Cultures define and describe what is normal and what is deviant. These definitions of normality vary across cultures and are influenced by a number of factors, such as religion. Cultures have been described in various ways, including sex-positive where the sexual act itself is seen as important for pleasure, or sex-negative where the sexual act is seen only as for procreative purposes. The role and development of paraphilias across cultures is also variable, with cultures defining what is legal or illegal. Such differences make collection of epidemiological data and comparison across paraphilias problematic. This discussion suggests that characteristics of cultures may influence the rate of reporting paraphilias, as well as the rate of paraphilias themselves. Furthermore, with increased industrialization and urbanization, families will become more nuclear, with attitudes toward sex and paraphilias changing as well. This review also explores whether paraphilias can be seen as culture-bound syndromes, and recommends consideration of a number of conceptual issues regarding the diagnosis and prevalence of paraphilias as future cross-cultural studies on this topic are developed.