Russian Health Ministry Approves New Treatment Standards for ‘Transvestism’ and BDSM
On September 16, 2026, the Scientific and Practical Council of the Ministry of Health of the Russian Federation approved new clinical guidelines titled “Disorders of Sexual Preference,” drafted by the professional association Russian Society of Psychiatrists. Published in the official state registry of clinical guidelines, the document represents the country’s first legally binding standard in years for diagnosing and managing conditions under category F65 of the International Classification of Diseases, Tenth Revision (ICD-10). As reported by the specialized Russian LGBTQ+ outlet Parni PLUS, the approved classification covers fetishism, exhibitionism, voyeurism, pedophilia, and sadomasochism, as well as “fetishistic transvestism,” a diagnosis that has raised serious concerns among human rights advocates and transgender communities.
According to reporting by the medical portal Medvestnik and national daily Kommersant, previous ministry guidance on these conditions dated back to 1999 and lapsed in 2012, while a draft proposed by the psychiatric society in 2023 failed to secure regulatory approval. Since 2025, Health Ministry clinical guidelines have been mandatory for all medical providers across Russia, including private clinics. The guidelines outline cognitive behavioral therapy (CBT) as the primary treatment modality, supplemented when necessary by selective serotonin reuptake inhibitor (SSRI) antidepressants such as fluoxetine or sertraline, and antiandrogenic drugs or GnRH analogues in severe cases or sexual offenses. The psychotherapy section also references behavioral modification techniques, including aversive therapy and orgasmic reconditioning.
The authors noted that the guidelines strictly adhere to ICD-10 criteria because the Russian government suspended implementation of ICD-11 in early 2024, citing the protection of “traditional values.” Under the World Health Organization’s ICD-11, paraphilic disorders were fundamentally redefined to focus on lack of consent or significant risk of harm or death, while consensual adult expressions of fetishism and fetishistic transvestism were fully depathologized and removed from the disease registry.
Human rights defenders and mental health professionals warn that retaining “fetishistic transvestism” (F65.1) within mandatory medical standards creates risks of misdiagnosis or deliberate medicalization targeting transgender individuals. In the wake of Russia’s July 2023 federal law completely banning gender-affirming medical care and legal gender recognition, alongside stalled clinical guidance on gender incongruence (F64), trans individuals face heightened risks of having their identities treated as sexual deviance or being subjected to conversion practices under the guise of therapy. The guidelines’ authors state, however, that atypical fantasies or cross-dressing do not constitute a disorder absent persistent subjective distress or functional impairment.
The Russian Society of Psychiatrists (RSP) is the country’s oldest psychiatric professional association, tracing its roots to the late 19th century and bringing together leading mental health researchers, including specialists from the V.P. Serbsky National Medical Research Center for Psychiatry and Narcology. In recent years, the organization has formulated official clinical protocols amidst intensifying state restrictions on LGBTQ+ individuals.
Previously, Uránia reported that Russian courts labeled “extremist” and banned nine independent LGBTQ+ initiatives, including rights groups Coming Out (Vykhod), Center T, and Parni PLUS itself, while the UN Special Rapporteur on Russia presented a report documenting transnational repression against Russian LGBTQ+ citizens and activists in exile.\n
