In comments to this post about DSM revisions that further marginalize alternative sexual interest in favor of more PIV-intercourse-centrism, Holly (of The Pervocracy) makes the following perfectly sensible observations and recommendations (emphasis mine.)

You can stick “philia” on anything, but generally paraphilias require either the involvement of non-consenting people or “significant distress or impairment” to be considered diseases—if you’re a sexual sadist who plays safely with willing partners and doesn’t feel bad about it, that’s just fine with the DSM.

The problem isn’t that someone who likes fat people and is happy about it is going to have treatment thrust upon them, the problem comes when someone likes fat people, feels guilty about it, and goes to a therapist. Classifying the philia itself as the problem encourages the therapist to try and change someone’s sexuality when they should really be working on the guilt.

Personally, I’d eliminate the specific sexual behaviors entirely from the DSM and just have two paraphilias: “Sexually Abusive Behavior Disorder” and “Sexual Identity Adjustment Disorder.” It doesn’t matter if someone feels bad because they like panties or amputees or asparagus, what matters is that they feel bad and that’s what treatment should be focusing on.

Yup.

I’ve evidently been sounding a bit harsh about hetero PIV intercourse ending in male ejaculation in the vagina (with or without STI barriers and contraception.) This hasn’t been my intent.

But I was motivated in part by proposals allegedly under consideration for psychiatry’s revised Diagnostic and Statistical Manual to add myriad paraphilias such as Gynandromorphophilia (attraction to trans women), Andromimetophilia (attraction to trans men), Abasiophilia (attraction to people who are physically disabled), Acrotomophilia (attraction to amputees), Gerontophilia (attraction to elderly people), Fat Fetishism (attraction to fat people) while effectively endorsing only “erotic interests … focused on copulatory or precopulatory behaviors, or the equivalent behaviors in same-sex adult partners.”

But here’s where I hit a bump: if you steer things that way then someone who compulsively and obsessively seeks only lights-out, man-on-top missionary-position PIV-intercourse to male ejaculation, for purposes of procreation only, with stacked seventeen-year-old cis-gendered Swedish superstars named Sven, they’re clearly burdened with a (pathological, non-recreational) fetish. But they get to go home with “perfectly normal” stamped on their foreheads instead of getting help

W, I say, TF good does that do them or anybody else?