Those with paraphilias, or variant sexual desires and practices, sometimes present with sexual dysfunction. Paraphiliacs seeking treatment in this way are almost always male, reflecting the vast preponderance of males over females among paraphiliacs. In their presentation, they often complain of difficulties in non-paraphiliac sexual relationships. For example, a man with a strong shoe fetish might seek help for an inability to obtain or maintain an erection in sex without contact with a woman's shoe. These patients need to be assessed carefully, and individually tailored treatment needs to be considered. The aim should be, as far as possible, to incorporate the paraphilia in a limited, controlled way into the person's sexual repertoire. Needless to say, criminal paraphilias such a pedophilia or zoophilia, or any paraphilia that the patient's partner finds intolerable, can not be considered for such incorporation. In such cases, help should be directed toward the control of the person's paraphiliac urges. Various psychological techniques are available for the control of paraphiliac desires and behaviors— for example, orgasmic reconditioning and covert sen-sitization. At the same time, help should also be given to reduce any anxiety about nonparaphiliac sex, and to build up skills and competencies needed for such activity. In other words, a multifaceted treatment program is often required.

It is also important to note that little can be achieved in the treatment of paraphiliacs unless the patient has motivation and is cooperative.

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