He shared his desires with his wife. They experimented a few times within agreed limits, without coercion, pain, or the use of stimulants. His wife did not object but also did not wish to engage frequently, a boundary he fully respected.
His perspective shifted after reading online articles that linked such preferences to terms like "deviant" or "perverse." He began to feel guilty, constantly scrutinized his thoughts, feared discovery by others, became less proactive in intimacy, and occasionally experienced erectile dysfunction due to overwhelming anxiety. This prompted him to seek an examination at the Men's Health Center.
During the evaluation, Dr. Tra Anh Duy noted that the patient maintained normal work function, retained control over his behavior, did not seek excessive stimulation, had no extramarital affairs, and his fantasies were directed only towards consenting adults. "The patient's greatest difficulty was not his sexual preferences but his feelings of shame, self-stigma, and anxiety," the doctor stated. The individual showed no signs of paraphilic disorder or compulsive sexual behavior disorder. After receiving counseling on sexual health and guidance for the couple to communicate more openly about their desires and boundaries, his anxiety significantly decreased, and his sex life returned to a natural state.
According to Dr. Duy, this is not an uncommon case. In sexual life, individuals might be attracted to specific attire, role-playing scenarios, new locations, or expressions of dominant-submissive roles that differ from their daily routines. These fantasies can sometimes confuse those experiencing them, especially when they compare themselves to vague "normal" archetypes found online.
From a medical perspective, being different from the majority does not equate to illness. What needs evaluation is not what someone likes, but whether that preference is based on consent, safety, control, and how it impacts their life. Sexual fantasies are images or situations that appear in one's thoughts and can create arousal, but this does not mean the person will act them out in real life.
A study of over 1,500 adults published in The Journal of Sexual Medicine revealed that many fantasies often considered "unusual" are, in fact, quite common. The American Psychiatric Association also differentiates between atypical sexual interests and paraphilic disorders. An individual is only considered to have a disorder when these interests cause significant distress, impair their ability to study, work, or engage in daily life, or involve behavior harmful to others.
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Dr. Duy counsels a couple. Photo: Lam Anh |
According to Dr. Duy, a sexual preference can be assessed using four criteria:
The first is consent. Participants must be adults, fully capable of making decisions, and genuinely willing. Silence, intoxication, fear of abandonment, or reluctant compliance are not considered consent. Behaviors such as peeping, recording, touching others, or exposing one's body without permission extend beyond the scope of personal preference.
The second is safety. Even with mutual agreement, behaviors that risk suffocation, injury, bleeding, infection, or life-threatening situations still require careful consideration.
The third is control. A healthy preference is only one aspect of sexual life. Conversely, if an individual repeatedly fails to control urges, spends most of their time seeking stimulation, and continues despite negative consequences, an evaluation is necessary.
The final criterion is the impact on life. According to the World Health Organization's (WHO) ICD-11, compulsive sexual behavior disorder is characterized by a persistent lack of control, leading individuals to prioritize sexual behavior over health, work, and family, and to continue despite negative consequences.
The doctor advises seeking consultation from a sexual health specialist or a psychiatrist/psychologist if urges become increasingly difficult to control, if a preference becomes the only condition for arousal, or if behavior negatively affects health, work, and relationships. Evaluation is even more crucial if fantasies involve children or non-consenting individuals, if the person fears causing harm, or has already crossed others' boundaries.
"The goal of treatment is not to judge or shame the patient, but to help them control their behavior, protect themselves and others involved, and build a safe, responsible sex life," Dr. Duy stated.
Le Phuong
