernail were "sharp." He loved books, turned the pages himself, looked at them, "talked" about them, and liked to be read to.

Very little cleanliness training had been instituted. William occasionally sat on a "toidey" at his mother's suggestion when she thought he was about to urinate. He enjoyed sitting there, but did not yet seem to know where his urine came from and did not urinate in the "toidey." Thumb-sucking with a soft diaper pressed against his face was his main lulling behavior, occurring only when he was tired. Genital self-stimulation was not used for this purpose.

Observation 24 (1;3 + 6): There was no genital self-stimulation in the bath. He was reclining as his mother dried him in her lap. His genitals were more exposed to him than usual. He tugged at his foreskin several times, accompanied, on this occasion, by a vocalized "aaah" with each tug (as though he were acknowledging a sensation in his penis from the tugging). He tugged a few more times and quickly had a full (3+) erection.

This observation clearly demonstrates erection from genital self-stimulation and suggests an increased conscious awareness of the sensation.

Observation 25 (1;3 + 15): Twice in the previous week William showed interest in his penis during the bath. He would lean over to look as he stood, and would reach for his penis, tugging at the foreskin.

Mrs. W. believed that there was a distinct change in his stimulating behavior. Earlier, he reached for his penis as if it seemed interesting as an object or part of himself. After he had touched it, a sensation resulted. Now, apparently more aware of its presence, he seemed to reach in order to create a sensation.

Observation 26 (1;3 + 18): At the beginning of the bath William stood with a 3+ erection. His mother felt sure he needed to urinate. She asked William if he wished to "make peepee" on the toilet. He replied with an unequivocal "No," which he repeated when the question was asked again. After about a minute and a half, while he played with a bucket, there was a spontaneous moderate detumescence (2+) without urination. He was washed, the water drained out, and he sat on the rubber mat with a 3+ erection. He had not touched or looked at his penis up to this time, despite erection throughout the bath. As his mother helped him categorize other body parts and objects, she asked: "Where is your penis?" He knew the meaning of the word and immediately began to lean over to try to see it. Because of his pendulous belly he had to push up with his feet to view it. He held his penis between his thumb and forefinger and squeezed it. He looked at it part of the time, and continued stimulating it by squeezing and tugging in a fashion suggesting that he was creating a sensation which was definitely pleasurable. This lasted about forty-five seconds and had a masturbatory character. He let go for half a minute. He repeated squeezing and pulling. He rubbed it between his thumb and fingers. This lasted thirty seconds; then he got out of the tub.

This observation illustrates his self-awareness in this area, the increasingly masturbatory character of his genital self-stimulation at times, and the definite association of the word penis with his organ.

Observation 27 (1;3 + 20): Several times this day when his diapers were changed, William squeezed his legs together and each time had a 3+ erection. On one occasion immediately following the squeezing of his thighs, causing the erection, he squeezed his mother's forearm with his fingers and then took her finger in his mouth and bit it (it appeared more like a "love bite," a discharge of some sexual excitement rather than anger).

The genital stimulation by thigh pressure, the squeezing of mother's arm, and the biting of her finger had a modal quality in common — an autoerotic excitement which was partially discharged toward his love object. This meaning was also deduced from other observations made at this time; in addition, they demonstrated: (1) a growing awareness of himself; (2) more masturbatory quality to his genital self-stimulation; (3) erection arising almost regularly in response to thigh pressure or manual self-stimulation of the genitalia; (4) greater individuation in his development; and (5) more clear-cut love for his mother as a distinct and separate person.

At the age of fifteen months and twenty-one days complete weaning, the omission of the night breast feeding, was begun.

Observation 28 (1;3 + 23): The mother was holding William in her lap. He put his hands on her fully clothed chest and ran them downward in a way that indicated a consciousness of her form as his hands moved over her breasts. Later in the day William was playing on the floor. Mrs. W. leaned over, and she found William staring down her blouse as an older male might.

It is difficult to decide whether to attach any great significance to this and similar observations. William's visual and tactile cognizance of his mother and her body paralleled his increased knowledge of his own. He had just given up nursing at the breast, at a late age for babies in his social group. His mother frequently observed that looking was very important to William, and I noted the extent to which he used this sensory modality to explore his genitals in the first months of the second year. Active looking would seem to be more a male sexual characteristic than female one, and we possibly may here be encountering early forms of this activity.

Observation 29 (1;4 + 5): During the past ten days William touched his penis more frequently. His increased comprehension of it was evident in his often touching it without simultaneously looking at it. At almost every diaper change, he reached for his penis. He seemed to know it was there and to realize it felt good to touch it. On the previous day, after Mrs. W. had put on his diapers, William slipped his hand down to his genitalia inside the diaper. This was a new behavior. Today he repeated this. At one point his mother kissed his foot. Immediately, he patted his genital area (over diapers and rubber pants) and said: "Oooh, oooh." His mother felt this could mean "kiss me here as you did on my foot" or "it feels good here," i.e., kissing his foot makes his genital area feel good.

At sixteen and a half months William touched his genitals in order to stimulate them, without having to look each time. His self image had reached the point where he now referred to himself by name.

Observation 30 (1;4 + 17): In the bath William was standing and started to urinate. For the first time he looked down and watched himself urinating, with some evidence of pride.

Observation 31 (1;4 + 18): Sitting in his crib after his bath with just an undershirt on and no diaper, William discovered a new game as his mother stepped out of the room momentarily. By "sucking in" his belly he could both see his penis and cause it to bob up and touch a plastic bottle resting in his lap. He apparently enjoyed the activity and the sensation and repeated it a number of times. He laughed as he repeated it, then touched his penis with his hand, "talked" about it, and giggled as he did. He next picked up the plastic bottle and pressed it against his penis. He also experimented with a paper cup in his bed, putting the cup over his penis and testicles. He removed it and again covered the genitalia with it (almost a peek-a-boo equivalent). After doing this several times, he handed the cup to his mother and said, "Back!" (He wished to stop, and she should put the cup away.)

Several times when the mother changed his diaper containing a bowel movement, he started to put his hand to the diaper area, and she gently forbade it. As a result, an association was established, and several times when there were no feces in the diaper, he started to put his hand toward his penis, said "Oooh," and inhibited the complete motion. Subsequently William was helped to differentiate that it was all right to touch his penis but not put his hand in the bowel movement.

Ernst Kris (at a seminar) has pointed out that some degree of castration threat during cleanliness training is experienced even by children of "enlightened" parents (who do not forbid masturbation or genital touching), because of the proximity of the genitals to the anus.

Observation 32 (1;4 + 23): In the bath William carried on active and rather absorbed manipulations and stimulation of his genitals for approximately five minutes. This resulted in a 3+ erection, which had been occurring frequently but not invariably with less concentrated stimulation. He lifted the penis upward, rolled the testicles and scrotum up toward the penis, squeezed the scrotum and penis together, and tugged on the foreskin and the glans. He was "talking" and chortling as he stimulated himself. Clearly this directed behavior brought him localized sensation and pleasure. There was no evidence of an orgasm.

Later during the night he awoke crying. When his mother went to him and changed his soaked diapers, he again had a full erection (3+). William squeezed his thighs together and "sucked in" his abdomen in a way suggesting an effort to stimulate the genitals. He was "speaking of it" as he did, and goose pimples appeared on his thighs. That these did not represent an orgasm is supported by the fact that the erection did not recede as the goose pimples disappeared.

This was the most prolonged and absorbed genital self-stimulation yet observed and could be called masturbation.

Observation 33 (1;4 + 26): Apropos of his recent more vigorous and active tugging on his genitals, William on this day was pulling on his penis and said, "Off, off!" His mother quietly explained it was his penis, and it didn't come off.

This behavior — possibly an early precursor of castration anxiety (William showed no anxiety as he said, "Off, off") — was developmentally related to his general approach to protuberances, tops and caps of boxes, cans, and bottles, which come off and are put back on. It suggests that the mental self representation of his penis was still rudimentary and not yet an integrated part of his body image. There was at this time beginning gender differentiation. Looking at a magazine with his mother, he distinguished a "boy" or "man" from a "durl," usually correctly.

Observation 34 (1;4 + 28): William was standing in the tub as water ran in from the faucet. By holding his pelvis forward, he was able to use the stream of water to stimulate his penis, which was fully erect (3+). This was repeated in the bath the following day and was associated with moderate erection (2+).

Observation 35 (1;5 + 4): At this time William was stimulating his genitals frequently and actively not only in the bath, but almost every time his diaper was changed, he would reach for his genitalia and stimulate himself. His mother each night put white salve on his perianal-scrotal area to prevent diaper rash from feces. This night when she did, his penis became erect (2+); he giggled and reached for it.

Observation 36 (1;5 + 9): During this period his putting his hand to his genitals was more prominent and frequent during diaper changes than during baths. His tugging on his penis and saying "off" continued, but was now done as a joke. He did this in his mother's presence; she would jest back, "Oh, Billy, you know your penis doesn't come off," and he laughed and repeated the "game." This behavior coincided in time with his having a few bowel movements on the toilet; thus he experienced a "body part" becoming separated from him and being flushed away, an experience which was associated with some apparent anxiety.

Observation 37 (1;5 + 14): During a diaper change William picked up a safety pin and tested the sharpness of the point on the skin over his testicles.

Observation 38 (1;5 + 17): Several times recently William treated his penis like a separate object, not only by saying "off" but by anthropomorphizing it — "feeding" it a cracker as he now did his stuffed dog and his toes. Again Mrs. W. and he made a joke of it as she would say: "Oh, your penis doesn't eat crackers." He would laugh and do it again.

Observation 39 (1;5 + 25): Four days previously he urinated in his small toilet for the first time and again made a bowel movement in it. This day he urinated in the bath, though he did not seem aware of having done so.

Observation 40 (1;5 + 28): On the previous day William had seen his father urinate and watched the process intently with great interest. He pointed to his father's penis, started to touch it, but instead commented on the bubbles in the toilet bowl. Mr. W. identified the penis with the word, which William could already say. On this day as his clothes were being changed, William tugged on his penis and muttered, "Boken." It was not clear whether this was related to his recent learning of the word, which he also applied to door latches, etc., resulted from a comparison with his father, or was part of the game which then followed: he continued to tug on his penis, saying, "Off." It was no longer an anxiety-free joke with his mother as she reassured him that it would not come off. He now showed mild concern about it, and in addition pursued his anthropomorphizing of his penis, offering it cookies and drinks of water.

In his bath at the end of the day he was standing and bent way over, looking at his genitals. He pushed the penis aside and pointed to his scrotum and testicles, uttering "Oooh, oooh" with concern. When his mother named them, "Those are your ballies," he repeated, "Ballies," and seemed relieved.

The same day when his diaper was being changed and his genitals were being powdered after a bowel movement, he giggled and said "more." He obviously enjoyed the stimulation, but it was not clear whether he felt more pleasure than, for example, when his abdomen was tickled. Still lying on the changing table, William put his stuffed dog down to his genitals. His mother asked, "What are you doing?" William answered, "Peebis" (penis). His mother inquired further, "What else is there?" William replied, "Ballies" and then "Peek." He did peek, talked of something else, and mentioned "Daddy." Mother made the connection for him, "Whom do you know who has a penis?" William: "Daddy." Mother: "Who else?" William: "Mommy." His mother explained that he and daddy did, but mommy did not.

