Web-Based Initiatives to Prevent Sexual Offense Perpetration: A Systematic Review.

PURPOSE OF REVIEW: Web-based programs to prevent sexual offense perpetration could provide an opportunity that avoids many of the barriers associated with in-person treatment. The aim of this systematic review is to give an overview of the literature on web-based initiatives aimed at sexual offense perpetration prevention published during the last 10 years (2013-2023) and to report data on the efficacy as well as issues of the discussed initiatives. RECENT FINDINGS: We included 18 empirical studies discussing web-based perpetration prevention initiatives, of which six are randomized controlled trials. Among the articles, four cover programs focusing on prevention of sexual reoffending and 14 discuss programs aimed at preventing initial sexual offenses. Evaluations and observations of web-based initiatives aimed at preventing sexual offense perpetration show overall promising results and are well-appreciated. However, evaluation studies are scarce and more randomized controlled trials replicating this effect are warranted.

Group Comparisons of the Sexual Interests and Behaviors of Assigned Males and Their Association with Genital Ablation Fantasies.

We describe here the sexual histories and characteristics of 338 individuals with interests in castration (orchiectomy) and, more broadly, genital ablation (i.e., orchiectomy, penectomy, and/or nullification), recruited from the Eunuch Archive. We compared four groups: those who only fantasize about castration (Fantasy, n = 66), those who wish to be castrated in the future (Aspiring, n = 166), and those who have been castrated (Eunuchs) both with (n = 42) or without (n = 64) androgen replacement therapy (ART). In our sample, 35.6-53.8% had sexual fantasies of castrating someone, 83.3-90.8% had fantasies of being castrated, 20.6-33.3% had fantasies of removing someone's penis, and 45.3-61.9% had fantasies of having a penectomy. The four groups had similar arousal by high-risk sex behaviors, anal sex play, attraction to people under 18, common sex behaviors, and fetishistic behaviors. Fantasy of being castrated by someone was associated with elevated high-risk sexual behaviors and attraction to individuals aged 18 to 49 after controlling for age, groups, and sexual attraction. In addition, after adjusting for age, groups, and sexual attraction, fantasy of castrating someone was associated with more attraction to individuals under the age of 18 and being aroused by interaction with a stranger, whereas fantasy of cutting off someone's penis was associated with less tendency for common sexual behaviors and digital sex communication. Fantasy of being penectomized was associated with high risk and fetishistic sexual behaviors. These results support screening for high-risk behaviors in individuals who endorse an interest in genital ablation, with treatments focused on harm reduction.

Psychometric Evidence That Paraphilia Is a Natural Kind.

Is the category paraphilia a natural kind? That is, do different paraphilias share anything scientifically interesting or are they classified together because they are unusual and sometimes problematic? We investigated this question systematically in 11 samples of paraphilic males (N = 4,617) and 11 samples of control males (N = 1,494). Primary data consisted of responses to the 11-item Paraphilic Interests Scale. Contrary to our initial hypothesis, the scale mean was similar for paraphilic and control samples. Using logistic regression and the same items, we derived three highly correlated measures that robustly discriminated paraphilic and control samples (ds ranging from 0.86 to 0.92). These successful measures capitalized on the unanticipated fact that some items (especially those assessing transvestism and masochistic humiliation) were positively associated with membership in paraphilic samples, while others (especially those assessing voyeurism) were negatively associated with such membership. Subsequent analyses focused on one of the measures, the Paraphilic Interests Scale Contrast (PISC). Consistent with prior findings distinguishing paraphilias and homosexual orientation, PISC was not elevated among homosexual males compared with heterosexual males among the control groups. Within four paraphilic samples, PISC was positively associated with additional paraphilic phenomena. Results provide tentative support for both the proposition that paraphilia is a natural kind and the usefulness of PISC as a measure of paraphilia.

Childhood Adversity and Offense-Supportive Cognitions Among Czech Adults with a Sexual Interest in Violence or Children.

