The DSM-IV-TR criteria was criticized simultaneously for being over-inclusive, as well as under-inclusive. Though most researchers distinguish between child molesters and pedophiles, Studer and Aylwin argue that the DSM criteria are over-inclusive because all acts of child molestation warrant the diagnosis. A child molester satisfies criteria A because of the behavior involving sexual activity with prepubescent children and criteria B because the individual has acted on those urges. Furthermore, they argue that it also is under-inclusive in the case of individuals who do not act upon it and are not distressed by it. The latter point has also been made by several other researchers who have remarked that a so-called "contented pedophile"—an individual who fantasizes about having sex with a child and masturbates to these fantasies, but does not commit child sexual abuse, and who does not feel subjectively distressed afterward—does not meet the DSM-IV-TR criteria for pedophilia, because this person does not meet Criterion B. A large-scale survey about usage of different classification systems showed that the DSM classification is only rarely used. As an explanation, it was suggested that the under-inclusiveness, as well as a lack of validity, reliability and clarity might have led to the rejection of the DSM classification.

Ray Blanchard, an American-Canadian sexologist known for his research studies on pedophilia, addressed (in his literature review for the DSM-5) the aforementioned objections to the DSM-IV-TR, and proposed a general solution applicable to all paraphilias. This meant namely a distinction between "paraphilia" and "paraphilic disorder". The latter term is proposed to identify the diagnosable mental disorder which meets Criterion A and B, whereas an individual who does not meet Criterion B can be ascertained but "not" diagnosed as having a paraphilia. Blanchard and a number of his colleagues also proposed that hebephilia become a diagnosable mental disorder under the DSM-5 to resolve the physical development overlap between pedophilia and hebephilia by combining the categories under "pedophilic disorder", but with specifiers on which age range (or both) is the primary interest. The proposal for hebephilia was rejected by the American Psychiatric Association, but the distinction between "paraphilia" and "paraphilic disorder" was implemented.

The American Psychiatric Association stated that "[i]n the case of pedophilic disorder, the notable detail is what wasn't revised in the new manual. Although proposals were discussed throughout the DSM-5 development process, diagnostic criteria ultimately remained the same as in DSM-IV TR" and that "[o]nly the disorder name will be changed from pedophilia to pedophilic disorder to maintain consistency with the chapter’s other listings." If hebephilia had been accepted as a DSM-5 diagnosable disorder, it would have been similar to the ICD-10 definition of pedophilia that already includes early pubescents, and would have raised the minimum age required for a person to be able to be diagnosed with pedophilia from 16 years to 18 years (with the individual needing to be at least 5 years older than the minor).

O'Donohue, however, suggests that the diagnostic criteria for pedophilia be simplified to the attraction to children alone if ascertained by self-report, laboratory findings, or past behavior. He states that any sexual attraction to children is pathological and that distress is irrelevant, noting "this sexual attraction has the potential to cause significant harm to others and is also not in the best interests of the individual." Also arguing for behavioral criteria in defining pedophilia, Howard E. Barbaree and Michael C. Seto disagreed with the American Psychiatric Association's approach in 1997 and instead recommended the use of actions as the sole criterion for the diagnosis of pedophilia, as a means of taxonomic simplification.

The "Diagnostic and Statistical Manual of Mental Disorders" 5th edition (DSM-5) has a significantly larger diagnostic features section for pedophilia than the previous DSM version, the DSM-IV-TR, and states, "The diagnostic criteria for pedophilic disorder are intended to apply both to individuals who freely disclose this paraphilia and to individuals who deny any sexual attraction to prepubertal children (generally age 13 years or younger), despite substantial objective evidence to the contrary." Like the DSM-IV-TR, the manual outlines specific criteria for use in the diagnosis of this disorder. These include the presence of sexually arousing fantasies, behaviors or urges that involve some kind of sexual activity with a prepubescent child (with the diagnostic criteria for the disorder extending the cut-off point for prepubescence to age 13) for six months or more, or that the subject has acted on these urges or suffers from distress as a result of having these feelings. The criteria also indicate that the subject should be 16 or older and that the child or children they fantasize about are at least five years younger than them, though ongoing sexual relationships between a 12- to 13-year-old and a late adolescent are advised to be excluded. A diagnosis is further specified by the sex of the children the person is attracted to, if the impulses or acts are limited to incest, and if the attraction is "exclusive" or "nonexclusive".

The ICD-10 defines pedophilia as "a sexual preference for children, boys or girls or both, usually of prepubertal or early pubertal age". Like the DSM, this system's criteria require that the person be at least 16 years of age or older before being diagnosed as a pedophile. The person must also have a persistent or predominant sexual preference for prepubescent children at least five years younger than them.

