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According to the World Health Organization, fetishistic fantasies are common and should only be treated as a disorder when they impair normal functioning or cause distress. Goals of treatment can include elimination of criminal activity, reduction in reliance on the fetish for sexual satisfaction, improving relationship skills, or attempting to remove deviant arousal altogether. The evidence for treatment efficacy is limited and largely based on case studies, and no research on treatment for female fetishists exists.
Cognitive behavioral therapy is one popular approach. Cognitive behavioral therapists teach clients to identify and avoid antecedents to fetishistic behavior, and substitute non-fetishistic fantasies for ones involving the fetish. Aversion therapy can reduce fetishistic arousal in the short term, but is unlikely to have any permanent effect.
Antiandrogens and selective serotonin reuptake inhibitors (SSRIs) may be prescribed to lower sex drive. Cyproterone acetate is the most commonly used antiandrogen, except in the United States, where it may not be available. A large body of literature has shown that it reduces general sexual fantasies. Side effects may include osteoporosis, liver dysfunction, and feminization. Case studies have found that the antiandrogen medroxyprogesterone acetate is successful in reducing sexual interest, but can have side effects including osteoporosis, diabetes, deep vein thrombosis, feminization, and weight gain. Some hospitals use leuprolide acetate and goserelin acetate to reduce libido, and while there is presently little evidence for their efficacy, they have fewer side effects than other antiandrogens. A number of studies support the use of SSRIs, which may be preferable over antiandrogens because of their relatively benign side effects. None of these drugs cure sexual fetishism, but they can make it easier to manage.
Relationship counselers may attempt to reduce dependence on the fetish and improve partner communication using techniques like sensate focusing. Partners may agree to incorporate the fetish into their activities in a controlled, time-limited manner, or set aside only certain days to practice the fetishism. If the fetishist cannot sustain an erection without the fetish object, the therapist might recommend orgasmic reconditioning or covert sensitization to increase arousal to normal stimuli (although the evidence base for these techniques is weak).
Selective serotonin reuptake inhibitors (SSRIs) are used, especially with exhibitionists, non-offending pedophiles, and compulsive masturbators. They are proposed to work by reducing sexual arousal, compulsivity, and depressive symptoms. However, supporting evidence for SSRIs is limited.
Antiandrogens are used in more severe cases. Similar to physical castration, they work by reducing androgen levels, and have thus been described as chemical castration. The antiandrogen cyproterone acetate has been shown to substantially reduce sexual fantasies and offending behaviors. Medroxyprogesterone acetate and gonadotropin-releasing hormone agonists (such as leuprolide acetate) have also been used to lower sex drive. Due to the side effects, the World Federation of Societies of Biological Psychiatry recommends that hormonal treatments only be used 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 are similarly effective and less invasive.
The prevalence of fetishism is not known with certainty. The majority of fetishists are male. In a 2011 study, 30% of men reported fetishistic fantasies, and 24.5% had engaged in fetishistic acts. Of those reporting fantasies, 45% said the fetish was intensely sexually arousing. In a 2014 study, 26.3% of women and 27.8% of men acknowledged any fantasies about "having sex with a fetish or non-sexual object". A content analysis of the sample's favorite fantasies found that 14% of the male fantasies involved fetishism (including feet, nonsexual objects, and specific clothing), and 4.7% focused on a specific body part other than feet. None of the women's favorite fantasies had fetishistic themes. Another study found that 28% of men and 11% of women reported fetishistic arousal (including feet, fabrics, and objects "like shoes, gloves, or plush toys"). 18% of men in a 1980 study reported fetishistic fantasies.
Fetishism to the extent that it becomes a disorder appears to be rare, with less than 1% of general psychiatric patients presenting fetishism as their primary problem. It is also uncommon in forensic populations.
Psychosexual disorders can vary greatly in severity and treatability. Medical professionals and licensed therapists are necessary in diagnosis and treatment plans. Treatment can vary from therapy to prescription medication. Sex therapy, behavioral therapy, and group therapy may be helpful to those suffering distress from sexual dysfunction. More serious sexual perversions may be treated with androgen blockers or selective serotonin reuptake inhibitors (SSRIs) to help restore hormonal and neurochemical balances.
Transvestism is the practice of dressing and acting in a style or manner traditionally associated with the opposite sex. In some cultures, transvestism is practiced for religious, traditional or ceremonial reasons.
The Internet has enabled people with this relatively rare paraphilia to discuss the subject and exchange anesthesia-related multimedia.
