Transvestism, impotence and temporal lobe dysfunction

Abstract

A 38-year-old right-handed transvestite was referred for psychiatric treatment because of depression and lifelong impotence. Specific questioning revealed marked global déjà vu experiences and vivid dreaming. Neurological investigation (EEG) showed a focal disturbance in the left fronto-temporal region, and this was supported by results of psychological testing. Treatment with small doses of phenytoin sodium and supportive psychotherapy resulted in rapid amelioration. Nine months later he married, and twenty months later remains well off medication. Even in the absence of spontaneous complaints referable to temporal lobe epilepsy, specific enquiry may as in this patient bring to light other evidence of temporal lobe dysfunction. The link between the patient's temporal lobe disturbance and transvestism is seen in his déjà vu experiences, part of what Hughlings Jackson called “dreamy states” or “reminiscence”. It seems that such sexual disturbances marked by repetitiveness of ritual and characterised by episodicity and “paroxysmalness”, to use another of Jackson's terms, may now be accepted as possible expressions of temporal lobe dysfunction and should be fully investigated accordingly.