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.

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.

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.

With paraphilic coercive disorder, the individual employs enough force to subdue a victim, but with sexual sadism disorder, the individual often continues to inflict harm regardless of the compliance of the victim, which sometimes escalates not only to the death of the victim, but also to the mutilation of the body. What is experienced by the sadist as sexual does not always appear obviously sexual to non-sadists: Sadistic rapes do not necessarily include penile penetration of the victim. In a survey of offenses, 77% of cases included sexual bondage, 73% included anal rape, 60% included blunt force trauma, 57% included vaginal rape, and 40% included penetration of the victim by a foreign object. Moreover, in 40% of cases, the offender kept a personal item of the victim as a souvenir.

On personality testing, sadistic rapists apprehended by law enforcement have shown elevated traits of impulsivity, hypersexuality, callousness, and psychopathy.

Although there appears to be a continuum of severity from mild ("hyperdominance" or "BDSM") to moderate ("paraphilic coercive disorder") to severe ('sexual sadism disorder), it is not clear if they are genuinely related or only appear related superficially.

Very little is known about how sexual sadism disorder develops. Most of the people diagnosed with sexual sadism disorder come to the attention of authorities by committing sexually motivated crimes. Surveys have also been conducted including people who are interested in only mild and consensual forms of sexual pain/humiliation (BDSM).

Most of the people with full-blown sexual sadism disorder are male, whereas the sex ratio of people interested in BDSM is closer to 2:1 male-to-female.

People with sexual sadism disorder" are at an elevated likelihood of having other paraphilic sexual interests.

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.

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.

Vorarephilia (often shortened to vore) is a paraphilia characterized by the erotic desire to be consumed by, or sometimes to personally consume, another person or creature, or an erotic attraction to the process of eating in general. Since vorarephilic fantasies cannot usually be acted out in reality, they are often expressed in stories or drawings shared on the Internet. The word "vorarephilia" is derived from the Latin "vorare" (to "swallow" or "devour"), and Ancient Greek φιλία ("philía", "love").

The fantasy usually involves the victim being swallowed whole, though occasionally the victims are chewed up, and digestion may or may not be included. Vore fantasies are separated from sexual cannibalism because the living victim is normally swallowed whole. Sometimes the consumers are human, but anthropormorphized animals, dragons, and enormous snakes also appear frequently in these fantasies. After consumption, the enlarged belly of the consumer is often described with great care. Vorarephiles sometimes prefer to differentiate between "soft vore" and "hard vore"; soft vore means the victim is swallowed whole and alive, and may possibly come back out in the case of a "non-fatal" scenario, while in hard vore the victim goes through a more gruesome, realistic digestion process, often getting chewed up beforehand.

Vore is most often enjoyed through pictures, stories, videos, and video games, and it can appear in mainstream media. In some cases, vorarephilia may be described as a variation of macrophilia and may combine with other paraphilias. Apart from macrophilia, vore fantasies often have themes of BDSM, microphilia, pregnancy fetishism, furry fetishism, "unbirthing" (a desire to be swallowed whole into the vagina and returned to the uterus), and sexual cannibalism.

One case study analysis connected the fantasy with sexual masochism, and suggested that it could be motivated by a desire to merge with a powerful other or permanently escape loneliness. With "no known treatment" for vorarephiles who feel ill at ease with their sexuality, psychologists at Toronto's Centre for Addiction and Mental Health have recommended trying to "adjust to, rather than change or suppress" the sexual interest. Medication for sex drive reduction could be used if deemed necessary.

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.

BDSM is practiced in all social strata and is common in both heterosexual and homosexual men and women in varied occurrences and intensities. The spectrum ranges from couples with no connections to the subculture outside of their bedrooms or homes, without any awareness of the concept of BDSM, playing "tie-me-up-games", to public scenes on St. Andrew's crosses at large events such as the Folsom Street Fair in San Francisco. Estimation on the overall percentage of BDSM related sexual behaviour vary but it is no longer assumed to be uncommon.

