The very first published psychiatric case of autofellatio, appearing in the American Journal of Psychiatry way back in 1938, was also one of the most outrageous and pathological. The patient was a 33-year-old store clerk who, prior to being referred to Yale psychiatrists Eugen Kahn and Ernest Lion, had just completed a 60-day jail sentence for sexual assault. "Among his perverse practices," explain the authors, "were pedophilia, cunnilinguism, homosexual acts (fellatio, sodomy and mutual masturbation), exhibitionism, transvestism, fetishism, algolagnia, voyeurism and peeping." But never mind all those vanilla paraphilias. The man's psychiatrists were especially intrigued by his more unusual habit. He seems a devious wee character, this patient of theirs. The authors describe him as being somewhat effeminate in posture, gait and mannerisms; he stood only 5 feet 2 inches tall—"somewhat thin and with wide hips," they wrote, with "a female pattern of distribution of his pubic hair" and "his gag reflex is very sluggish."
The patient was the third-oldest of eight children and grew up in a strict, religious family, which the physicians felt he rebelled against by egregiously breaching their high moral standards. In recounting to the psychiatrists the origins of his interest in autofellatio, the troubled clerk recalled being invited at the age of 14 by a "cripple boy" to engage in oral sex with him. The patient, being shy, had refused this offer, but the thought of it simmered and, lacking the courage to approach anyone else, he took matters upon himself: "He kept trying night after night, managing to bend his back more and more until he finally succeeded in August, 1923." (The 89th anniversary of this event is coming up, in case you want to mark it on your calendar.) It turns out he liked it—so much, in fact, that even amidst the long litany of perversions he enjoyed, self-irrumatio instantly became his favorite autoerotic act.
In an odd Pavlov's dog sort of way, the authors even describe how the man's sexual arousal had since then been accompanied by a "constricting feeling in the throat." That must be a terribly annoying feeling, I'd imagine, and apparently also one not easily resolved. "He has attempted to secure substitute gratification," say the authors, "by smoking, or by stimulating his pharynx with a banana, vaginal douche or a broom handle. These have yielded various degrees of satisfaction." And he did apparently get over his adolescent shyness and lack of confidence, too—he particularly enjoyed fellating himself in front of a shocked audience.
Since this initial case report by Kahn and Lion, a handful of others have trickled in over the years, with subsequent investigators attempting to find a set of common personality denominators in those who prefer autofellatio over other forms of sex. In a 1954 article in Psychoanalytic Review, for instance, William Guy and Michael Finn saw a theme beginning to emerge. "In all of the clinical descriptions," observe these authors, "one finds repeatedly such phrases as sensitive, shy, timid, effeminate, and passive." This is code for "queer," I believe, and in fact other writers have more expressly noted the often-suppressed homosexual desires in these autofellators.
In fact, judging by the scant literature, one of the big psychoanalytic questions yet to be resolved satisfactorily seems to be the extent to which engaging in autofellatio—or perhaps simply the desire to do so—signals a latent erotic attraction to the same sex. I suspect, however, that the overrepresentation of gay men in the antiquated case reports is simply a reflection of the cultural ethos of those times. The most recent psychiatric investigations on autofellatio date to the late 1970s (around the time that Freud's particular grip on psychiatry lost its tenuous hold), and the earlier ones to the 1930s, so as a rule the men described therein faced baseless moralistic proscriptions against homosexuality. This meant other men's penises were very hard to come by. So it's not terribly surprising that those too frightened to perform fellatio on another man would develop severe neuroses after indulging in their own penises.
A 1946 article from the American Journal of Psychiatry exemplifies this phenomenon. The case involves a 36-year-old, highly intelligent, personable, but virginal staff sergeant (not to be confused with the military man we met earlier) with closeted homosexual desires. According to the official record, he'd first performed autofellatio at age 13, but he became so frightened by this "impulse" that he resisted ever doing so again—that is, until a month prior to arriving at the psychiatric ward of the hospital. After giving himself head in private, the sergeant became intensely paranoid that the other soldiers somehow knew of his autofellatio, and that every little snigger, whisper, or averted glance concerned this transgression. He suffered a nervous breakdown on hearing the word "cocksucker" floating about so casually and playfully in the military barracks, convinced it was meant just for him.
It's a rather sad ending for him, too, because despite his responding well to the doctors' reassurance that he was being overly paranoid, the sergeant was discharged for being "no longer adaptable within the military service." The therapists assigned to the case, Major Morris Kessler and Captain George Poucher, reached a rather strange conclusion, one that I have a hunch you might disagree with: "Sexual self-sufficiency," they write, "either by masturbation or autofellatio, is tantamount to having an affinity for one's own sex." In other words, if you were a fan of manual masturbation in 1946, my heterosexual male friends, you'd have been branded a secret homosexual pervert who likes penises so much that he gives himself hand jobs. This would have made autofellatio a devil of a case under the Clinton-era "Don't Ask, Don't Tell" ban on gays in the military had it arisen then. And, seriously, good riddance to those ignorant days of yore. To each his own—quite literally in the case of autofellatio.
I know, I know, I didn't even get a chance to talk about autocunningulism in females. Given the even more serious anatomical hurdles in lacking a protruding reproductive device, such behavior in women may not even be possible. I confess I don't know; and there's no mention of it in the scientific literature. The closest female comparison to autofellatio I stumbled upon is the case of women who suckle from their own breasts, for sexual or other purposes. One therapist writes of an especially self-sufficient female patient who had a habit of doing this. When he asked her why, she merely replied, "I'm hungry." But that's another article for another day.