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Exploring the relationship between paraphilic interests, sex, and sexual and life satisfaction in non-clinical samples.

Limited research has indicated that paraphilic interests and behaviours do not necessarily decrease sexual and life satisfaction; some research suggests such interests may actually enhance satisfaction. The present study assessed how paraphilic-associated interests and behaviours were related to sexual and life satisfaction in a sample of 173 men and 356 women. Paraphilic interest rates were similar to existing population-based studies. Men reported significantly higher levels of most paraphilic interests than women, apart from masochism. Those with paraphilic interests rarely felt negatively affected. However, those interested in criminal paraphilic interests or both criminal and legally feasible paraphilic interests had lower levels of sexual satisfaction when they did not engage in paraphilia-associated sexual behaviour. The sexual satisfaction of those interested only in legally feasible paraphilic interests was not impacted whether or not they engaged in paraphilia-associated sexual behaviour. Further analyses indicated that those without a paraphilic interest and those who have a paraphilic interest and have disclosed to their partner have higher levels of sexual satisfaction than those who have not disclosed to their partner or who do not have a stable partner. Additionally, among those who had disclosed to a partner, sexual satisfaction was not affected whether the individual engaged in the paraphilic interest with or without their partner. These results suggest a multifaceted relationship that warrants further consideration and examination.

KEY WORDS: Gender differences, paraphilia, paraphilic interests, sexual behaviour, sexual satisfaction

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Paraphilic disorders (paraphilias) and paraphilic interests are conceptualized separately within The Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition (DSM-5; American Psychiatric Association, 2013a). A paraphilic interest consists of persistent sexual arousal to atypical objects or situations, whereas paraphilic disorders also include clinical distress or harm to self or others. The DSM-5 specifies that the distress should not be the sole result of interpersonal rejection caused by consenting or solitary behaviours. Instead there is a focus on whether people are substituting typical sexual activity with their atypical interests or if they are causing harm to others (Giami, 2015). Based on the updated criteria some individuals may have paraphilic interests without a mental disorder, and as summarized by De Block and Adriaens (2013), research has suggested that a significant number of healthy people simply incorporate their paraphilic interests within their sexual lives (Hinderliter, 2010; McConaghy, 1988; McConaghy, 1999; Moser & Kleinplatz, 2006; Renaud & Byers, 1999). This also suggests that atypical sexual interests and behaviours do not have to be viewed necessarily as pathological (American Psychiatric Association, 2013b; De Block & Adriaens, 2013; Giami, 2015; Shindel & Moser, 2011). However, researchers have voiced differing opinions on the definition of paraphilic disorders across the various editions of the DSM (e.g., Blanchard, 2010, 2013; Briken, Fedoroff, & Bradford, 2014;Joyal, 2014; Langstrom, 2010; Robles et al., 2015; Suppe, 1984). As Balon (2013) noted, this problem in defining paraphilias is magnified by the fact that there is no gold standard in assessing the thresholds required for sexual arousal, behavioural patterns, and distress associated with paraphilias when using the DSM-5 criteria.

Paraphilic interests have been increasingly important to study as the growth of the internet is allowing individuals access to communities made up of others with atypical interests. Potter (2013) suggested that such communities may allow people to experiment with atypical behaviour in a safe manner, rather than acting upon such interests. However, the question remains whether individuals can entertain atypical sexual fantasies (e.g., rape fantasies or sexual interest in children) and not be moved to act on them (Potter, 2013). There is a growing body of literature examining this issue, particularly in the context of those sexually attracted to children (i.e., minor-attracted persons). An increasing number of studies have surveyed minor-attracted persons to identify potential protective factors that allow individuals to refrain from acting on their sexual interests; factors such as antisocial traits, self-regulation, and attitudes towards adult-child sexual interactions have been found to differentiate those who do and do not act on their interests (e.g., Cohen, Ndukwe, Yaseen, & Galynker, 2017; Mitchell, Bravo, & Galupo, 2017). Knowledge of risk and protective factors identified in such research may help increase resiliency among minor-attracted persons and reduce situations that may increase their likelihood of an offence.

THE IMPACT OF PARAPHILIC INTERESTS

Research has suggested that individuals who have specific paraphilic interests are not necessarily negatively impacted. For example, research has found that individuals interested in sadistic and masochistic behaviours have increased psychological adjustment, education, and socioeconomic status (Richters, Grulich, de Visser, Smith, & Rissel, 2003; Richters, de Visser, Rissel, Grulich, & Smith, 2008; Wismeijer & van Assen, 2013). Further, Rogak and Connor (2018) found that the incorporation of sadistic and masochistic behaviours in a relationship did not impact relationship satisfaction. Research specifically examining the relationship between paraphilic interests and sexual or life satisfaction has also been conducted. Ahlers et al. (2011) found that general life satisfaction, as well as sexual satisfaction, were not impacted by the presence of a paraphilic interest. Joyal and Carpentier (2017) recently examined sexual satisfaction among those with paraphilic interests; they found that only those with masochistic interests had increased levels of sexual satisfaction. However, additional research is needed given these limited findings.

A primary limitation of research examining paraphilic interests is that it has focused on individuals who have already engaged in the paraphilic behaviours, often in a forensic setting. Although this is important research, it is crucial to investigate the characteristics and protective factors that allow some individuals to manage their paraphilic interests in everyday life without criminal consequences. For some, as the research above notes, these interests may actually enhance an individual's sexual satisfaction. Studying this set of individuals may help researchers and clinicians understand how they can identify, prevent, and treat offenders who struggle with such interests. This information could also be used to discover how some individuals have dealt with their paraphilic interests in a manner that has not resulted in harm to others or themselves and assist others to avoid offending behaviour. Dombert et al. (2016) conducted a recent community survey in Germany examining sexual interest in children and found that individuals with a sexual interest in children perceived a need for therapy. This is promising; ideally, as knowledge about risk and protective factors increase, help to those who need it will increase.

Research examining paraphilic interests in non-clinical samples has been increasing, and how such interests are measured is critical. There tends to be a focus on distress and impairment in forensic and clinical-based measures, which may distort estimates of paraphilic interests in non-clinical samples or miss out on relevant information. Further, research on non-clinical samples tends to ask participants about their sexual arousal or sexual repulsion to paraphilic interests (e.g., Dawson, Bannerman, & Lalumiere, 2016), but often research does not distinguish between individuals who simply find the situation arousing and those who actively involve it in their sexual lives (e.g., masturbation fantasies, inclusion in sexual activities). This differentiation has begun to be addressed in recent research (Ahlers et al., 2011; Dombert et al., 2016), which may assist in the development of more "kink-friendly" services for those hoping to integrate paraphilic interests in their lives.