Alfred Kinsey stated in his 1953 nonfiction book "Sexual Behavior in the Human Female" that 12% of females and 22% of males reported having an erotic response to a sadomasochistic story. In that book erotic responses to being bitten were given as:

A non-representative survey on the sexual behaviour of American students published in 1997 and based on questionnaires had a response rate of about 8–9%. Its results showed 15% of homosexual and bisexual males, 21% of lesbian and female bisexual students, 11% of heterosexual males and 9% of female heterosexual students committed to BDSM related fantasies. In all groups the level of practical BDSM experiences were around 6%. Within the group of openly lesbian and bisexual females the quote was significantly higher, at 21%. Independent of their sexual orientation, about 12% of all questioned students, 16% of lesbians and female bisexuals and 8% of heterosexual males articulated an interest in spanking. Experience with this sexual behaviour was indicated by 30% of male heterosexuals, 33% of female bisexuals and lesbians, and 24% of the male gay and bisexual men and female heterosexual women. Even though this study was not considered representative, other surveys indicate similar dimensions in a differing target groups.

A representative study done from 2001 to 2002 in Australia found that 1.8% of sexually active people (2.2% men, 1.3% women but no significant sex difference) had engaged in BDSM activity in the previous year. Of the entire sample, 1.8% men and 1.3% women had been involved in BDSM. BDSM activity was significantly more likely among bisexuals and homosexuals of both sexes. But among men in general, there was no relationship effect of age, education, language spoken at home, or relationship status. Among women, in this study, activity was most common for those between 16 and 19 years of age and least likely for females over 50 years. Activity was also significantly more likely for women who had a regular partner they did not live with, but was not significantly related with speaking a language other than English or education.

Another representative study, published in 1999 by the German Institut für rationale Psychologie, found that about 2/3 of the interviewed women stated a desire to be at the mercy of their sexual partners from time to time. 69% admitted to fantasies dealing with sexual submissiveness, 42% stated interest in explicit BDSM techniques, 25% in bondage. A 1976 study in the general US population suggests three percent have had positive experiences with Bondage or master-slave roleplaying. Overall 12% of the interviewed females and 18% of the males were willing to try it. A 1990 Kinsey Institute report stated that 5% to 10% of Americans occasionally engage in sexual activities related to BDSM. 11% of men and 17% of women reported trying bondage. Some elements of BDSM have been popularized through increased media coverage since the middle 1990s. Thus both black leather clothing, sexual jewellery such as chains and dominance roleplay appear increasingly outside of BDSM contexts.

According to yet another survey of 317,000 people in 41 countries, about 20% of the surveyed have at least used masks, blindfolds or other bondage utilities once, and 5% explicitly connected themselves with BDSM. In 2004, 19% mentioned spanking as one of their practices and 22% confirmed the use of blindfolds or handcuffs.

A 1985 study found 52 out of 182 female respondents (28%) were involved in sadomasochistic activities.

- Recent surveys

A 2009 study on two separate samples of male undergraduate students in Canada found that 62 to 65%, depending on the sample, had entertained sadistic fantasies, and 22 to 39% engaged in sadistic behaviors during sex. The figures were 62 and 52% for bondage fantasies, and 14 to 23% for bondage behaviors. A 2014 study involving a mixed sample of Canadian college students and online volunteers, both male and female, reported that 19% of male samples and 10% of female samples rated the sadistic scenarios described in a questionnaire as being at least "slightly arousing" on a scale that ranged from "very repulsive" to "very arousing"; the difference was statistically significant. The corresponding figures for the masochistic scenarios were 15% for male students and 17% for female students, a non-significant difference. In a 2011 study on 367 middle-aged and elderly men recruited from the broader community in Berlin, 21.8% of the men self-reported sadistic fantasies and 15.5% sadistic behaviors; 24.8% self-reported any such fantasy and/or behavior. The corresponding figures for self-reported masochism were 15.8% for fantasy, 12.3% for behavior, and 18.5% for fantasy and/or behavior. In a 2008 study on gay men in Puerto Rico, 14.8% of the over 425 community volunteers reported any sadistic fantasy, desire or behavior in their lifetime; the corresponding figure for masochism was 15.7%. A 2017 cross-sectional representative survey among the general Belgian population demonstrated a substantial prevalence of BDSM fantasies and activities; 12.5% of the population performed one of more BDSM-practices on a regular basis.

Gynophobia or gynephobia is an abnormal fear of women, a type of specific social phobia. In the past, the Latin term horror feminae was used.

Gynophobia should not be confused with misogyny, the hatred, contempt for and inveterate prejudice against women, although some may use the terms interchangeably, in reference to the social, rather than pathological aspect of negative attitudes towards women.

An antonym is philogyny, the love, respect for and admiration of women.

