Rare Sexual Attractions
There are some paraphilias that are relatively rare. Apotemnophilia refers to the sexual attraction to amputations. Coprophilia and urophilia refer respectively to sexual excitement deriving from contact with feces and urine. Klismaphilia is sexual excitement resulting from the use of enemas. Frotteurism is sexual arousal resulting from rubbing the genitals against the body of a fully clothed person in crowded situations, and necrophilia is sexual arousal derived from viewing or having sexual contact with a corpse.

Causes of Paraphilia Unclear
It is unclear what causes a paraphilia to develop. Psychoanalysts theorize that an individual with a paraphilia is repeating or reverting to a sexual habit that arose early in life. Behaviorists suggest that paraphilias begin through a process of conditioning. Nonsexual objects can become sexually arousing if they are repeatedly associated with pleasurable sexual activity. Or, particular sexual acts (such as peeping, exhibiting, bestiality) that provide especially intense erotic pleasure can lead the person to prefer that behavior. Although the origins of most paraphilias are not understood, in some cases there seems to be a predisposing factor such as difficulty forming person-to-person relationships.

Whatever the cause, paraphiliacs rarely seek treatment unless an arrest or discovery by a family member traps them into it. In most cases, the paraphilia results in such immense pleasure that giving it up is unthinkable. Treatment approaches have included traditional psychoanalysis, hypnosis, and behavior therapy techniques.

Research on the outcome of these therapies has been incomplete, but often they have not be very successful. More recently, a class of drugs called antiandrogens that drastically lower testosterone levels temporarily have been used in conjunction with these forms of treatment. The drug lowers the sex drive in males and reduces the frequency of mental imagery of sexually arousing scenes. This allows concentration on counseling without as strong a distraction from the paraphiliac urges. Increasingly, the evidence suggests that combining drug therapy with cognitive behavior therapy can be effective.

Copyright 2002 Sinclair Intimacy Institute