“You can’t help how you feel, but you can control your actions,” says psychosexologist Kateřina Klapilová. Surprisingly, many Czechs have unusual sexual preferences
Sexuality is one of the most intimate aspects of human life. And it is precisely when it deviates from what society considers normal that fear, stigma and simplistic judgements very quickly arise. Paraphilias are perhaps the most striking example of this: whilst public debate often automatically associates them with danger or sexual offending, the reality is considerably more complex. An unusual sexual preference in itself does not make a person a perpetrator – and modern sexology is increasingly drawing a clear distinction between what a person feels and experiences in their fantasies, and how they actually behave.
This is precisely the topic that Kateřina Klapilová, a psychosexologist, researcher and head of the Centre for Sexual Health and Intervention at the National Institute of Mental Health, has been focusing on for many years. She studied medical psychology and psychopathology, holds a European certification in psychosexology, and has been conducting research into sexuality, sexual preferences and sexual health for more than fifteen years. She is also behind the Parafilik programme, which offers specialist support to people with paraphilic preferences and aims to prevent problematic sexual behaviour. The support system also includes the anonymous SexHelp helpline – specifically the section dedicated to paraphilias – which people can contact if they have doubts about their sexual preferences, are concerned about their own fantasies, or are experiencing a mental health crisis as a result of them. Furthermore, since 2026, Klapilová has been the first woman in history to chair the Czech Society for Sexual Medicine.
Kateřina, perhaps you could start by telling me how you actually came to do this work?
To be honest, I never expected that I would one day specialise in this particular field. I first studied biology and then went on to obtain a PhD in medical psychology, but the very beginning of my professional journey is linked to the fact that I come from Kroměříž.
Professor Stanislav Kratochvíl worked at the psychiatric hospital in Kroměříž; he was our first – and, in essence, still our only – true psychosexologist. He was a friend of my grandfather, who used to prescribe spa stays for him. Thanks to this, I was given all his books as a child and later as a teenager. Professor Kratochvíl influenced me so much that I decided to specialise in psychosexology.
However, this field does not yet exist as a separate discipline in the Czech Republic. Here, sexology is conceived solely as a medical specialism, so I had to build my own professional path in a multidisciplinary way. Gradually, I worked my way up to obtaining an international psychosexology certificate and completing a number of therapeutic training courses focused on working with sexuality.
For the most part, however, my public professional life has been that of a researcher. I’ve been conducting research into sexuality for around twenty years, perhaps even longer, but I’d rather not count it exactly. I founded the Centre for Sexual Health and Intervention ten years ago. Today, it is the largest – and indeed the only – sexology laboratory and centre for applied sexological research in the Czech Republic. That, in a nutshell, sums up my professional journey.
In your work and research, you focus on paraphilias. When this term is mentioned, many people immediately think of something dangerous or criminal. But what do paraphilias actually mean?
I prefer to describe them as people who love differently. I think that’s a lovely and, at the same time, easy-to-understand way of putting it. According to medical definitions and the ICD-11 classification, these are people who require unusual objects or unusual sexual activities for their sexual gratification. However, the very term ‘unusual’ is problematic, as we know from nationwide surveys that some of these preferences may not actually be all that unusual.
At the same time, it is important to emphasise that, according to the latest classification of diseases, not everyone who has a paraphilic preference – that is, who is attracted to less common objects or activities – automatically receives a diagnosis. Most often, for example, we are talking about psychosexually immature objects, as in the case of paedophilia or hebephilia, or about unusual activities, which include, for example, a preference for non-consensual sex or sexual violence – that is, sexual aggression or sadism.
Even in these cases, however, it need not constitute a medical diagnosis or a condition requiring treatment. It may simply be one of the many forms of variability within the human psyche. If a person has their preference under control, it does not cause them significant stress, does not disrupt their social functioning or mental health, and does not lead to breaking the law, then it is part of natural variability, not a diagnosis. This is precisely what I always try to emphasise.
Does that mean that fantasies themselves are something different from their actual realisation in real life?
Of course. The motto of the Parafilik programme, which we launched in 2019, is: ‘You can’t help your feelings, but you can control your actions.’ What takes place solely on a psychological level – that is, in fantasies, feelings, inner turmoil or urges – does not in itself necessarily require medical intervention.
This is the fundamental difference from older classifications of disorders, according to which the mere presence of these patterns in the realm of fantasy was sufficient to warrant a diagnosis.