This observation captures the moment at which William actually discovered his scrotum and testicles. Though he had previously touched and stimulated them many times, on this occasion there was a new element: a fuller awareness which contained mingled puzzlement, surprise, and some concern.

At eighteen months William was large for his age and well coordinated. His gross and fine motor skills continued to be good; he liked tools (screwdrivers, wrenches, hammers), was an active explorer, and remained mechanically inclined. He had a ravenous appetite, but his diet was still quite restricted, although gradually less so. He drank milk well from a cup, which he handled himself. His language development, thought processes, and concept formation continued to be advanced. He had a vocabulary of over 150 words, most of which he used spontaneously, spoke with simple sentences, and used possessives.

Bowel and urinary training was still at the beginning stages. William occasionally made a bowel movement or urinated in the infant toilet. He now associated urinating with his penis and the penis with the presence of his father (when his father came to his changing table, William would often start to speak about his penis, which he called "peebis," "pedis," "peemis," or "penis"). There was greater absorption in pleasure in his genital self-stimulation. He had learned to seek pleasure through such stimulation but did not use it as a means of comfort or relief from frustration.

While William developed much autonomy and individuation, he needed his mother when he suffered from the stomach distress, which still contributed to a sleep problem. He showed affectionate behavior with a small doll and his stuffed dog. The latter and a cotton blanket and diaper were his most treasured bed companions. He greatly enjoyed being read to, could fill in many words of the stories, and showed the beginnings of fantasy play. He opened doors, ran from his mother in a teasing way, and tried to climb out of his crib (which Mrs. W. was able to discourage for a few months). He sucked his thumb while he sniffed at his diaper at sleeptime. Despite the casualness of the toilet training he showed an organized orderliness and cleanliness. He tended to grasp the essence of situations without preoccupation with minor details.

Observation 41 (1;6 + 3): The combination of William's awareness of his penis and his mastery of the word resulted in his mentioning his penis almost every time his diaper was changed. He talked of its existence even under the diaper. The naming was not always accompanied by touching.

Observation 42 (1;6 + 6): William's mother lightly pinched his buttocks and asked, "What is mommy pinching?" William replied, "Penis" (as though everything below the belt and above the knees were called penis).

This observation illustrates the fluctuations in the accuracy of the self representations. One day he clearly knew this body part and at other times he did not.

Observation 43 (1;6 + 8): In the bath William, apparently needing to urinate, had a full erection (3+). He looked at his genitals and "sucked in" his abdomen which caused his erect penis to point straight up. He liked this and repeated the "sucking in" a number of times. The erection fluctuated during the bath and again was 3+ as he sat in the tub with the water running out. He had just been scolded for splashing excessively and reached with both hands to his penis without gazing at it and rather vigorously squeezed the glans and body for a full two minutes. He pulled the foreskin over the glans and back from it. The intensity and duration of the self-stimulation were unusual. He never did urinate. After he stopped the stimulation, the tumescence receded to 0 within a minute.

Observation 44 (1;6 + 17): William had learned well that his mother did not like him to put his hand into a bowel movement. When his diaper containing feces was being changed, he put his hand in the vicinity of his genitalia and the movement and asked, "Touch?" His mother replied, "Wait a minute until I've cleaned you up." After she had, he asked again, "Touch?" She said, "Yes"; he touched his penis with his finger, and that was all. His whole focus was on touching rather than on stimulating himself.

Observation 45 (1;6 + 29): Several times recently when William called his mother to his crib during the night, she found his diapers quite wet and changed him. As she took off the wet diapers, he had a full erection (3+); he then stretched his legs, squeezed his genitalia with his thighs, showing a lot of excitement. On this occasion he raised his right knee, put his right hand on it, and said, "Pedis."

Since he was fairly well able to differentiate between his knee and penis at this time, the occurrence suggested that some sensation from the genitalia was experienced up the leg and in the knee.

Observation 46 (1;7 + 1): After a quiescent period of several weeks William again showed a fair amount of interest in his genitals and stimulated himself moderately. Several times at diaper changing he put his "doggie" (still his favorite inanimate companion) down to his genitals. Today when he did, he squeezed the "doggie" there several times between his thighs, without verbal comment. He had a partial erection.

Several times the following was observed: After he was undressed for his bath, William would sit on the floor stimulating his penis with his fingers. It quickly became fully erect and he tugged on his penis with excitement of considerable intensity. He would bob his erect penis up and down with his fingers. The degree of absorption in self-stimulation was still such that he could be readily distracted. Whenever his mother said it was time for his bath or nap, he turned to his mother at once.

Certainly this kind of genital self-stimulation was more masturbatory than anything observed during the first year.

His willingness to use the "toidey" had waned in recent weeks. Occasionally he wished to sit on it, but even less often urinated in it. Frequently he looked at and touched and stroked his penis as he sat on the "toidey." It would quickly become erect from such stimulation, and he would sometimes spontaneously say "Peemis" as he rubbed it.

Observation 47 (1;7 + 7): William had a fair degree of urinary control at this time, though he did not consistently exercise it. He could sit on his "toidey," let out some urine, stop, announce "more peepee," let out more, declare "baby peepee" (a little bit), and urinate again.

Observation 48 (1;7 + 10): On his changing table William playfully pulled off a sock and announced: "Off sock." He then tugged on a toe and added with a laugh, "Off toe." Mrs. W. kiddingly instructed: "Toes don't come off."

The experimentation with body parts and body coverings and what comes off and what does not showed many variations during the mastery of this stage of reality testing.

As Anna Freud (1965) suggested, this behavior is a sample of the prolonged play which ultimately leads to the differentiation of the self and object representations. At this stage the "not-I" and the "I" and what comprised the self still involved many ambiguities.

Observation 49 (1;7 + 13): Three times this day William made a very active approach to his genitals with his hand, once during a diaper change and twice while walking nude, before and after his bath. He grabbed his penis and scrotum together, put his fingers under the scrotum, lifted the penis and scrotum up, and with his thumb repeatedly pushed the end of the penis in. No marked erection resulted. The whole activity would go on intensely for twenty to thirty seconds at a time. There was also some tugging on the penis itself.

The pushing inward of the penis represented additional exploration which was correlated with his current pleasurable interest in pushing buttons of all kinds — doorbells, electric switches, etc.

Observation 50 (1;7 + 17): William continued to prefer urinating in his diapers or in the bath rather than on the toilet. As was frequent, tonight in the bath he had a 3+ erection without touching his penis, and urinated standing up. This was quickly followed by detumescence. Often he urinated sitting in the bath as warm water entered the tub.

Observation 51 (1;7 + 18): Sitting in a swimsuit, William stimulated his nonerect penis through the cloth with his forefinger. He continued the stroking movements until he had a 3+ erection. After approximately a minute the stroking decreased, and his attention was directed elsewhere.

Observation 52 (1;7 + 20): William discussed his parents' double bed with his mother, checking who slept where. He insisted that the place beside the mother was his place, not his father's.

This incident was characteristic of a variety of behavior indicating early oedipal feelings. He greatly enjoyed "possessing" his mother's body, climbing over her when she rested, kissing her, running his hands over her clothes. There was a clear-cut increase in these activities when his father was not present. Mrs. W. did not forbid such behavior, but often distracted William to prevent his becoming too excited.

Observation 53 (1;7 + 26): William had been urinating less often in the bath. Tonight he had a 3+ erection in the tub. He was sitting, contracting his abdominal wall inward, which caused his penis to bob upward. On one such "bob up" he started to urinate and "shot himself in the face." He was not much affected by it and became interested in his mother's rinsing his face with water. During the preceding days the masturbatory type of genital self-stimulation had been observed less frequently, but on the few occasions when it was, he tugged very vigorously on his penis for a few seconds.

Observation 54 (1;8 + 2): William's conscious intention to urinate in the bath rather than on the toilet was now more definite. When his dry diaper was removed prior to his bath, he was asked if he would like "to make peepee in the toilet." He emphatically answered "No, in the bath!" and he did.

At twenty and one half months William's cognitive development had proceeded to the point at which he comprehended his own name more fully. He regularly used "mine" or "Billy's book" or in listing family members who carried out a particular activity, he gave his own name with the others.

Observation 55 (1;8 + 25): When William's mother removed his diaper prior to his bath, his penis was 3+ erect. She asked whether he would like to make "peepee" in the toilet. He answered clearly and without hesitation: "No, in the baff." Mother: "Where do big boys make peepee?" William: "In the toidet." Mother: "Do you want to be a big boy?" William: "Yeth." Mother: "Do you want to make peepee in the toilet?" William: "No! In the baff," and again he did.

For some weeks he himself suggested going to the toilet. He requested a magazine which he "read," turning the pages one by one and commenting on the pictures as he sat on the toilet. Rarely did he defecate or urinate there. It was a stalling device used most often prior to a nap or bedtime.

He appeared to be rather proud when he urinated in the tub, often put his hand or finger in the stream, and sometimes, before urinating, thrust his erect penis into the stream of water entering the tub from the faucet. This seemed moderately enjoyable. While Mrs. W. did not shame him for this behavior, she repeatedly suggested it was better to urinate in the toilet. She drained the tub, letting in fresh water after he voided, thus indicating that children did not bathe in urine water.

Observation 56 (1;9 + 0): At twenty-one months William's awareness of his scrotum and testicles became more definite. Before his bath, he was sitting nude on the floor. Looking down at his genitalia, he pointed to his scrotal sac and asked: "Dat is?" His mother replied, "Those are your ballies." He then named them: "Ballies."

Observation 57 (1;9 + 3): Today William watched his mother empty his bowel movement from the diaper into the toilet. The feces were brownish and ball-shaped. When she flushed the toilet, William commented: "Billy's other penis down the toidet." His mother explained very carefully: "Billy's penis and ballies are right here [she had already put on fresh diapers and pointed to the genital area through them] and they don't come off!" On the previous day, while sitting on the toilet, he had leaned over, pointed to his scrotal sac and testicles, and asked: "Dis is?" His mother had explained: "Those are your ballies."

In this observation it is not clear whether "other penis" means "penis" or "testicle" to William. His confusion of his bowel movement with his penis or testes contributes to an early form or precursor of castration anxiety and is reminiscent of Bell's description (1964) of confusion of testicles and bowel movements in somewhat older boys. She postulates a precursor testicular castration anxiety preceding a penile castration anxiety.

Observation 58 (1;9 + 4): William today called his penis a "BM" when his diaper was off. His mother bantered with him and said, "You know that is your penis, not a BM."

At this time William usually could identify his penis and other visible body parts correctly by name (see Observation 59). It was not clear whether this error was due to a fluctuation in the gradual differentiation of the self representations or to a minor regression resulting from the anxiety experience of the previous day (Observation 57).

