Paraphilia, known as sexual perversion and sexual deviation.
It is the experience of intense sexual arousal to atypical objects, situations, fantasies, behaviors, or individuals.
Paraphilias are rarely observed in women.
The term paraphilia as a non-pejorative designation for unusual sexual interests.
Paraphilia described as recurrent, intense sexually arousing fantasies, sexual urges, or behaviors generally involving: the following:
Non-human objects
The suffering or humiliation of oneself or one’s partner
Children
Non-consenting persons
Homosexuality and non-heterosexuality
Homosexuality is now widely accepted to be a normal variant of human sexuality.
Sexual disorders once considered paraphilias, such as homosexuality are now regarded as variants of normal sexuality.
The causes of paraphilias are unclear.
Research points to a possible prenatal neurodevelopmental correlation.
Wilson Sex Fantasy Questionnaire exam determined that males with a pronounced degree of fetish interest had a greater number of older brothers, a high 2D:4D digit ratio, indicating excessive prenatal estrogen exposure, and an elevated probability of being left-handed, suggesting that disturbed hemispheric brain lateralization may play a role in deviant attractions.
It is proposed paraphilias are conditioned early in life, during an experience that pairs the paraphilic stimulus with intense sexual arousal.
All the forms of sexual perversion have their roots in the natural and normal sex life, connected with the feelings and expressions of our physiological erotism.
Sexual pervasions are hyperbolic distortions, of certain partial and secondary expressions of this erotism which is considered ‘normal’ or at least within the limits of healthy sex feeling.
Disagreements regarding which sexual interests should be deemed paraphilic disorders versus normal variants of sexual interest.
What is considered deviant in one cultural setting may be more acceptable in another setting: Cultural relativism is important to consider when discussing paraphilias, because there is wide variance concerning what is sexually acceptable across cultures.
Consensual adult activities, entertainment involving sexual roleplay, novel, superficial, or trivial aspects of sexual fetishism, or incorporating the use of sex toys are not necessarily paraphilic.
Optional paraphilia refers to an alternative route to sexual arousal.
In preferred paraphilias, a person prefers the paraphilia to conventional sexual activities, but also engages in conventional sexual activities.
The DSM-IV-TR describes paraphilias as recurrent, intense sexually arousing fantasies, sexual urges or behaviors generally involving nonhuman objects, the suffering or humiliation of oneself or one’s partner, or children or other nonconsenting persons that occur over a period of six months, which cause clinically significant distress or impairment in social, occupational, or other important areas of functioning: exhibitionism, fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, voyeurism, and transvestic fetishism.
Some paraphilias may interfere with the capacity for sexual activity with consenting adult partners.
Currently the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), states a paraphilia is not diagnosable as a psychiatric disorder unless it causes distress to the individual or harm to others.
The DSM-5 stat that paraphilias do not require or justify psychiatric treatment in themselves.
Having paraphilia would be a necessary but not a sufficient condition for having a paraphilic disorder.
A paraphilic disorder occurs when an atypical sexual interest causes distress or impairment to the individual or harm to others..
While many dozens of paraphilias exist, there is coding specific listings for eight that are forensically important and relatively common: voyeuristic disorder, exhibitionistic disorder, frotteuristic disorder, sexual masochism disorder, sexual sadism disorder, pedophilic disorder, fetishistic disorder, and transvestic disorder.
Experts believe that paraphilic sexual interests cannot be altered.
The goals of therapy:reduction in the person’s discomfort with their paraphilia and to limit any criminal behavior.
Psychotherapeutic and pharmacological methods are available to these ends.
Cognitive behavioral therapy can help people with paraphilias to avoid acting on their interests.
Cognitive behavioral therapy is currently the only form of psychotherapy for paraphilias supported by randomized double-blind trials.
While drug treatments can help people control their sexual behaviors, they do not change the content of the paraphilia.
Selective serotonin reuptake inhibitors (SSRIs) work by reducing sexual arousal, compulsivity, and depressive symptoms:
exhibitionists, non-offending pedophiles, and compulsive masturbators.
For severe cases antiandrogens work by reducing androgen levels: chemical castration.
The antiandrogen cyproterone acetate has been shown to substantially reduce sexual fantasies and offending behaviors.
Medroxyprogesterone acetate and GnRH agonists also are used to lower sex drive.
Hormonal treatments are utilized when there is a serious risk of sexual violence, or when other methods have failed.
Surgical castration has largely been abandoned because these pharmacological alternatives.
Sexual masochism is the most commonly observed paraphilia in women: approximately 1 in 20 cases of sexual masochism being female.