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Six-Year-Old Masturbates in Public
Q: Our six-year-old daughter has a long-standing problem controlling her impulse to masturbate in public. She is now in second grade and her teachers are concerned that she'll injure herself because of the force she uses to rub herself. We notice this problem at home, too, and always tell her that this should be a private practice -- but she doesn't seem to be able to control it. The doctor says that she doesn't have any infection and prescribed estradiol cream twice a day for two weeks. Any suggestions?
A: Masturbation (touching one's genitals for stimulation and pleasure) is common. Children use their hands to rub themselves or position themselves against an object, but don't cause themselves physical harm. It happens most frequently when a child is bored, stressed, or tired, and continues because of how good it feels. It's important for masturbation to be accepted as a normal part of your child's sexual life. Guilt or punishment should be avoided. It's not always easy for parents to react calmly when their child is exploring and manipulating her body for enjoyment.
However, at the age of six years, your daughter should be able to understand that this activity is performed only in private. You've done the right thing in informing her that masturbation is not a social activity and must be limited to a room when she is alone. Her teachers need to do the same; they also should be reassured that she won't injure herself masturbating. Your daughter is at an age where open masturbation suggests limited social awareness or less than optimal management of the behavior. Everyone needs to be consistent in reinforcing the message that this is not done in school or other places when people are around; it's done when alone.
I have not prescibed estrogen cream for this problem, but more often for labial adhesions (when the skin of the genitalia stick together). It would be best to further discuss management with her pediatrician. Since this has been a "long-standing problem," you and her doctor need to work closely together to help your daughter control her impulses better.
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Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.