In the Diagnostic and Statistical Manual of Mental Disorders , published by the American Psychiatric Association, it is classified under 302.89 – Paraphilia NOS and has no diagnostic criteria other than a general statement about paraphilias that says the diagnosis is made if the behavior, sexual urges, or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Macrophilia is a fascination with or a sexual fantasy involving giants, more commonly expressed as giantesses . A study of the condom usage habits of New Zealand sex workers said that they offered various safe sex alternatives to vaginal sex to clients who refused to wear a condom. These are often fake. The term breast fetishism is also used to refer to cultural attention to female mature milfs breasts and the sexuality they represent, with debate continuing as to whether the modern widespread fascination with breasts among heterosexual males in western societies is a sexual fetish. The name was coined from the title of the controversial book. This is commonly called double vaginal penetration or double stuffing. Crush pornography features objects being crushed by an actress or actor, who generally plays an overtly dominant role. These actors often play the top roles but this is not always the anime hentai case, such as with Kristen Bjorn and some Bel Ami models. Sadism describes sexual pleasure derived by inflicting pain, degradation, humiliation on another gay bear porn person or causing another person to suffer. However, gay pornography in the modern world is mostly concentrated in the making of home videos , cable broadcast and emerging video on demand and wireless markets, as well as images and movies for viewing on the Internet. Content featuring male bisexuality has been a growing trend since the advent of internet pornography. Exhibitionism: Becoming noticeably desperate or wetting oneself with the express purpose of being seen by strangers. Hentai narrow Japanese usage and broad international usage are often incompatible.