(442) The Importance of Understanding Paraphilias and Paraphilic Disorders (PD) for General Health and Sexology
Authors: Sampaio M , Becher G , Moraes C , Luz H , Abdo C 
Published: May 2023

Abstract

Introduction
Sexual fantasies and behaviors are crucial dimensions of the human experience. Paraphilias and paraphilic disorders (PD), categorized by modern sexology as corresponding to the unconventional sexual experiences of a given society at a given time, are complex and still affected by stigma and uncertainty concerning epidemiology, etiology, and clinical management. These topics are rarely addressed in health professionals’ training, including in the field of sexology, which can significantly impact the quality of care.

Objective
To identify inherent problems in the study and dissemination of knowledge on paraphilias and PD; to indicate solutions aiming to reduce stigma and to offer better care.

Methods
Narrative review and experience report of the committee for paraphilias and PD from a Brazilian association of sexology.

Results
Even though the quality of sexology training in health providers’ education might be varied, it is frequently claimed that it is insufficient for the identification and management of sexual health issues. According to a Austrian medical university’ study, the topic of human sexuality is almost exclusively addressed in the curricula of gynecology, endocrinology, and psychiatry, often focusing on contents such as anatomy, STIs, sexual dysfunctions, pregnancy, and infertility. On the other hand, topics such as pornography and paraphilias are rarely addressed. Dealing with paraphilic individuals is challenging, both for general practitioners and specialist sexologists, and poor training can lead to stigmatizing attitudes, such as pathologizing of unconventional sexual experiences and moral judgment. The knowledge and skills acquired through supervised training on the field of paraphilias and PD proved to be useful in conducting a careful sexual interview, a complete psychiatric anamnesis and establishing a positive therapeutic relation. For example, patients with these characteristics may initially report complaints related to sexual dysfunctions, such as reduced desire or difficulty in getting an erection. However, once their sexuality is approached holistically, the dysfunction might be better explained by the displacement of the sexual object, a defining condition of the paraphilic experience. In such an occasion, the veiled conception that the study of paraphilias and PD is exclusive to psychiatrists and psychologists can relegate it to a blind spot, resulting in negligence on the part of other health professionals, including sexologists. This situation can lead to misdiagnosis, underdiagnosis and inadequate treatment of PD. Ignoring the possibility that a patient may have a PD might shield the professional from dealing with its ethical difficulties, but it addresses neither the patients’ nor social problems – given the risk of criminal sexual behavior.

Conclusions
To match their complexity, the approach to paraphilias and PD requires high levels of clinical, ethical, and academic understanding. Educational programs capable of tackling these issues would improve sexual health care. It is of fundamental importance that understanding and practice in paraphilias and PD is improved, and it is up to institutions, such as universities and expert associations, to promote discussion of these topics, despite any moral discomfort or tendency to avoid ethical implications of knowing a patient may engage in criminal behavior.

Disclosure
No