How fine can the line be between fantasy and a person actually starting to act?
It varies from person to person. There are people for whom the risk of this boundary becoming blurred is higher. To assess this, we have standardised tools that take into account factors which science has gradually identified through work with this population and with perpetrators of sexually motivated offences. We know that it is precisely these factors that can blur the line between fantasy and actual behaviour. There are around 20 of them in total.
These include, for example, the ability to form and maintain a stable relationship, mental health in other areas, and the ability to control impulses. Paraphilia itself is, of course, also a risk factor, because if a person acts on their sexual inclinations, they may commit a criminal offence. For the average person, this situation does not usually arise, as their sexual fantasies generally do not cross the boundaries of the law. It is important to bear this in mind as well.
Other factors that play a role include, for example, a history of criminal behaviour, the degree of social integration, or loneliness. If several of these factors accumulate in a single person, the resulting risk may be higher.
For such people, the line between fantasy and action is generally more blurred. This is because they lack sufficient psychological or biological resilience, and often also lack a strong social support network and the ability to adapt to social norms.
How do you proceed with such a person? Are medication or, where appropriate, more drastic methods still used today, or are they a thing of the past?
The next steps depend primarily on the risk assessment. At first glance, this may seem like the least interesting part of the whole process, but in reality it is absolutely crucial.
If a person with a paraphilic orientation seeks help voluntarily, has not yet committed any offences and is not behaving in a problematic manner, the risk of them engaging in problematic behaviour is usually low. They may seek help, for example, because their sexuality is negatively affecting other areas of their life, worsening their mental health or disrupting their relationships.
Such a person is usually motivated to learn how to manage their sexuality, understand it better and integrate it into their life in such a way that they do not cross any boundaries, whilst at the same time being able to lead a happy and sexually fulfilling life. In such cases, the method of first choice is long-term psychoeducation and psychotherapy. In the Parafilik programme, this work usually takes around a year.
If a person is at increased risk – for example, if they have already engaged in problematic behaviour, are facing criminal prosecution for a sexually motivated offence, or have previously undergone compulsory residential treatment and are now continuing with court-ordered outpatient sexological treatment – psychotherapy may be supplemented with medication. Antidepressants or other medicines that can support the therapeutic process are used, for example.
In the case of a high-risk individual who, for example, has repeatedly committed sexually motivated offences and simultaneously exhibits multiple risk factors, medication aimed at reducing sexual desire or hormonal levels may also be considered. These factors may include significantly heightened sexual desire, poor impulse control, a lack of insight into one’s own sexuality, or a history of criminal behaviour.
Individual approaches should always be tailored to the level of risk posed by the specific individual. Treatment is voluntary, and pharmacological intervention should always be accompanied by a psychotherapeutic programme and expert therapeutic supervision.
When is the right time for a person to realise that they should seek professional help? Could a sign be, for example, a deterioration in their mental state, or the fact that their sexuality is beginning to significantly interfere with their life?
Yes, precisely when the diagnostic criteria are met. This means that a person has a paraphilic orientation which is beginning to cause them serious problems. For example, they may feel that they are struggling to control themselves and might commit a problematic act. Or there may be a marked deterioration in their mental health, depression, or thoughts about the value of their own life. Sometimes, someone close to them notices the changes and brings their loved one to see a specialist.
The Parafilik programme is also designed for loved ones, who can contact us, for example, by telephone. Support from family and other loved ones is an important part of the whole programme. Another reason for seeking help may be a situation where paraphilic tendencies significantly interfere with a person’s daily life and cause them serious mental health difficulties.
Depression, for example, is more common in this group. The likelihood of suffering from it can be several times higher than in the general population. Suicidal tendencies are also more common. Particularly in the case of paedophilic or hebephilic preferences, which are heavily stigmatised in society, the risk of self-harm or severe depressive symptoms can be exceptionally high. I therefore say that once a person meets the diagnostic criteria, this can be one of the deadliest diagnoses.
So, if a problem arises relating to behaviour or mental health, it is advisable to start considering seeking professional help. If a person has already committed a sexually motivated offence and is caught by the system, professional care should be provided automatically. In principle, this is indeed what happens in the Czech Republic.
