Exam‑Room Paraphiliac

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Medical Professional Attraction

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Most fantasies remain within one’s head. But sometimes they migrate into reality. A few patients might have a paraphiliac proclivity towards doctors or nurses that exaggerates their perception of beauty and mutual attraction. The uniform may trigger exigent sexual attraction.

Inappropriate Conduct

The American Medical Association (AMA) clearly states that sexual contact that is con­current with the doctor/patient relation­ship constitutes sexual misconduct. But it takes a fuzzier position on relation­ships that might develop later.

According to the 2020 Medscape Internal Medicine Ethics Report, 60% of more than 5,000 physicians surveyed, outright condemn a romantic or sexual relationship with a patient. Only a tiny minority (1%) give romance with current patients a green light, but a sizable share (30%) say that a romantic relation­ship with a former patient may be acceptable, at least 6 months after the profes­sional relationship terminates.

It gets murkier when some weigh the type of medical care. Eye exams are considered by some professionals to carry less weight than oncology, gynecology, or psychology. But the white-coat fetish may eschew boundaries.

Unmasking the Physician

A common occurrence of white-coat attraction is a patient who is flirtatious with medical professionals. They may be doctors, nurses, or dental hygienists.

Let’s dissect a ficticious encounter between a female doctor and male patient. From the moment the physician enters the examination room, the patient’s heart races. She introduces herself and, to confirm the patient’s identity, asks: “What is your date of birth?”

The patient notices a coy smile as the doctor lowers her head with uninterrupted eye contact to jot down the answer. The patient pauses as his fantasy begins. He complements the doctor’s appearance, which widens her smile. She gently slides a lock of hair behind her ear with a raised eyebrow and asks the next question. “Are you sexually active?”

The conversation, to him, seems like questions in a pick-up bar. Surprised by the context, the patient replies, “I don’t know. It depends on the extent of the examination.” The female doctor smiles and says, “I’ll put that down as a ‘yes.’”

Can you lower your underwear please?” He grabs the waist of his underpants, but is interrupted by a question.

“What is your date of birth?” The patient realizes she is fully dressed, with him wearing a standard gown. She inquires with more insistence, “Please confirm your date of birth.” He now realizes that the last few moments occurred only in his imagination. Wondering if any part of this fantasy became audible causes his heart to race.

He anxiously responds before being asked again. “I’m a leapling. It’s February 29, 1984.” But the reverie is all too familiar to this patient. It happens each time he sees a female doctor, nurse, or dentist. And the notion of her coming on to him follow long after his visits end.

A Step Beyond Sex Addict

The preceding is a fictional example of mild episodic paraphilia (erotomania). While some medical professionals distinguish between fetishes (lifeless objects) and paraphilias (animate beings), MedicineNet categorizes fetishes as a subset of paraphilias.

The broader definition of fetishes identifies obsessions and problems with controlling impulses. These are characterized by amoral recurrent and intense sexual fantasies, urges, and behaviors involving unusual objects, activities, or situations not considered sexually arousing to others. In fact, the general public may view the behavior as distasteful or perverted.

Objects or situations can become arousing if they are frequently and repeatedly associated with a pleasurable sexual activity. Twenty times more common among men than women, paraphiliac urges and behaviors can cause significant distress (anxiety, depression) and/or personal, social or career problems. A long list of celebrities, politicians, and athletes have gone into rehabilita­tion centers for deviant behavior.

To be most effective, professionals recommend long-term paraphiliac treatment with diligent patient compliance. There is no single unifying theory that adequately explains the pathogenesis of sexual impulse disorders.

Currently, doctors may prescribe two distinct classes of psycho­pharma­co­logical agents: anti­androgens and serotonergic anti­depressants. It is imperative that people with paraphilia of an illegal nature receive professional help before they harm others or create legal repercus­sions for themselves.

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