Individuals with paraphilic interests in sexual violence or children may be more likely to sexually offend if they possess offense-supportive cognitions. These cognitions may develop in response to childhood adversity. However, this idea is largely based on research in men convicted of sexual offenses and may not generalize to non-incarcerated adults with paraphilic interests. In a sample of 178 adults screened for paraphilic interests in violence or children (from the general Czech population), we hypothesized that childhood sexual abuse and emotional neglect would be associated with offense-supportive cognitions about rape and child molestation. Participants came from a nationally representative sample of Czech adults and were selected if they self-reported high levels of sexual interest in violence and/or children. Participants completed an online survey with self-report measures of sexual orientation, offense-supportive cognitions (Bumby RAPE and MOLEST scales), and childhood sexual abuse and emotional neglect (Childhood Trauma Questionnaire). Controlling for gender, age, and sexual orientation, we found that both rape-supportive cognitions and child molestation-supportive cognitions were significantly associated with higher levels of childhood sexual abuse, but not emotional neglect. These findings indicate that childhood sexual abuse may lead to offense-supportive cognitions among men and women with paraphilia.

Paraphilias, Sociodemographic and Forensic Profiles of Men Convicted of Sexual Offenses in Turkey.

This study investigated the psychiatric, paraphilic, and forensic profiles of men who were convicted of sexual offenses. It also examined childhood trauma exposure in the group with potential paraphilia. The study was performed in the closed prison located in the Istanbul Silivri Penal Institutions Campus. The interview data of 100 men convicted of sexual offenses were obtained from the psychiatric interview notes based on the DSM-5 criteria, the results of the 28-item Childhood Trauma Questionnaire administered to the participants with paraphilia, and the forensic profiles from examination files. It was found that 39% of individuals were drug users and 36% were alcohol users. Considering the crime scenes, 42% of men convicted of sexual offenses committed the offense in their own house. Pedophilia was the most common among men with paraphilia (59%). The victim age was significantly lower (p < .001), and the male victim ratio was higher (p < .05) in the group with paraphilia than in the group without paraphilia. Sexual offenses against children aged 10 years and below and against males may be suggestive of paraphilia and an increased risk of recidivism.

Other Specified Paraphilic Disorder: Patterns of Use in Sexually Violent Predator Evaluations.

"Sexually violent predator" (SVP) legislation requires, in part, that an individual has a mental abnormality that causes difficulty in controlling sexual behavior. Previous research has found paraphilia not otherwise specified (NOS) as one of the most prevalent diagnoses proffered in SVP evaluations. However, the fifth edition of the Diagnostic and Statistical Manual (DSM-5) modified paraphilia NOS diagnosis in two ways. First, this diagnosis was divided into two new diagnostic categories: other specified paraphilic disorder (OSPD) and unspecified paraphilic disorder. Second, OSPD required an added specifier to indicate the individual's source of sexual arousal. To date, no study has systematically explored how the revision to paraphilia NOS has affected diagnoses within SVP evaluations. The current study explored the frequency and diagnostic reliability of paraphilic disorders in a sample of 190 adult men evaluated for SVP civil commitment using the DSM-5. Results indicated that OSPD was the second most common paraphilic disorder, next to pedophilic disorder. However, there was poor to fair agreement (kappa = 0.21, p < .01) between independent evaluators in providing this diagnosis. Additionally, the two most common OSPD specifiers were non-consent and hebephilia, despite recent debate and rejection of these constructs from the DSM-5. While these constructs were the most prevalent, the specifiers contained quite varied terminology, suggesting vague diagnostic tendencies within these evaluations. Given that the presence of a mental abnormality is the cornerstone to the constitutionality of SVP commitment, diagnostic practices should be based in reliable and valid techniques.

A Qualitative Exploration of Sleep-Related Sexual Interests: Somnophilia and Dormaphilia.