ASSESSING PARAPHILIC INTERESTS IN NON-CLINICAL SAMPLES

Seto, Kingston, and Bourget (2014) suggested that the assessment and diagnosis of paraphilic disorders requires a multimodal approach; however, self-report is often the only accessible measure used to measure sexual interests and behaviours. Other methods to assess paraphilic interests have been developed and used, such as the Implicit Association Test, phallometric testing, and viewing time have also been used successfully (Babchishin, Nunes, & Hermann, 2013; McPhail et al., 2017; Schmidt, Babchishin, & Lehmann, 2017). Overall, the various measures target different sexual interests and behaviours, so evaluating paraphilic interests and/or paraphilic disorders among different samples can be difficult when no measure is consistently used (e.g., a gold standard).

The overall rate of paraphilic interests in non-clinical, non-forensic samples has been investigated to a limited degree. Research using convenience sampling has shown prevalence rates that range from 15% to 62% (Abdullahi, Jafojo, & Udofia, 2015; Ahlers et al., 2011; Dawson, Bannerman, & Lalumiere, 2016; Joyal & Carpentier, 2017; Makanjuola, Adegunloye, & Adelekan, 2008). This literature utilized populations such as university students, teachers, community members, as well as provincial surveys. In a Canadian provincial survey of paraphilic interests, Joyal and Carpentier (2017) found that rates differed based on the method of data collection used. Although the exact prevalence rate is unknown, some research has suggested individual differences (e.g., sex, relationship status) associated with paraphilic interests. Most research has suggested sex differences with regards to paraphilic interests; men generally have higher rates of paraphilic interests than women (Dawson et al., 2016; Makanjuola et al., 2008). However, some research in sub-Saharan Africa found no association between sex and paraphilic interests (Abdullahi et al., 2015). Bouchard, Dawson, and Lalumiere (2017) extended sex difference findings by further examining the relationship between paraphilic interests and behaviours. Consistent with prior research, they found that men reported more paraphilic interests; however, they found that men also reported engaging in paraphilic-associated sexual behaviours. The authors noted the importance of sexual drive in linking paraphilic interests and sexual behaviours, and suggested that sexual drive is an important factor in understanding paraphilias. Marital status has been found to be related to paraphilic interests, although the results are conflicting (Ahlers et al., 2011; Makanjuola et al., 2008). With regards to age, younger individuals tend to have higher rates of paraphilic interests than older individuals (Abdullahi et al, 2015; Makanjuola et al., 2008).

THE PRESENT STUDY

Past research has suggested that paraphilic interests are more prevalent than commonly assumed (e.g., Ahlers et al., 2011; Dawson et al., 2016; loyal & Carpentier, 2017). The present study aimed to provide a more nuanced investigation of paraphilic interests that differentiated between feelings, thoughts, and behaviours. Specifically, the study sought to identify sexual arousal to paraphilic interests and then understand the paraphilia-associated sexual behaviours (i.e., sexual fantasies, masturbation fantasies, sexual behaviour) the individuals engage in. From our perspective, the underlying sexual interests should be examined to better understand what is related to whether the individuals choose to incorporate or not incorporate these interests into their sexual lives. Providing supportive resources to those who have such interests can potentially help those individuals incorporate their atypical sexual interests into their lives in a non-harmful manner. If the behaviour can be acted on without harm, then it can potentially be used as a healthy sexual outlet. Further, by examining the experiences of those who do not offend, we may acquire a deeper understanding of how to distinguish between those who are at risk of problematic or offending behaviours. These individuals can then be provided the needed clinical resources for behavioural management, and those who are not at risk can seek more supportive resources if needed.

Due to the sensitive nature of such interests, the best method to survey participants was a primary consideration. Cantor and McPhail (2016) strongly recommend a mixed-method approach for such specific sexual interests and the ability to provide rich information. Due to the length of the measure used, a full mixed-method protocol was not used; however, the present utilized survey methodology to collect both quantitative and qualitative information from the participants. Collection of data via online forums (e.g., Reddit), also known as online message boards, has successfully been used in past academic research to yield a large sample size for an atypical sexual behaviour (polyamorous; Mitchell, Bartholomew, & Cobb, 2014). Online forums allow individuals to participate in discussions at their own convenience, rather than requiring synchronous communication; these factors have allowed for increased discussion of sensitive topics. This can be particularly helpful for data collection, as forums tend to be easily observable, easy to navigate, accessible, and safe for researchers (Im & Chee, 2006). Overall, the present study sought to build on existing literature, and explore how paraphilic interests and sexual behaviours are related to sexual and life satisfaction. Further, the present study sought to understand how sex and legal feasibility of the paraphilic interest are related to these variables and to relationship variables. Consistent with previous research, it was expected men would report higher levels of paraphilic interests. It was also expected that those who identified having paraphilic interests would have similar sexual and life satisfaction compared to those who did not identify having a paraphilic interest.

METHOD

Participants

A total of 309 participants (55 men, 253 women) were recruited from a Canadian university using a psychology class subject pool. A total of 584 participants (297 men, 287 women) were recruited from online sexuality forums. The online survey was run until the pool was exhausted; it was officially closed after no responses had been recorded for one month. The university sample was collected over a two-semester period (eight months). After that period, minimal students were available to receive data from during the summer months, and the survey was closed out for data analysis.

The final sample (n = 529) included in the analyses consisted of 44 men and 215 women from the university and 129 men and 141 women from the sexual forums, for a total of 173 men and 356 women.

Measures

The measure used was the Sexual Life and Sexual Behaviour Questionnaire (SLSB). The SLSB is a revised version of the Questionnaire on Sexual Experiences and Behaviour / Fragebogen zum Sexuellen Erleben und Verhalten used in the Ahlers et al.'s (2011) study. Initial development occurred at the Institute of Sexology and Sexual Medicine, part of a medical university in Berlin. The measure was designed to be a standardized survey instrument for sexual health information, and until recently was only available in German (Ahlers, Schaefer, & Beier, 2004). Due to the authors' focus on developing an easy to use survey tool that provides extensive coverage of issues related to sexual health, there has been a lack of rigorous testing and psychometric validation thus far (Ahlers et al., 2008). The primary author received the revised measure in February of 2015. The same researchers who constructed and revised the German measure also translated to English. The updated measure had not been used in academic research at the time of data collection, although it should be noted that Joyal and Carpentier (2017) used some question phrasing from the paraphilia-related section of the original measure in their recent study. Although validation studies have not been conducted using this measure, it was chosen because it has been successfully used to assess paraphilias in non-offender samples, and provides a comprehensive evaluation of sexuality, sexual interests, sexual behaviours, and sexual arousal patterns. The SLSB has seven sections that assess personal information (e.g., demographics), views and experiences (e.g., sexual satisfaction, frequency of sexual behaviours, and sexual pain), sexual and gender identity, sexual tendencies (e.g., paraphilic interests and paraphilia-associated sexual behaviours), and medical illnesses and procedures.

