Most psychologists believe that paraphilic sexual interests cannot be altered. Instead, the goal of therapy is normally to reduce the person's discomfort with their paraphilia and limit any criminal behavior. Both psychotherapeutic and pharmacological methods are available to these ends.

Cognitive behavioral therapy, at times, can help people with paraphilias develop strategies to avoid acting on their interests. Patients are taught to identify and cope with factors that make acting on their interests more likely, such as stress. It is currently the only form of psychotherapy for paraphilias supported by evidence.

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.

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.

In the DSM-5 all paraphilia disorders can be diagnosed by two main criteria that are referred to criteria A and criteria B respectively. The A and B criteria include a duration in which the behavior must be present for (typically 6 months) and specific details of actions or thoughts that are correlated specifically with the respective disorder being diagnosed.

Frotteurism is a paraphilic interest in rubbing, usually one's pelvic area or erect penis, against a non-consenting person for sexual pleasure. It may involve touching any part of the body, including the genital area. A person who practices frotteuristic acts is known as a "frotteur". Toucherism is sexual arousal based on grabbing or rubbing one's hands against an unexpecting (and non-consenting) person. It usually involves touching breasts, buttocks or genital areas, often while quickly walking across the victim's path. Some psychologists consider toucherism a manifestation of frotteurism, while others distinguish the two. In clinical medicine, treatment of frotteuristic disorder involves cognitive behavior therapy coupled with the administration of a SSRI.

The prevalence of frotteurism is unknown. The DSM estimates that 10%–14% of men seen in clinical settings for paraphilias or hypersexuality have frotteuristic disorder, indicating that the population prevalence is lower. However, frotteuristic acts, as opposed to frotteuristic disorder, may occur in up to 30% of men in the general population. The majority of frotteurs are male and the majority of victims are female, although female on male, female on female, and male on male frotteurs exist. This activity is often done in circumstances where the victim cannot easily respond, in a public place such as a crowded train or concert.

Usually, such nonconsensual sexual contact is viewed as a criminal offense: a form of sexual assault albeit often classified as a misdemeanor with minor legal penalties. Conviction may result in a sentence or psychiatric treatment.

Courtship disorder is a theoretical construct in sexology in which a certain set of paraphilias are seen as specific instances of anomalous courtship instincts in men. The specific paraphilias are biastophilia (paraphilic rape), exhibitionism, frotteurism, telephone scatologia, and voyeurism. According to the "courtship disorder hypothesis", there is a species-typical courtship process in human males consisting of four phases, and anomalies in different phases result in one of these paraphilic sexual interests. That is, instead of being independent paraphilias, this theory sees these sexual interests as individual symptoms of a single underlying disorder.

According to the "courtship disorder hypothesis", there is a species-typical courtship process in humans consisting of four phases. These phases are: "(1) looking for and appraising potential sexual partners; (2) pretactile interaction with those partners, such as by smiling at and talking to them; (3) tactile interaction with them, such as by embracing or petting; (4) and then sexual intercourse."

The associations between these phases and these paraphilias were first outlined by Kurt Freund, the originator of the theory: A disturbance of the search phase of courtship manifests as voyeurism, a disturbance of the pretactile interaction phase manifests as exhibitionism or telephone scatologia, a disturbance of the tactile interaction phase manifests as toucheurism or frotteurism, and the absence of the courtship behavior phases manifests as paraphilic rape (i.e., biastophilia). According to Freund, these paraphilias "can be conceptualized as a preference for a pattern of behavior or erotic fantasy in which one of these four phases of sexual interaction is intensified and distorted to such an extent that it appears to be a caricature of the normal, while the remaining phases are either omitted entirely or are retained only in a vestigial way."

Freund noted that "troilism" (a paraphilia for observing one’s sexual/romantic partner sexually interacting with a third party, usually unbeknownst to the third party) might also be a courtship disorder, troilism being a variant of voyeurism.

Appropriate behaviors depend on the social and cultural context, including time and place. Some behaviors that are unacceptable under most circumstances, such as public nudity or sexual contact between dancers, may be accepted or even encouraged during celebrations like Carnival or Mardi Gras. Where such cultural festivals alter normative courtship behaviors, the signs of courtship disorder may be masked or altered.