Somnophilia is an under-researched paraphilia. Consequently, there are discrepancies in its definition and conceptual understanding. Also, literature regarding the sexual interest in being asleep during sexual activity (dormaphilia) is even more limited. As such, there is a need to understand these paraphilias more deeply. This study recruited 232 participants online to discuss the content, origin, sexual appeal, emotional appraisal, and behavioural enactment of their somnophilic and dormaphilic interests and fantasies. A Thematic Analysis led to the identification of four main themes: (1) Relevance of Sleep State; (2) Roles within Sleep Sex; (3) Enactment of Sleep Paraphilia and (4) Lack of Consent and Awareness. These four themes spanned across both those reporting somnophilic and dormaphilic fantasies. The Discussion explores the multi-faceted nature of the interests, and implications for the understanding of somnophilia and dormaphilia. This study provides the first qualitative exploration of sleep-related paraphilias, opening avenues for future research and practice.

Sexual symptoms in post-traumatic stress disorder following childhood sexual abuse: a network analysis.

BACKGROUND: Even though recent research indicates that sexual symptoms are highly prevalent in post-traumatic stress disorder following childhood sexual abuse and cause severe distress, current treatments neither address them nor are they effective in reducing them. This might be due to a lack of understanding of sexual symptoms' specific role in the often complex and comorbid psychopathology of post-traumatic stress disorder following childhood abuse. METHODS: Post-traumatic, dissociative, depressive, and sexual symptoms were assessed in 445 inpatients with post-traumatic stress disorder following childhood sexual abuse. Comorbidity structure was analyzed using a partial correlation network with regularization. RESULTS: A total of 360 patients (81%) reported difficulties engaging in sexual activities and 102 patients (23%) reported to suffer from their sexual preferences. Difficulties engaging in sexual activities were linked to depressive and hyperarousal symptoms, whereas sexual preferences causing distress were linked to anger and dissociation. Dissociative amnesia, visual intrusions, and physical reactions to trauma reminders were of central importance for the network. Dissociative amnesia, depressed mood, lack of energy, and difficulties engaging in sexual activities were identified as bridge symptoms. Local clustering analysis indicated the non-redundancy of sexual symptoms. CONCLUSIONS: Sexual symptoms are highly prevalent in survivors of childhood sexual abuse with post-traumatic stress disorder. Further research is needed regarding the link of difficulties engaging in sexual activities, depression, and post-traumatic stress disorder, as well as regarding the association of dissociation and sexual preferences causing distress. Sexual symptoms require consideration in the treatment of post-traumatic stress disorder following childhood sexual abuse.

Sexual Sadism Disorder and Coercive Paraphilic Disorder: A Scoping Review.

BACKGROUND: Valid and reliable diagnostic criteria are essential in forensic psychiatry and sexual medicine due to the severe implications of potential misdiagnoses. One challenge in this field is the poor operationalization of sexual sadism disorder (SSD) and coercive paraphilic disorder (CP+) definitions. AIM: The aim of this scoping literature review is to provide a comprehensive overview of the key conceptual differences between SSD and CP+, as well as consider pragmatic and clinically useful approaches to their diagnostic formulation. METHODS: Arksey and O'Malley's methodological framework was followed. A literature search of Medline, PsychInfo, Web of Science, and Cumulative Index to Nursing and Allied Health Literature electronic databases was conducted. Publications in English describing the construct and/or operational definition of SSD or CP+ were included. Full-text studies were reviewed by 2 authors and data was charted and synthesized qualitatively. RESULTS: The initial search provided 1,271 records, after which 120 full-text papers were considered for eligibility and 48 studies were ultimately included. The most common sources of definitions for SSD and CP+ were the Diagnostic and Statistical Manual of Mental Disorders (n = 53) and the International Classification of Disease (n = 12). There was more variation of terms used for CP+ than SSD. Both CP+ and SSD are critiqued by reviewed literature for having low validity, reliability, and consistency, as well as being conflated with sexual crime. SSD is better described due to having diagnostic criteria and validated diagnostic tools. CLINICAL IMPLICATIONS: Currently, clinicians rely mostly on the DSM to diagnose SSD or CP+. As applications of SSD and CP+ definitions vary, interpretations may not be generalizable between clinicians. Furthermore, specific diagnoses may be practically unhelpful and unreliable. It may therefore be beneficial for treatment to be determined by risk of harm. In addition to these concerns, the stigma associated with SSD and CP+ may also impact treatment. STRENGTHS & LIMITATIONS: Strengths of this study include duplicate review and charting to increase methodological rigor, transparent reporting to minimize publication bias, and encompassing a comprehensive scope. Limitations include the weaknesses of low strength of reviewed literature and risk of publication bias. CONCLUSION: Despite their significant implications, the definitions of SSD and CP+ are inconsistent and lack reliability. Future research is necessary to develop stronger diagnostic criteria and tools. Liu A, Zhang E, Leroux EJ et al. Sexual Sadism Disorder and Coercive Paraphilic Disorder: A Scoping Review. J Sex Med 2022;000:1-11.

