Assessment of Erotic Preferences
Assessment of sexual anomalies is often difficult because there are so many theoretical preconceptions and so few facts. Moreover, about half of clinical cases present more than one anomalous behavior71 and the clinician is faced with making sense of the seemingly infinite combinations of behaviors. Some theorists have prematurely linked anomalies that may have occurred in a patient by chance. The large number of physiological measures used as indices of erotic arousal has also served to confuse the assessment process110.
Order can be imposed and solutions to these problems derived by examining orgasmic preferences. That is, how does the individual prefer to have his sexual climax. Usually the most frequent behavior leading to orgasm reflects this preference but not always. A married man can have intercourse thousands of times with his wife and yet prefer young boys with whom he may only have risked contact a dozen times.
Two assessment tools are most valuable in working out erotic preference patterns; phallometry or measurement of penile reactions, and a standardized sex history questionnaire. These measures may seem personal, intrusive and embarrassing to some clinicians but there is good scientific reason for resorting to them. To date, penile reactions are the most valid index of erotic behavior in a cooperating individual. Researchers have attempted to use many other psychological measures of sexual arousal, which are less obtrusive than phallometry, but none have its validity nor its accuracy. Zuckerman110 has reviewed the varied indices used to measure erotic arousal.
Sexual arousal has been measured via brain activity, sweating, heart rate