Several terms have been used to distinguish "true pedophiles" from non-pedophilic and non-exclusive offenders, or to distinguish among types of offenders on a continuum according to strength and exclusivity of pedophilic interest, and motivation for the offense (see child sexual offender types). Exclusive pedophiles are sometimes referred to as "true pedophiles." They are sexually attracted to prepubescent children, and only prepubescent children. Showing no erotic interest in adults, they can only become sexually aroused while fantasizing about or being in the presence of prepubescent children, or both. Non-exclusive offenders—or "non-exclusive pedophiles"—may at times be referred to as "non-pedophilic" offenders, but the two terms are not always synonymous. Non-exclusive offenders are sexually attracted to both children and adults, and can be sexually aroused by both, though a sexual preference for one over the other in this case may also exist. If the attraction is a sexual preference for prepubescent children, such offenders are considered pedophiles in the same vein as exclusive offenders.

Neither the DSM nor the ICD-10 diagnostic criteria require actual sexual activity with a prepubescent youth. The diagnosis can therefore be made based on the presence of fantasies or sexual urges even if they have never been acted upon. On the other hand, a person who acts upon these urges yet experiences no distress about their fantasies or urges can also qualify for the diagnosis. "Acting" on sexual urges is not limited to overt sex acts for purposes of this diagnosis, and can sometimes include indecent exposure, voyeuristic or frotteuristic behaviors, or masturbating to child pornography. Often, these behaviors need to be considered in-context with an element of clinical judgment before a diagnosis is made. Likewise, when the patient is in late adolescence, the age difference is not specified in hard numbers and instead requires careful consideration of the situation.

Ego-dystonic sexual orientation () includes people who acknowledge that they have a sexual preference for prepubertal children, but wish to change it due to the associated psychological or behavioral problems (or both).

Uniform fetishism is a sexual fetishism where an individual is sexually aroused by uniforms.

Historically voyeurism has been treated in a variety of ways. Psychoanalytic, group psychotherapy and shock aversion approaches have all been attempted with limited success. There is some evidence that shows that pornography can be used as a form of treatment for voyeurism. This is based on the idea that countries with pornography censorship have high amounts of voyeurism. Additionally shifting voyeurs from voyeuristic behavior, to looking at graphic pornography, to looking at the nudes in Playboy has been successfully used as a treatment. These studies show that pornography can be used as a means of satisfying voyeuristic desires without breaking the law.

Voyeurism has also been successfully treated with a mix of anti-psychotics and antidepressants. However the patient in this case study had a multitude of other mental health problems. Intense pharmaceutical treatment may not be required for most voyeurs.

There has also been success in treating voyeurism through using treatment methods for obsessive compulsive disorder. There have been multiple instances of successful treatment of voyeurism through putting patients on fluoxetine and treating their voyeuristic behavior as a compulsion.

Bondage pornography is the depiction of sexual bondage or other BDSM activities using photographs, stories, movies or drawings. Though often described as pornography, the genre involves the presentation of bondage fetishism or BDSM scenarios and does not necessarily involve the commonly understood pornographic styles. In fact, the genre is primarily interested with the presentation of a bondage scene and less with depictions of sexuality, such as nudity or sex scenes, which may be viewed as a distraction from the aesthetics and eroticism of the bondage scenario itself.

Historically, most subjects of bondage imagery have been women, and the genre has been criticized for promoting misogynistic attitudes and violence against women.

Although small spy cameras had existed for decades, advances in miniaturization and electronics since the 1950s have greatly aided the ability to conceal miniature cameras, and the quality and affordability of tiny cameras (often called "spy cameras" or subminiature cameras) has greatly increased. Some consumer digital cameras are now so small that in previous decades they would have qualified as "spy cameras", and digital cameras of twenty megapixels or more are now being embedded in some mobile camera phones. The vast majority of mobile phones in use are camera phones.

Certain image capturing devices are capable of producing images through materials that are opaque to visible light, including clothing. These devices form images by using electromagnetic radiation outside the visible range. Infrared and terahertz-wave cameras are capable of creating images through clothing, though these images differ from what would be created with visible light.

Mechanophilia (or mechaphilia) is a paraphilia involving a sexual attraction to machines such as bicycles, motor vehicles, helicopters, ships, and aeroplanes.

Mechanophilia is treated as a crime in some nations with perpetrators being placed on a sex-offenders' register after prosecution. Motorcycles are often portrayed as sexualized fetish objects to those who desire them.

Clothing fetishism or garment fetishism is a sexual fetish that revolves around a fixation upon a particular article or type of clothing, a collection of garments that appear as part of a fashion or uniform, or a person dressed in such a garment.

The clinical definition of a sexual fetish would require that a person be fixated on a specific garment to the extent that it exists as a recurrent (or exclusive) stimulus for sexual gratification.

