Should a Paraphilia Prevent a Doctor from Practicing Medicine?

A paraphilia is a recurring, intense sexual interest in atypical objects, situations, fantasies, behaviors, or individuals that is not accepted by the dominant culture. A paraphilic disorder occurs when a paraphilia causes an individual significant distress or impairment, involves harm or risk of harm to others, or when the individual has acted on the paraphilic interest with a nonconsenting partner. Some examples of paraphilic disorders are exhibitionistic disorder, voyeuristic disorder, frotteuristic disorder, sexual masochism disorder, sexual sadism disorder, and pedophilic disorder.  

Historically, little to no distinction has been made between paraphilias and paraphilic disorders in the medical community. However, the most recent Diagnostic and Statistical Manual of Mental Disorders (the DSM-5) clearly separates the two, stating that while paraphilic disorders justify psychiatric treatment, paraphilias themselves do not necessitate it.

People with diverse sexual interests, including paraphilias, may feel stigmatized or embarrassed by their condition, which may prevent them from seeking care, receiving a proper diagnosis, and starting any necessary treatment. What’s more, this bias can extend to other diverse sexual interests as well, such as BDSM, which is a consensual sexual activity.

Institutions may contribute to the stigma of diverse sexual interests, whether intentionally or not. Two authors investigated one potential example of this scenario when they reviewed the questions on the medical licensure applications of all 50 U.S. states and the District of Columbia for a recent study in The Journal of Sexual Medicine.

The researchers found that eight out of the 51 medical boards include questions about the applicant’s history with paraphilias and paraphilic disorders on their applications for medical licensure, without making a clear distinction between the two terms. While the wording varied slightly among the eight applications, in general, they inquired about whether or not the candidate has been diagnosed with or received treatment for a paraphilia or paraphilic disorder.

In each case, the questions about paraphilias appeared in the final section of the applications, which includes questions related to actions against the practitioner’s license, malpractice issues, and any history of physical or mental illnesses that could potentially endanger patients.

To learn more about the purpose of including questions regarding paraphilias, the authors contacted each state medical board that poses such questions to its applicants. Seven of the eight medical boards responded, but none were willing or able to share the number of affirmative responses to the questions about paraphilias. However, they did share that a positive response would prompt further investigation into the candidate, possibly including an in-person interview, and decisions about the application would be handled on a case-by-case basis.

The authors of this study concluded that having questions about paraphilias and paraphilic disorders on medical licensure applications may contribute to the stigma of diverse sexual interests and reinforce barriers to seeking treatment or other health care services for both physicians and patients. Although they did not see the benefit of keeping these questions on the applications, they felt that such questions could at least be modified to clearly differentiate between paraphilias and paraphilic disorders. In the end, the original intent behind including and retaining these questions remained unclear.

Particularly of note, during the time of this study, the Mississippi State Board of Medical Licensure removed their question about paraphilias and replaced it with a statement recognizing that some physicians may have physical or mental health issues for which they should seek medical treatment.

Resources:

Cranstoun, L.M., & Moser, C. (2021). The Paraphilias and Medical Licensure in the United States. The Journal of Sexual Medicine, 18(6), 1130-1133. https://www.jsm.jsexmed.org/article/S1743-6095(21)00356-8/fulltext.

Paraphilia. (2021, April 25). In Wikipedia. Retrieved June 23, 2021, from https://en.wikipedia.org/wiki/Paraphilia.