HSDD, like many sexual dysfunctions, is something that people are treated for in the context of a relationship. Theoretically, one could be diagnosed with, and treated for, HSDD without being in a relationship. However, relationship status is the most predictive factor accounting for distress in women with low desire and distress is required for a diagnosis of HSDD. Therefore, it is common for both partners to be involved in therapy. Typically, the therapist tries to find a psychological or biological cause of the HSDD. If the HSDD is organically caused, the clinician may try to deal with that. If the clinician believes it is rooted in a psychological problem, they may recommend therapy for that. If not, treatment generally focuses more on relationship and communication issues, improved communication (verbal and nonverbal), working on non-sexual intimacy, or education about sexuality may all be possible parts of treatment. Sometimes problems occur because people have unrealistic perceptions about what normal sexuality is and are concerned that they do not compare well to that, and this is one reason why education can be important. If the clinician thinks that part of the problem is a result of stress, techniques may be recommended to more effectively deal with that. Also, it can be important to understand why the low level of sexual desire is a problem for the relationship because the two partners may associate different meaning with sex but not know it.
In the case of men, the therapy may depend on the subtype of HSDD. Increasing the level of sexual desire of a man with lifelong/generalized HSDD is unlikely. Instead the focus may be on helping the couple to adapt. In the case of acquired/generalized, it is likely that there is some biological reason for it and the clinician may attempt to deal with that. In the case of acquired/situational, some form of psychotherapy may be used, possibly with the man alone and possibly together with his partner.
Flibanserin is the first and only medication approved for women for the treatment of HSDD. It is only slightly effective over placebo, having been found to increase the average number of satisfying sexual events per month by 0.5 to 1. The side effects of dizziness, sleepiness, and nausea occur about three to four times more often. Overall improvement is slight to none.
Diaper fetishism, nappy fetishism or diaperism, is a type of garment fetish or paraphilic infantilism. A person with a diaper fetish derives pleasure from the diaper and/or use of it. Being forced to wear diapers as a form of humiliation is sometimes a behavior encountered in sexual masochism.
It is important to note that the diaper fetish community actively opposes and condemns child molesters. Both men and women can practice diaper fetishes, both inside and outside a relationship. As of September 2015, Huffington Post Arts & Culture published an interview on diaper fetishes that was widely regarded as informative within the community. While this clothing fetish is obscure, diaper fetishists engage in the behavior privately or with a partner who shares a mutual interest in the fetish.
Anesthesia fetish is considered edgeplay when realised outside the boundaries of fantasy, and may result in various degrees of harm, or death. Fantasies are elaborated by the viewing of images and reading of stories of anesthetic inductions. Edgeplay may involve obtaining and scening with various anesthesia-related paraphernalia—usually anesthesia masks for breathplay, the acquisition of anesthetics for anesthetizing others or being anesthetized oneself, and the occupation of a medical setting or environment for the same practice.
Some anesthesia fetishists who seek to be anesthetized may feign or induce medical conditions in an attempt to obtain general anesthesia from medical personnel. This is considered safer than playing with anesthetic agents outside of a medical setting, but may nevertheless be an abuse of all concerned.
In 2007, a study was conducted by the University of Bologna on around 5000 fetishist participants to see the prevalence of fetishes. The study analyzed the content inside online fetish communities and found only 669 participants referring to nails, an extension of hand fetishism. This did not refer to fingernails specifically, and the amount of 669 was less than 1% of the participants.
The following are some of the partialisms commonly found among people:
Diaper fetishists and diaper lovers (DLs) are often associated with adult babies, as both wear diapers, but the former do not engage in childlike behavior, while that is the distinguishing characteristic of adult babies (ABs). The majority of diaper lovers do not engage in any kind of infantile activity and are only interested in diapers. However, in certain individuals it is possible for an overlap to occur, as one can view themselves as neither exclusively an adult baby nor a diaper lover. Hence adult babies and diaper lovers collectively refer to themselves as AB/DLs. Diapers and rubber pants with "baby" prints are sold in adult sizes.
Hand fetishism or hand partialism or also Quirofilia is the sexual fetish for hands. This may include the sexual attraction to a specific area such as the fingers, palm or nails, or the attraction to a specific action performed by the hands; which may otherwise be considered non-sexual—such as washing or drying dishes. This fetish may manifest itself as a desire to experience physical interaction, or as a source of sexual fantasy.
Hand fetishism is recognized by the porn industry; however, it is one of the least common fetishes, despite foot fetishism being the most common.
Hand fetishism is usually based in the biological indication that a partner is healthy and a good potential mate.
A fetish (derived from the French "fétiche"; which comes from the Portuguese "feitiço"; and this in turn from Latin "facticius", "artificial" and "facere", "to make") is an object believed to have supernatural powers, or in particular, a human-made object that has power over others. Essentially, fetishism is the emic attribution of inherent value or powers to an object.
