Sexual fetishism

Sexual fetishism or erotic fetishism is a fixation on an object that is not sexual by its nature.^[2] The object is usually not seen as sexual.^[3] The object of interest is called the fetish, the person is called a fetishist.^[4] If the fetish causes psychological problems, it may be seen as a mental disorder.^[2][5]The term was made in the late 1800s^[6] by Alfred Binet.^[7]

Examples of common or well-known fetishes include feet and footwear (shoes, socks), rubber, bondage, furry or cross-dressing.

Doctors only use the word to objects or body parts. In common speech, people also use the word fetish for a sexual interest in specific activities, peoples, types of people, substances, or situations.^[8]

According to the World Health Organization, fetishistic fantasies are common and should only be treated when they kee people from functioning normally or cause distress.^[5] Almost any object can become a fetish. The only exception for this are sex toys, such as dildoes or vibrators: They were designed for sexual arousal.

Partialism is a type of sexual fetishism where the sexual want of a body part is more than the sexual want of the person who has the body part. Martin Kafka states that partialism is not exactly the same as fetishism,^[7] although common use does not agree.^[9]

Fetishes are common, and only need to be treated in severe cases. Goals of treatment can include elimination of criminal activity, making people rely less on the fetish for sexual satisfaction, improving relationship skills, reducing or removing arousal to the fetish altogether, or increasing arousal towards more acceptable stimuli. The evidence for treatment efficacy is limited and largely based on case studies, and no research on treatment for female fetishists exists.^[10]

Cognitive behavioral therapy is one popular approach. Cognitive behavioral therapists teach clients to identify and avoid antecedents to fetishistic behavior, and substitute non-fetishistic fantasies for ones involving the fetish. Aversion therapy and covert conditioning can reduce fetishistic arousal in the short term, but requires repetition to sustain the effect. Multiple case studies have also reported treating fetishistic behavior with psychodynamic approaches.^[10]

Antiandrogens may be prescribed to lower sex drive. Cyproterone acetate is the most commonly used antiandrogen, except in the United States, where it may not be available. A large body of literature has shown that it reduces general sexual fantasies. Side effects may include osteoporosis, liver dysfunction, and feminization. Case studies have found that the antiandrogen medroxyprogesterone acetate is successful in reducing sexual interest, but can have side effects including osteoporosis, diabetes, deep vein thrombosis, feminization, and weight gain. Some hospitals use leuprorelin and goserelin to reduce libido, and while there is presently little evidence for their efficacy, they have fewer side effects than other antiandrogens. A number of studies support the use of selective serotonin reuptake inhibitors (SSRIs), which may be preferable over antiandrogens because of their relatively benign side effects. Pharmacological agents are an adjunctive treatment which are usually combined with other approaches for maximum effect.^[10]

Relationship counselors may attempt to reduce dependence on the fetish and improve partner communication using techniques like sensate focusing. Partners may agree to incorporate the fetish into their activities in a controlled, time-limited manner, or set aside only certain days to practice the fetishism. If the fetishist cannot sustain an erection without the fetish object, the therapist might recommend orgasmic reconditioning or covert sensitization to increase arousal to normal stimuli (although the evidence base for these techniques is weak).^[10]

Human fetishism has been compared to Pavlovian conditioning of sexual response in other animals.^[11][12][13] People have artificially made rats become sexually aroused. Both male and female rats will develop a sexual preference for other rats that have no special smell, or that smell bad if those scents are paired with their early sexual experiences.^[11] Injecting morphine or oxytocin into a male rat during its first exposure to scented females has the same effect.^[11] Rats will also develop sexual preferences for the location of their early sexual experiences, and can be conditioned to show increased arousal in the presence of objects such as a plastic toy fish.^[11][12] One experiment found that rats which are made to wear a Velcro tethering jacket during their formative sexual experiences exhibit severe deficits in sexual performance when not wearing the jacket.^[11] Similar sexual conditioning has been demonstrated in gouramis, marmosets and Japanese quails.^[11]

Possible boot fetishism has been reported in two different primates from the same zoo. Whenever a boot was placed near the first, a common chimpanzee born in captivity, he would invariably stare at it, touch it, become erect, rub his penis against the boot, masturbate, and then consume his ejaculate. The second, a guinea baboon, would become erect while rubbing and smelling the boot, but not masturbate or touch it with his penis.^[14]