Observation 59 (1;9 + 9): William was examining his nude body in his mother's presence. He tugged at the nipple of one of his breasts and asked: "Dat is?" Mother: "That is your breastie." He then pulled at his other nipple and asked the same question. Next he indicated his umbilicus and queried: "Dat is?" His mother replied, "That is your belly button." William then pointed to his penis and said, "Dat is my penis!"

Observation 60 (1;9 + 13): At diaper changing before bed William grabbed his penis in a stimulating way three separate times, developing a 2+ (moderate) erection, and then squeezed his genitalia between his thighs. Mrs. W. reported that this rough masturbatory-looking behavior was not typical. She noted his rectum moving, expelling gas, and thought his clutching the genital area might be associated with intestinal distress rather than just pleasure or play.

At twenty-one and a half months genital self-stimulation occurred from time to time (see Observation 61) but was not prominent and did not seem an important source of autoerotic comfort or pleasure. His thumb-sucking with a soft diaper against the snout area still fulfilled that need much more extensively.

Observation 61 (1;9 + 15): In the early morning William's father changed his wet diaper, and William rubbed his penis five or six times with his hand, which resulted in a beginning erection, starting from 0 and increasing to 2+. This seemed to involve slight to moderate pleasure. His father asked: "What is that?" William answered, "Billy's penis." He then shifted his hand to his scrotum and questioned: "Dat is?" His father replied: "Those are Billy's ballies." When the dry diaper was put on him, William's attention shifted to his right foot. With a laugh he spontaneously exclaimed, "Billy's piggies." His father said, "Those are Billy's toes." William joked further, insisting with a big chuckle, "Billy's piggies!"

This observation illustrates a gradient of self representation at this age. William had a fairly clear mental picture of his penis, to the degree that he himself could spontaneously or in response to a question identify it by name as his own. His mental representation of his scrotum was less clear and less advanced so that he asked his father what it was as he had on several occasions in the previous two weeks. The representations of his toes were more organized than either those of his penis or scrotum in that he not only knew they were his toes, but he could joke about them and call them his "piggies." He knew not only his own toes but also those of his parents and dolls.

Observation 62 (1;9 + 17): During the past ten days on a number of occasions when William's diaper containing a bowel movement was changed, William reached for his penis and gave evidence of concern whether it was still there. Each time his mother would assure him that his bowel movement came out, but his penis and ballies did not come off.

William's association of shedding his bowel movement and losing his genitalia, each representing the loss of a body part, is another instance of an early form of castration fear.

Observation 63 (1;9 + 20): William had a 1+ erection before entering the bathtub. He refused an invitation to urinate in the toilet. In the bath he showed a 2+ erection without any external genital stimulation and began to urinate standing up, facing his mother and father, who was there at this time. He watched the stream with fascination and pride. After the first burst, he tried to put his hand in the urine jet, touching it only slightly. Detumescence to 0 occurred within ninety seconds of his completing the micturition. He made no approach to his genitalia but played in the water. Someone mentioned his having "made peepee." This stimulus directed his attention to his penis. He squeezed the corona with a lot of force and said, "Billy's penis." He moved his fingers to the scrotal area, and asked: "Dat is?" His mother returned the question, "What is it?" He laughed and replied, "Billy's ballies." He again pressed the corona between his right fingers, directing the meatus upward. He put his left forefinger to the meatus to examine it. William then tugged on the loose skin of his penis, pulling it laterally. All this stimulation resulted in a 2+ erection. "Crazy Foam" (a moldable soap) diverted him. In the bath he did not touch his genitals, but while sitting in his mother's lap and being dried, William made three separate and vigorous approaches to his penis. During the first he squeezed the corona very hard, making the meatus open. He inquired, "Dat is?" His mother explained, "That is the hole your peepee comes out." He squeezed additionally and tugged at the loose skin. Each of these active stimulations of the corona and loose skin resulted in erection, which then faded between times. He seemed interested in the feeling resulting from such mauling (such forceful handling might well have created pain had someone other than he himself done it), but he was also exploring the meatus, which opened and closed as he pressed and released.

This observation is of special interest because for the first time William focused his attention on the meatus. In my perusal of the relevant literature I have not found a reference to the timing of a boy's first awareness of this anatomical detail. It is also worthy of comment that William had recently (this observation was an exception) not been putting his hand in the urine stream. Rather he often cleared away objects in the way of the intended spurt (as he sat in the tub) when he felt the urine coming and proudly watched it shoot. There was an early exhibitionistic aspect to it. He obviously liked himself very much in this regard. At this stage of his life it was all pride — no shame.

Observation 64 (1;9 + 22): In the bath William again focused on the meatus and asked about it. He also actively stimulated his penis by holding the loose skin in the thumb and forefinger of both hands moving the skin forward and backward over the glans, resulting in an erection. This genital self-stimulation resembled the masturbation of an older boy.

Observation 65 (1;9 + 27): In saying a nursery rhyme, "Sing a Song of Sixpence," William jokingly supplied some of his own endings. For "the queen is in the parlor eating milk and honey" he substituted the baby for "milk and honey." (Mrs. W. was in the fifth month of a new pregnancy, and William had been told that his mother had a baby in her belly.) Later he referred to "my baby." His mother asked, "Where is your baby?" expecting him to designate one of two dolls he had. Instead he patted his epigastrium and uttered, "In Billy's belly."

This pregnancy fantasy in a twenty-two-month-old boy is a vivid example of the fluctuating identifications the preoedipal child can experience. In the following two months William often expressed the pregnancy fantasy, but just as often he was a baby, regressing in terms of crawling, using an affected "baby talk" and a babyish sound through his teeth, and suggesting his mother get him a bottle (never carried out). In addition, when she referred to him as a boy at such a moment, he corrected her, "I am not a boy; I am a baby."

His request for a bottle was a creation of his imagination and originated in seeing other "babies" with bottles because he was weaned directly to a cup and had not had a bottle since he was a small infant.

On several occasions during this period William explored and asked questions about his scrotum and testicles, his meatus, and his foreskin. Although he often actively stimulated his penis, this activity should not be characterized as genuine masturbation because it lacked self-absorption and because it involved a cognitive process in the sense that he was thinking about what he was doing, studying, questioning, and recording, not just experiencing the pleasurable sensation.

Observation 66 (1;10 + 10): William's self-stimulation in the bath resulted in the most intense excitement observed during the two years, but did not reach orgastic intensity. He was quite absorbed in rubbing his penis for a short period and really seemed to enjoy himself. He had a full erection and was again interested in the meatus; he pointed to it and acted pleased with it. In addition to squeezing his penis, he tried with both hands to pull the foreskin over the glans, but the degree of erection made this impossible.

Earlier in the day at a diaper changing he announced to his mother, "Billy made a BM." When his mother removed the diaper and found none, she said, "You didn't make a BM." William insisted, "Yes, I did." His mother tested, "Where is Billy's BM?" Without looking down, he took hold of his penis. His mother explained, "You know that is Billy's penis." She supported his trunk so that he could see his genital area and asked again, "Where is Billy's BM?" He was then looking at his genitals and pointed to his testicles, "Dat is Billy's BM."

William continued to confuse bowel movements and his genitals, especially the scrotal organs. He showed another distortion of his image of himself in repeatedly elaborating his pregnancy fantasy.

Bornstein (1953) gives the usual psychoanalytic definition: "We define masturbation as autoerotic manipulations of the genital as well as of other erogenous zones. By erogenous zones we understand 'a portion of skin or mucous membrane in which stimuli produce a feeling of pleasure of definite quality'" (p. 65). I found the traditional psychoanalytic definition of masturbation too general and of limited usefulness to capture the details and study the genesis of infant genital sexual behavior. My definition (closer to Kinsey's view, 1948, p. 498) emphasized primarily consciously sought pleasure rather than exploration, self-absorption not readily distracted, mounting excitement, with an orgastic rather than soothing rhythm. The term masturbation is limited to (1) the genital zone and includes (2) the quality of self-absorption, (3) consciously intended self-arousal, (4) with mounting excitement, and (5) a climax type of rhythm (though not necessarily resulting in orgasm) rather than lulling, (6) where seeking pleasure predominates over exploring and acquiring knowledge. If masturbation is viewed in this way, one can state that, in the case of William, it still occurred infrequently during the second year but definitely more often than in the first year.

In the first quarter of the second year there was greater consciousness of penile sensation, greater deliberateness in William's genital self-stimulation, and an observable increase in genital sensitivity especially beginning in the fifteenth month. Observations 32, 43, 46, 64, and especially 66, are illustrative of the intermittent genital self-stimulations which were transitional between the largely exploratory behavior of the first year and the more definitely masturbatory stimulation of the oedipal years. These episodes were more masturbatory in character than anything seen in the first year and yet did not completely coincide with masturbation as defined above; they were intermingled with much exploratory and reality-testing stimulation and quiescent periods. Observation 66 included behavior most closely resembling an orgasm but was unconvincing in that regard. No other orgasm was observed.

Observation 67 (1;10 + 15): The family had recently discussed "the baby in mommy's belly." William again said he had a baby in his belly. When his mother asked him what the baby did, he announced, "The baby eats milk and peas and walks around." He then demonstrated with a wide-based strut how the baby walks. Mrs. W. remonstrated, "In your belly, Billy?" He insisted, "Yes, mommy, it does."

Observation 68 (1;10 + 22): On this day William told his mother: "Billy is a girlie." Mother: "Billy is a boy. Billy isn't a girl." William: "Oh, yes, Billy is a girlie; eat the girlie's toe." He held up his toe for his mother to pretend to nibble it. His mother went on, "Billy has a penis. Girls don't have a penis. Billy is a boy. Is Betsy a girl?" (Betsy was a little girl relative whom William knew well.) William: "Yes." Mother: "Does she have a penis?" William: "No, Billy has a penis and Billy is a girlie. Put the girlie's shoe on."

At this point William experimented with being a girl, but was not willing to give up his male genitals to that end. William evinced an unusual degree of self-awareness, especially body awareness and sexual role differentiation, but this observation illustrates the young child's simultaneous acceptance of the reality principle and his resistance to it (Jacobson, 1964, p. 111).

Observation 69 (1;10 + 23): As William's diaper was being changed, he was kicking his mother's belly, and the following conversation ensued. Mother: "Don't hurt the baby." William patted his mother's bosom and claimed, "Billy no want to hurt the baby." Mother: "You know the baby's in my belly; that's not my belly. What is it?" William: "Finger." Mother: "No!" William: "Penis." Mother: "What is it?" William: "Breastie, breastie hanging down." The mother, struck by the train of thought and description, asked: "What hangs down on Billy?" William: "Billy's penis. Girlies have a penis?" Mother: "You know girls don't have a penis."

This confirmation of the breast-penis equation from the mouth of a twenty-three-month-old child was supported by a number of other observations. It should be noted that a few days earlier William had seen his mother undressed for the first time. His curiosity had focused on her breasts rather than on her genital area.

