Open in a separate window Sexual Gratification Sexual gratification is commonly reported by patients and accepted by clinicians as the reason for autoerotic or consensual sexual acts involving the insertion of foreign objects into the erogenous zones of the urethra, 23 , 24 , 28 — 30 vagina, 31 or rectum. Psychoanalysts have long observed that psychosexual energy libido can become invested in actions that do not lead directly to orgasm, such that some behaviors may be primarily reinforced by a compelling emotional payoff that has become layered upon a secondary outcome of orgasm, or occurs in the absence of orgasm. A deeper understanding of the patient's situation may also distinguish between nonpathologic sexual preferences and the paraphilic disorders. When a patient's sexual history reveals a pattern of recurrent behaviors, fantasies, or urges involving nonhuman objects that causes significant distress or functional impairment, a paraphilic disorder fetishism may be diagnosed.
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