One who exhibits a clothing fetish may be aroused by the sight of a person wearing a particular garment, or by wearing the garment oneself which can be because of the look one achieves by wearing it or the way it feels while it is being worn (and might also get some arousal by seeing somebody in it and imagining how it feels). In later case arousal may originate from the way its fabric feels (see clothing fetish by fabric type) or from the way the garment feels and functions as whole (restrictive clothing being an example).

Others with a clothing fetish may be aroused by the sight of such garments, even without wearing them and in the absence of other person wearing them, and may also derive pleasure from collecting them.

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".

Zoophilia is a paraphilia involving a sexual fixation on non-human animals. Bestiality is cross-species sexual activity between human and non-human animals. The terms are often used interchangeably, but some researchers make a distinction between the attraction (zoophilia) and the act (bestiality).

Although sex with animals is not outlawed in some countries, in most countries, bestiality is illegal under animal abuse laws or laws dealing with buggery or crimes against nature.

Among the most common uniforms in uniform fetish are those of a police officer, prison officer, soldier, schoolgirl, nurse, French maid, waitress, cheerleader, and Playboy Bunny. Some people also regard nuns' habits or even aprons as uniforms. The uniforms may be genuine, realistic, or they may be sexualized through the use of a very short miniskirt, a very long hobble skirt or a corset, through the use of stockings, fishnet tights, or high heels, or by being made of leather or latex, according to preference. Sometimes uniforms are used according to what activity is being done. For example, someone may wear a nurse's uniform to administer an enema or a police uniform to handcuff and cage someone. Two people may dress as inmates for cell mate-on-cell mate activities in a prison setting or as a submissive to a third (prison guard) roleplayer. This may add a sense of authenticity to the game play. A stripper dressed as a police officer is a popular fixture at birthday and bachelor parties. The "officer" begins with a mock "arrest", often using handcuffs, of the guest of honor before going into a dance routine.

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.

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.

Sadomasochism is the giving or receiving pleasure from acts involving the receipt or infliction of pain or humiliation. Practitioners of sadomasochism may seek sexual gratification from their acts. While the terms sadist and masochist refer respectively to one who enjoys giving or receiving pain, practitioners of sadomasochism may switch between activity and passivity.

The abbreviation S&M is often used for sadomasochism, although practitioners themselves normally remove the ampersand and use the acronym S-M or SM or S/M when written throughout the literature. Sadomasochism is not considered a clinical paraphilia unless such practices lead to clinically significant distress or impairment for a diagnosis. Similarly, sexual sadism within the context of mutual consent, generally known under the heading BDSM, is distinguished from non-consensual acts of sexual violence or aggression.

Wet and messy fetish (WAM), also known as sploshing, is a form of sexual fetishism whereby a person becomes aroused when copious amounts of a substance are applied to the naked skin, face, or to clothing. Several websites are dedicated to WAM.

Many people with WAM fetishes are drawn to the tactile sensations of wet or messy substances against their skin. Other individuals simply prefer the visual appeal of others getting wet or messy with products that have different textures, consistencies and colours. A subject will often be pelted with cream pies (sometimes using shaving foam rather than real cream pie filling), have slime dumped on them, or sit on cakes. Another common theme is the pouring of substances inside clothing while it is being worn; clothing chosen for this can vary from swimsuits or underwear to full outfits. Normal street clothes, either casual or office wear, are commonly featured in WAM productions, but many other types of outfits, from wedding attire to industrial overalls or more specialist fetishwear such as PVC, latex, or leather items may be used. White items are particularly popular with some fans of this fetish.

Messy substances most commonly focused on by WAM participants include whipped cream, raw eggs, milk, lotion (see lotion play), paint, oil, mud, pudding, chocolate sauce, fruit juice, beer, shaving foam, custard, baked beans, treacle, ketchup, ice cream, peanut butter, slime, and cake batter, among others.

A fetish for bodily fluids such as feces, urine, vomit, semen, and female ejaculate is not considered part of WAM. The former three are typically considered coprophilia, urophilia, and emetophilia; urophilia is somewhat commonly found in mainstream pornography. The latter two are also somewhat mainstream.

WAM fetish videos (made by both fans and commercial producers) may include nudity and sexual acts, while others may only feature fully clothed participants. Videos can be seen frequently public video hosting sites like YouTube. Some of these videos are flagged but most of them remain available despite the sexual undertones, mainly because a large majority of wet and messy videos posted publicly do not include nudity and are therefore considered suitable for all audiences to view. Indeed, not only is much WAM video content indistinguishable in any easily defined sense from the kind of slapstick featured in mainstream entertainment, but scenes of slimings or pieings from the mainstream media are often compiled and marketed by producers towards a WAM fetishist target audience.