At about the same time (twenty-two and a half months) William exhibited a type of behavior that can be interpreted as another precursor of castration anxiety. When his temperature was taken rectally (an unusual event) at the time of a mild respiratory infection, he grabbed his genitalia and looked at them as though he needed to check if they were all right. Similar "checkups" often occurred during a diaper change following a bowel movement.

Observation 70 (1;11 + 14): Mrs. W. noted that recently William had been playing with his scrotum when his diapers were changed and had discovered the testicles. He did not seem to handle the scrotum when the testicles were retracted. On this occasion when his wet diapers were removed, he had an erection. He handled his penis and scrotum. In his mother's words: "He asked to 'peek' at himself, which he often has done after a BM, as though to see if he lost anything — I think he believes his testicles are a BM; I raised his buttocks to let him peek. This time the testicles were very prominent in the sac and were pulled by gravity to hang toward him. He seemed to see them, and he squeezed them and focused on them. After that he focused on his penis. He asked to go on the toidey, sat fifteen minutes but didn't urinate."

We might expect awareness of the scrotal organs to come later than awareness and understanding of the penis for several reasons:
    (1) the more anterior position and greater accessibility and visibility of the penis;
    (2) the heightened pleasurable sensitivity and erectile capacity of the penis;
    (3) the focus resulting from the urinary function;
    (4) the tendency of parents to name and draw attention to the penis prior to the scrotal area;
    (5) the closeness of the scrotum to the anus and the similarity of its appearance to feces increase the likelihood that the scrotum will be included in the fecal aversion.

The observations of William confirm Bell's (1964) main thesis that the common innervation of sphincter ani, scrotal sac, testes, cremasteric muscle, and penis results in a confusion of sensations causing an association of testicular loss with fecal loss. Abraham (1920) promulgated "anal castration fear" as a forerunner of genital castration fear and stated, "Psycho-analysis, however, has shown that the child in this early psychosexual period of development considers its faeces as a part of its own body. The process of identification further establishes a close relation between the ideas 'faeces' and 'penis'. The boy's anxiety regarding the loss of his penis is based on this assimilation of the two ideas. He is afraid that his penis may be detached from his body in the same way as his faeces are" (p. 343).*
      * I had the opportunity to observe a two-year-old girl who, watching her male sibling of two months being diapered, pointed to his scrotum and said he had made a bowel movement. Her mother reported that this misidentification continued for several months. Only repeated explanations about his scrotal organs dispelled this notion. Moreover, the error was always unidirectional, i.e., the scrotum was always called a bowel movement, but a bowel movement was never called scrotum.

At twenty-three and a half months William began to show more anxiety, of the separation type, manifested by crankiness, demandingness, disturbed sleep with frequent calling "Mommy, mommy," and crying when his mother went out for errands without him. The specific source of this upsurge of anxiety was not clear, but seemed to be associated with the following factors: (1) the baby growing in "mommy's belly" (William crawled some, talked about the baby, and often wanted to be the baby); (2) his parents had been away on an overnight trip which seemed the acute stimulus for the anxiety; (3) his mother's increased fatigue, body awkwardness, and lessened patience in conjunction with the progressing pregnancy; (4) his confusing bowel movements with testicles and concern about loss (as mentioned above, he often needed to check his genitalia after making a bowel movement); (5) new motor skills — he had discovered how to climb out of his crib, which, combined with a burst of aggressive energy, kept him fired up day and night. That early forms of castration anxiety were mingled with separation anxiety was suggested by the following:

Observation 71 (1;11 + 20): Lying on the changing table, William said, quite unrelated to anything previously spoken, "Mommy, don't sing dat song any more!" Mother: "What song?" William: "Cut off their tails with a carving knife." Mother: "You mean Three Blind Mice?" William: "Yesth. Don't sing that song." A little while later, William: "Sing that song." The mother did not.

Mrs. W. actually had sung this song only a few times and not at all for several weeks. She found that telling him she loved him, that she would not go away and would not stop loving him when the new baby came seemed to lower his anxiety noticeably.

Loewenstein described an observation of a ten-month-old boy who experimented to determine whether his penis would stay with his body when he crawled away. Loewenstein stated his belief that this represented a model upon which later castration anxiety is formed. William demonstrated the further elaboration of this type of reality testing from about ten to nineteen months by his repeated investigations of caps and tops, body parts, and coverings in his relentless search for the detachable and the nondetachable, the "I" and the "not-I".

At two years William was a vigorous, muscular, but not chubby boy. Although the gastrointestinal disturbance had improved, it still was a problem and continued to contribute to his sleep difficulty. He would wake at 4, 5, or 6 A.M. almost daily. (Anna Freud (1965, p. 157) mentioned the universality of sleep problems during the second year.) He acquired new motor skills: on his second birthday he went ice skating for the first time. On double runners he was able to "skate" (moving his feet followed by a glide) unaided, and with few falls, after about fifteen minutes. Verbal communication continued to be advanced. He differentiated past, present, and future tenses, used conjunctions such as so that, utilized subject pronouns (he, she I, you, we), object pronouns (me, him, her, you), and a variety of prepositions, adjectives, participles, and adverbs. He identified five or six colors, distinguished right from left usually correctly, counted to six, and showed great interest in books and magazines.

Occasionally he would ask to sit on his toilet but rarely urinated in it. He could control his urination, as evidenced in his bath, where he continued to urinate almost daily. However, the rest of the time micturition and defecation were performed in his diapers. A degree of stubbornness, not previously prominent, was emerging. The burst of autonomy, noted at twenty-three and a half months, was expressed in such behavior as insisting on putting himself to bed at night. Whereas earlier he had wanted an elaborate routine of back patting, storytelling, and drinks of water prior to sleep, he now said goodnight to his mother outside his room, closed his own bedroom door, and climbed into his high-sided crib alone. The heightened independence coincided with signs of greater separation anxiety at other times. His increased individuation was a source of both pride and some fear. At times it contributed to a tendency to regression. For example, he repeatedly insisted that he be referred to as a baby, not a boy, as if he needed to be cared for, lest he "run away with himself."

He sucked his thumb when tired. His genital self-stimulation was sporadic; his diapers were off relatively little in the course of a day. Before, during, and after his daily bath was the longest period. Perhaps one day in seven he would stimulate himself intensely; three days in the week he might explore or stimulate his genitals slightly to moderately and the other three days direct very little attention to them. At times he could be quite seductive. On several occasions at this age he suggested that his mother squeeze his penis (she responded by distracting him to other pursuits).

William at two was a friendly child capable of strong emotions and attachments. He was quite responsive to people he knew and strangers, and especially affectionate with babies. He was very fond of his mother and would seek her at moments of stress. Though less intense and sensuous, his relationship with his father was close and represented fun and activity. There were various indications of a growing fantasy life. He exhibited some oedipal feelings, at times wishing exclusive possession of his mother and displaying some rivalry with his father. There were also clear-cut identifications with his father.

By twenty-five months his need to regress to the "baby" role was greatly reduced, and this was also the time at which he first spoke of his (and others') penis and "ballies" as a unit, apparently seeing them associated together rather than unrelated.

Interestingly, a major factor in his relinquishing the regression seemed to be certain restrictions that were imposed on his hyperactivity. Apparently, the restraint lowered his anxiety about his autonomy.

At twenty-five months William injured his right thumb (his sucking thumb) requiring a bandage that completely covered the thumb. Though William complained that he would have nothing to suck, he was able to "be brave" despite pain and anxiety about the injury because of the comforting of his mother's care and the promise he could suck again when his loved thumb was healed. However, during the night he awoke crying. Half-asleep and evincing some anxiety, he gave as a clue, "I can't see my thumb" (he had a night light permitting some visibility in the room). His mother, appraising the source of his discomfort, offered to remove the big bandage and substitute a Band-aid, permitting him to see the end of his thumb. When this was done, a big smile of relief appeared on his face, and he returned to sleep. In this instance, the inability to visualize directly a body part patently created anxiety.

Karen

Karen was a cuddly baby with reddish brown hair. Her physical health was excellent during her first year and subsequently. She was breast-fed exclusively for 9 months, then bottles were substituted gradually. Nursing was stopped at 10 months. Karen smiled at a mobile above her crib at three weeks, purposefully put her thumb in her mouth at three and a half months, sat with support at five months, was creeping at eight months. At 10 months she stood alone, walked with holding on, was advancing rapidly in language comprehension, and used two words meaningfully — one of them, "ma ma." As part of my study, she was given developmental examinations at 31, 37, 43, 48, and 53 weeks by an independent examiner. These indicated a steady, even progression of development at a slightly advanced level.

Karen first began to touch her genital area with her hands at eight months. These were transitory contacts, not frequent, not well focused, and seemed accidental. In fact, by nine and three quarter months she still did not touch her genital area in any purposeful way. At eight months her mother noted a sensitivity of the external genitals evinced by "goose pimples," limited to that area, from waterspray in her bath. Her mother offered her a rich sensuous experience, and the child seemed exuberant in her enjoyment of her body and its movements, but by 10 months there was no special focus as yet on the genitals. At nine and a half months she enjoyed splashing water between her legs in the bath. Between eight and a half and nine and a half months her face would sometimes register pleasure when her diaper was changed; she occasionally enjoyed the cleansing process (of both genital and anal areas). Between nine and a half and 10 months, she would from time to time squeeze her thighs together when her diaper was off, with a facial expression of evident enjoyment. Because she wanted to roll over, diapering at 10 months was not consistently a pleasurable time. Being with people was her greatest pleasure. She still sucked her thumb, but only in moments of regression — at bedtime, in illness, or in the early morning when she was alone in her crib.

At 10 months, one week she began to touch her external genitals with her hand when her diapers were being changed, but without evincing pleasure. By contrast, the body movement of bouncing in a special jumper chair was obviously a source of great pleasure for her. On one occasion, at 10 and a half months, her mother noted her rubbing the insides of her thighs with her hands (Karen was wearing a diaper and was resting in her crib at the time); on other occasions the mother observed her giving her labia a pinch when her diaper was off.

At 11 months the child showed considerably more excitement during cleansing at diaper change. She would often squeeze her thighs together and fairly frequently reach down and pinch her genital area when her diapers were off. This behavior continued off and on during the next month.

Karen saw her nude genitals in the mirror at 12 and a half months. Her mother held her up to the mirror because she felt she was now old enough to understand her body in this way. Karen looked down at herself as well as into the mirror, but demonstrated no other noticeable reaction to seeing herself thus for the first time. She had not yet seen a little boy without clothes.

The period between 12 and a half and 16 months was rather quiescent. She continued to enjoy splashing water onto her genitals in the bath, and occasionally touched or pinched herself in this area; but interest and play with other body areas, e.g., the eyes, hair, mouth, teeth, tongue, nose — her own and her mother's — were much greater than curiosity about or focus on the genitals. Interest in the ear and its invagination started at about 14 months. Body games with her mother, initially centering on the breasts in nursing, and later on the eyes, the nostrils, the feet, and then the ears gave the child the early sense of twoness — her first lesson in mathematics. Karen pointed to her mother's ear. Her mother confirmed, "That is my ear." The child poked her finger into the canal and then turned her mother's head around to point to her mother's other ear. This is a complex mental act, as one ear disappeared as the other came into view. It demonstrated a primitive awareness of duality. Observing herself in the mirror became important to her at this age; she would smile at herself and be pleased when she saw her hair combed, or a new barette, or a clean dress.

