William Lightbody: "Oh, no, no, no I can't eat 15 gallons of yoghurt."
Dr. John Harvey Kellogg: "Oh, it's not going in that end, Mr. Lightbody."
From Road to Wellville (Alan Parker, 1994)

The enema has an illustrious medical history, dating to Egypt as early as 1500 B.C. The myth says that Egyptians learned of the procedure from observing the sacred Ibis, a bird that is reputed for saving people from plagues. The god of medicine and science, Thoth, exposed the enema to a handful of priest-physicians who were standing on the banks of the Nile. Thoth landed on the water in the form of the sacred Ibis. Filling his beak with water, he injected it into his anus to cleanse himself. Observing this, the priest-doctors began to utilize the process, which became known as the Divine Clyster¹.

Ancient Egypt is not the only place in history where the enema was practiced. Traces of colon cleansing have been discovered in Central Africa, among primitive tribes of the Amazon, and were written about extensively by Chang Tsung-Cheng in the 10th century Sung Dynasty. The enema was known as a clyster through ancient Roman times, and its popularity rose in the Court of King Louis XIV, who is said to have received over 2,000 enemas in his lifetime. However, with the rise of health disorders of the bowels and large intestines at that time, the enema diminished in popular practice after the French Revolution, and rose again during the 20th century.

While the history of the enema, particularly its use for therapeutic or medical reasons, is far-reaching, figures such as Casanova and Cardinal Richelieu are said to have been enthusiasts for much more pleasurable purposes. Dr. John Harvey Kellogg, the inventor of the infamous cornflake cereal, is alleged to have been a textbook example of the fetishist who not only performed it as part of his daily ritual, but also replaced sexual intercourse with the enema. If he derived any sexual pleasure from the procedure is not known, but it would be a defining feature of enema eroticism, particularly where it concerns medical fetishism.

Coined as a paraphilia in 1973, Dr. Joanne Denko distinguished enema fetishism as klismaphelia. In studying one patient case, she identified the routine of "inducing sexual pleasure from the enema as the inevitable result of a pathogenic environment (using the enema as a behaviour modification or form of punishment). This included excessive and prolonged administration of enemas by the mother and orientation by both parents to the enema as a way of life. A second case is quite different in that the practice developed only in middle adult years, during a period of great stress, and then, apparently, under the tutelage of a sexual partner²".

On one hand, Dr. Denko surmises that klismaphelia had developed from life experiences and became an integrated part of her first patient's personality. In the second case, she deduces that her patient's enema fetish was an accident whereby he discovered his own sexual response to the enema and gradually slipped into a klismaphiliac role to the exclusion of sex.

Dr. Denko's research is based on experiences with klismaphiliac individuals in a clinical setting, but what about those who enjoy enema fetishism as part of their sexual relationships?

In a paper for the American Journal of Psychotherapy, Jeremy Agnew describes klismaphilia as meeting all the qualifications of anal masturbation particularly because it can create an intense sexual response. "In the female, pressure on the back of the vagina can stimulate the same set of nerves and produce the same erotic experience as deep penetration of the rectum. The increasing pressure caused by the filling and distension of the rectum as the enema solution is injected causes pressure on these same nerves and sensitive stretch receptors, and this produces a similar sexual sensation. In the male, the anterior wall of the rectum is next to the prostate and seminal vesicles. Filling and dilating the rectum with enema solution will cause direct pressure on these structures, as well as causing stimulation of the rectal stretch receptors³."

It's certainly not difficult to see why people experience sexual excitement from the enema, but often times, particularly among those who identify themselves as fetishists, there is a lot more involved than the physiological response of the body. In fact, some individuals enjoy the rituals of preparing for and giving or receiving an enema, others find the sensations or smell of the equipment to be a particular turn-on, and others find pleasure among the power exchange in role-play surrounding the enema, roles that can include the medical play of doctor/nurse and patient.

"On some occasions in my life, it's been incorporated into BDSM play in a punishment/humiliation manner, but not often," said an enthusiast named cymbidia, member of a BDSM online community. "For me, the allure is sensation, fullness, and squeaky-clean cleanliness. It's another way to feel and a process of cleaning myself, often in preparation for anal play, but just as often because I like the sensations."

