Abstract Introduction/Objective Sexsomnia and somnophilia are sleep-related sexual manifestations still poorly recognized by many healthcare professionals. These issues deserve attention as they can significantly affect both those who experience them and others. This narrative review aims to explore how these conditions impact clinical practice and to broaden the understanding of human sexuality. Materials and Methods Narrative review based on articles indexed in PubMed, evaluated qualitatively. Results Sexsomnia is a parasomnia involving automatic sexual behaviors during sleep, such as masturbation, vocalizations, or attempts at sexual intercourse, without recollection upon awakening. Somnophilia, in contrast, is a paraphilia characterized by sexual arousal toward sleeping individuals, posing ethical and legal risks when consent is absent. While somnophilia alone is not inherently pathological, it becomes a paraphilic disorder if it causes significant distress, functional impairment, and/or involves consent violations. Fantasies of domination or submission may arise in somnophilia and require careful assessment, especially when consent boundaries may be crossed. Differential diagnosis demands a detailed clinical approach, including structured interviews, sexual history, exploration of fantasies, and objective tools like polysomnography to differentiate involuntary sleep behaviors from intentional acts or psychiatric disorders. Management requires empathetic listening, tailored therapeutic strategies, and a multidisciplinary approach involving neurology, psychiatry, psychology, and sex therapy. Conclusion Identifying and managing sexsomnia and somnophilia ethically, empathetically, and through a multidisciplinary lens is essential, with full consideration of clinical and legal implications. Financing No conflict.
Santos et al. (Sun,) studied this question.