BDSM is a variety of often erotic practices or roleplaying involving bondage, discipline, dominance and submission, sadomasochism, and other related interpersonal dynamics. Given the wide range of practices, some of which may be engaged in by people who do not consider themselves as practicing BDSM, inclusion in the BDSM community or subculture is usually dependent upon self-identification and shared experience.

The term "BDSM" is first recorded in a Usenet posting from 1991, and is interpreted as a combination of the abbreviations B/D (Bondage and Discipline), D/s (Dominance and submission), and S/M (Sadism and Masochism). BDSM is now used as a catch-all phrase covering a wide range of activities, forms of interpersonal relationships, and distinct subcultures. BDSM communities generally welcome anyone with a non-normative streak who identifies with the community; this may include cross-dressers, body modification enthusiasts, animal roleplayers, rubber fetishists, and others.

Activities and relationships within a BDSM context are often characterized by the participants taking on complementary, but unequal roles; thus, the idea of informed consent of both the partners is essential. The terms "submissive" and "dominant" are often used to distinguish these roles: the dominant partner ("dom") takes psychological control over the submissive ("sub"). The terms "top" and "bottom" are also used: the top is the instigator of an action while the bottom is the receiver of the action. The two sets of terms are subtly different: for example, someone may choose to act as bottom to another person, for example, by being whipped, purely recreationally, without any implication of being psychologically dominated by them, or a submissive may be ordered to massage their dominant partner. Despite the bottom performing the action and the top receiving they have not necessarily switched roles.

The abbreviations "sub" and "dom" are frequently used instead of "submissive" and "dominant". Sometimes the female-specific terms "mistress", "domme" or "dominatrix" are used to describe a dominant woman, instead of the gender-neutral term "dom". Individuals who can change between top/dominant and bottom/submissive roles—whether from relationship to relationship or within a given relationship—are known as "switches". The precise definition of roles and self-identification is a common subject of debate within the community.

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.

Some types of BDSM play include, but are not limited to:

- Animal roleplay

- Bondage

- Breast torture

- Cock and ball torture (CBT)

- Erotic electrostimulation

- Edgeplay

- Flogging

- Golden showers (urinating)

- Human furniture

- Japanese bondage

- Medical play

- Paraphilic infantilism

- Predicament bondage

- Pussy torture

- Sexual roleplay

- Spanking

- Suspension

- Torture

- Tickle torture

- Wax play

Erotophobia has many manifestations. An individual or culture can have one or multiple erotophobic attitudes. Some types of erotophobia include fear of nudity, fear of sexual images, homophobia, fear of sex education, fear of sexual discourse.

The Internet has enabled people with this relatively rare paraphilia to discuss the subject and exchange anesthesia-related multimedia.

In order to determine the relative prevalence of different fetishes, researchers at the University of Bologna 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. The top garment fetish was clothes worn on the legs or buttocks (such as stockings or skirts), followed by footwear, underwear, whole-body wear (such as costumes and coats), and upper-body wear (such as jackets or waistcoats).

Sexual sadism disorder is the condition of experiencing sexual arousal in response to the extreme pain, suffering or humiliation of others. Several other terms have been used to describe the condition, and the condition may overlap with other conditions that involve inflicting pain. It is distinct from situations in which consenting individuals use mild or simulated pain or humiliation for sexual excitement. The words "sadism" and "" are derived from Marquis de Sade.

There is some crossover between the wet and messy fetish and clothing destruction fetishes. Some WAM productions will see models start out fully dressed, usually in quite smart outfits such as formal dresses or suits; they will then be covered in messy substances, after which their messy clothes are cut up, typically with scissors, leaving them naked or nearly so.

WAM is sometimes also combined with bondage, where a subject is first restrained or chained up and then hosed down or messed up. Wet and Messy fetishism lends itself well to domination/submission role-playing.

"Cake Sitting" (the act of deliberately sitting on a large cake or gateaux, either clothed or nude) is often considered a sub-fetish in its own right, but may be linked to the Crush fetish. While participants who sit on cakes for pleasure will do so for the tactile sensory experience, or as part of submissive role-playing, those who enjoy watching the act will often focus specifically on the crushing of the dessert as a visual stimulus for a sexual reaction.

As with all activities involving bondage or potential risk to breathing, this is a risky activity. Maintaining an airway, preventing positional asphyxia, and ensuring that the enclosed person has a means of escape at all times are of paramount importance, if these activities are not to result in death.

See the articles on bondage, and erotic asphyxiation for some discussion of the risks involved.

There is no universal cure for genophobia. Some ways of coping with or treating anxiety issues is to see a psychiatrist, psychologist, or licensed counselor for therapy. Some people experiencing pain during sex may visit their doctor or gynecologist. Medicine may also be prescribed to treat the anxiety brought on by the phobia.