The thought of enemas brings back negative memories for many people. How klismaphilia develops is probably complex and multi-factorial, but for those who develop it, the thought of or just hearing the word 'enema' is enough to cause an erection. Here are some common ways klismaphilia plays out, though in reality, much like all fetishes, each person's scene is highly idiosyncratic.
Anal eroticism - Let's face it, the anus and rectum are areas of eroticism. Like the genitals, for some, the anus and rectum can be a source of great enjoyment. Touching, massaging, and penetrating the anus feels good. Think of dildos. With an enema, there is the added benefit of a liquid being injected into the rectum and filling the colon. And, don't forget that the prostate gland lies in easy reach of fingers and enema nozzles.
Medfet - An enema is a medical procedure typically used to treat constipation. For some players, the medical scene is a turn-on. It may bring back memories of being sick and being hospitalized, or maybe being home from school and being given an enema by a caring parent or relative. Themes of being taken care of, being subjected to scary medical procedures, being exposed, helpless, and anxious are common. The player can be either the doctor/nurse or the patient. Both roles can be sexually exciting.
Age/role-play - Similar to the medical scene, age/role-play can invite feelings of being taken care of, helplessness, embarrassment, control, and possibly discipline/punishment. Common scenes can be: father/son, coach/player, uncle/nephew, teacher/student.
BDSM - An enema can run the gamut from a very pleasant and sensual experience to a painful and cramping one. Enemas can be used in a BDSM scene where the bottom submits to the top. This can involve varying degrees of discomfort and pain as determined by the players. Being given an enema while restrained or using a balloon retention nozzle to make the sub conform are options. Obviously this play requires the agreement of both players and needs to include a safe word to terminate the session. Enemas in BDSM scenes are frequently combined with spanking or other discipline or punishments.