Paraphilias are intense, recurrent sexual desires bordering on obsession-compulsion and directed toward unusual targets such as inanimate objects (women’s underwear, urine, feces), animals, children, inflicting pain, or receiving pain.1

Paraphilias overwhelmingly afflict men. The only paraphilia for which women receive a diagnosis to any significant degree is sexual masochism (~ 1 woman for 20 men diagnosed).2

Non-paraphilic sexual compulsion disorders are intense, recurrent sexual desires bordering on obsession-compulsion and involve conventional sexual activities directed toward adults.

Table 1 provides a listing of the more common paraphilias (paraphilias tend to at most characterize a few percent of the population).

Table 1: Some Common Paraphilias
Sexual pleasure lies in Label
Exposing one's sexual organs to unsuspecting individuals Exhibitionism
Non living objects Fetishism
Touching and rubbing against a non-consenting person Frotteurism
Receiving humiliation or suffering Sexual Masochism
Inflicting humiliation or suffering Sexual Sadism
Cross-dressing Transvestic Fetishism
Secretively observing people undress or having sex Voyeurism
Notes: Paraphilias are rare but some are more common than others. High intensity sexual desire, recurrence, and obsessive-compulsive desire are required for a paraphilia diagnosis.

Non-paraphilic sexual compulsion disorders typically accompany paraphilias (e.g., Table 2). Note the relative overrepresentation of nonheterosexual men in Table 2.

Table 2: Some aspects of men with paraphilias (PARs) and non-paraphilic sexual compulsion disorders (NPSCDs). See last row for sample sizes.
A Type of Promiscuity Total 10 11
Heterosexual 7 3
Homosexual 1 6
Bisexual 2 2
B Type of Promiscuity* Total 21 21
Heterosexual 19 13
Homosexual 4 9
C Pedophilic Total 11 Not-applicable
Heterosexual 4
Homosexual 3
Bisexual 1
Incestuous - heterosexual 2
Incestuous - homosexual 1
Type of Promiscuity Total SO NSO 13
5 4
Heterosexual 3 3 8
Homosexual 1 0 2
Bisexual 1 1 3
D Type of Promiscuity** Total 28 28
Heterosexual 22 19
Homosexual 9 10
Sexual orientation*** Total 65 35
Heterosexual 52 26
Homosexual 4 6
Bisexual 9 3
E Pedophilic**** Total 20
Heterosexual 9
Homosexual 7
Bisexual 1
Incestuous 3
Type of Promiscuity**** Total 53
Heterosexual 25
Homosexual 18
Bisexual 10
F Sexual orientation*** Total 88 32
Heterosexual 69 14
Homosexual 2 12
Bisexual 17 6
SO = sex-offenders, NSO = Non-sex-offenders. * 2 men with PARs and 1 man with NPSCDs reported both heterosexual and homosexual promiscuity; ** 3 men with PARs and 1 man with NPSCDs reported both heterosexual and homosexual promiscuity; *** based on Kinsey 0-6 scale, 0-1 classified as heterosexual, 2-4 classified as bisexual, 5-6 classified as homosexual; **** data for PARs and NPSCDs combined. The study samples were as follows: 30 consecutive respondents to a newspaper advertisement soliciting individuals with PARs and NPSCDs in study A;3 63 consecutively evaluated outpatient men in study B;4 60 consecutive male outpatients in study C;5 100 consecutive male outpatients in study D;6 and 120 consecutively evaluated male outpatients in studies E7 and F.8 The number of individuals with PARs and NPSCDs were: 15 and 15, respectively in study A; 34 and 26, respectively in study B; 42 and 18, respectively in study C (among the 42 individuals with PARs, 30 were sex-offenders and 12 were not sex-offenders); 65 and 35, respectively in study D; 88 and 32, respectively in studies E and F. The participants in these studies appear to have been drawn from the Belmont-Cambridge-Boston area; it is unlikely that the prevalence of nonheterosexuals in this region approaches that seen in the participants.