At 15 months Karen seemed a well-organized little girl with good communicative ability with both parents. She was able to convey her needs and wishes and to accept reasonable frustrations. She had a vocabulary, and walked quite securely. "Bye-bye," verbally and as a hand movement, was used actively to ease separations. Darting away from mother, so characteristic of children of this age, was combined with hiding as a variant of peek-a-boo. Looking at magazines with her father, she could clearly distinguish a boy from a girl by hair and dress characteristics.

Passing flatus or having a bowel movement and then discussing it with her mother gave her some beginning awareness of that part of her body. On the rare occasion when she would urinate standing without a diaper on, talking it over with mommy gave some early knowledge of that body area.

At 15 and a half months a single word "tushy" was used by the mother in an undifferentiated way to categorize the child's buttocks, anal, urethral, and genital areas. This is a point of difference between the ways parents tend to treat boys and girls which will be discussed later. At other times the mother would distinguish between Karen's "peepee tushy" and her "B.M. tushy." When her mother would wash Karen's anal and genital area in the bath, Karen would repeat the "washing" herself. The behavior was imitative rather than masturbatory at this age.

Around 16 months the mother noticed that the child's genitals were more sensitive to cleansing activities than previously. A skin rash in the genital area apparently contributed to the sensitivity. The rash seemed to provoke vigorous scratching in the bath. The effect of the increased genital sensitivity was a more pleasurable response to the application of salve for the rash or to the spray of water in the bath. At 16 and a half months the mother regularly referred to Karen's genital-urethral area as her "peepee-tushy" but was not entirely satisfied with this characterization. On another occasion in the bath Karen put her finger down to her genital (labia) and said, "oooh," indicating some excitement. This was one of a number of activities at this age testing the limits or boundaries of her body self. The child could locate her "peepee-tushy" now, when asked, as one of the games of naming body parts played by mother and daughter. Karen's mental representation of her breast was at about the same level. Between 16 and a half and 17 months Karen would carry out in her bath the autoerotic play of putting her hands on her abdomen and pulling on the skin (of her "tummy").

At 17 months Karen was ebullient, robust, with a deep attachment to both parents. For several consecutive days, when her clothes were off, she would take a clean cotton diaper she carried around, press it into her genital area, and rub with definite pleasure. This was repeated a number of times on each occasion. Her fat abdomen made it difficult for her to see and touch her genitals simultaneously. A trip to the pediatrician again emphasized two quarter-sized skin irritations on the left vulva which had been present for almost a month and which may have contributed significantly to the several recent episodes of vigorous genital rubbing with the diaper. Another time Karen, undressed, rubbed her bottom on the bed cover, either because of the irritation associated with the rash or because it felt good, or both. The following day she did the same rubbing, and wanted her father to watch her.

On one occasion, at 17 months 20 days, Karen contracted her abdominal muscles, when undressed, and looked down at her genitals. She was obviously quite pleased with herself and put her hand there. Two days later, when she was seen scratching and rubbing her genitals, it was evident that her rash was present again.

At 18 months there was still relatively little emphasis on toilet training. She had a small toilet chair which she sat on from time to time. Two days before she was 18 months old she urinated in it for the first time. She had not yet used it for defecating. She was very much aware of the part of her body where her "peepee" came out. She was deriving some pleasure from stimulating her genital area (labia and clitoris), though not frequently and this occurred definitely more often when the irritation of the rash was present. She was proud of her general genital area. When her mother would ask where her "peepee-tushy" was, she would reach for the area with a big smile. She also learned about naming body parts on her doll.

When nude now, she would show interest in her genitals, squeezing the labia between her fingers. This increase of interest coincided with the expanded attention put on urine control by mother and daughter.

At 18 and a half months, in the tub, she would show more absorption in putting one or both hands on her clitoris and vulval area and squeezing or rubbing. The intensity of pleasure and the absorption in the activity with less distractibility suggested a more masturbatory quality than had been observed previously. The self-stimulation continued almost daily in the bath. She would put her finger between the labia and rub the clitoris with vigor and self-absorption. This lasted about three weeks, after which no such behavior was seen for about a week. At 20 months Karen expressed concern about the genital area of a doll she was given as a present. The doll had a hole between the legs; someone had put a "band-aid" over this area, and Karen was quite distressed about this. She spent time examining the genital areas of other dolls and of stuffed animals. This brief example illustrating a precursor of castration anxiety or concern about body intactness is corroborated by many other reports of such concern or anxiety during the second year of both girls and boys.

At 20 months it was clear that Karen was capable of having fantasies expressed in words. There was no definite evidence these were associated with genital sensation at this time. They concerned simple happenings she concocted mentally, i.e., a dog took her shovel and bucket when such had not occurred. Nonverbal fantasy play with her dolls was elaborate and extensive.

At 21 months Karen still showed some interest in stimulating her genitals in the bath but with diminished frequency and intensity. Several times, she imitated her mother's wiping herself with toilet tissue after urination. Karen was showing some willingness to urinate in her small toilet; she would anticipate sitting on it by announcing, "Pee-pee," and sometimes would urinate in the "toidey" after she sat on it.

By 22 months there was only occasional genital self-stimulation in the bath. She would squeeze the labia between her fingers or rub the clitoral area. It seemed more likely to occur when there was a skin irritation present. Just before she was 23 months old, on one occasion, she poked a small plastic nozzle momentarily between her labia, then poked it into her umbilicus without comment. Genital self-stimulation occurred about one out of two or three baths, was brief, and moderately pleasurable.

At two years Karen was especially focused on "tushies" and "breasts." A relative had recently given birth to a baby boy, and Karen had repeated opportunities to see the baby being diapered and nursing at the breast. When Karen was given a doll on her second birthday, she immediately wanted to examine its "tushy." Her mother helped her to differentiate between a boy's "tushy" and a girl's in the same way she had repeatedly aided Karen's distinguishing her urinary area from her "B.M. tushy." Occasionally, but in a somewhat vaguer way, the mother had differentiated a genital or vulval area as her "pussy."

Inasmuch as my intention is to detail only the first two years, I shall summarize Karen's further development only briefly. Genital self-stimulation continued throughout her third year off and on with no great peaks except during the last two months of the third year, when the intensity and frequency were greater. The method of stimulation varied: she used her finger, rubbed her pelvis on the bed sheet, or used small objects such as a ball, soap, or rubber whale. Sometimes the clitoris, sometimes the labia, and sometimes the opening of the vagina was the chief focus. Occasionally she would visually and manually explore the clitoris or vagina. Early in the third year, taking several showers with her mother encouraged her curiosity about mother's genital area and breasts, and there was much discussion of male-female differences and differences between little girls and big women. Continued urine and bowel training focused attention on those areas. Exposure to pregnancy brought on elaborations of how babies and B.M.'s get out. Karen showed growing pride in her body, particularly the genital area, and she developed modesty. At 26 months Karen specifically stated she didn't wish her doctor (pediatrician) to look at her "tushy." There was some denial of male genitals in a photograph. Gender differentiation progressed.

At 31 months, on one occasion, she inserted a marble in her vagina. When her mother discouraged this, stating it might get stuck, Karen retorted, "Daddy will get it out." This occurrence and others gave the mother the opportunity to discuss with Karen three holes, a "peepee" hole, a hole where B.M. comes out, and, in between, a hole where babies come out of grown women. At times when Karen had a chance to see the baby boy relative undressed, his genitalia were labelled more specifically by Karen's mother as "penis" and "bailies" rather than the earlier "peepee tushy." Karen's mother repeatedly encouraged Karen to feel proud of her body including her genital area. In general, this succeeded, but late in the third year, when Karen observed a little boy urinating, she looked at her own genitals with distinct disappointment. On several earlier occasions, she verbalized fantasies of "broken tushies.".

At two years nine months Karen, finishing some ice cream on a stick, in a joking tone expressed another fantasy, "Daddy putting something in Karen's tushy." The exact stimulus and meaning of the fantasy were not clear.

The genital self-stimulation during the last two months of the third year occurred in the bath and at other times when Karen's diapers were off. She wore training pants during the day. The label "masturbatory" seemed more appropriate now in that the activity was intense, pleasurable, rhythmic, purposeful, self-absorbed, and carried out with what seemed mounting excitement. It occurred frequently, at least every third day and for a while daily.

Other Children

A comparison of the age of onset and quality of genital play and self-stimulation in the five girls studied longitudinally is of considerable interest. The combination of each child's individual characteristics and the attitude and family atmosphere resulted in marked differences. Sandy, unlike Karen who was a first child, had a brother five years older with whom she had considerable unclothed play in her first year. Her discovery of her genitals happened as follows. Sandy, at five months three weeks, was given a bath with her mother. Her five-and-a-half-year-old brother also joined the bath. All three played together on the bed afterward, and Sandy noticed her brother's penis. She bent over, picked it up, squeezed and pulled it, and tried to lean over to put it in her mouth. Before that could happen, he pulled away, laughing and a little cross. She then bent over and tried to look at her own genital area which was covered with a diaper.

I cite this incident to stress what a different set of experiences Sandy had compared with Karen, who had no opportunity to see a nude male until a chance occurrence midway in the second year, and no consistent viewing of male genitals until she was almost two. Sandy was seven months old when she discovered her "vagina"; this was an accidental discovery with exploration of brief duration. She poked a finger inside the labia and for about two minutes pushed her finger around, watching her hand. During her eighth month this was not repeated; genital self-stimulation was largely confined to pinching her inner thighs. Sometimes she would pinch the lips of the vagina also, with obvious enjoyment. Her mother felt certain that she had difficulty seeing her genital area because of her fat belly. During her tenth month pinching her inner thighs and genital area was frequent. She often found her introitus with her fingers, but the mother noted that the manipulation did not have the accuracy shown by her son with his genitals when he had been the same age as Sandy. It is also noteworthy that the mother, who was outspoken in her support of the Women's Liberation Movement and eager to provide equal opportunity for her daughter and her son, had at this time no word for her daughter's genital area. She was not yet using "vagina" with the child, whereas she found it easier to use "penis" with her son at an early age. Throughout the eleventh and twelfth months the child continued to poke her vaginal region and pinch the general area without great accuracy or focused stimulation. The mother repeatedly commented that Sandy's genitals seemed rather inaccessible to the child.

The history of Dolly's self-stimulation is quite a different story. In her first 16 months there was relatively little genital self-stimulation or exploration except for occasional accidental activity. Her mother, who was quite knowledgeable in these matters, felt Dolly was "rather bland" during diaper changing as far as genital interest was concerned. Dolly's first real awareness of her genital-buttocks region began at 16 months when she would pat her buttocks in front of a mirror with her palms, exclaiming "body, body" and smiling broadly. At about 18 months she would pat her genital area with both hands at almost every diaper change. Starting at 19 months two weeks, and lasting about two months, there was a burst of interest and activity directed at her genitals. On the first occasion, Dolly, lying nude on her back, put the nipple of her bottle and then a pacifier nipple to her genitals. The next day she placed her teddy bear there; later in the same day the following was observed: With her feet planted apart and her hands and the top of her head on the floor, she looked up at her genitals, patted her buttocks with one hand, laughed, and said, "body."