Specialised programmes exist within secure treatment centres and in prisons, regardless of whether the offender exhibits paraphilic preferences. We ourselves are developing programmes designed for offenders of sexually motivated crimes against both children and adults, as well as for rapists. These include, for example, the GLM+ therapeutic programme, which is currently being trialled in Czech prisons. Protective treatment centres, in turn, have their own therapeutic programmes. In Slovakia, for example, the Parafilik programme forms part of secure treatment centres and detention facilities. This is how the care system is organised.
So far, we have mainly discussed non-consensual or illegal objects and forms of desire. But do consensual sexual fantasies and practices, such as BDSM, also count as paraphilias? Especially given that, according to surveys, they may not be as unusual as is sometimes assumed.
Yes, definitely. We can draw on the results of our own research. We have access to some of the most extensive data in the world on the prevalence of various types of paraphilic preferences, drawn from both our 2016 study and the more recent CzechSex survey.
It appears that certain preferences occur relatively frequently within the population. For preferences associated with BDSM activities, such as sadism (a preference for inflicting humiliation or pain) or masochism (a preference for being humiliated and receiving pain), the figures are in the tens of per cent. These are certainly not negligible figures.
If we look at all the paraphilic preferences included in this extensive survey, we find that approximately thirty per cent of the population reported at least one of them. By this, we do not mean merely a minor quirk or a marginal part of one’s sexual repertoire. In the questionnaire, a preference was defined as a strong and substantial component of sexual arousal. In terms of fantasies, therefore, these preferences are relatively widespread.
With paraphilias and paraphilic disorders, it is important to note that these are not merely practices that a person occasionally incorporates into their sex life or has tried from time to time. It is a persistent pattern of sexual arousal, without which a person is often unable to experience their sexuality satisfactorily or achieve sexual satisfaction. We therefore also distinguish between exclusive and non-exclusive preferences.
But where, in your view, does the line lie between a practice that is acceptable in private and between consenting adults, and behaviour that may cause harm to a specific individual or to society? Is consent the primary factor, or do other circumstances also need to be taken into account?
When we talk, for example, about fetishism or BDSM practices, consensus – or, where applicable, a pre-agreed contract – is absolutely essential, which is common practice within these communities. What is important, therefore, is the free consent of all those involved, consistent respect for that consent, and the certainty that nothing will happen to which any of the participants has not consented. Of course, at the same time, there must be no conduct that contravenes the law.
Furthermore, such practices should not cause a person serious psychological distress or lead to mental suffering. How the individual subjectively experiences the situation also plays a significant role.
Another red line is physical harm that requires medical treatment. If bodily integrity is compromised in a way that endangers health or life, this is a further indication that it is appropriate to seek professional help. In such a case, this behaviour is problematic, even if it takes place with consent.
This does not necessarily always mean seeking the care of a sexologist. In some cases, a therapist who specialises in sexuality and is familiar with these issues may be able to help. However, if the difficulties are more serious, it is advisable to recommend a specialist assessment in the field of sexology. In such a situation, some of the diagnostic criteria may already have been met.
Let us return to non-consensual paraphilias. What role does the internet play in them today? Does it help people to seek out information and professional help, or might it, on the contrary, reinforce certain fantasies and patterns of behaviour? In the context of paedophilia, for example, there is debate as to whether animated material depicting children should be permitted, or whether such content might actually exacerbate the difficulties faced by people with paedophilic preferences. How does Czech law view such material?
These are very important and, at the same time, controversial questions. Legislation in this area lags significantly behind technological developments and often struggles to define what is still legal and what is no longer legal. New technologies bring with them a vast array of readily available options that neither the legal system nor professional practice can keep up with in time.
Under Czech law, any material depicting a child or a minor in an erotic context is illegal. It makes no difference whether it was created using artificial intelligence, whether it involves an artificially generated avatar, or, for example, a short story in which it is clear that the character depicted is a minor.
The same applies to deepfake material, generated images or drawings that a person creates themselves or has generated by artificial intelligence. Although it is very easy to create such content today, from a legal perspective, such material is illegal.
By doing so, a person exposes themselves to the risk of criminal prosecution for the production of child pornography, which falls under the category of sexually motivated criminal activity. Furthermore, if they possess such material, or even distribute it further, they face severe penalties.
For anyone who feels the need to use such material and prefers it to their own fantasies, this information is therefore absolutely crucial. It is a breach of the law that could cause them serious problems and have a profound impact on the rest of their lives. There is no need to overcomplicate this matter. It is clear-cut information that people with these needs must be aware of, as it can have a significant impact on their lives.