Multiple paraphilias tend to co-occur, i.e., there exists a tendency toward disparate erotic targets among paraphiles:

  • In a sample of autogynephilic men (aroused by imagining oneself as a woman or having a woman’s body parts), 90% acknowledged some history of transvestism (cross-dressing ), 38% acknowledged transvestism alone, and 55% acknowledged both fetishism and transvestism.9
  • Two or more of the following are often found in the same individual: voyeurism, exhibitionism and obscene telephoning, toucheurism and frotteurism, and the preferential rape pattern.10, 11
  • Bondage and transvestism commonly accompany hypoxiphilia (deriving sexual pleasure by depriving oneself of oxygen). Among hypoxyphiles, anal self-stimulation with foreign objects and self-observation with mirrors or cameras correlate with transvestism; the highest levels of transvestism occur with low levels of bondage, i.e., transvestism and bondage compete with each other.12
  • Among heterosexual men, the presence of sexual masochism increases the likelihood of transvestism and vice versa.13
  • Among 164 Finnish men in two Bondage & Discipline/Sadism & Masochism clubs, approximately 50% indulged in urine play, 18% played with feces, and 42% were into enemas.14 In the entire sample, 7.4% were exclusively sexually sadistic, 18.4% were predominantly sexually sadistic, 23.9% were sexually sadomasochistic, 35.6% were predominantly sexually masochistic, and 14.7% were exclusively sexually masochistic. Their participation in various activities was as follows: rimming (77.5%), fisting (32.9%), enema (42.7%), playing with feces (18.2%), sex with animals (7.3%), hypoxyphilia (16.5%), cross-dressing (26.8%), flagellation (81.8%), electric shocks (16.4%), mummifying (13.4%), and gagging (53%). 25% indulged in the role playing of execution scenes, and 11% enacted rape scenes.
  • There exists an association between pedophilia and exhibitionism.15, 16, 17
  • Some case reports:18
    • Freund and Blanchard described a homosexual child molester that wanted a prepuce as long as that of a little boy.
    • Consider the case of a bisexual pedophile that also had nappy fetishism. He put on nappies and urinated into them before masturbation. Sometimes he wore nappies all day, changing into them before masturbating. He sometimes deliberately left his nappies hanging out from his shorts or from his fly, so that people could see them (exhibitionism).
    • Consider the case of a 26-year-old man charged with 10 counts of smearing feces on the skirts of girls. From age 4 years onward, he began putting on nappies for the purposes of urinating and defecating into them, initially “feeling good” while doing this. From age 11 years onward, this activity was accompanied by sexual arousal.
  • A large proportion of individuals having sex with animals also have sex with humans (see zoophilia).
  • McNally and Lukach described the case of a mildly mentally retarded exhibitionistic zoophilic man who also enjoyed sex with women. He sexually enjoyed exposing himself to large dogs of either sex and then masturbated in front of them; he did not have sexual contact with dogs.19
  • Two reports:20
    • In a sample of child molesters, over 80% of non-familial child molesters and at least 70% of incest offenders had multiple paraphilias. 17.6% of homosexual child molesters, 17.8% of heterosexual child molesters, and 15.1% of incest offenders had 6 or more paraphilias.
    • In a sample of 561 non-incarcerated paraphiles who were guaranteed confidentiality, most paraphiles had participated in at least 10 different types of unusual sexual behaviors.

In a random sample of 2,450 Swedish adults, hypersexuality was strongly associated with paraphilic interests (OR = 4.6-25.6).21 In this study, transvestic fetishism was associated with sexual sadomasochism, voyeurism, exhibitionism and male homosexuality/bisexuality.22

Homosexuals use euphemisms to address paraphiles (Table 3). The euphemisms, apart from being non-offensive, also appear as terms of affection or endearment, thereby suggesting that the practices may not be uncommon in the homosexual community. See Table 2 above for data that male homosexuals/bisexuals are overrepresented among paraphiles; for the overrepresentation of homosexuals among specific paraphiles, see the pages on sadomasochism, pedophilia and zoophilia.

Table 3: Some Paraphiles
Erotic target Label Homosexual term (see more)
Children Pedophile Chicken hawk
Dead bodies Necrophile Coffin queen
Feces Coprophile Mud-man
Urine Urophile Golden queen
Animals Zoophile Interspecies lover
Notes: High intensity sexual desire, recurrence, and obsessive-compulsive desire are required for a paraphilia diagnosis.


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