This study surveys the discharge register of a large London teaching hospital over 20 years and presents data on its 48 cases of clinical sexual fetishism. An attempt was made to answer two questions: (1) What are the clinical problems these patients present? They have more to do with the perception of fetishes as personally or socially unacceptable than with ‘objective’ restrictions placed on sexual activity. (2) What is the classification used to describe? The data have not enabled any conclusions to be drawn about the existence of particular fetishist syndromes. Certainly, a fifth or more of the sample had fetishes for clothes or rubber or rubber items, or wore or stole a fetish or fetishes; but this information is insufficient to allow one to assume that these patients had something significant in common, and leaves open the question of what more precisely each individual was attracted to.