In your view, could the use of such material potentially exacerbate a person’s problem, or, conversely, could it help them to fulfil their needs?
There are a huge number of factors at play here. Traditional sexology would tell you that, where unrealistic sexual objects are involved and no actual victim is present, this can reduce sexual frustration in some people.
However, I’m reluctant to say this publicly without a broader context, as it really only applies to certain individuals. Such material may reduce sexual frustration, but only in people who are not at increased risk, who have a clear understanding of their behaviour and feel in control of it, who know why they are using the material, and who do not, for example, have other options for sexual release. It is therefore highly individual.
For many people, on the other hand, it can lead to the line between fantasy and actual behaviour becoming blurred. This is because a person associates a minor as a sexual object with sexual gratification. This is, of course, something that can reinforce further similar behaviour and push one’s own behavioural boundaries. For some, therefore, it may act as a sort of first door that opens. It is a double-edged sword.
Another problem is the reinforcement of the idea that a child can be an erotic object. This is often one of the common cognitive patterns found in people with paedophilic or hebephilic preferences. They may, for example, ask themselves why a child could not be a sexual object. It is important to emphasise here that a child cannot be a sexual object because they are not capable of giving valid consent. A child is, of course, capable of sexuality, but they cannot consent to sexual activities with another person, because, until a certain age, neither their body nor their psyche is sufficiently mature to assess the consequences in a manner appropriate to their stage of development, nor to consent to any direct sexual contact with an adult or any other person.
I often explain this using the example of victims of sexual abuse aged twelve, thirteen or fourteen. Amongst the general public, the impression may arise, sometimes supported by certain testimonies, that the child encouraged the sexual contact themselves or that the situation did not have serious consequences for them, because they do not behave according to the pattern people expect – they do not resist, they do not cry, and so on. However, this is not the correct way to approach the matter, as the child is not mature enough to fully assess the implications of sexual advances; the perpetrator usually acts from a position of authority or as someone in whom the child has absolute trust; and reactions to such an event can vary greatly.
A large proportion of sexually motivated offences committed by individuals with paedophilic tendencies may not appear brutal at first glance. For example, the perpetrator may fall in love with the child. And, after all, we do not primarily wish to harm those we love. However, even seemingly subtle acts, such as stroking intimate parts, can have extremely devastating consequences for a child.
Although it may not be easy from a legal point of view to prove that the child was unhappy with the act in question, it is essential to insist on a firm boundary: by the very nature of their psychosexual development, a child cannot give valid consent.
It is similar to an adult stepping into a boxing ring against a child and saying to them: ‘Do you want to box? Let’s go all out.’ The child replies: ‘Yes, of course, I’m looking forward to the fight.’ And then they get punched.
How well prepared are Czech experts to work with people with paraphilic preferences? Is it easy today to find a therapist, psychiatrist or sexologist who is not daunted by this topic?
Czech sexology has a long tradition of working with paraphilias; that needs to be emphasised. However, the history of consistent psychotherapeutic work based on scientific evidence is considerably shorter.
Czech doctors and sexologists are probably very proficient in both diagnosis and medication. We also have a high-quality system of protective treatment. In a certain respect, this is quite exceptional, because in our country we understand and treat paraphilia as a medical diagnosis. A similar approach exists, apart from the Czech Republic, in Germany and several other countries, for example, but it is by no means common worldwide.
In other countries, people with paraphilic preferences who commit a criminal offence are often simply sent to prison without receiving appropriate specialist care. The Czech system is therefore not fundamentally flawed. When incidents do occur, it is relatively effective at recognising that treatment is needed alongside punitive measures.
For a long time, however, evidence-based psychotherapeutic approaches were lacking in our country. Sexologists generally did not know how to work with them, nor did psychologists, as there was no specialised training available. The biggest problem was providing care for people who had not yet committed any offence and who sought professional help voluntarily. This is because experts mainly dealt with the forensic population – that is, people who had already committed an offence and had been referred for treatment by the police or another part of the system.
What has changed in care since the launch of the Parafilik programme?
Before the Parafilik programme was launched, working with clients who were distressed by their sexual orientation and sought care voluntarily was virtually non-existent here. Yet the number of such clients is steadily increasing. Today, women with paraphilic preferences also come to our clinics. This is a rather different clientele from the one experts used to see before the programme began.