Questions targeted to men or women were automatically provided based on the biological sex the participant provided. Due to the nature and length of the questionnaire, as well as the fact that not all questions would apply to participants, none of the questions required answers except for the question querying biological sex (referred to in the questionnaire as "sex assignment at birth"). However, it should be noted that all participants answered the demographic questions with the exception of the education question; 15 participants did not complete this question. Given the small number of missing data, rather than impute or remove the cases, pairwise deletion was utilized.

Each paraphilic interest in the measure was assessed through a variety of questions and was based on DSM-IV-TR criteria (American Psychiatric Association, 2000). This section was of particular importance for this study; unlike existing questionnaires that examine sexual interests, the SLSB differentiated between arousal to paraphilic interests, and different forms of engagement in paraphilia-associated sexual behaviour (e.g., fantasizing vs. actual behaviour). The first question asked participants how sexually arousing a given situation/person is. Rather than using diagnostic-related terminology, these questions included explicit descriptions, such as "How sexually arousing do you find pubescent girls and their bodies (beginning to get pubic hair, small breasts)?" This question was asked using a 5-point numeric scale ranging from 1 (Not at all) to 5 (Extremely). The second question asked how long they have had that interest. Paraphilia-associated sexual behaviours were then evaluated by including questions about general fantasies ("How often do you engage in this fantasy during sexual fantasies?"), masturbation fantasies ("How often do you engage in this fantasy during masturbation fantasies?"), and sexual behaviours ("How often do you engage in this fantasy during sexual behaviour?). Sexual fantasies were defined as "sexual fantasies, daydreams, and thoughts," masturbation fantasies were defined as "fantasies accompanying self-satisfaction," and sexual behaviours were defined as fantasies carried out in sexual activity. These questions were asked using a 5-point numeric scale ranging from 1 (Never) to 5 (Almost Always). The final two questions asked how often they are negatively impacted by this fantasy, and how often this fantasy negatively impacts their relationship, social, and work life. These questions were asked using a 5-point numeric scale ranging from 1 (Not at all) to 5 (Extremely).

Participants were also asked, "How happy are you with your sexual life?" and "How happy are you with your life?" to assess sexual and life satisfaction. Both questions are asked using a 5-point numeric scale ranging from 1 (Not at all) to 5 (Extremely).

Categorization of Paraphilic Interests, Engagement, and Legal Feasibility

Although participants were asked many questions pertaining to their relationships, sexuality, and health, the results provided here will focus on their sexuality. Participants rated their level of sexual arousal to various paraphilic interests on a 5-point numeric scale. The name of the paraphilic interest was not provided, only a description. Participants were categorized as having a paraphilic interest if they rated their level of paraphilia-associated sexual arousal as very or extreme (n = 297). Those who rated their level of sexual arousal as not at all, slightly, or moderate were rated as not having a paraphilic interest (n = 232). This is consistent with similar literature (e.g., Joyal & Carpentier, 2017) and is consistent with the persistent nature of paraphilic interests described in the DSM-5. If participants expressed any paraphilia-associated sexual arousal, then engagement in sexual fantasies, masturbation fantasies, and sexual behaviour in relation to the interest was rated on 5-point numeric scale.

Participants who had rated that they were Not at all aroused by the paraphilic interest did not complete the paraphilia-associated sexual behaviours questions. Participants who rated themselves as engaging in the pattern not at all or rarely were categorized as not engaging in the behaviour (n = 66). Those who rated themselves as engaging in the pattern (if they rated themselves as engaging in it sometimes, often, or almost always) were categorized as engaging (n - 391).

Fetishism, transvestism, masochism, and sadism were categorized as legally feasible behaviours. Voyeurism, exhibitionism (with and without masturbation), frotteurism (touching generally and touching in sexual areas), and prepubescent and pubescent related sexual interests were categorized as criminal behaviours. Voyeurism was included as a criminal behaviour because the question indicated that the person being watched was unaware of the participant (i.e., non-consenting). Participants were then coded as endorsing legally feasible behaviours (n = 201), criminal behaviours (n = 36), or both legally feasible and criminal behaviours (n = 59).

Procedure

The primary author contacted the leading moderators of forums (r/sex, r/SampleSize, r/TwoXChromosomes) on Reddit to explain the study and request to post a recruitment ad-poster for the study and a link to the online questionnaire. Moderator preferences dictated whether they posted the questionnaire link or gave permission to the primary author to post the questionnaire link. Following completion of the sexuality questionnaire, a single question on the final page asked participants to rate how honest they had been in their responses, with answer options that ranged from Not At All Honest to Completely Honest. Following the debriefing form, participants were provided with a hotlink. For subject pool participants, this link allowed the participants to send their name to the researcher so they could receive their extra course credit, without linking the information to their questionnaire answers. For online participants, this link allowed the participants to send their name to the researcher so they could enter a draw for a gift card (final odds of winning 1:39), without linking the information to their questionnaire answers.

The study was evaluated as minimal risk, as it did not expose participants to any risks outside of their normal dayto-day lives. However, since this study asked participants to disclose personal information around the topic of sexuality and paraphilic interests, the largest risk to individuals was disclosure of criminal activities. We strictly guarded participant identities and the links to their answers to prevent any identification of participants based on their answers; however, there were limitations. The recruitment ad included information about the Qualtrics survey system used in this study (e.g., where the information is stored, who has access to this information, that it is subject to U.S. laws, etc.). Although risk was minimal, participants were instructed that they could withdraw from the study at any time without penalty. To protect the identities of our participants, we did not ask for any identifying information. The survey system recorded the IP addresses of the participants, but this information was deleted when the data were retrieved.

Analysis

As the survey took some participants over an hour to complete, a single question was used to assess self-reported honesty, rather than longer measures to assess impression management or social desirability. In the past, this approach has yielded useful information in the context of sensitive topics such as sexual behaviour (Zimmerman & Langer, 1995). Participants were excluded if they did not complete the survey or rate their honesty in the survey as a 4 (Mostly Honest) or 5 (Completely Honest). There was also an attention check item within the questionnaire; no participants who were included based on honesty showed atypical responses to the question.

An alpha value .05 was used an indicator of statistical significance throughout the analyses. Demographic characteristics for men and women are provided in Table 1. Chi-square analyses were conducted on the main demographic characteristics to see whether they should later be used as covariates. Education, ethnic origin, and relationship status significantly differed between men and women, whereas religious status did not. Frequency counts, adjusted residuals, and the chi-square results are provided in Table 1. Differences between sample types (online forum vs. psychology students) were considered; however, due to the unequal sex distribution of the samples, sex remained the primary variable of interest.

Basic psychometric properties were assessed for the sexual arousal and engagement questions. Cronbachs a for the 13 questions addressing sexual arousal to paraphilic interests was .75. Cronbachs a for the 39 questions addressing various types of engagement in relation to paraphilic arousal was .98.

