Paraphilias only become a clinical concern if they cause significant distress or dysfunction to the individual, or cause some sort of harm. In other words, simply being kinky is not a disorder. As clinicians, we have to be exceptionally careful not to pathologize healthy variants of sexual interest and expression.
The cases of female paraphilics presented in a paper by Fedoroff, Fishell, & Fedoroff (1999) demonstrate how paraphilias can become a clinical concern. Here is a sample case:
Case 2. This bisexual woman was brought to the emergency room by police, but not charged. Police had been called to a man's apartment when she appeared at his door and told him she wanted to have sex with him after she tied him to the bed. Instead of letting her in, the man called the police. When they arrived, she told them she would go with them quietly if they first let her carry out her sexual wishes. She was searched and a rope and large hunting knife were seized. On examination, she was hyper-talkative, grandiose, and irritable. She reported an insatiable sex drive directed toward the man she had intended to rape. She also described a belief that her mother had been attempting to poison her.
Comment: This woman was clearly in the manic phase of a bipolar mood disorder at the time of assessment. During the previous 3 weeks she had also shown symptoms of erotomania. Erotomania is a delusional disorder. It is one example of a psychiatric disorder that can result in behaviour (e.g., stalking) that is sometimes confused with paraphilic behaviour (Menzies, Fedoroff, Green, & Isaacson, 1995). She had become convinced that the man, with whom she had daily but casual contact, had become madly in love with her and seduced her by sending her coded messages to which she had responded.
When asked why she thought the man in question had not opened the door of his apartment to her she said, "I think he is a naive virgin". Although her presentation was coloured mainly by her major mental illness, she did admit to having strong sadistic and masochistic sexual fantasies (including non-consensual activities) which, while not required for sexual arousal, greatly enhanced it.
This is an interesting case in that her behaviour seems to be driven by her bipolar disorder; however, also contributing to her behaviour is her paraphilic sexual interest. Keep in mind that paraphilias, especially when presentations are more severe such as these, are relatively rare in women. You can read the rest of the cases here (warning: many of the cases involve child sexual assault).