The term "sadomasochism" is used in a variety of different ways. It can refer to cruel individuals or those who brought misfortunes onto themselves and psychiatrists define it as pathological. However, recent research suggests that sadomasochism is mostly simply a sexual interest, and not a pathological symptom of past abuse, or a sexual problem, and that people with sadomasochistic sexual interest are in general neither damaged nor dangerous.

The two words incorporated into this compound, "sadism" and "masochism", were originally derived from the names of two authors. The term "Sadism" has its origin in the name of the Marquis de Sade (1740–1814), who not only practiced sexual sadism, but also wrote novels about these practices, of which the best known is "Justine". "Masochism" is named after Leopold von Sacher-Masoch, who wrote novels expressing his masochistic fantasies. These terms were first selected for identifying human behavioural phenomena and for the classification of psychological illnesses or deviant behaviour. The German psychiatrist Richard von Krafft-Ebing introduced the terms "Sadism" and "Masochism"' into medical terminology in his work "Neue Forschungen auf dem Gebiet der Psychopathia sexualis" ("New research in the area of Psychopathology of Sex") in 1890.

In 1905, Sigmund Freud described sadism and masochism in his "Drei Abhandlungen zur Sexualtheorie" ("Three papers on Sexual Theory") as stemming from aberrant psychological development from early childhood. He also laid the groundwork for the widely accepted medical perspective on the subject in the following decades. This led to the first compound usage of the terminology in "Sado-Masochism" (Loureiroian "Sado-Masochismus") by the Viennese Psychoanalyst Isidor Isaak Sadger in his work "Über den sado-masochistischen Komplex" ("Regarding the sadomasochistic complex") in 1913.

In the later 20th century, BDSM activists have protested against these ideas, because, they argue, they are based on the philosophies of the two psychiatrists, Freud and Krafft-Ebing, whose theories were built on the assumption of psychopathology and their observations of psychiatric patients. The DSM nomenclature referring to sexual psychopathology has been criticized as lacking scientific veracity, and advocates of sadomasochism have sought to separate themselves from psychiatric theory by the adoption of the term "BDSM" instead of the common psychological abbreviation, "S&M". However, the term BDSM also includes, B&D (bondage and discipline), D/s (dominance and submission), and S&M ( and masochism). The terms "bondage" and "discipline" usually refer to the use of either physical or psychological restraint or punishment, and sometimes involves sexual role playing, including the use of costumes.

In contrast to frameworks seeking to explain sadomasochism through psychological, psychoanalytic, medical or forensic approaches, which seek to categorize behavior and desires, and find a root cause, Romana Byrne suggests that such practices can be seen as examples of "aesthetic sexuality", in which a founding physiological or psychological impulse is irrelevant. Rather, according to Byrne, sadism and masochism may be practiced through choice and deliberation, driven by certain aesthetic goals tied to style, pleasure, and identity, which in certain circumstances, she claims can be compared with the creation of art.

Theodore Millon has proposed four subtypes of masochist. Any individual masochist may fit into none, one or more of the following subtypes:

Until the 1990s, it tended to be described mostly as acrotomophilia, at the expense of other disabilities, or of the wish by some to pretend or acquire disability. Bruno (1997) systematised the attraction as factitious disability disorder. A decade on, others argue that erotic target location error is at play, classifying the attraction as an identity disorder. In the standard psychiatric reference "Diagnostic and Statistical Manual of Mental Disorders", text revision (DSM-IV-tr), the fetish falls under the general category of "Sexual and Gender Identity Disorders" and the more specific category of paraphilia, or sexual fetishes; this classification is preserved in DSM-5.

Historically, masochism has been associated with feminine submissiveness. This disorder became politically controversial when associated with domestic violence which was considered to be mostly caused by males. However a number of studies suggest that the disorder is common. In spite of its exclusion from DSM-IV in 1994, it continues to enjoy widespread currency amongst clinicians as a construct that explains a great many facets of human behaviour.

Sexual masochism that "causes clinically significant distress or impairment in social, occupational, or other important areas of functioning" is still in DSM-IV.

Attraction to disability or devotism is a sexualised interest in the appearance, sensation and experience of disability. It may extend from normal human sexuality into a type of sexual fetishism. Sexologically, the pathological end of the attraction tends to be classified as a paraphilia. (Note, however, that the very concept "paraphilia" continues to elude satisfactory definition and remains a subject of ongoing debate in both professional and lay communities) Other researchers have approached it as a form of identity disorder. The most common interests are towards amputations, prosthesis, and crutches.

