Editing Sexual fetishism (section)

== Treatment ==

According to the [[World Health Organization]], fetishistic fantasies are common and should only be treated as a disorder when they impair normal functioning or cause distress.<ref name="ICD" /> Goals of treatment can include elimination of criminal activity, reduction in reliance on the fetish for sexual satisfaction, improving relationship skills, reducing or removing arousal to the fetish altogether, or increasing arousal towards more acceptable stimuli. The evidence for treatment efficacy is limited and largely based on [[case studies]], and no research on treatment for female fetishists exists.<ref name="darctreatment">{{cite book|author=Darcangelo, S., Hollings, A., Paladino, G.|url=https://archive.org/details/sexualdevianceth00laws|title=Sexual Deviance: Theory, Assessment, and Treatment, 2nd edition|date=2008|publisher=The Guilford Press|editor=Laws, D. R.|pages=[https://archive.org/details/sexualdevianceth00laws/page/n136 122]–127|chapter=Fetishism: Assessment and Treatment|isbn=9781593856052 |editor2=O'Donohue, W. T.|url-access=limited}}</ref>

[[Cognitive behavioral therapy]] is one popular approach. Cognitive behavioral therapists teach clients to identify and avoid antecedents to fetishistic behavior, and substitute non-fetishistic fantasies for ones involving the fetish. [[Aversion therapy]] and [[covert conditioning]] can reduce fetishistic arousal in the short term, but requires repetition to sustain the effect. Multiple case studies have also reported treating fetishistic behavior with [[Psychodynamics|psychodynamic]] approaches.<ref name="darctreatment" />

[[Antiandrogen]]s may be prescribed to lower sex drive. [[Cyproterone acetate]] is the most commonly used antiandrogen, except in the United States, where it may not be available. A large body of literature has shown that it reduces general sexual fantasies. Side effects may include [[osteoporosis]], [[liver dysfunction]], and feminization. Case studies have found that the antiandrogen [[medroxyprogesterone acetate]] is successful in reducing sexual interest, but can have side effects including osteoporosis, [[diabetes]], [[deep vein thrombosis]], feminization, and weight gain. Some hospitals use [[leuprorelin]] and [[goserelin]] to reduce libido, and while there is presently little evidence for their efficacy, they have fewer side effects than other antiandrogens. A number of studies support the use of [[selective serotonin reuptake inhibitor]]s (SSRIs), which may be preferable over antiandrogens because of their relatively benign side effects. Pharmacological agents are an adjunctive treatment which are usually combined with other approaches for maximum effect.<ref name="darctreatment" />

[[Relationship counseling|Relationship counselors]] may attempt to reduce dependence on the fetish and improve partner communication using techniques like [[sensate focusing]]. Partners may agree to incorporate the fetish into their activities in a controlled, time-limited manner, or set aside only certain days to practice the fetishism. If the fetishist cannot sustain an erection without the fetish object, the therapist might recommend orgasmic reconditioning or [[covert sensitization]] to increase arousal to normal stimuli (although the evidence base for these techniques is weak).<ref name="darctreatment" />