At this age Dolly was much involved in toilet training matters; she would often sit on the toilet even though she had not made use of it as yet. "Body" was her word for her buttocks as well as for her genital-urethral region. During the month following age 19 months two weeks, there was some genital exploration, self-stimulation, or similar play with a doll on 17 out of 31 days. The next month there was such behavior on 13 out of 30 days. There was then a definite decrease of this behavior as she became absorbed in observing her own and all family members' urinating. During the two months of intense genital interest she would rub her genitals on a bedspread, use a variety of objects to stimulate herself, or would pat or finger her labia or genital-urethral region. She had the dexterity to spread her labia apart, a skill not available in her first year. When Dolly was 21 months old, her mother noticed she would for the first time laugh and squeal when her genitals were washed or anointed, revealing a new sensitivity to outside stimulation. Her older sister used the name "vagina" which Dolly adopted at this age, now differentiating her "dina" from her "body" (buttocks).

Olivia first consistently touched her genitals at 10 and three quarter months; her mother felt she did not discover this part of her body before this. She touched the area and poked a finger between the labia. She would also use her blanket to stimulate her genitals when she was nude, rocking and squealing excitedly. The genital self-stimulation continued off and on through the next four months, for gradually longer periods, but it was still not prolonged or absorbed. Sometimes she used her whole hand to explore the area and put her fingers between the labia. At 14 months she would look down curiously at her external genitals. In the next three and a half months the duration of stimulation increased and the pleasurable sensation experienced was definitely greater. At 17 and a half months application of ointment to a rash in the area elicited pleasure rather than objection as before.

Ginny was very similar to Dolly in that focused genital self-stimulation did not occur until she was well into her second year. Prior to 18 months Ginny had demonstrated no specific clitoral or vaginal exploration or sustained genital self-stimulation. Up to this age she had shown only random touching of her thighs or genitals. On the one hand, the parents were permissive in the sense of being nude with the child regularly. Ginny had shown interest in both parents' pubic hair and the mother's breasts; she had reached for her father's penis and grabbed it, laughing as she did so. On the other hand the mother did not permit the child to play ever without diapers as she didn't want an "accident" of urination or defecation. As a result by one and a half years the child had never seen her nude genitals in a mirror.

DISCUSSION

I have made a fairly extensive survey of the literature, particularly psychoanalytic writings, on the topic of genital self-stimulation in girls in the first two years of life, and found a striking paucity of useful data. Henry Hart searched his Index (1971) for references to masturbation or genital play in girls under two and a half years. Though he has over 4,000 references on masturbation, only 73 relate to our topic, and of these only 17 are relevant enough to include in the reference list.

Many authors have stressed the need for continuous observation of the infant during the whole of the first year of life (and subsequently) to get an accurate appraisal of the genital self-stimulation of the young child. The main thrust of this article is to present such observations, though admittedly using the mother as main observer introduces other problems.

The Developmental Line toward Masturbation

Approaching the study of William's genital self-stimulation in terms of developmental lines (Anna Freud, 1963, 1965) yields insight into the way in which elements of the self representations are laid down. This study is limited by covering only the first two years, but we are able to follow the line starting from
   (1) the mother's care of the infant's body through
   (2) the child's accidental touching of his genitalia,
   (3) experiencing a pleasant sensation as a result of manipulation, to
   (4) the point at which he actually seeks his genitals in order to obtain a sensation, which ultimately leads to
   (5) unmistakable masturbation in the oedipal period.

Or we can pursue the line of the mental representation of this body area from
   (1) the point where the infant's and the mother's parts are not clearly differentiated from each other, through
   (2) early memory traces from sensations in the penis,
   (3) to memory schemata comprising visual and tactile perceptions as well as sensations from the genitalia, leading to
   (4) the registration of the penis as an object, a period during which there exists confusion about its separateness (it is fed crackers like a distinct being and is seen as detachable like a bowel movement),
   (5) a stage where it is clearly experienced as part of the self ("Dat is my penis!") and identified with a word and a personal possessive, to
   (6) a level at which the penis is not only part of the body image but also highly prized and recorded mentally in association with the scrotum and prized and recorded mentally in association with the scrotum and testicles, an organ capable of great pleasurable feeling, and the function of urination.

Although William's early knowledge of his body, fostered by his mother's verbal teaching, illustrates the importance of secondary-process symbols (language) for the laying down of mental representations, as Novey (1961) has correctly noted, the most primitive object representations are largely affective. Many authors have stressed that the earliest self representations are of the body self. Greenacre (1958), e.g., discussed the significance of the face and genital areas in the establishment of the body self and the contribution that the development of body image makes to the sense of identity.

The observations of William in temporal sequence give a picture of the increasing clarity of the mental image of the different genital organs. Striking are the fluctuations and regressions: at one point a mental representation seems definitely established and at the next it appears blurred. At nine months no mental representation of the genitalia could yet be discerned by the observer. At ten months nine days William had to check whether his penis was still there after he had previously examined it (cf. Loewenstein, 1950). At eleven months eight days he stimulated himself with intent, from which I infer considerable advance in memorial capacity. The firmer establishment of this faculty was seen at fifteen and a half months. Gender differentiation began to appear at sixteen and a half months. William then had enough of a mental concept of his penis so that he no longer needed to look each time he wished to stimulate it; yet the representation of this body part was still rudimentary in that he could tug on it, uttering "off, off," as he did with a toe or a sock. While William partly understood the meaning of the word "penis" by fourteen and a half months, he began to use it correctly at seventeen and a half months, although occasionally he would also call his buttocks "penis." By twenty months he expressed his conscious intent to urinate in the bathtub, knowing definitely the role of his penis in doing it. Two weeks later he used personal possessives in relation to his penis and called himself by name, but at twenty-one months he could slip into calling his penis a BM.

At many specific times gradients of the self representations could be distinguished. For example, at twenty-one and a half months he identified his toes more definitely than his penis or scrotum and his penis was more precisely represented than the latter (Observation 61); he knew his penis better than his nipples or umbilicus (Observation 59).

It is also noteworthy that the fuzziness of self representations can contribute to symbolic equations. In a number of observations (see 57, 58, 66), William confused his penis with feces (i.e., he misidentified the words), or his scrotal organs with feces (see 66), or associated his penis with his mother's breasts (see 69).

Age of Onset of Genital Play

When Spitz (Spitz and Wolf, 1949) presented his initial data on genital play, his observations were limited to the first year of life. His review of the literature netted only Bender's (1939) work for listing the exact age of onset — eight or nine months in normal children. Spitz (ibid., p. 90) charted the onset of genital play for 13 children. Of these, one child showed genital play before six months; two between six and eight months; five between eight and ten months; and all by one year. He was so impressed with the fact that the occurrence of genital play in the first year was dependent on a good quality of mother-child relationship that he made the existence of genital play an indicator of the quality of object relations. Absence of genital play meant a deficient mother-child relationship. He later modified this position (1962) by saying that in an atmosphere of good mothering genital play would invariably appear by 18 months. My own observations are consistent with the second statement. I have seen examples in girls with reasonably good mothering of essentially no genital play in the first year, followed by significant genital play by the middle or end of the second year.

Levine (1951); Bornstein (1953); Levine and Bell (1956); Sears, Maccoby, and Levin (1957); Engel (1962); Provence and Lipton (1962) all include statements of age of onset of genital play in normal children, but without differentiating between boys and girls. Mittelman (1955) describes a male infant repeatedly fingering his penis at 31 weeks. In contrast, a female infant at nine months was never observed fingering her genitals. Mittelman concludes; "While not universal, this difference seems to be the rule between male and female infants" (p. 244). Kestenberg (1956) reports a female infant who "started masturbation by means of thigh pressure at the age of about 6 weeks" (p. 457). She further declares that boys frequently not only discover their penis by the second half of the first year, but also are aware of the pleasant sensation its handling can evoke. "Girls seem to discover their external genital later, simply because of its lesser accessibility to manual exploration" (p. 459).

Summarizing Mrs. W.'s and my own observational data, we find:

       1.    After his initial discovery of his penis at eight months, William did not pursue genital exploration for over two months. After 10 months 6 days visual and tactile interest in his genitals was regular and frequent. It was not daily, and periods of no interest were interspersed among the active times. However, there was active genital self-stimulation throughout his eleventh and twelfth months. His thirteenth month included a definite increase of tactile self-stimulation and visual interest in his genitals. By 15 months he seemed to stimulate his genitals with intent and expectation of pleasure. From 15 and a half months on his genital self-stimulation from time to time had a masturbatory character. Around 17 months there was evidence of greater genital skin sensitivity to cleansing. He called his penis by name after seventeen months.

In contrast, the acquisition of meaningful knowledge of the scrotum and testicles proceeded in the following sequence:
   (1) Sporadic and rather undifferentiated touching and grasping of the scrotum occurred in the first year, starting at ten months eighteen days; especially during the eleventh month, William handled the penis and scrotum together.
   (2) A more specific focus on the scrotum, amounting to discovery, was seen at seventeen and a half and eighteen months (Observations 37 and 40).
   (3) More precise "discovery" took place at twenty-one months when he asked, "Dat is?" several times (Observations 56, 57, 61).
   (4) At twenty-one and a half months he could name the organs "ballies" (Observation 63).
   (5) At twenty-three and a half months he differentiated the testicles within the scrotum (Observation 70).
   (6) By twenty-five months William conceptualized the penis and scrotal organs as a totality.

With discontinuities there was an increasingly masturbatory quality to his stimulation as the second year progressed. In the first year and the early part of the second year William's genital self-stimulation surpassed in intensity, frequency, self-absorption, activity, and precise focusing anything seen in the girls studied. Two other sources of data confirm this finding.

       2.    In my study I have longitudinal observations of three other boys from different families. With definite variations in timing, preferred method of stimulation, and progression all three more closely resembled William's behavior in this regard than the patterns in the girls. Two of the three boys presented data quite like William, with genital discovery around eight months, off-and-on genital play in the rest of the first year, especially after 10 months, and progressively mounting interest and self-stimulation in the second year, with a more masturbatory quality emerging as the second year went on. The third boy had a variation. He also first noticed and touched his genitals two days after he was eight months old. He did not manipulate his genitals again for the duration of the first year. However, he carried out a form of genital self-stimulation rather often in his twelfth month. He would rub his genitalia on a Raggedy Andy doll in a "humping," rhythmic manner. This continued till he was 13 months old, when manual stimulation occurred. By 15 months he was evincing much interest in his genitals and was enjoying the sensation of stimulation. By 18 months exploration and self-stimulation of his genitals was at a high level and sometimes had a masturbatory quality.