We encounter people with various fetishistic preferences, such as ABDL and BDSM, but also women with hebephilic or paedophilic preferences, who are now appearing in our clinics more frequently.
As part of the Parafilik programme, we have developed a specialised training course which has been completed by more than twenty regional therapists in the Czech Republic and Slovakia. The programme is provided in outpatient clinics and in secure treatment facilities, and is delivered by both sexologists and psychologists, most commonly within the healthcare sector. So, should a problem arise, we can refer a client to a trained specialist in various parts of the country.
We also connect clients with care via the SexHelp helpline, specifically its section dedicated to paraphilias. This serves as a preliminary stage of healthcare. Through this service, we recommend therapists who are skilled at working with these clients and who are able to use psychotherapy on its own or combine it with medication as required.
This year we are launching another intake for the training programme, as there is considerable interest in it amongst psychologists, sexologists and psychiatrists. This is very good news, and I believe we are gradually succeeding in improving the situation in this area.
We also offer the training through specialist sexological societies. It is therefore not just an initiative of our centre. For example, the Czech Society for Sexual Medicine and the Sexological Society of the Czech Medical Association of J. E. Purkyně are involved. I think that we are now beginning to have a fairly extensive network of competent therapists.
But does everyone with a paraphilic preference have to consult a sexologist or psychotherapist directly?
Not every problem requires medical care. Help can also be sought from therapists who specialise in working with sexual minorities, for example through the organisation ‘S barvou ven’, through kink-aware therapy, or through sexual assistance. A sexologist or specialist psychotherapist within the healthcare system should be consulted only when there is a genuine health issue. There is no need to place an unnecessary burden on the healthcare system with situations that can be resolved in other ways.
It is also very important that, through the Parafilik programme, we have managed to effectively link the various forms of care. With people with paraphilic preferences, just as with other sexological diagnoses, we must bear in mind that they often do not want to talk about their problems. There is a particularly high level of stigma and shame associated with paedophilic preferences, as they are automatically linked to sexually motivated criminal behaviour. People often do not confide in anyone at all about such matters.
In the past, when they found themselves in a crisis situation, they had to wait for specialist help and faced long waiting times for appointments. Today, they have the option of contacting a counselling centre or calling the Sexhelp: Paraphilia helpline in real time – that is, at the very moment they are experiencing a crisis. This significantly facilitates subsequent access to medical care.
If anyone reading our interview recognises themselves as someone dealing with similar feelings, fantasies or sexual preferences, what should they do first?
The simplest first step is to contact the Parafilik helpline. People can turn to it when they have doubts about their sexual orientation, when their preferences are beginning to negatively affect their mental health, or when they find themselves in a crisis situation. They may be concerned about their thoughts, how they feel in the presence of a child, the nature of their fantasies, the content they have searched for online, or what they are sexually attracted to. In such a situation, they can call the helpline or submit an anonymous enquiry via the counselling service.
This is also the most common route. People who are shy or afraid of direct contact usually write first. Only later do they ring and establish personal contact. They often do not reveal their identity or show their face until a later stage, as many are initially afraid to do so even to a professional.
The helpline is staffed by trained counsellors who know how to talk about sexuality sensitively and openly. It is a familiar topic for them, which is extremely important in this field. Helpline staff are often the first people to whom clients confide their concerns.
Is communication on the helpline anonymous?
Yes. It is an anonymous service provided as part of social care, specifically through the specialised National Helpline for Sexual and Gender Health. Contact with the helpline and the counselling service can therefore be made anonymously.
Once a person subsequently enters the healthcare system, their anonymity ceases. However, they are clearly informed of this fact in advance.
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Kateřina Klapilová is a psychosexologist, therapist and head of the Centre for Sexual Health and Intervention at the National Institute of Mental Health. She is the founder and supervisor of the Parafilik programme, the first prevention programme for people with paraphilic preferences in the Czech Republic, and of the SexHelp helpline: the National Helpline for Sexual and Gender Health. Her research focuses on representative surveys of the sexual health and behaviour of the Czech population (CZECHSEX; Love and Intimacy in the Czech Republic), on atypical sexual preferences, and on the development and evaluation of interventions in the prevention of sexual offences. She is the chair of the Czech Society for Sexual Medicine and is actively involved in sexual health and the prevention of sexual violence, both at national and international levels.