Castration for Pleasure: Exploring Extreme Castration Ideations in Fiction.

The Eunuch Archive (EA) is an online community which includes individuals who read and write sexual fantasies with themes related to castration and eunuchs. Here we analyzed the 100 stories rated highest by EA readers among the >8800 currently posted. Our goal was to gain insights into commonalities within, and specifics of, castration sexual fantasies. Simply stated, we want to know what the authors (and readers) fantasize about and why. The most popular EA stories link sexual gratification and romantic partnership with genital abuse. They are characterized by the absence of consent for genital ablations and multiple SM-related paraphilias. Many stories feature attraction to, and ablation of, the genitals of pubescent or adolescent males. Some EA members have acted on their interests and been voluntarily castrated. Others wish to be. The most popular stories in the EA collection typically link the sacrifice via SM abuse to securing a permanent sexual partnership. The idea of sacrificing one's genitals to build dyadic adhesion has been noted before in individuals with extreme castration ideations. Here we identify the common features of sexualized fantasies that are popular among individuals with exceptional interest in castration.

Measurement and Correlates of Zoophilic Interest in an Online Community Sample.

Sexual interest in animals (zoophilia) is a scant investigated topic owing partially to difficulties in assessing the behavior outside of a clinical setting. While there have been previous attempts to categorize individuals with a sexual interest in animals into classification systems, this requires extensive clinical interviews and psychometric testing. Previous classifications also lack clarity on the adjacent concept of furryism (i.e., interest in anthropomorphized animals) and how it may be related to zoophilia. As there are currently no validated psychometric measures of zoophilia, individuals with a sexual interest in animals are a challenging population to research and may be underdetected in clinical settings. The central aim of the present study was to examine the measurement and correlates of sexual attraction to nonhuman animals through the development and refinement of psychometric and visual stimulus measures of animal sexual interest. Participants included 1,228 respondents (72% zoophilic and 35% furries; 67% men and 22.9% women) recruited from the online community. The results indicated that a Sexual Interest in Animals-Self-Report (SIA-SR) scale had four distinct subscales with excellent discrimination for self-reported zoophilia. Moreover, endorsement of sexual interest in horses and dogs from visual stimuli was most common among the individuals in the sample, while dog and horse sexual and romantic attractiveness ratings also had the largest and most consistent associations with SIA-SR scores and self-reported zoophilia. The results contribute to a greater understanding of the sexual interest patterns for persons with zoophilia and have implications for theory, future research, and clinical practice.

Paraphilic Sexual Attraction to Males Without Genitals Is Associated with Traumatic Childhood Experience, Body Image, and Thoughts/Behaviors Related to Genital Ablation.

In rare cases, some male individuals are sexually attracted to men who have their genitals removed. We investigate here if paraphilic attraction to men without genitals was associated with childhood experience, body image, and thoughts/behaviors related to body modification. An online survey, consisting of both validated questionnaires and questions developed by our team, was launched on the Eunuch Archive and MTurk websites. Out of 875 participants, 48.5 and 32.2% reported being attracted to males without testicles or without a penis, respectively; 49.7 and 31.0% felt they would themselves be attractive without testicles and without a penis, respectively. In terms of body modification, many reported having tattoos (19.0%) and piercings (26.1%). About half (48.3%) had played as children with male action figures without genitals, i.e., GI Joe, and Ken dolls. Additionally, some participants reported having: (1) witnessed animal castration (23.7%); (2) having been threatened with castration during their childhood (11.9%); (3) receiving genital injuries inflicted by others (11.0%); (4) pretending to be castrated (60.2%); (5) thinking of self-castration (54.2%); or (6) injuring their own penis (23.4%). Having received genital injuries inflicted by others was associated with attraction to males without testicles (OR = 1.997, p < .05), but not for attraction to males without a penis. Paraphilic attraction to males without genitals (i.e., castrated or penectomized) was associated with feeling attractive without genitals, having pretended to be castrated, considering self-castration, and having injured one's own penis. In conclusion, paraphilic attraction to males without genitals may be associated with traumatic early life events, body image, and desire for one's own genital ablation.

