Mental health articles

OF mental health care and mentally ill

Sexual variations and deviations

Sexual variations and deviations Paraphilias are problems arising from sexual preferences that are unwelcome to the patients, to others or to society at large. They represent modifi cations of the capacity for erotic response to another adult and can be understood as a disconnection between sex and affection.

Most paraphilias involve behaviours that play a small part in usual adult lovemaking: for example, exposing, sexual looking, dominating, submitting, dressing up and sexual regard for particular objects. In a paraphilia, however, such behaviour becomes the erotic end in itself. While a range of paraphiliac activities has been described, recurring patterns include sadomasochism (the infl iction or experience of pain), transvestism (cross-dressing), fetishism and various illegal activities such as exposing the genitals in public and sexual preference for pre-pubertal children. The assessment and treatment of paraphilias is a specialist matter, especially when the patient presents via the criminal justice system.

Psychological treatments are often of considerable value, but the availability of services is very patchy and awareness of local arrangements is essential.

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