RESULTS

Paraphilic Interests and Paraphilia-Associated Sexual Behaviours

Sexual arousal means and standard deviations for men and women are provided in Table 2, as well as the total number and percentage of paraphilic interests for the sexes. Overall, at least one paraphilic interest was reported by 56% of the sample. In terms of sex differences, 63% of men and 53% of women reported the presence of at least one paraphilic interest. The chi-square results indicated that men (M = 1.30, SD = 1.48) reported significantly more paraphilic interests than women (M = 0.79, SD = 0.95), [chi square](1) = 4.92, p = .03, r = .10. Men were significantly more sexually aroused for nearly all the paraphilic interests. However, women had a significantly higher level of sexual arousal to being masochistic than men, and men and women did not differ with regards to level of sexual arousal to prepubescent and pubescent males. Across the samples, the most common paraphilic interests were masochism, sadism, and voyeurism. Interestingly, both men and women showed higher means of sexual arousal towards prepubescent and pubescent females compared to prepubescent and pubescent males.

As expected, rates of endorsement generally decreased when progressing from fantasy-oriented behaviour to sexual behaviour for both samples. Chi-square results indicated that men engaged in significantly more fetish and being sexual dominant masturbation fantasies than women. However, women engaged in significantly more sexual fantasies, masturbation fantasies, and sexual behaviour related to masochism, relative to men. Full results for engagement in sexual behaviours for the sexes are provided in Table 3. No other significant sex differences were found in terms of rates of endorsement.

Impact of Paraphilic Interests

Although varied paraphilic interests were present, participants rarely rated that they were negatively affected by their fantasies, or that their fantasies negatively impacted their relationships, social life, or work. As education, ethnicity, and relationship status were found to differ between men and women, they were used as the covariates. The distribution of sexual satisfaction for sex, presence of paraphilic interest, engagement in sexual behaviours related to a paraphilic interest, legal feasibility, and the interaction terms were first assessed for normality. All groups violated the assumption of normality; therefore, parametric ANCOVAs could not be performed. Given this limitation, a 2 Sex (Male/Female) x 2 Paraphilic Interest (Present/Absent) x 2 Engagement in Paraphilic-Related Behaviours (Engagement/Non-Engagement) x 2 Legal Feasibility (Legal/Illegal) nonparametric factorial analysis of covariance (ANCOVA) using ranked sexual satisfaction data was conducted to assess whether these variables impacted the participants' sexual satisfaction above and beyond demographic variables.

The ANCOVA revealed a significant two-way interaction between engagement in sexual behaviours related to a paraphilic interest and legal feasibility, F(1, 275) = 4.06, p = .045, d = 0.11, and a significant main effect of sex, F(l, 275) = 5.57, p = 0.02, d = 0.04 on sexual satisfaction. The covariate relationship status had a significant effect on sexual satisfaction, F(l, 275) = 41.56, p < .001, [[eta].sub.p.sup.2] = .13. No other significant interactions or main effects were found. The overall ANCOVA model accounted for 18% of the variance in sexual satisfaction (adjusted 15%). As can be seen in Figure 1, those who were interested in legally feasible paraphilic interests had high levels of sexual satisfaction, whether or not they were engaging in sexual behaviours related to the paraphilic interest. However, for those interested in criminal paraphilic interests or both criminal and legally feasible paraphilic interests, sexual satisfaction was high when they were engaging in sexual behaviours related to the paraphilic interest, but very low when they were not engaging in sexual behaviours related to the paraphilic interest. An examination of the mean ranks indicated that women ([M.sub.rank] = 274.95) reported significantly higher levels of sexual satisfaction than men ([M.sub.rank] = 235.56; difference = 39.39).

A 2 Sex (Male/Female) x 2 Paraphilic Interest (Present/ Absent) x 2 Engagement In Paraphilic-Related Behaviours (Engagement/Non-Engagement) x 2 Legal Feasibility (Legal/ Illegal) factorial ANCOVA was used to assess whether these variables impacted the participants' life satisfaction above and beyond demographic variables. There were significant main effects for sex, F(1, 275) = 7.48, p = .007, d = 0.11, education, F(l, 275) = 7.13, p = .008, d = 0.15, and relationship status, F(l, 275) = 9.29, p = .01, d = 0.17, for life satisfaction. The overall ANCOVA model accounted for 11% of the variance in life satisfaction (adjusted 8%). An examination of the mean ranks indicated that women ([M.sub.rank] = 273.78) reported significantly higher levels of life satisfaction than men ([M.sub.rank] = 242.16; difference = 31.62).

Given the preceding results, a one-way analysis of variance (ANOVA) was conducted to evaluate the relationship between relationship status on sexual satisfaction. As expected, the results of the ANOVA indicated that the effect of relationship status on sexual satisfaction was significant, F(5, 517) = 5.12, p < .001, d = 0.81. The effect size was large and indicated that a sizable portion of the variation in sexual satisfaction was explained by relationship status. Post-hoc comparisons using the Tukey HSD test indicated that the mean rank score for single individuals ([M.sub.rank] = 195.52) was significantly different than for the married ([M.sub.rank] = 273.68; difference = -78.15), co-habiting ([M.sub.rank] = 296.67; difference = -101.15), non-cohabiting ([M.sub.rank] = 332.84; difference = -137.32), and long distance ([M.sub.rank] = 302.80; difference = -107.27) individuals. The only other significant difference was between the mean rank score of individuals who were divorced/separated ([M.sub.rank] = 220.06) and those who were non-co-habiting (difference = -112.78). These findings suggest that, generally, single individuals had lower levels of sexual satisfaction than individuals in all other relationship statuses, except for those who were divorced/ separated. Those who were divorced/separated only had significantly lower sexual satisfaction than non-co-habiting individuals.

Given the lack of differentiation in sexual satisfaction for most relationship statuses, a one-way ANCOVA was conducted to see whether disclosure of a paraphilic interest to a partner, controlling for legal feasibility of the interest, was related to sexual satisfaction among those in a relationship. The results of the ANCOVA indicated that the effect of disclosure of a paraphilic interest on sexual satisfaction was significant, F(3, 288) = 26.08, p < .001, d = 1.03. The effect size was large and indicated that a sizable portion of the variation in sexual satisfaction was explained by disclosure of the paraphilic interest. Post-hoc comparisons using the Tukey HSD test indicated that the mean rank score for individuals without a paraphilic interest ([M.sub.rank] = 281.57) was significantly different than for individuals who had not disclosed to their partners ([M.sub.rank] = 184.42; difference = 97.15) and individuals who did not have a stable partner ([M.sub.rank] = 151.46; difference = 130.12). Sexual satisfaction among individuals who had disclosed paraphilic interests to their partners ([M.sub.rank] = 316.03) significantly differed from individuals who had not disclosed to their partners (difference = 131.61), and individuals who did not have a stable partner (difference = 164.57). Interestingly, sexual satisfaction among those without paraphilic interests did not differ from individuals who had disclosed paraphilic interests to their partners. These findings suggest that, generally, individuals who do not have a paraphilic interest and those who have a paraphilic interest and have disclosed to their partner have higher levels of sexual satisfaction than those who have not disclosed to their partner or who do not have a stable partner.