Are Female Paraphilias Hiding in Plain Sight? Risqué Male-Male Erotica for Women in Sinophone and Anglophone Regions.

Female-oriented male-male erotica is a genre of popular culture often know as Boys' Love (BL), yaoi, and danmei. It is one of the largest by-and-for women sexual subcultures and a global phenomenon. With the largest data sets in the field, we ask: Which risqué sexual content do Sinophone (Chinese-speaking) and Anglophone (English-speaking) participants particularly enjoy in BL and does this differ between cultures?, and Are there sub-demographics in Sinophone and in Anglophone culture who enjoy particular forms of risqué sexual content in BL and do these forms relate also to enjoyment of particular storylines and concern with legal issues? The material studied meets the DSM-5 definition of the paraphilic, and little is known about paraphilias in women or in the general population. Using Categorical Principal Component Analysis we explored one 15-response question from our Sinophone (N = 1922) and Anglophone (N = 1715) BL fandom surveys: Which risqué sexual content do you particularly enjoy in BL? We also tested for associations with seven demographic and other BL content-related questions. Notably, the component structure was nearly replicated between the two independent samples, in order of strength: BDSM Specialist, Mechanoid/Animal Sex Specialist, Underage Sex Specialist, and Minority Paraphilia Specialist. In both samples, it was the avid BL fans and/or those who liked explicitly sexual stories, a largely overlapping demographic, who most engage the risqué content, while, for the Sinophone, this included also more non-heterosexual and/or other-gendered people. We conclude that women's paraphilias have been largely overlooked because they might be expressed more commonly through fantasy than action, that their mass expression has awaited both the means and the market force, and that current conceptualization of, and assumptions about, paraphilias is overly modeled on that of men.

Loving Objects: Can Autism Explain Objectophilia?

Objectophilia (also known as objectum-sexuality) involves romantic and sexual attraction to specific objects. Objectophiles often develop deep and enduring emotional, romantic, and sexual relations with specific inanimate (concrete or abstract) objects such as trains, bridges, cars, or words. The determinants of objectophilia are poorly understood. The aim of this paper is to examine the determining factors of objectophilia. We examine four hypotheses about the determinants of objectophilia (pertaining to fetishism, synesthesia, cross-modal mental imagery, and autism) and argue that the most likely determining factors of objectophilia are the social and non-social features of autism. Future studies on the determinants of objectophilia could enhance our understanding and potentially lessen the marginalization experienced by objectophiles.

The Relation Between the Paraphilias and Anxiety in Men: A Case-Control Study.

Despite a multitude of theoretical views, it is still unclear how individuals develop and sustain paraphilic interests (e.g., sexual attraction to children, interest in non-consensual violence). It is also not clear from these views why many paraphilic interests, and especially many paraphilias and paraphilic disorders, are much more common in men than in women. One possible factor affecting male's higher rate of paraphilias is anxiety, because anxiety can potentiate sexual arousal in men. We speculated that paraphilic interests could develop when feelings of anxiety are recurrently generated by atypical sexual stimuli, and when that anxiety repeatedly potentiates sexual arousal, reinforcing sexual response to atypical stimuli. It follows that men with paraphilic interests are susceptible to anxiety disorders, because an anxiety disorder would facilitate the hypothesized developmental process. We conducted a retrospective file review of 1048 consecutive patients (944 male patients retained for analysis) referred to an outpatient sexual behavior clinic at a psychiatric hospital to investigate the link between paraphilias and anxiety. Male patients with a paraphilia had 1.64 greater odds than male patients without a paraphilia of having been diagnosed with an anxiety disorder, but they also had elevated rates of many other types of disorders. Therefore, there does not seem to be a specific link between paraphilias and anxiety in this sample. The discovery of a general link between the paraphilias and psychological disorders in men opens new avenues for studying the developmental origins and consequences of male paraphilic interests.

