For example, as of May 2000, per DSM-IV-TR, "Because some cases of Sexual Sadism may not involve harm to a victim (e.g., inflicting humiliation on a consenting partner), the wording for sexual sadism involves a hybrid of the DSM-III-R and DSM-IV wording (i.e., "the person has acted on these urges with a non-consenting person, or the urges, sexual fantasies, or behaviors cause marked distress or interpersonal difficulty")".The DSM-IV-TR also acknowledges that the diagnosis and classification of paraphilias across cultures or religions "is complicated by the fact that what is considered deviant in one cultural setting may be more acceptable in another setting”. Some argue that cultural relativism is important to consider when discussing paraphilias, because there is wide variance concerning what is sexually acceptable across cultures.Consensual adult activities and adult entertainment involving sexual roleplay, novel, superficial, or trivial aspects of sexual fetishism, or incorporating the use of sex toys are not necessarily paraphilic. Paraphilial psychopathology is not the same as psychologically normative adult human sexual behaviors, sexual fantasy, and sex play. Intensity and specificity
Clinicians distinguish between optional, preferred and exclusive paraphilias, although the terminology is not completely standardized. An "optional" paraphilia is an alternative route to sexual arousal. In preferred paraphilias, a person prefers the paraphilia to conventional sexual activities, but also engages in conventional sexual activities. The literature includes single-case studies of very rare and idiosyncratic paraphilias.
), Sexual Deviance: Theory, Assessment, and Treatment, 2nd ed., Guilford Press, 2008, ISBN 978-1-59385-605-2

Further reading
Kenneth Plummer, Sexual stigma: an interactionist account, Routledge, 1975, ISBN 0-7100-8060-3
Elisabeth Roudinesco, Our Dark Side, a History of Perversion, Polity Press, 2009, ISBN 0-7456-4593-3
David Morgan (psychoanalyst), Married to the Eiffel Tower. Married to the Eiffel Tower, a post on the blog Documentary Heaven. Castellini, Giovanni; Alessandra H. Rellini, PhD; Cristina Appignanesi, MD; Irene Pinucci, MD; Matteo Fattorini, BA; Elisa Grano, BA; Alessandra D. Fisher, PhD; Emanuele Cassioli, MD; Lorenzo Lelli, MD; Mario Maggi, MD; Valdo Ricca, MD (1 September 2018). "Deviance or Normalcy? The Relationship Among Paraphilic Thoughts and Behaviors, Hypersexuality, and Psychopathology in a Sample of University Students". Journal of Sexual Medicine. 15 (9): 1322–1335. doi:10.1016/j.jsxm.2018.07.015. PMID 30224020. S2CID 52290404. Archived (PDF) from the original on 24 March 2020. External links

DSM-IV and DSM-IV-TR list of paraphilias
Proposed diagnostic criteria for sex and gender section of DSM5