The recommendations list psychotherapy, antidepressants, and hormonal medications among the treatment options, and the authors advise cognitive behavioral therapy for all patients with SPD. Medication treatment should be accompanied by psychotherapy.
The diagnosis is proposed if pronounced sexual fantasies or urges persist for a long time, are expressed in specific actions, or become a source of serious concern for the person themselves. Doctors are also instructed to take into account the partner’s consent, the risk of harm, and the patient’s overall behavior.
The main method of diagnosis remains a clinical interview with a doctor. If the data from it are insufficient, additional psychological assessment of the psychosexual sphere is prescribed, and if pedophilia is suspected and to assess the risk of socially dangerous acts, psychometric tests are permitted that identify distorted perceptions of adults and children.
The authors separately note that instrumental methods for diagnosing SPD are still not widely used in Russian practice. According to them, there is a lack of reproducible methods for such examinations and for interpreting the results.
The choice of drug therapy depends on the severity of the condition: for a mild form, psychotherapy may be sufficient, while in more complex cases selective serotonin reuptake inhibitors, antiandrogens, and gonadotropin-releasing hormone analogues are added. For contact forms of paraphilic behavior, cyproterone or medroxyprogesterone may be prescribed, and for severe forms of the disorder — triptorelin or leuprorelin.
At the same time, SPD is not formally always included in the list of indications for these hormonal drugs, so the decision to prescribe is made by a medical commission. Treatment is possible only with the patient’s voluntary informed consent. The sexual preference disorders in the current ICD-10 used in Russia include fetishism, exhibitionism, voyeurism, pedophilia, and sadomasochism, while Russia has not officially moved to ICD-11.
In ICD-11, which came into force in 2022, fetishism as a separate disorder was removed, and sadomasochism was renamed and narrowed to “compulsive sexual sadistic disorder”, where the diagnosis applies only to coercion without the partner’s consent. The WHO does not consider these conditions a disease, and transsexualism was also removed from the list of mental disorders in ICD-11. The Russian Society of Psychiatrists had already attempted to prepare such a document in June 2023: then a draft with the same title was submitted for professional discussion, and the 2026 version received the status of an officially approved clinical guideline.
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