There is a considerable personality disorder diagnostic co-occurrence. Patients who meet the DSM-IV-TR diagnostic criteria for one personality disorder are likely to meet the diagnostic criteria for another. Diagnostic categories provide clear, vivid descriptions of discrete personality types but the personality structure of actual patients might be more accurately described by a constellation of maladaptive personality traits.

"Sites used DSM-III-R criterion sets. Data obtained for purposes of informing the development of the DSM-IV-TR personality disorder diagnostic criteria."

Abbreviations used: "PPD – Paranoid Personality Disorder, SzPD – Schizoid Personality Disorder, StPD – Schizotypal Personality Disorder, ASPD – Antisocial Personality Disorder, BPD – Borderline Personality Disorder, HPD – Histrionic Personality Disorder, NPD – Narcissistic Personality Disorder, AvPD – Avoidant Personality Disorder, DPD – Dependent Personality Disorder, OCPD – Obsessive-Compulsive Personality Disorder, PAPD – Passive-Aggressive Personality Disorder."

Child abuse and neglect consistently show up as risk factors to the development of personality disorders in adulthood. A study looked at retrospective reports of abuse of participants that had demonstrated psychopathology throughout their life and were later found to have past experience with abuse. In a study of 793 mothers and children, researchers asked mothers if they had screamed at their children, and told them that they did not love them or threatened to send them away. Children who had experienced such verbal abuse were three times as likely as other children (who did not experience such verbal abuse) to have borderline, narcissistic, obsessive-compulsive or paranoid personality disorders in adulthood. The sexually abused group demonstrated the most consistently elevated patterns of psychopathology. Officially verified physical abuse showed an extremely strong correlation with the development of antisocial and impulsive behavior. On the other hand, cases of abuse of the neglectful type that created childhood pathology were found to be subject to partial remission in adulthood.

Gynophobia was previously considered a driving force toward homosexuality. In his 1896 "Studies in the Psychology of Sex", Havelock Ellis wrote:

It is, perhaps, not difficult to account for the horror – much stronger than that normally felt toward a person of the same sex – with which the invert often regards the sexual organs of persons of the opposite sex. It cannot be said that the sexual organs of either sex under the influence of sexual excitement are esthetically pleasing; they only become emotionally desirable through the parallel excitement of the beholder. When the absence of parallel excitement is accompanied in the beholder by the sense of unfamiliarity as in childhood, or by a neurotic hypersensitiveness, the conditions are present for the production of intense "horror feminae" or "horror masculis", as the case may be. It is possible that, as Otto Rank argues in his interesting study, "Die Nacktheit in Sage und Dichtung," ["sic"] this horror of the sexual organs of the opposite sex, to some extent felt even by normal people, is embodied in the Melusine type of legend.

In his book "Sadism and Masochism: The Psychology of Hatred and Cruelty", Wilhelm Stekel discusses "horror feminae" of a male masochist.

In "The Dread of Woman" (1932), Karen Horney traced the male dread of woman to the boy's fear that his genital is inadequate in relation to the mother.

Professor Eva Keuls argues that violent Amazons are the evidence of the obsessive fear of women in Classical Athens.

A cuckold is the husband of an adulterous wife. In evolutionary biology, the term is also applied to males who are unwittingly investing parental effort in offspring that are not genetically their own.

Psychology regards cuckold fetishism as a variant of masochism, the cuckold deriving pleasure from being humiliated. In Freudian analysis, cuckold fetishism is the eroticization of the fears of infidelity and of failure in the man's competition for procreation and the affection of females. In his book "Masochism and the Self," psychologist Roy Baumeister advanced a "Self Theory" analysis that cuckolding (other forms of sexual masochism) among otherwise mentally healthy people was a form of escapism. According to this theory, cuckold fetishists are relieving themselves of the stress of the burden of their social role and escaping into a simpler, less-expansive position.

If a couple can keep the fantasy in the bedroom, or come to an agreement where being cuckolded in reality does not damage the relationship, they may try it out in reality. However, the primary proponent of the fantasy is almost always the one being humiliated, or the "cuckold": the cuckold convinces his lover to participate in the fantasy for them, though other "cuckolds" may prefer their lover to initiate the situation instead. The fetish fantasy does not work at all if the cuckold is being humiliated against their will.