[Aggressiveness, assertiveness, and sexual deviance: An empirical-quantitative examination of Stoller's perversion theory]. / Aggressivität, Assertivität und sexuelle Devianz: Eine empirisch-quantitative Prüfung der Stoller'schen Perversionstheorie.

Aggressiveness, assertiveness, and sexual deviance: An empirical-quantitative examination of Stoller's perversion theory Objectives: The main aim of the present study was to empirically examinate the psychodynamic-founded perversion theory of Robert D. Stoller (1979), particularly his assumption of a transformation of aggressive impulses into sexual deviant fantasies due to traumatic experiences. Methods: In the present study different aspects of the theory were examined by using a sample (N = 954) of individuals convicted of sexually motivated offenses who had been clinically and forensically assessed between 2002 and 2018 at the Federal Evaluation Centre for Violent and Sexual Offenders (FECVSO) in the Austrian Prison System. As a part of the psychological testing procedure, German-speaking questionnaires for the assessment of aggressiveness and assertiveness were applied. Results: The results indicated that participants with a diagnosis of paraphilia showed significantly less spontaneously expressed aggression and less social competence compared to individuals without such a diagnosis. Conclusions: The findings of the present study are in line with the core assumptions of Stoller's perversion theory by demonstrating an inverse relationship between the diagnosis of paraphilia and self-reported aggression.

Exploratory Factor Analysis of Unusual Sexual Interests.

BACKGROUND: Unusual sexual interests are largely intercorrelated, yet not much is known about underlying patterns of clusters between various sexual interests. AIM: To identify underlying clusters of unusual sexual interests using exploratory factor analysis. METHODS: We conducted exploratory factor analysis with self-reported interest in a wide variety of unusual sexual acts for an online, international sample (N = 669; 61% female), and for women and men separately. Factor regression weights were correlated to self-reported sex life satisfaction, sexual outlet, and psychiatric symptoms. OUTCOMES: Participants rated the attractiveness of 50 unusual sexual activities, and reported on their sex life satisfaction (Arizona Sexual Experiences Scale), sexual outlet, and symptoms regarding ADHD (Adult ADHD Self-Report Screening Scale for DSM-5), depression, anxiety, and stress (Depression, Anxiety, and Stress Scale). RESULTS: We identified 5 factors of unusual sexual interests that were largely comparable for women and men: submission/masochism, forbidden sexual activities, dominance/sadism, mysophilia (attraction to dirtiness or soiled things), and fetishism. For women, unusual sexual interests related to more psychiatric symptoms and higher sexual outlet, whereas this relation was less explicit for men. CLINICAL IMPLICATIONS: Different factors of unusual sexual interests may serve different underlying functions or motivations, for instance related to sexual, and emotional regulation. A better understanding of the nature of unusual sexual interests is important to be able to influence sexual interests that are unwanted or cause damage to others. STRENGTHS & LIMITATIONS: Strength of this study include its anonymity, the avoidance of sexual orientation effects, and the possibility to indicate only a slight endorsement toward sexual items. Limitations include the sample's generalizability and the truthfulness of online responding. CONCLUSION: Unusual sexual interests could be clustered into 5 factors that were largely comparable for women and men: submission/masochism, forbidden sexual activities, dominance/sadism, mysophilia, and fetishism. Schippers EE, Smid WJ, Huckelba AL, et al. Exploratory Factor Analysis of Unusual Sexual Interests. J Sex Med 2021;18:1615-1631.

The Paraphilias and Medical Licensure in the United States.

