Autoerotic paraphilic manipulations may be not only incredibly unusual but also hazardous and possibly fatal. Autoerotic experimenters sometimes combine several paraphilic mechanisms, both potentially lethal and non-lethal. A tragic outcome is usually a direct consequence of the life-threatening paraphilic mechanism(s); however, it may also result from an accidental complication arising from the constellation of the paraphilic realization. In this report, we present a case of an autoerotic death of a 30-year-old man who applied two potentially lethal paraphilic mechanisms-body wrapping and foreign body anal insertion-together with two other non-lethal paraphilic activities, autofetishism and transvestitism. However, the man\'s death ultimately occurred due to another associated autoerotic activity-stimulation of the lower abdomen with an electric massager, which accidentally short-circuited and caused fatal electrocution. Such autoerotic fatalities constitute a distinct subcategory of accidental autoerotic death.

BACKGROUND: Paraphilias are recurrent and arousing fantasies, thoughts, and behaviors that cause distress to sufferers and surrounding people. This case report details the challenge of managing multiple paraphilias with compulsive sexual behavior.
METHODS: A 48-year-old Malay man presented with compulsive sexual behavior, encompassing voyeuristic, frotteurism, and exhibitionistic behavior, increasing progressively over the years, with accompanying overvalued ideas of erotomania. Despite the high level of dysfunction occupationally and socially, there were no apparent psychotic, manic, or depressive symptoms. An organic workup was unremarkable, and he was diagnosed with multiple paraphilias. Treatment with selective serotonin reuptake inhibitors was commenced, and psychologically he was managed with techniques specific to compulsive sexual behavior.
CONCLUSIONS: Though rare in the literature, both paraphilic disorders and compulsive sexual behaviors are very distressing to sufferers and their families alike, and thorough biopsychological investigations are essential to ensure reversible causes are not overlooked.

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.

Recent debates have evolved regarding the classification/conceptualization of compulsive sexual behavior disorder (CSBD). Conclusions regarding an agreed upon CSBD model are hindered by reliance on the latent disease model. Competing biological-based frameworks are moving forward to replace latent disease classification more broadly but have been met with limited success. We suggest that CSBD researchers move towards developing dimensional, transtheoretical, process-based models. We further suggest additional research, particularly mixed methods and longitudinal studies. Finally, we request that federal funding bodies take a more active role in supporting CSBD research.

Autoerotic asphyxia is a form of deviant sexual behavior that seeks sexual gratification by means of manipulation with one\'s own body resulting in asphyxia, and may sometimes turn out to be fatal. Autoerotic fatalities involving autoerotic asphyxia are divided into two groups: \"typical\" autoerotic fatalities involve mechanical compression of the neck, chest or abdomen, whereas \"atypical\" autoeroticism involves sexual self-stimulation by other means. Cases where asphyxiophilic behavior is accompanied by volatile substance abuse are reported to be rather rare, but may involve a high risk of fatal results. This paper presents a case of accidental \"atypical\" autoeroticism involving victim\'s abuse of toluene, which, combined with asphyxiophilic airway occlusion, led to death. For the sake of comprehensiveness, both a verbal description and a schematic representation of the major metabolic pathways of acute and chronic abuse metabolic markers is provided.

UNASSIGNED: Autoerotic death is defined as an accidental death that occurs when some type of apparatus is used to enhance sexual stimulation and causes an unintended death. We present the case of an atypical autoerotic death of a 23-year-old man found deceased in a bathroom. An electrical cord with a standard wall plug on one end and exposed wires twisted into loops on the other end was on the floor near his body. Minute black burns were present on each nipple. The outlet was protected by a ground fault circuit interrupter that was demonstrated to be in working order. An electrical consultant concluded that the cause of death could not be electrocution. Ground fault circuit interrupters work by detecting differences in current within a circuit. If a ground fault occurs, the circuit is broken to prevent a fatal electrocution. In the present case, the ground fault circuit interrupter did not shut off because the decedent had wired himself in parallel with the circuit. This, with the other scene findings, indicated this to be a case of atypical autoerotic death. Autoerotic deaths by means other than asphyxiation are rare. This case serves to illustrate the circumstances of an atypical autoerotic death by means of electrocution.

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BACKGROUND: Information about the frequency of zoophilic behaviour in the general population is scarce.
OBJECTIVE: To review cases, case series and prevalence studies of zoophilia in adults in the general population.
METHODS: A review of publications was carried out in MEDLINE via PubMed, Scopus and the Biblioteca Virtual en Salud [Virtual Health Library] ranging from January 2000 to December 2017.
RESULTS: Thirteen papers were reviewed (ten case reports, two case series and one cross-sectional study). Twelve patients were described, the case series totalled 1,556 people and the cross-sectional study included 1,015 participants and reported a prevalence of zoophilic behaviour of 2%.
CONCLUSIONS: Information on the prevalence of zoophilic behaviour in the general population is limited. The Internet will probably be a valuable tool for further investigating these behaviours in coming years.

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.

Paraphilia is a complex psychological and psychiatric disorder that has been difficult to treat. Leuprorelin has been used as one of the therapeutic methods for paraphilia. Leuprorelin administration could change insulin resistance and accelerate bone loss. The case study in this work was a 59-year-old man who visited a hospital with the chief complaints of frotteuristic behaviors in public places, a continuous increase in sexual desire, and sexual molestation behavior that started in 2007. We injected leuprorelin (3.6 mg) intramuscularly every month for this patient with paraphilia and comorbidities of osteoporosis and hyperthyroidism. The clinical global impression (CGI), Sex Addiction Screening Test (SAST), Wilson Sex Fantasy Questionnaire (WSFQ), physical examination, and laboratory tests were performed. After 12 months of leuprorelin injection for paraphilia, we found a significant improvement in abnormal sexual behavior/desire without aggravation of osteoporosis/hyperthyroidism. Gonadotrophin-Releasing Hormone (GnRH) analogs could be used as alternative or supplementary treatment methods for paraphilia with osteoporosis/hyperthyroidism.