Sexual disability is commonly thought of as being secondary to another condition or disease. It may also be a primary disability of the peripheral genitalia, or of their mental governance in the brain/mind. Paraphilias are an example of the latter. Acrotomophilia is a paraphilia that pertains to amputation and amputees. Apotemnophilia pertains to self-amputation. Each of these little known syndromes offers a challenge to diagnosis and to sex therapy.