       3.    Three of the five girls mentioned above had at least one brother. In each case the parents reported a difference in the quality of first-year and early second-year genital play between the girl and her brother. The boy's genital self-stimulation was more active, more vigorous, and more to the point — more accurately directed to the genitals for exploration and stimulation.

       4.    Karen first touched her genitals at eight months; at 10 months she more consistently reached to her genital area at diaper changing; there was some active but not well-focused genital self-stimulation at 11 months with evidence of more reactivity of the area to cleansing. The self-stimulation was mostly thigh-squeezing and pinching. Twelve and a half to 16 months was a quiescent period with occasional touching or pinching, but she was much more absorbed in exploring and stimulating other body areas. At 16 months her genitals were more exquisitely sensitive to cleansing. At 17 months there was vigorous genital rubbing with a diaper coincident with a rash. At 17 and a half months she could see her genitals better by contracting abdominal muscles. From 18 months on there was more genital focus. For three weeks, starting at 18 and a half months, there was vigorous clitoral stimulation and squeezing of the vulval area almost daily with a more masturbatory quality. At 21 months the stimulation was less than at 19 months; at 22 months it occurred only occasionally. At two years she was absorbed in breasts and the "tushies" of others. During the third year stimulation continued off and on till a peak in the last 2 months of the year, which had an intensity and frequency of stimulation of clitoris, labia, and vagina rightfully labelled as masturbation.

       5.    Sandy "discovered" her "vagina" at seven months with a brief manual exploration. According to Kestenberg (1956), by toilet-training time (second year) the girl has explored her external genital, but has not discovered the vagina or even the opening of the vagina. One of the girls in my study at age 10 years asked her mother where the vagina was and how big a hole it was even though she had been repeatedly informed verbally through early childhood. This is confirmed by Kestenberg's analysis of prepuberty girls; they do not have awareness of the vagina as an organ. Therefore, Sandy's "discovery" was random touching and manipulation only. Sandy, at eight months, pinched her inner thighs and labia with some pleasure. At 10 months pinching the area was more frequent and her fingers would reach inside of the labia accidentally. In the next several months her inaccurate and nonfocused poking and stimulation continued.

       6.    Dolly demonstrated little genital self-stimulation in her first 16 months. First came buttocks-patting, then patting of the genitals at 18 months. At 19 and a half months there was an explosive onset of genital interest and stimulation for about two months. A definite increase of sensitivity to cleansing activities was observed at 21 months.

       7.    Olivia first touched and poked her genitals at 10 and three quarter months. Self-stimulation of her genitals, especially with a blanket, continued for the next four months with gradually longer periods of stimulation but still with not much absorption. From 14 to 17 and a half months there was extension of the duration of stimulation, and increased pleasure from it. At 17 and a half months cleansing evoked more pleasurable response.

       8.    Ginny, like Dolly, showed no specific clitoral or vaginal exploration in the first year. Significant focused genital self-stimulation did not occur until after she was 18 months old.

Boy-Girl Differences

In considering the differences in early genital self-stimulation between girls and boys we confront two and possibly three factors. Primarily , there is the anatomical factor, second, a cultural one, and third a possible drive difference mediated by hormones. The accessibility of the male's genitals (penis and scrotum) means that the little boy can finger his genitals more readily and, equally important, can see what he is manipulating or can look without touching. For example, if you compare the boy's fingering with the use of thigh pressure in the girl, he is registering the sensation in his genitals, his fingers, and his eyes. The sensation in the thighs is less clear and more diffuse gthan in the fingers, and the girl can't see her genital organs. Kestenberg (1956) points out that it is only the visual experience which enables the child to accept the organ as his own, a feeling of organ constancy. "It is extremely rare that the girl can attain the organ constancy of her external genital in the first or even the second year of life as the boy can" (p. 459). The occurrence of erections means that from birth the male has an experience different from that of the female. Wolff (1966) concludes: "No analogous startle substitutes such as clitoral erections were observed in girls — either because there are no analogues or because they are difficult to detect by direct observation" (p. 16). Additionally, attention is directed to the boy's genitals because the penis is the organ of urination and because of sensations in the testicles especially associated with their movement. Rhythmic motility in infancy is more apt to stimulate the male genitals because the penis projects more than the clitoris (Mittelman, 1955) and because the testicles and scrotum are pendulous and mobile. William (Kleeman, 1966) could discover precisely (at 21 and a half months) his urinary meatus, or could proudly display his urinary stream in the bath, experiences not available to a Karen. The girl tends to focus on the inside (genitally) and the boy on the outside. In all likelihood, vaginal sensations cannot be compared with the pressure of the male organ (Deutsch, 1944). In the exploration of her genitals the little girl encounters an obstacle generally unknown to the boy: that of pain (Bonaparte, 1953). One of my subjects during her second year placed a plastic box in her vulva and quickly withdrew it when a sharp edge hurt her.

As a result of the factors enumerated, at any given age in the first two years, the girl's mental self-representations of the genitals are more uncertain and vague than the boy's (cf. Moore, 1968). Finally, of interest from the standpoint of comparative biology, in rhesus monkeys masturbation is very infrequent in the female, in contrast to the male (Spitz, 1962).

A cultural issue largely neglected in the literature is the startling fact that the same mother treats her little girl differently from her little boy which influences her response to their genital self-stimulation. This is very subtle, and I can illustrate it only obliquely with a few examples. Murphy (1962) demonstrates that mothers express a gender differentiation very early in the manner of positioning babies while nursing, reflecting the attitudes that "mother knows best" with the girl and that respect is due the boy's autonomy. Karen's mother felt it was time for her girl to see her genitalia in the mirror at 12 and a half months. Her son was given the opportunity to observe his genitals in a mirror in his ninth month. Speaking even more generally, I have been struck by the repeated observation that parents name the boy's genital organs for him much sooner and more precisely than they do the girl's. The girl's clitoris, vulva, and vagina are specified later than the boy's penis and even "bailies." Parents are apt to use one word (e.g., "tushy") to include anal, urinary, and genital organs for girls, or no name at all, while they can comfortably call a penis a penis. The testicles are named by some but not by most. Sears, Maccoby and Levin (1957) offer abundant data on how parents deny sexuality or fail to see genital play or masturbation in their children. No parents in their study helped the children identify the emotional state related to sex play, such as "You are feeling sexy; that's why you are acting like that" (p. 190).

The possibility of drive differences between boys and girls in infancy mediated by hormones cannot be eliminated. Kestenberg (1956) specifies the possible role of maternal hormones in the infant's body. Hamburg and Lunde (1966) have reviewed the role of sex hormones in the development of sex differences in human behavior. New biochemical techniques for determination of hormone levels and recent studies describing several sex differences in newborn human infants open up whole areas of potential knowledge. In addition, children of the same gender vary considerably in their level of sexual impulse.


Conclusions

Though my conclusions are based on the observations and a thorough review of the literature, they are tentative at best. The number of children studied closely is small; they are all normal children from middle-class white American families; the majority of the observations were made by the parents, only partly checked by me and others. A statement by Josine Muller in 1932 still applies to some extent: "Now we know that only the most obvious sexual activities of children are observed by those who bring them up and by physicians. Children who practice vaginal masturbation (rocking in their seats or use of muscles) in a masked form are not detected" (p. 362).

Opportunity for complete observation of a normal boy's genital self-stimulation during the first and the second years reveals a rich and varied repertoire of activities. This child's verbal facility permitted the collection of more nonspeculative data than are usually obtainable at this age.

Unanswered questions about early male and female sexual development continue to exceed those that can be answered at this time.

Conclusions for William's first year

The observations combined with a study of the relevant literature suggest:
       1. Under normal conditions a boy's genital self-stimulation in the first year primarily fosters discovery of a body part and helps the establishment of a body self. The erotic aspect is secondary.
       2. Mild to moderate pleasure characterizes the activity as time progresses without self-absorption or mounting excitement. Orgastic intensity or masturbation are inappropriately precocious indications of disturbance.
       3. Although there is great individual variation in erogenous zone sensitivity, the genitals do not usually have the pleasure potentiality of the mouth at the end of the first year; however, there is a gradual increase in eroticity. Self-stimulation of the genitals does not usually serve as an autoerotic activity substitutive for the mother's stimulation in the way that other means, such as thumb sucking, do.
       4. The factors of tumescence and testicular movements add to the sensation differentiation of the genital area from other body parts.
       5. Genital exploration of a meaningful kind, as opposed to random tactile contact with the genitalia, is a development relatively late in the first year (from eight to ten months on) after the infant has developed skills of manual-visual coordination and forefinger-thumb dexterity, and has used them on his foot and toes, his mother's body, and other objects in his surroundings.
       6. Whereas tumescences are largely reflex throughout much of the first year (partly associated with the function of micturition), late in the first year and increasingly in the first months of the second year they can be aroused also by tactile stimulation of the penis.
       7. Of the factors contributing to the genesis of genital self-stimulation in the first year maturational processes and good infant-mother relations seem to play a more essential role than the direct process of the infant's repeating actively the genital stimulation which he received passively from the mother. In addition, self-stimulation seems partly reflective of an early identification process. A slightly different way to conceptualize this is that good maternal-infant relations facilitate the discharge of maturational drive representatives in the form of self-stimulation.
       8. In the case reported, focused stimulation early in the first year because of dermatitis did not appear to affect subsequent normal emergence of genital self-stimulation. Observation suggested that the same trauma in the second year would have a more significant impact.
       9. Any assessment of this child's autoerotic activities must include recognition of his above-average oral experience, resulting from the combination of his food intolerance and gastrointestinal distress which prolonged nursing as an attempted compensation, and the mother's own orality.
       10. The visual component of genital exploration was important and at times predominated over the tactile.

Conclusions for William's second year

A longitudinal or developmental line approach to the study of the genital exploration and self-stimulation of a normal boy during his first two years revealed the following findings with regard to other developmental and maturational events:
       1. Genital self-stimulation during the second year showed a gradual progression with discontinuities from the largely exploratory behavior of the first year toward behavior having a clearly masturbatory quality in the oedipal years.
       2. I found the traditional psychoanalytic definition of masturbation too general to capture the details of infant behavior. My definition emphasized primarily consciously sought pleasure rather than exploration, self-absorption not readily distracted, mounting excitement, with an orgastic rather than soothing rhythm. If masturbation is viewed in this way, one can state that, in the case of William, it still occurred infrequently during the second year but definitely more often than in the first year.
       3. There was no genital excitement that could be labeled an orgasm in this period.
       4. Erections resulting from genital tactile stimulation and tumescences arising reflexly from the need to urinate followed by detumescence after micturition were both more frequently seen in the second year than in the first.
       5. During this period several component instinctual drives of infantile sexuality (libidinal) were in evidence; e.g., looking (scoptophilia), exhibitionism (with its related/associated affect, pride), and early manifestations of oedipal feelings.
       6. The boy had gradual acquisition of knowledge about the penis, scrotal sac, testicles, and meatus urinarius. Meaningful knowledge of the scrotal sac and testicles appeared later than a comparable awareness of the penis, the precise "discovery" of the scrotal organs occurring at twenty-one months.
       7. Finding and exploring the meatus urinarius took place at twenty-one and a half months.
       8. This child's advanced language facility afforded an unusual opportunity to gain some insight into the structuring of the self representations, particularly their gradual progression, interrupted by fluctuations and regressions of the mental representations of self and object, especially as they pertain to this important body area, and to discern gradients of clarity of representation of different body parts. Ambiguity/indistinct differentiations of mental representations contribute to the well-known symbolic equations of feces = penis or testicles and breast = penis.
       9. William's pregnancy fantasy was an identification with the active, all-powerful, baby-producing mother, an addition to being male, not a substitution. It represented only one aspect of his many identifications with his mother and was one facet of his fantasy role playing.
       10. In addition to the better known roots of castration anxiety inherent in birth, oral deprivation, and daily loss of feces, William demonstrated an anal-genital confusion of sensation which resulted in anxiety about the genitals related to the loss of feces. William alternately associated and confused penis and feces and scrotal organs and feces, and did not exhibit primarily the testicular-anal misunderstandings which Bell stressed. Likewise, he showed a visual jumbling of scrotal and fecal percepts, though largely independent of sitting on the toilet. There was suggestive evidence that motility of the testicles can contribute to castration anxiety as Bell claimed.
       11. Two other maturational factors also predispose to later castration anxiety. These are (a) the prolonged reality testing involved in differentiating between the "I" and the "not-I" and between the detachable and the nondetachable, and (b) the separation anxiety centering around the love object in the individuation-separation phase.