Considering this finding, a final one-way ANCOVA was conducted to see whether engaging in the sexual interest with or without their partner, controlling for legal feasibility of the interest, was related to sexual satisfaction among those who had disclosed to their partners. The results of the ANCOVA indicated that the effect of engaging in the paraphilic interest with or without their partner on sexual satisfaction was not significant, F(1, 151) = 0.03, p = .60, d = .05. The effect size was negligible and indicated a very small portion of the variation in sexual satisfaction was explained by engaging in the paraphilic interest with or without their partner.

Participants' Feedback on Questionnaire

Participants were provided an open-response option to leave feedback on the structure/content of the survey. Many participants suggested that including more open-ended questions would be beneficial. They stated that human sexuality has a wide range of possibilities, and that close-ended questions did not always match their preferences. Several participants discussed positive versus negative impact of paraphilic interests on an individual's life. As the measure is rooted in the criteria of the DSM, there is an implicit focus on how paraphilic interests may negatively impact the lives of the participants. Many participants thought this was problematic, and that it is important to consider that some individuals have learned to successfully incorporate their paraphilic interests into their everyday lives. These individuals focused on the fact that although their actions may be considered atypical sexual acts, they are fully consenting adults and have fully consenting partners.

DISCUSSION

The present study translated and administered an existing German measure (Ahlers et al., 2011) to assess paraphilic interests and paraphilia-associated sexual behaviours. Like the results of Ahlers and colleagues (2011), and more recently Joyal and Carpentier (2017), the findings suggest that paraphilic interests are not infrequent, or particularly distressing, in non-clinical samples. Joyal and Carpentier (2017) found that 46% of their sample expressed a paraphilic desire, whereas Ahlers and colleagues (2011) found that 62% reported a paraphilic interest. The present study was consistent with these findings, with the presence of at least one paraphilic interest reported by 56% of the sample. Masochism, sadism, and voyeurism were the most common interests. Rates of paraphilic interests between the sexes significantly differed; 63% of the men reported at least one paraphilic interest, whereas 53% of the women did. These findings also agree with previous literature, which suggests that men typically have higher rates of paraphilic interests (Bouchard et al., 2017; Dawson et al., 2016; Joyal & Carpentier, 2017; Makanjuola et al., 2008). Although most participants reported at least one paraphilic interest, they did not all engage in paraphilia-associated sexual behaviours. Many of those individuals reported experiencing high levels of paraphilia-associated sexual arousal, but they did not include that interest in their sexual fantasies, masturbation fantasies, or sexual behaviour. Of those who did engage in those patterns, there were higher rates of incorporating the paraphilic interest in sexual fantasies or masturbations than in actual sexual behaviour, which also is consistent with previous research (Ahlers et al., 2011; Dombert et al., 2016).

Although varied paraphilic interests were reported in the present study, participants rarely reported any negative impact related to these interests. These findings are in line with the existing research that has suggested paraphilic interests (e.g., masochism) do not necessarily cause psychological distress or relationship impairment (Richters et al., 2008; Rogak & Connor, 2018). However, it is important to recognize that the level of impairment or distress can be impacted by other factors such as personality, which research has begun to examine (van Bommel, Uzieblo, Bogaerts, & Garofalo, 2018).

Research has not yet examined the role of legality in the expression, and satisfaction associated with, paraphilic interests. In the present study, those interested in criminal or criminal and legally feasible paraphilic interests had low sexual satisfaction if they were not engaging in sexual behaviours. For those interested only in legally feasible paraphilic interests, sexual satisfaction was high (relative to others). This finding should be explored in future research, as existing research tends to separate findings based on forensic or non-forensic settings; yet, the current finding may suggest that the legal or illegal label associated with the paraphilic interest plays a major role in sexual satisfaction. It may be that the concerns about engaging in such interests vastly differ between those who are interested in legal or illegal behaviour, or there may be additional factors impacting this relationship.

Women were found to report significantly higher sexual satisfaction than men, regardless of the considered factors; however, the effect size was small. Although significant, the minimal relationship is in agreement with the findings of existing literature, which suggests that sex is not the most important predictor of sexual satisfaction (e.g., Ziheri & Masten, 2010). With regards to life satisfaction, women were found to report significantly higher levels than men, but there were no other significant relationships found with regards to paraphilic interests. The effect size for this relationship was small.

Relationship status was also found to effect sexual satisfaction; the effect size for this factor was large. Further analyses indicated that single individuals generally had lower levels of sexual satisfaction than all other individuals with the exception of those who were divorced/separated; those were divorced/ separated had lower sexual satisfaction that non-co-habiting individuals. This finding makes sense, as those who had the lowest levels sexual satisfaction were the least likely to be engaged in an ongoing sexual relationship. Further investigation was then done into the role of relationships among those with paraphilic interests. The results indicated that individuals who did not have a paraphilic interest or had a paraphilic interest and had told their partner had higher levels of sexual satisfaction than those who had not told their partner or who did not have a partner, regardless of the legal feasibility of the interest. The effect size for this relationship was large. Further, analyses indicated that for those who had told their partner, engaging in sexual behaviours related to the paraphilic interest with or without their partner did not affect their sexual satisfaction. Moreover, the effect size for this relationship was negligible. Overall, these findings are in line with existing literature that has found the presence of a paraphilic interest does not necessarily have to negatively impact general life satisfaction or sexual satisfaction (Ahlers et al., 2011; Joyal & Carpentier, 2017).

The results should be considered within the limitations of the study. The rates of paraphilic interests may have been artificially inflated due to self-selection bias. The study was advertised with the title "An Investigation into Sexual Interests Within University and Online Samples," and described in such a way that it was apparent that sexual interests were being examined; therefore, individuals who chose to participate may have been substantively different than those who chose not to participate. Moreover, the online sample consisted of individuals who frequented an online forum of sexuality, further increasing the likelihood of a self-selection bias. Conversely, the presence of paraphilic interest was coded based on reporting high levels of sexual arousal (very or extremely) to the paraphilic interests rather than providing traditional labels. Future research should examine how paraphilic interest rates, engagement in paraphilia-associated sexual behaviours, and satisfaction change based on how paraphilic interests are coded. Although bias may have been present, the presence of all types of paraphilic interests in this large sample suggest the need to open the discussion of atypical sexual interests in areas other than forensic or psychiatric settings.

As the research advances, it is also important to consider sex differences, and account for other variables that have been suggested as covariates such as handedness, IQ, impulsivity, risk proclivity, and sex drive given their association with paraphilic interests (Dawson et al, 2016, 2014). Further, even larger and more diverse samples will be needed to see the full picture of what paraphilic interests look like in the general population. Modern technology and the use of the internet to attain online samples appears to be yielding high-quality data for psychological research and may allow researchers to attain such diverse data (Ramsey, Thompson, McKenzie, & Rosenbaum, 2016). This ability to collect high-quality data may be related to individuals being better able to access communities that are "kinkfriendly" and can become their community (Potter, 2013).

