The most common paraphilias are pedophilia, voyeurism, and exhibitionism. Sex offenders may have multiple paraphilias. Treatment has been considered less effective when court ordered, although many adjudicated sex offenders have benefited from treatments, such as group psychotherapy and antiandrogen drugs. Serum testosterone should be monitored and maintained in the normal female range. Treatment is usually long-term, because deviant sexual arousal patterns usually recur shortly after testosterone levels return to normal.
Drugs are most effective when used as part of multimodal treatment programs.
Common fetishes include aprons, shoes, leather or latex items, and women's underclothing. The fetish may replace sexual activity with a partner or may be integrated into sexual behavior with a willing partner, usually as a requirement for erotic arousal. Minor fetishistic behavior as an adjunct to consensual sexual behavior is not considered a psychiatric disorder because distress, disability, and clinically significant dysfunction are absent. More intense, obligatory fetishistic arousal patterns may cause serious problems in a relationship. When the fetish becomes the sole object of sexual desire, sexual relationships are often avoided.