Erotophobia is a term coined by a number of researchers in the late 1970s and early 1980s to describe one pole on a continuum of attitudes and beliefs about sexuality. The model of the continuum is a basic polarized line, with erotophobia (fear of sex or negative attitudes about sex) at one end and erotophilia (positive feelings or attitudes about sex) at the other end.
The word erotophobia is derived from the name of Eros, the Greek god of erotic love, and Phobos, Greek (φόβος) for "fear".
Acrotomophiles may be attracted to amputees because they like the way they look or they may view the amputee’s stump as a phallic object which can be used for sexual pleasure.A small number of Acrotomophiles may enjoy the idea of dominating the amputee during couples play and they may also become aroused with the thought of having to take care of an amputee.
In order to determine the relative prevalences of different types of fetishes, scientists obtained a sample of at least 5000 individuals worldwide from 381 Internet discussion groups. The relative prevalences were estimated based on (a) the number of groups devoted to a particular fetish, (b) the number of individuals participating in the groups and (c) the number of messages exchanged. Using these measures, feet and shoes were found to be the most common target of preferences. This is consistent with an analysis of millions of search queries by users from the USA that were accidentally released during the AOL search data scandal. Sixty-four (64) percent of the sampled population that had a preference for an object associated with the body had a preference for shoes, boots, and other footwear.
Males with late onset gender dysphoria "frequently" display transvestic fetishism.
Some male transvestic fetishists collect women's clothing, e.g. panties, nightgowns, babydolls, bridal gowns, slips, brassieres, and other types of nightwear, lingerie, stockings, pantyhose, shoes, and boots, items of a distinct feminine look and feel. They may dress in these feminine garments and take photographs of themselves while living out their fantasies.
According to DSM-IV, this fetishism was limited to heterosexual men; however, DSM-5 does not have this restriction, and opens it to women and men with this interest, regardless of their sexual orientation.
There are two key criteria before a psychiatric diagnosis of "transvestic fetishism" is made:
1. Individuals must be sexually aroused by the act of cross-dressing.
2. Individuals must experience significant distress or impairment – socially or occupationally – because of their behavior.
Although macrophilia literally translates to simply a "lover of large," in the context of a sexual fantasy, it is used to mean someone who is attracted to beings larger than themselves. Generally, the interest differs between people, and depends on gender and sexual orientation. They often enjoy feeling small and being abused, degraded, dominated, or eaten, and they may also view female giants as being powerful and dominating.
Commenting on why there are not as many female macrophiles, psychologist Helen Friedman theorized that because women in most societies already view men as dominant and powerful, there is no need for them to fantasize about it. Women that take on the roles of the giantess within this fetish often find the practice to be empowering and enjoy being worshipped.
The roots of macrophilia may lie in sexual arousal in childhood and early adolescence which is accidentally associated with giants, according to Dr. Mark Griffiths's speculation.
Acrotomophilia (from the Greek ἀκρότομος "having the top cut off" (from ἄκρον "akron" "extremity" and -τομος "-tomos" from τέμνω "temno" "I cut") and φιλία "philia" "love") is a paraphilia in which an individual expresses strong sexual interest in amputees. It is a counterpart to "apotemnophilia", the sexual interest in "being" an amputee.
Mysophilia relates to soiled or dirty material or people. Mysophiliacs may find dirt, soiled underwear, feces, or vomit to be sexually arousing.
It is possible for people with mysophilia to be aroused by unclean locales, such as an alleyway, or a dirty room/bathroom; wearing the same clothing for many days at a time; or not bathing, from mere days to several weeks.
Macrophilia is a fascination with or a sexual fantasy involving giants, more commonly expressed as giantesses (female giants). It is typically a male fantasy, with the male playing the "smaller" part—entering, being dominated, or being eaten by the larger woman. Others involve partners who naturally have a significant difference in size.
Though coined as late as the 1910s, the phenomenon is not new. It was referred to in the Hebrew Bible. The word has undergone several changes of meaning since it was first coined and is still used in a variety of senses. Today, the term "transvestite" is commonly considered outdated and derogatory, with the term "cross-dresser" used as a more appropriate replacement. This is because the term "transvestite" was historically used to diagnose medical disorders, including mental health disorders, and transvestism was viewed as a disorder, but the term "cross-dresser" was coined by the transgender community. In some cases, however, the term "transvestite" is seen as more appropriate for use by members of the transgender community instead of by those outside of the transgender community, and some have reclaimed the word.