Since the enema is so closely related to feces, some might wrongly assume that enthusiasts are also into scatological play. However, there's often little contact between the players and excrement since the enema nozzle obstructs the release, and when it's eventually removed the recipient, as cymbidia points out, often hurries to discharge and more often than not they do so in private. "I find the entire process erotic, quite frankly, except the releasing part, when I really, really want to be alone. I don't do scat play at all. Whether with a partner or alone, my fondness for enemas is almost always about the sensations the process produces in me."

While the enema can elicit an intensely erotic physiological experience, some people find the psychological aspects of enema to be just as powerful. Wizard of Ass, who is the owner and webmaster of Enemas.com suggests that it's more about the psychology than the paraphernalia, and that there are many dimensions within and outside of medical play.

"Enemas have the distinctive appeal to me in that they are the deepest form of probing. The water flows far deeper than any finger, penis, dildo or speculum could ever reach, hence the intimacy of probing someone so deeply is a huge part of the appeal for me. Another appealing element is that of the embarrassment, or violation of the recipient. Those elements have a definite draw because of the transgression quality - a common theme in BDSM. Above and beyond all, I also like the nurturing elements of giving someone a 'healing enema'. For example, lovingly rubbing their belly in between enemas, or if they get cramps.

"Enemas, including in the form of medical play, can be a punishment or a reward; they can be a violation or a loving treatment, or a combination of some of those elements. It's all highly psychological, and the frame of mind, especially the recipient's attitude, greatly affects the outcome. For example, both in my personal life and in some of the 50+ movies I've produced, sometimes enemas were meant as a punishment. But, hey, if the recipient happens to enjoy them, then they are punishment no more!"

As with any medical fetish, there are safe methods and also irresponsible procedures that can be dangerous for the recipient and have extreme consequences for the administrator of the enema. For example, in February 2005, a Texas woman was charged with criminally negligent homicide after she dispensed a sherry enema to her husband, who subsequently died of poisoning from a .47 blood alcohol level⁴. The problem with using substances such as alcohol during an enema scene is that the alcohol is directly absorbed into the body much more rapidly than if it were orally ingested. When drinking alcohol we are aware of our intake and will possibly pass out before ever reaching a lethal toxicity. However, during an enema it's much more difficult to gauge intake, particularly for a submissive, until it's too late. As BDSM enthusiasts always emphasize, 'Safe, sane and consensual' should always be a part of enema play.

"My advice for the beginner is to start simple," writes A Wizard of Ass. "For starters, buy an enema bag at your local store. Feel the water temperature with your elbow, which is more sensitive than the hand. Preferences vary, but I think the optimal temperature is when it feels a shade on the cool side - not cold."

When it comes to sex, the enema can be a sensational pleasure in sensual scenes; it can be a form of excitement in doctor and patient psychological role-play scenarios or a form of punishment and humiliation. In whatever way one enjoys giving or receiving, the enema is just one aspect of medical fetishism, and it's often regarded as medical due to the equipment used and the long history of the enema as a medical procedure. However, as Wizard pointed out to me in our interview, the role of the enema in sexual play can have a much broader appeal. Certainly, everyone has their own unique experiences and preferences, and where one individual enjoys the pleasures of klismaphilia, others are more attracted to medical fetishes involving the speculum.

References
[1] Shealy CN. 1999. The Complete Illustrated Encyclopedia of Alternative Healing Therapies. Dorset: Element Books Limited.

[2] Denko, Joanne D., MD. Klismaphilia- Enema as Sexual preference. Enema Fun, 22 Oct. 2005.

[3] Agnew, Jeremy. Klismaphelia: A physiological perspective. American Journal of Psychotherapy, Vol. XXXVI, No. 4, 4 Oct. 1982. Speculum Pages, 22 Dec. 2005.

[4] Associated Press. Wife of Texas man killed by sherry enema surrenders. 2, Feb. 2005. MSNBC, Internet Broadcasting Systems Incorporated.