Although the present study found that sex was related to sexual satisfaction, some factors within the study may be relevant. These results were based on self-report data. As self-report measures depend on the participants' honesty, using them to assess sexual interests and behaviours has its limitations. Sexual interests are considered a private matter by most, and when there are potential negative outcomes associated with some interests (e.g., cheating on spouse, illegal behaviours) the likelihood of reporting decreases. Assuring anonymity of participants and finding ways to incentivize participants' honesty remain a concern for future research. Finally, the measure used in the study was only recently translated to English. Due to the length of the measure, no additional measures were included; this did not provide an opportunity to explore convergent validity. Future research should include additional sexuality measures to do so, and more generally more information on the psychometric properties of the measure needs to be collected and examined.

The results of the current study suggest that many individuals who have paraphilic interests and experience paraphilia-associated sexual behaviours do not experience accompanying distress, but instead successfully incorporate these interests into their life and relationships. Although there may have been differences, it is important to note that those with paraphilic interests still generally rated their sexual and life satisfaction high. Understanding how successful incorporation takes place could be useful in helping those who are struggling with such desires. Sexual satisfaction is an important part of a fulfilling life for most members of the population; however, what sexual satisfaction consists of may vary depending on the individual. Research has shown that non-sexual factors, such as interpersonal behaviours between wife and husband, can impact sexual satisfaction (Schoenfeld, Loving, Pope, Huston, & Stulhofer, 2017). Further exploration of the biological, psychological, physical, and social factors that impact sexual satisfaction among those with specific sexual paraphilias is currently limited and needed.

Although sexual behaviour patterns provide insight into the incorporation of desires, future research should be sure to clarify what sexual behaviour means in the context of the measure. The current measure had some issues in distinguishing between sexual fantasies used during sexual activity (e.g., role playing having sex with an underage female) versus sexual fantasies occurring through sexual activity (e.g., having sex with an underage female). Distinguishing between these two types of activities will be critical to determining how someone is or is not integrating their paraphilic interests into their lives in an appropriate and legal manner. Further, identifying and understanding why some individuals move from fantasy to behaviour, versus only engaging in fantasies will also play a critical role. Findings from Bouchard and colleagues (2017) recent study suggested that factors such as sexual drive may be involved in this transition, but ongoing research is needed to determine the generalizability of the result.

The potential integration of such behaviours may require differing assessment and treatment methods of paraphilic interests than what is currently used for clinical or forensic samples. The results from this study suggest that if individuals can disclose their paraphilic interests to their partners, they may have increased sexual satisfaction, regardless of whether they engage in sexual behaviours related to that interest with their partner or with an outside partner. This process of disclosure is something that could be targeted within therapy. Those with alternative sexual lifestyles, such as paraphilic interests, present to therapy with unique concerns such as disclosure (Voss, 2016). This need for therapy targeted to their specific needs has been perceived by the individuals themselves, such as those with a sexual attraction to children (Dombert et al., 2016). Unfortunately, many therapists receive little to no training with regards to sexuality, are uncomfortable discussing sexual topics, and may be biased against specific sexual interests (Heiden-Rootes, Brimhall, Jankowski, & Reddick, 2017; Humy, 2015; Kolmes, Stock, & Moser, 2006). However, if they choose to seek it out, training has become increasingly available to assist professionals in becoming more "kink-friendly" (Pillai-Friedman, Pollitt, & Castaldo, 2015).

CONCLUSION

This study sought to examine the relationship between paraphilic interests, paraphilia-associated sexual behaviours, sex, and sexual and life satisfaction in a non-clinical sample. Consistent with existing literature, the study identified that paraphilic interests are relatively common. Participants expressed low amounts of distress associated with their paraphilic interests and reported generally high levels of life and sexual satisfaction. However, relationship status, legal feasibility of paraphilic interests, and disclosure to partners was related to sexual satisfaction. Ideally, this information, and the findings of future research, will assist clinicians to help individuals incorporate their atypical sexual interests into their lives in a beneficial way. The information also may provide insight into how to help individuals identify and management problematic behaviours.

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Crystal L. Mundy (1) and Jan D. Cioe (1)

(1) University of British Columbia Okanagan, Kelowna, BC

Acknowledgements: The authors would like to acknowledge the assistance of Dr. Christoph Ahlers and Dr. Gerard Schaefer, who graciously provided a translated version of the German sexuality measure and made it available for our study. This project was supported in part by the Social Sciences and Humanities Research Council of Canada (SSHRC) through research awards to the first author.

Correspondence concerning this article should be addressed to Crystal L. Mundy, University of British Columbia, Irving K. Barber School of Arts and Sciences, Psychology Department, ASC 201, 3187 University Way, Kelowna, BC V1V 1V7, Canada. E-mail: crystalmundy@alumni.ubc.ca

Caption: Figure 1. Engagement in sexual behaviours related to paraphilic interest
Table 1. Contingency Table, Adjusted Residuals, and Chi-Square
Results for Sex and Demographics

Demographic                Male Count       Female Count
                         (Adj. Residual)   (Adj. Residual)

Education
  (highest or current)
  High school diploma       19 (2.4)          19 (-2.4)
  Some college              17 (1.7)          21 (-1.7)
  2-year degree             18 (1.8)          22 (-1.8)
  4-year degree            90 (-4.7)          260 (4.7)
  Graduate studies          22 (2.1)          26 (-2.1)

Ethnic Origin
  Aboriginal                1 (-0.8)            5 (0.8)
  African                   2 (-0.2)            5 (0.2)
  Asian                    13 (-1.6)           43 (1.6)
  Caribbean                  2 (0.7)           2 (-0.7)
  European                  94 (4.0)         128 (-4.0)
  Latin, Central, and        6 (0.4)          10 (-0.4)
    South American
  North American           36 (-2.7)          115 (2.7)
  Oceanic                    9 (0.2)          17 (-0.2)
  Other                     8 (-1.6)           30 (1.6)
  Not Applicable             2 (1.3)           1 (-1.3)

Relationship Status
  Married                   30 (3.4)          27 (-3.4)
  Co-habiting               32 (0.2)          63 (-0.2)
  Non-co-habiting          22 (-2.3)           74 (2.3)
    (same city)
  Long distance            16 (-1.6)           50 (1.6)
    (separate cities)
  Divorced/separated        11 (2.6)           7 (-2.6)
  Single                   62 (-0.5)          135 (0.5)

