Exam-Room Paraphilia

Are the doctors as attractive as they seem?

By Kevin RR Williams

BEHAVIOR Most fantasies remain within one's head. But sometimes they transmigrate into reality. Patients may have a paraphilic proclivity towards doctors or nurses, heightening their perception of beauty and mutual attraction. The uniform or semi-dominatrix position of a medical professional may trigger exigent sexual attraction.

Inappropriate Conduct

Whereas the American Medical Association (AMA) clearly states that sexual contact that is concurrent with the doctor/patient relationship constitutes sexual misconduct, it takes a fuzzier position on relationships that might develop later. According to Medscape's 2012 ethics survey, 68 percent of the 24,000 doctors 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 (22%) say that a romantic relationship with a former patient may be acceptable, as long as at least 6 months have passed since the professional relationship was terminated.

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.

Unmasking the Physician

Let's look at a potentially dangerous 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, hands him a business card 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. His mind briefly flashes to a conversation on a sunny beach, where a bikini model asks his age while sipping cocktails. Refocussing, the patient complements the doctor's appearance, which widens her smile. A lock of hair is gently moved behind her ear with a raised eyebrow. He senses mutual chemistry.

    The conversation seems to veer further from professional inquiries as she asks, "What type of work do you do?" Without identifying a job title, the patient lists his most impressive accomplishments. "Of course, none of this compares with saving lives as you do," he commends. Unsuccessfully restraining a blush, she thanks him while fumbling with the chart as her torso twists like a washing machine in the gentile cycle.

    The patient presents a business card and circles a direct mobile number. "This is my work. But how do I contact you, if there are any‚Ķ complications?" he asks. She extends her card, displaying a main office number. "Is there a way to phone you directly if the office is closed?" he inquires. She smiles and jots down her mobile number before cradling it in his palm with both her hands. He begins leaning toward her, but is interrupted by the question: "What is your date of birth?"

    The stunned patient looks in his hand and sees only the doctor's unmarked card. More insistently, the question is asked, "Can you confirm your date of birth, please?" 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 pound. He anxiously responds before being asked again: "It's February 29, 1980." But this reverie is all too familiar to this patient. It happens each time he sees a female doctor, nurse or or dentist. And the thoughts follow him long after each visit ends.

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 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, paraphilic 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, it is recommended that paraphiliac treatment be provided on a long-term basis with diligent patient compliance. There is no single unifying theory that adequately explains the pathogenesis of sexual impulse disorders. Currently, two distinct classes of psychopharmacological agents are frequently prescribed: 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.

Tags: hyperphilia, immoral, nymphomania, sadomasochistic, satyriasis, therapy

  1. When Is It Okay to Date a Patient? medscape.com
  2. Paraphilias. medicinenet.com
  3. Paraphilias. psychologytoday.com
  4. Famous Sex Addicts. marieclaire.com
  5. Therapy for Sexual Impulsivity: The Paraphilias and Paraphilia-Related Disorders psychiatrictimes.com