BACKGROUND: As part of their mission to protect the public from exploitation, state medical boards query physicians about a wide range of topics prior to licensure, including in some cases whether the applicant has been diagnosed with or been treated for paraphilias or paraphilic disorders. AIM: We investigated the prevalence of questions inquiring about the applicants' history of paraphilias and paraphilic disorders on applications for medical licensure. METHODS: The allopathic medical licensure application forms for each of the 50 United States and the District of Columbia were reviewed. Medical boards with questions pertaining to paraphilias or paraphilic disorders were asked how many affirmative responses had been obtained in the prior 5 years and how they would treat an affirmative response. OUTCOMES: Eight medical boards inquired about paraphilias or paraphilic disorders, however there was no evidence of an affirmative response to these questions in the prior 5 years. RESULTS: Of the 51 applications reviewed, 8 (16%) inquired whether the applicant had, was diagnosed with, or had been treated for a paraphilia or paraphilic disorder. The wording of the questions was variable and often failed to distinguish between paraphilias and paraphilic disorders. All but one medical board responded to requests for further information. The medical board staff members stated that an affirmative response would result in case-by-case review, including request for further information and possibly an in-person appearance before the board. None of the medical boards were willing or able to provide a formal count of affirmative responses in the last 5 years. CLINICAL IMPLICATIONS: Medical boards may be contributing to the stigma experienced by both physicians and patients with diverse sexual interests. The benefit of retaining these questions is not clear. STRENGTHS AND LIMITATIONS: This study is the first to investigate the use of paraphilias and paraphilic disorders as screening questions for medical licensure. Data regarding the number of affirmative responses were limited by the medical boards' inability or unwillingness to respond to share the information. CONCLUSIONS: Eliminating or modifying physician licensing application questions pertaining to paraphilias and paraphilic disorders may decrease the stigma encountered by persons with diverse sexual interests. Removal also may diminish the barriers to accessing health care services for both physicians and patients with diverse sexualities. If the questions are retained, they should conform to the current DSM-5 nosology, which distinguishes between the mere presence of a paraphilia and a diagnosis of a paraphilic disorder. Cranstoun LM, Moser C. The Paraphilias and Medical Licensure in the United States. J Sex Med 2021;18:1130-1133.

Fatal strangulation during consensual BDSM activity: three case reports.

Autoerotic accidents are well-known occurrences in forensic casework. Reports about unintentional deaths in a sexual context involving other persons are much rarer. Three cases of fatal incidents related to asphyxiophilia during consensual BDSM activity are reported. Two men died while visiting a dominatrix, the third one in the presence of a male casual sexual partner. Paraphernalia associated with BDSM/fetishism were found at the scene in all cases. Autopsy findings were compatible with death by strangulation. The cases are compared with published autoerotic accidents and similar unintentional deaths involving other individuals. The difficulties concerning the forensic assessment and reconstruction of the cases are discussed.

Enhanced D2 Agonism Induces Conditioned Appetitive Sexual Responses Toward Non-reproductive Conspecifics.

Brain mechanisms of sexual attraction toward reproductive partners develop from a systematic interrelationship between biology (nature) and learning (nurture). However, the causes of attraction toward non-reproductive partners are poorly understood. Here, we explored the role of Pavlovian learning under dopaminergic agonism on the development of sexual preference and brain activation for young male rats. During conditioning, adult sexually naïve males received either Saline (Saline-Paired) or the D2-receptor agonist quinpirole (QNP-Paired) and cohabited in contingency, or out of contingency (QNP-Unpaired) during 24 h with an almond-scented prepubertal juvenile male (PD25). Conditioning occurred every 4 days for three trials. Social and sexual responses were assessed four days after the last conditioning trial in a drug-free test, and males chose freely between a scented young male (PD37) and a novel receptive female. Four days later, males were exposed to the conditioned odor only and brain Fos-IR and serum testosterone were analyzed. Saline-Paired and QNP-Unpaired males displayed more non-contact erections (NCEs) and genital investigations for females, whereas QNP-Paired males expressed more NCEs and genital investigations for young males. In the QNP-Paired group, exposure to the young male-paired odor evoked more Fos-IR in limbic, hypothalamic and cortical areas, but no differences in serum testosterone were observed. Cohabitation with juvenile males during enhanced D2 agonism results in atypical appetitive sexual responses and a higher pattern of brain response for the young male-paired odor, with no changes in serum testosterone. We discuss the potential implications for the development of pedophilic disorder and perhaps other paraphilias.