Dealing with paraphilia

the piece below appeared in the health lifeline section of The Star with Dr. A. J. Morgan, thought we would post it, interesting the response, we think to this query on sexual fantasies.

Dear Readers,
J.S. is a 22-year-old man, who is concerned over his growing sexual fantasies which, he believes, are probably abnormal but seem to have become his primary source of sexual gratification. He is most sexually stimulated when imagining himself exposing his genitalia to various women - some known, some imagined. He fantasises about the act when masturbating and even during sexual intercourse. He has even thought of actually committing the act in reality but has restrained himself out of fear of the repercussions should he be caught. J.S. is embarrassed to even discuss these urges with his family doctor and asks Lifeline what he can do to let go of this fantasy.

Societal norms
A significant number of individuals fantasise about sexual acts when they masturbate or have intercourse, which may be beyond what they are willing to participate in. In fact, an act is not necessarily described as deviant behaviour (paraphilia) unless societal norms and social functioning have been violated and the rights of others have been transgressed. It is, therefore, a matter of degree.
Where the erotic mental (sexual) activity, in this case, exhibitionism, becomes the major source of sexual gratification, with or without orgasm, then something is wrong. If the individual can only achieve an orgasm through either fantasising about the act or actually performing the act, then the behaviour is sexually deviant. Exhibitionism, if it occurs under the above conditions, would then be a form of deviant sexual behaviour, or paraphilia.

Persons who have these different sexual interests are often ostracised by society and it is difficult to determine the extent to which this behaviour occurs in any given population, as it is hidden.
The urge to participate in deviant sexual behaviour usually develops during adolescence. Usually, the person fantasises about his or her sexual interest during masturbation and attempts to use this method to satisfy his or her sexual urges. What they often do not realise is that, as time passes, the links between the fantasies and masturbation only strengthen the urge to actually perform the act. After a while, exhibitionists may conclude that exposing their genitalia is actually an enjoyable sexual experience for their victim, rather than an assault. They may interpret the victims' response as showing sexual interest.

See a shrink
Most family physicians would refer a person with these behavioural and sexual problems to a specialist, usually a psychiatrist or psychologist, as the most successful method of treatment for sexual deviation is psychological intervention in the form of cognitive behavioural treatment. This targets the reduction of deviant sexual arousal and the enhancement of normal sexual arousal, while helping the person to develop effective coping and pro-social skills.

The SSRI antidepressant group of medication which include Paxil, Prozac and Zoloft can reduce the sexual drive and, therefore, reduce deviant sexual behaviour, so they can be useful in the treatment of this condition. Other hormonal treatment can also be prescribed.
J.S. should take the first step by visiting a family physician whom he trusts and in whom he has confidence in. There is help available.

Write Lifeline
P.O. Box 1731
Kingston 8