Paraphilias are sexual impulse disorders characterised by intensely arousing, recurrent sexual fantasies, urges and activities that are considered ‘deviant’ with respect to cultural norms. Behaviours classified as paraphilias include exhibitionism, paedophilia, voyeurism, fetishism, transvestite fetishism, sexual sadism and masochism, and frotteurism. An accompanying set of sexual impulse disorders, the paraphilia-related disorders, have also been identified.Three major classes of psychopharmacological agents (antipsychotics, antiandrogens and serotonergic antidepressants) have been used as treatments for sexual impulsivity. For nonpsychotic individuals, antipsychotics should no longer be considered as primary agents for the control of sexual impulsivity due to the nonspecificity of their effect and the adverse effects associated with their use.Commonly used antiandrogens are medroxyprogesterone and cyproterone. Since data regarding their efficacy in sexually aggressive men are most extensive, antiandrogens remain the primary treatment for sexually dangerous offenders. While effective (presumably by reducing the physiological effects of circulating testosterone), these agents are associated with adverse effects such as body weight gain, fatigue, depression, feminisation and decreased spermatogenesis.Based on the available animal and clinical literature, diminished central serotonin (5-hydroxytryptamine; 5-HT) neurotransmission may be involved in the aetiology of human sexual impulse disorders. Indeed, recent and emerging data suggest that serotonergic antidepressants, especially serotonin reuptake inhibitors, may be useful for the amelioration of sexual impulse disorders.