Medical pornography involves sexualized medical, often fake, including gynecological pelvic examinations, rectal examinations, and pelvic or gynecological ultrasounds. 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. A lesbian is a female homosexual; a female who experiences romantic love or sexual attraction to other females. However, gay pornography in the modern world is mostly concentrated in the making of home videos , cable broadcast anime hentai and emerging video on demand and wireless markets, as well as images and movies for viewing on the Internet. Top and dominant are widely recognized for those partner in the relationship or activity who are, respectively, the physically active or controlling participants. This young gay porn genre also features male-on-male fellatio through a small hole made in a bathroom divider. The milf fuck Girls Gone Wild series is one example. In recent years, however, many celebrities have benefited from the publicity resulting from the release of a sex tape. Studies among BDSM practitioners in the US have shown that about half of all men find the idea of bondage to be erotic; many women do as well. Cartoon pornography depicts illustrated or animated fictional characters in erotic and sexual situations. Some pornographic films use an artificial semen substitute to simulate or enhance creampie shots. Sadomasochistic scenes sometimes reach a level that appear more extreme or cruel than other forms of BDSM—for example, when a masochist is brought to tears or is severely bruised—and is occasionally unwelcome at BDSM events or parties. The fantasy is typically based around one or more larger beings dominating a smaller being.