Religious Status
  Non-religious            126 (1.4)         238 (-1.4)
  Christian                27 (-1.0)           68 (1.0)
  Jewish                      3(1.8)           1 (-1.8)
  Islamic                   1 (-1.0)            6 (1.0)
  Hindu                     1 (-0.6)            4 (0.6)
  Buddhist                  1 (-0.8)            5 (0.8)
  Other                    14 (-0.5)           34 (0.5)

Demographic              Total N           Chi-Square Results

Education
  (highest or current)
  High school diploma      38      [chi square](4) = 22.05, p < .001
  Some college             38
  2-year degree            40
  4-year degree           350
  Graduate studies         48

Ethnic Origin
  Aboriginal                6      [chi square](9) = 22.66, p = .007
  African                   7
  Asian                    56
  Caribbean                 4
  European                222
  Latin, Central, and      16
    South American
  North American          151
  Oceanic                  26
  Other                    38
  Not Applicable            3

Relationship Status
  Married                  57      [chi square](5) = 22.55, p < .001
  Co-habiting              95
  Non-co-habiting          96
    (same city)
  Long distance            66
    (separate cities)
  Divorced/separated       18
  Single                  197

Religious Status
  Non-religious           364      [chi square](6) = 7.07, p = .31
  Christian                95
  Jewish                    4
  Islamic                   7
  Hindu                     5
  Buddhist                  6
  Other                    48

Note. Pearson chi square was used for the education and relationship
status variables. Likelihood ratios were used for the ethnic and
religion variables due to cells with expected counts of less than
five. All cells met the minimum frequency of one.

Table 2. Sexual Arousal to Paraphilic Interests by Sex

Paraphilic            Men          Women       Male PI
Interest            M (SD)        M (SD)       Present
                                                n (%)

Fetishes          1.99 (1.15)   1.56 (0.92)   20 (12%)

Transvestism      1.42 (0.85)       --         6 (3%)

Masochism         2.69 (1.37)   3.10 (1.44)   52 (30%)

Sadism            2.72 (1.30)   2.06 (1.19)   48 (28%)

Voyeurism         2.37 (1.38)   1.66 (1.04)   41 (24%)

Exhibitionism     1.32 (0.82)   1.08 (0.38)    6 (3%)
(w/o
masturbation)

Exhibitionism     1.24 (0.69)   1.06 (0.31)    5 (3%)
(w/
masturbation)

Frotteurism       1.24 (0.69)   1.12 (0.48)    5 (3%)

Sexually          1.70 (1.13)   1.17 (0.54)   17 (10%)
touching
strangers

Prepubescent      1.33 (0.79)   1.11 (0.48)   8 (0.1%)
females

Prepubescent      1.06 (0.31)   1.05 (0.33)   2 (0.01%)
males

Pubescent         1.65(1.06)    1.08 (0.30)    15 (9%)
females

Pubescent         1.08 (0.37)   1.06 (0.32)    0 (0%)
males

Paraphilic          Female PI        Chi-Square Results      Eta
Interest          Present n (%)

Fetishes             19 (5%)      [chi square](4) = 21.07,   .20
                                          p < .001

Transvestism           --                    --              --

Masochism           161 (45%)     [chi square](4) = 12.52,   .14
                                          p = .01

Sadism              52 (15%)      [chi square](4) = 35.08,   .25
                                          p < .001

Voyeurism            32 (9%)      [chi square](4) = 41.76,   .28
                                          p < .001

Exhibitionism       1 (0.3%)      [chi square](4) = 21.55,   .20
(w/o                                      p < .001
masturbation)

Exhibitionism       1 (0.3%)      [chi square](4) = 16.69,   .18
(w/                                       p = .002
masturbation)

Frotteurism         2 (0.6%)      [chi square](4) = 9.96,    .11
                                          p = .04

Sexually             5 (1%)       [chi square](4) = 48.45,   .30
touching                                  p < .001
strangers

Prepubescent        1 (0.3%)      [chi square](4) = 33.08,   .23
females                                   p < .001

Prepubescent        3 (0.8%)      [chi square](4) = 5.26,    .06
males                                     p = .26

Pubescent           2 (0.6%)      [chi square](4) = 80.58,   .37
females                                   p < .001

Pubescent           1 (0.3%)      [chi square](4) = 9.27,    .04
males                                     p = .03

Note. Sexual arousal was rated on a 5-point numeric scale.
Participants were categorized as having a paraphilic interest if
they rated their level of sexual arousal to the paraphilic interest
as very or extreme (n = 297). Those who rated their level of sexual
arousal as not at all, slightly, or moderate were rated as not
having a paraphilic interest (n = 232). Nominal by interval eta is
provided, with sex assumed as the independent variable.

Table 3. Engagement in Paraphilia-Related Sexual Behaviours by Sex

Paraphilic Interest             Men          Women      Male Engagement
                              M (SD)        M (SD)           n (%)

Fetish
  Sexual Fantasies          2.59 (0.99)   2.57 (1.10)      52 (57%)

  Masturbation Fantasies    2.96 (1.02)   2.48 (1.12)      61 (67%)

  Sexual Behaviour          2.26 (0.96)   2.49 (1.12)      39 (43%)

Transvestism (males only)
  Sexual Fantasies          1.98 (1.12)        --          12 (24%)

  Masturbation Fantasies    2.10 (1.17)        --          17 (34%)

  Sexual Behaviour          1.48 (0.68)        --           5 (10%)

Masochism
  Sexual Fantasies          2.60 (1.13)   3.07 (1.08)      62 (50%)

  Masturbation Fantasies    2.70 (1.16)   2.74 (1.39)      67 (54%)

  Sexual Behaviour          2.09 (0.96)   2.89 (1.09)      41 (33%)

Sadism
  Sexual Fantasies          2.76 (1.00)   2.59 (0.92)      77 (61%)

  Masturbation Fantasies    2.77 (1.16)   2.09 (1.13)      78 (61%)

  Sexual Behaviour          2.52 (1.06)   2.42 (0.95)      61 (48%)

Voyeurism
  Sexual Fantasies          2.19 (1.10)   1.92 (1.00)      41 (38%)

  Masturbation Fantasies    2.40 (1.10)   2.04 (1.09)      47 (44%)

  Sexual Behaviour          1.40 (0.74)   1.54 (0.86)      12 (11%)

Exhibitionism (w/o)
  Sexual Fantasies          2.17 (1.12)   2.04 (0.94)      13 (37%)

  Masturbation Fantasies    2.31 (1.23)   2.04 (1.04)      15 (43%)

  Sexual Behaviour          1.50 (0.83)   1.67 (1.11)        2 (6%)

Exhibitionism (w/)
  Sexual Fantasies          1.97 (0.87)   1.96 (0.91)      10 (34%)

  Masturbation Fantasies    2.24 (1.06)   2.04 (1.11)      13 (45%)

  Sexual Behaviour          1.28 (0.53)   1.43 (0.79)        1 (3%)

Frotteurism
  Sexual Fantasies          1.63 (1.04)   1.64 (0.90)       4 (13%)

