Clinical Review ABC of sexual health

Sexual variations

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7184.654 (Published 06 March 1999) Cite this as: BMJ 1999;318:654
  1. W P de Silva.

    “Sexual variations” refer to sexual desires and behaviours outside what is considered to be the normal range, although what is unusual or atypical varies between cultures and from one period to another. Defining normality is extremely difficult (and arbitrary), because the definition involves making a value judgment and therefore labelling how we view other people.


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    Sexual variations are also referred to as paraphilias, a neutral term for behaviours formerly called deviant. They can be defined as conditions in which a person's sexual gratification is dependent on an unusual sexual experience revolving round particular sex objects.1 They are much more common in men than women.

    History and culture

    Sexual variations have existed and been recorded for millennia in different parts of the world. For example, early Buddhist texts contain numerous references to sexually variant behaviours among monastic communities over 2000 years ago. These behaviours included sexual activity with animals and sexual interest in corpses.

    A case example of fetishism from Krafft-Ebing (1887)

    Z began to masturbate at the age of 12. From that time he could not see a woman's handkerchief without having orgasm and ejaculation. He was irresistibly compelled to possess himself of it. At that time he was a choir boy and used the handkerchiefs to masturbate within the bell tower close to the choir. But he chose only such handkerchiefs as had black and white borders or violet stripes running through them. At age 15, he had coitus. Later on he married. As a rule, he was potent only when he wound such a handkerchief around his penis. Often he preferred coitus between the thighs of a woman where he had placed a handkerchief. Whenever he espied a handkerchief, he did not rest until he was in possession of it. He always had a number of them in his pockets and around his penis

    In the clinical literature …

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