Conclusions Applicable to Boys and Girls

       1. In normal children genital self-stimulation is a small fraction of the child's total behavior. Singling it out for observation should not be construed as establishing a hierarchy of importance in relation to many other aspects of behavior, i.e., object relations, self-development, cognitive function, etc. For most normal individuals the genital self-stimulation of the first two years is just one of many aspects of experience contributing to healthy personality growth and sexual development. A developmental line emerges from the first random fingering of the genitals, usually in the first year, to masturbatory stimulation, usually toward the end of the third year and further into the phallic phase. The developmental line has discontinuities both in frequency and regularity of stimulation and in motivation behind the stimulation. At the beginning it tends toward exploration and boundary-setting; later it becomes predominantly pleasure-seeking (erotic).

       2.    Normal children have a wide range of preferred self-stimulation activities and styles. Although there are normal children, there is no well-defined "normal" sequence of genital self-stimulation leading to masturbation (Escalona, 1963).

       3.    Generally, infants in the first year of life are not yet capable of the directed, volitional behavior required for the masturbatory act. Spitz (1962) rightly prefers to call this behavior "genital play." The change from genital play to masturbation is a gradual and discontinuous process and with a poorly defined point in time, varying for different children. The change seemed to occur in the last quarter of the third year for Karen.

       4.    Innate or, especially, environmental factors can lead to heightened genital sensitivity in the first year of life and symptomatic genital self-stimulation (Greenacre, 1954).

       5.    My data concur with the research finding of Roiphe, Galenson, and Sperling (Sperling, 1970): in normal boys and girls, approximately between 15 and 24 months, there is an increase in genital sensation and awareness. Whether or not further study confirms Roiphe's contention that this is an endogenous genital arousal, what is clear from my observations is a heightened genital sensitivity to external stimulation, an increase of pleasure potential. The combination of improved sensorimotor skills, this increase of genital sensitivity, and the fact that drive tensions are less diffuse in the second year (Francis, see Panel, 1968) results in an increase of genital self-stimulation, normally in the second year, which surpasses anything usually seen in the first year. In William the genital sensitivity increase was evident around 15 months; in Karen it was apparent around 16 months.

       6. The maturational event of increased genital sensation coincides with the maturation of anal and urinary structures resulting in increased anal and urethral sensation and capacity for sphincter control. The common innervation of the areas undoubtedly results in initial intermingling of anal, urinary, and genital sensations. The heightened anal and urethral sensation draws the child's attention to the area, just as the increased pleasure potential of the genitals does. Bowel and bladder training magnify further the attention directed to this whole body area.

       7.    Genital self-stimulation is thus a behavioral manifestation of the multiple factors of maturational processes, progressive awareness of one's own body, the quality of maternal care (Spitz), and the interaction between the child and the mothering person (Escalona).

       8.    Many other factors can influence the character of the genital self-stimulation. In addition to the powerful impact of parental attitude, the interaction with siblings and the birth of a new baby can especially be cited. Under certain circumstances, seeing the genitals of the opposite sex can have significant impact.

       9.    My observations do not include any climax type of excitement in these normal children during the first two years which can clearly be called an orgasm. In general, the genital self-stimulation during this period is normally without any great emotional excitement (Levine, 1951).

       10.    Normally one observes the emergence of body and genital pride, and the beginnings of exhibitionism and castration anxiety in the course of the second year.

       11.    The categorization of gender, largely a cognitive function, begins around 15 months and reaches a zenith in the last third of the third year (see Kleeman, 1971).

       12.    Through the experience of sensations, the genitals contribute to a part of the primitive body ego, the sense of self, and the awareness of gender (Stoller, 1964).

Conclusions Related to Male-Female Differences

       1.    Parents especially, but research observers as well, tend to confuse semantically vulva and vagina (Kestenberg, 1968) which further complicates evaluation of observations of genital self-stimulation in girl babies.

       2.    In the five girls observed longitudinally, two somewhat different patterns of onset of genital self-stimulation can be discerned. In the first pattern, typified by Karen, genital touching begins around eight months, gradually increases with discontinuity, until genital self-stimulation reaches an efflorescence around the middle of the second year. The second pattern emerges as a burst of genital self-stimulation in the middle of the second year (e.g., Dolly) after almost no interest in or stimulation of the genitals in the first year.*
       * The mother of the boy and four of the five mothers of the five girls were quite permissive in allowing the genital interest and self-stimulation to emerge naturally. The fifth (mother of Ginny) was restrictive only in the sense of not allowing undiapered running around.

       3.    Spitz, in his enthusiasm for discovering that genital play in the first year depends on an adequate mother-child relationship, made the presence of genital play in the first year and good object relations covariants. Whereas it is generally true that genital play is absent where the mothering is inadequate, the opposite (namely, in an atmosphere of adequate care genital play is always evident) is not always true. Dolly and Ginny are two girls with good object relations who displayed essentially no genital play until 18 months or later.

       4.    There is a primary femininity in infancy. The girl's earliest gender identity (core gender identity), i.e., her sense that she belongs to one sex and not the other, starts at birth with the assignment of gender. This assignment and rearing experiences (including parental attitudes) are more crucial in determining gender identity than are chromosomal sex or other anatomical attributes. Under normal circumstances, however, the anatomy of the genitals, their sensations (including those derived from genital self-stimulation), and a biological force (Stoller, 1968) all contribute to the core gender identity. Penis envy need not be the initiator of this development and, in fact, usually is not.

       5.    In some writings reddening of the genitals is cited as evidence that the child has stimulated herself/himself or masturbated. While this is probably sometimes true, in the case of Karen where an almost complete record was available of her self-stimulation, it was possible to determine that her genital redness fostered scratching and encouraged other stimulation of and attention to her genitals. The rash was primary for her and the self-stimulation secondary.

       6.    Aside from the initial date of genital touching which seems partly accidental, generally the genital self-stimulation of girls is later in onset, less vigorous, less focused, less frequent, and shows less intentional self-arousal and self-absorption than that of boys in the first year and early part of the second year.

At the end of the second year the boy is more knowledgeable about his penis, scrotum, testicles, and meatus urinarius than the girl is about her labia, clitoris, vagina, and urinary meatus. The vagueness of the girl's explorations and the lack of the visual modality in comprehending her organs result in less firm mental self-representations of her genitalia at a comparable age to the boy (Moore). The visual experience supplies the feeling of belonging and organ constancy (Kestenberg). The girl also has an unclear idea in the first two years just where the urine emerges.

The reasons for these differences between boys and girls, in addition to the visual factor, include the greater accessibility of the male organs to manual manipulation and exploration, the fact that the penis is the organ of urination as well as genital organ, the existence of penile erections from birth, the testicular sensations, including movement, and the fact that the protruding penis and pendulous scrotal organs are more stimulated by the rhythmic motility of the child than is the clitoris (Mittelman). Last but not least, parents react differently to girls and boys. The most dramatic example of this is that mothers generally have much more difficulty naming the girl's genital organs and do so at a later date than for their sons. The factor of drive differences at different ages mediated by hormones is a distinct possibility.

       7.    Because the anatomy of the boy directs his sexuality outward and is more clearly visible compared with the girl (whose sexual organs are inside), even the observer of the girl's genital self-stimulation sees less.

Recommendations for Further Study

On the basis of my observations and in the course of reviewing the literature, I have been struck by a number of additional issues in need of further investigation and discussion:
       1.    The fate of Freud's ideas on female sexuality and masturbation.
       2.    More precise definition of genital play and masturbation.
       3.    The relative incidence of thigh pressure, rocking, lap-sitting, use of objects, and manual means of self-stimulation and the relative incidence of focus of the stimulation: clitoris, labia, introitus, or vagina.
       4.    Comparison of soothing versus excitatory stimulation (Escalona, 1963).
       5.    Definition of orgasm and determination whether it occurs and the necessary conditions in the first two years of life.
       6.    The earliest fantasies associated with genital self-stimulation.
       7.    Upravelling the interrelations of oral and anal sensation and phase development, and genital sensation and phase development.
       8.    The hypothesis that a regularly occurring genital arousal in boys and girls in the second year is consequent on the establishment of preliminary sphincter control or is consequent on changes in bowel and bladder functioning (Roiphe, 1968; Sperling, 1970).
       9.    The timetable of increase of genital sensation in the small child, whether gradual or explosive, and the conditions contributing to it.
       10.    The hypothesis that the early genital experiences in the second year serve to organize the child's relationship to his human environment and to his unfolding self-development (Sperling, 1970).
       11.    Relation of genital self-stimulation to delineation of body image and boundary setting.
       12.    The existence, onset, and importance of vaginal and penile sensations in infancy.
       13.    Interrelations of motility and genital function in infancy (Mittelman, 1955).
       14.    The hypothesis that free motility in the first year fosters genital play in that period (Mittelman).
       15.    The significance of the mother's general care of the child's body as contributor to genital self-stimulation or genital sensation.
       16.    Conditions under which external stimulation other than genital can evoke genital arousal.
       17.    The effect of parental attitude on emergence of genital play (cf., Sears, Maccoby and Levin, 1957).
       18.    Interaction between infant characteristics and the nature of the maternal environment in relation to preferred mode of genital self-stimulation (Escalona).
       19.    To what extent and under what circumstances genital self-stimulation is the child's pleasurable substitute on her own body for the absent mother (A. Freud, 1953).
       20.    The impact of stress or overstimulation on genital sensation or discharge of tension through genital channels (Greenacre).
       21.    The relation between doll play and genital sensation (Galenson; Kestenberg).
       22.    The possible developmental line from the form and quality of genital self-stimulation to the subsequent defense system of the individual (Spitz, 1962).


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