By Dr Milton Lum

SEXUAL desires and behaviours are considered unusual or abnormal, i.e. beyond the normal range, when sexual gratification is achieved from experiences that are dependent on particular sexual objects. This kind of behaviour occurs for a major period of time, interferes with the sexual relations or daily functioning of those affected and may cause distress to them. Although they recognise the negative impact on their lives, they are not able to control them.

The definition of normality depends on culture and the times. It may be problematic as it involves making value judgments and even categorising others.

This is influenced, to a large extent, by sexual stereotyping. For example, when a woman pets a child, she is nurturing; when a man pets a child, it can be construed as molesting.

"Sexual preference disorders" is preferred to the term previously used, "sexual deviation", as it clarifies the essential nature of this group of behaviours, i.e. arousal in response to an inappropriate stimulus. These disorders are more common in men than women. There is no local published data available on the prevalence of these disorders, but this does not mean that they do not exist or the prevalence is low.

There are various types of sexual preference disorders listed in the World Health Organisation's International Classification of Diseases (ICD).

Fetishism

Fetishism is the reliance on some non-living object as a stimulus for sexual arousal sexual gratification. Many fetishes are extensions of the human body, such as articles of clothing or footwear. Other common examples are characterised by particular textures such as rubber, plastic or leather. This disorder is more common in males than females.

Fetishistic transvestism is the wearing of clothes of the opposite sex principally to obtain sexual excitement and to create the appearance of a person of the opposite sex. This disorder is distinguished from transsexual transvestism by its clear association with sexual arousal and the strong desire to remove the clothing once orgasm occurs and sexual arousal declines. It can occur as an earlier phase in the development of transsexualism. This disorder is usually unheard of in females.

Exhibitionism

Exhibitionism is the tendency to expose the genitalia to strangers (usually of the opposite sex) in public places, without inviting or intending closer contact. There is usually, but not invariably, sexual excitement at the time of exposure and the act is commonly followed by masturbation. In general, childhood trauma, e.g. sexual abuse or significant childhood experiences, can manifest itself in exhibitionism. Male genital exhibitionism is an indicator of future sexual offences in some individuals.

Voyeurism

Voyeurism is the tendency to look at people engaging in sexual or intimate behaviour such as undressing without their knowledge, followed by sexual excitement and masturbation. The differentiation of innocent enjoyment of nudity from voyeurism can be difficult.

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