  Masturbation Fantasies    1.72 (1.05)   1.61 (1.00)       5 (16%)

  Sexual Behaviour          1.52 (1.03)   1.97 (1.16)       5 (16%)

Sexually touching
Strangers
  Sexual Fantasies          2.22 (1.18)   1.98 (0.92)      25 (40%)

  Masturbation Fantasies    2.37 (1.20)   2.12 (1.09)      29 (47%)

  Sexual Behaviour          1.56 (1.13)   1.61 (0.95)       9 (15%)

Prepubescent Females
  Sexual Fantasies          2.03 (1.18)   1.70 (0.98)      10 (28%)

  Masturbation Fantasies    2.14 (1.18)   1.70 (1.03)       9 (25%)

  Sexual Behaviour          1.33 (0.86)   1.65 (1.18)        2 (6%)

Prepubescent Males
  Sexual Fantasies          1.56 (0.71)   1.53 (1.17)        2 (11%)

  Masturbation Fantasies    1.79 (0.86)   1.53 (0.87)        3 (16%)

  Sexual Behaviour          1.28 (0.75)   1.41 (1.06)        1 (6%)

Pubescent Females
  Sexual Fantasies          1.95 (1.11)   1.65 (0.94)      16 (25%)

  Masturbation Fantasies    2.09 (1.11)   1.61 (0.78)      18 (28%)

  Sexual Behaviour          1.27 (0.60)   1.59 (1.10)        3 (5%)

Pubescent Males
  Sexual Fantasies          1.68 (0.82)   1.55 (0.83)       4 (21%)

  Masturbation Fantasies    1.79 (0.79)   1.70 (1.13)       4 (21%)

  Sexual Behaviour          1.11 (0.32)   1.50 (1.05)        0 (0%)

Paraphilic Interest           Female          t-test Results        Eta
                            Engagement
                              n (%)

Fetish
  Sexual Fantasies           60 (51%)    [chi square](4) = 2.44,    .01
                                                 p = .66

  Masturbation Fantasies     56 (47%)    [chi square](4) = 14.16,   .21
                                                 p = .007

  Sexual Behaviour           56 (47%)    [chi square](4) = 5.43,    .10
                                                 p = .25

Transvestism (males only)
  Sexual Fantasies              --                  --               --

  Masturbation Fantasies        --                  --               --

  Sexual Behaviour              --                  --               --

Masochism
  Sexual Fantasies          194 (71%)    [chi square](4) = 18.95,   .19
                                                 p < .001

  Masturbation Fantasies    151 (56%)    [chi square](4) = 15.12,   .01
                                                 p = .004

  Sexual Behaviour          174 (64%)    [chi square](4) = 44.28,   .33
                                                 p < .001

Sadism
  Sexual Fantasies           96 (51%)    [chi square](4) = 6.21,    .09
                                                 p = .18

  Masturbation Fantasies     61 (32%)    [chi square](4) = 28.98,   .28
                                                 p < .001

  Sexual Behaviour           85 (46%)    [chi square](4) = 4.20,    .05
                                                 p = .38

Voyeurism
  Sexual Fantasies           33 (25%)    [chi square](4) = 4.47,    .12
                                                 p = .35

  Masturbation Fantasies     38 (29%)    [chi square](4) = 9.51,    .16
                                                 p = .05

  Sexual Behaviour           13 (10%)    [chi square](4) = 8.83,    .09
                                                 p = .06
Exhibitionism (w/o)
  Sexual Fantasies           12 (44%)    [chi square](4) = 4.85,    .06
                                                 p = .30

  Masturbation Fantasies     10 (38%)    [chi square](4) = 2.18,    .12
                                                 p = .70

  Sexual Behaviour           6 (22%)     [chi square](4) = 6.89,    .09
                                                 p = .14

Exhibitionism (w/)
  Sexual Fantasies           7 (29%)     [chi square](3) = 1.74,    .004
                                                 p = .63

  Masturbation Fantasies     8 (35%)     [chi square](4) = 4.00,    .09
                                                 p = .41

  Sexual Behaviour            2 (9%)     [chi square](3) = 1.36,    .12
                                                 p = .71

Frotteurism
  Sexual Fantasies           7 (21%)     [chi square](4) = 5.18,    .01
                                                 p = .27

  Masturbation Fantasies     7 (21%)     [chi square](4) = 6.31,    .06
                                                 p = .18

  Sexual Behaviour          11 (33%)     [chi square](4) = 6.53,    .21
                                                 p = .16

Sexually touching
Strangers
  Sexual Fantasies          11 (26%)     [chi square](4) - 4.36,    .11
                                                 p = .36

  Masturbation Fantasies    14 (33%)     [chi square](4) = 2.29,    .11
                                                 p = .68

  Sexual Behaviour           6 (15%)     [chi square](4) = 4.29,    .02
                                                 p = .37

Prepubescent Females
  Sexual Fantasies           5 (25%)     [chi square](4) = 3.74,    .14
                                                 p = .44

  Masturbation Fantasies     4 (20%)     [chi square](4) = 5.08,    .19
                                                 p = .28

  Sexual Behaviour           4 (20%)     [chi square](4) = 4.30,    .16
                                                 p = .37

Prepubescent Males
  Sexual Fantasies           3 (16%)     [chi square](4) = 6.88,    .02
                                                 p = .14

  Masturbation Fantasies     4 (24%)     [chi square](3) = 7.82,    .15
                                                 p = .05

  Sexual Behaviour           2 (12%)     [chi square](4) - 3.34,    .08
                                                 p = .50

Pubescent Females
  Sexual Fantasies           3 (13%)     [chi square](4) = 1.82,    .13
                                                 p = .77

  Masturbation Fantasies      2 (9%)     [chi square](4) = 4.06,    .21
                                                 p = .40

  Sexual Behaviour           3 (14%)     [chi square](4) = 3.88,    .18
                                                 p = .42

Pubescent Males
  Sexual Fantasies           4 (20%)     [chi square](2) = 0.87,    .08
                                                 p = .65

  Masturbation Fantasies     3 (15%)     [chi square](4) = 4.91,    .05
                                                 p = .30

  Sexual Behaviour           3 (15%)     [chi square](3) = 2.94,    .24
                                                 p = .40

Note. Sexual fantasies, masturbation fantasies, and sexual
behaviour were rated on a 5-point numeric scale. Participants who
rated themselves as engaging in the pattern not at all or rarely
were categorized as not engaging in the behaviour (n = 66). Those
who rated themselves as engaging in the pattern (if they rated
themselves as engaging in it sometimes, often, or almost always)
were categorized as engaging (n = 391). Nominal by interval eta is
provided, with sex assumed as the independent variable.
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Author:Mundy, Crystal L.; Cioe, Jan D.
Publication:The Canadian Journal of Human Sexuality
Date:Dec 1, 2019
Words:11037
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