Pedophilia -- pr "paraphilia," as it is known in the medical profession -- is an abnormal desire of an adult for sexual contact with children. Pedophiles are almost always men, and they are obsessive: they're driven by such strong urges that they seem unable to restrain themselves. Pedophiles have been know to molest children only hours after being released from a lengthy prison sentence. In some instances, they kill their victims in order to cover up their crimes.
Over the years, society has initiated many attempts to control pedophilia -- incarceration, psychotherapy, various medications, chemical treatment, even castration (i.e., surgical removal of the testicles). Few of these have proven successful. A Norwegian study reported that castration significantly reduced the recidivist rate of these sexual predators. However, this radical procedure has not received wide support in the United States. A Texas man, convicted of child molestation, begged to be castrated in order to prevent him from repeating his crime, but a court ruled that such surgery would constitute "cruel and unusual punishment," forbidden by the U.S. Constitution.
In sum, pedophilia poses a formidable problem for society, and particularly to those growing number of children who became the victims of sexual abuse. In the United States, up to 500,000 cases are reported each year, and many more go unreported. In 1990, this crime cost over $2 billion -- and this figure does not include psychotherapy for the children involved, and for their parents.
In recent years, several laws have been passed designed to cut down on the incidence of pedophilia.
- "Megan's Law," was passed by the state of New Jersey and recently upheld by the U.S. Supreme Court. This law requires notification of neighbors when a convicted sex offender moves into a community.
- A Kansas statute, also upheld by the Supreme Court, allows for civil commitment of a convicted sex offender after he's served his prison sentence. The law requires a formal court procedure, like a sanity hearing. Those committed would undergo long-term therapy and would be released only after a judge is convinced that treatment has been successful. (Unfortunately, therapy has proven ineffectual in most cases.)
- California has passed a law allowing the courts to require a convicted offender to receive periodic injections to inhibit his sex drive. The procedure has been call "chemical castration," though this is a misnomer, since the treatment involves no mutilation and is a reversible process.
This last approach has come under attack by a number of critics who point out that its side effects are sometimes severe. However, a new study by Ariel Rosler, MD, and Eliezer Witztum, MD, of Israel -- published in the New England Journal of Medicine (Feb. 12, 1998, Vol. 338, No. 7 Pages 416-422) promises a better method of chemical treatment.
The study involved 30 volunteers, men with an average age of 32, with a long-term history of paraphilia. The researchers report using a substance called triptorelin, which acts through the pituitary gland and markedly reduces the level of testosterone. Subjects received 3.75 milligrams of triptorelin, injected into a muscle each month.
The results were striking. These men reported a significant decrease in deviant sexual fantasies and desires, as well as a marked des\crease in abnormal behavior. For example, while subjects received this medication for one year, the incidence of abnormal sexual behavior dropped from an average of five per month to zero. The serum testosterone concentration fell from an average of 545 mg to an average of 23 mg. The beneficial effects appeared after three months of treatment and were persistent in all 24 men who continued therapy for at least one year.
None of the 24 individuals committed a sexual offense while on treatment, even though they lived in their usual environment. Their deviant sexual fantasies and urges were markedly decreased. These results were reported not only by the subjects themselves but also by family members and probation officers.
Unlike earlier substances used to inhibit abnormal sexual urges, subjects reported few side effects.
When six subjects ceased the treatment, five out of those six monitored experienced a return of deviant symptoms, their testosterone levels increased, and two were subsequently prosecuted for sex crimes and sentenced to prison. It seems clear from this study, that in order to eliminate the problem, pedophiles must continue monthly injections.
The study has some limitations. In the first place, the sample was small -- only 30 men. In addition, the researchers did not employ a double blind technique, wherein a placebo os given to a comparable control group. Instead, it was an observational study, one in which an entire group is observed over a period of time. Other studies will no doubt follow, perhaps more controlled and comprehensive.
Nevertheless, the current study strongly suggests that this method of therapy is effective in the treatment of pedophilia. If so, the implications are considerable. Pedophiles living in the community may receive reliable medication and lead normal lives, free from an obsession-compulsion that results in behavior society punishes severely. Pedophiles who are now incarcerated may look forward to easier parole and successful rehabilitation. Of course, they would have to receive monthly injections -- though perhaps, after more research, a different schedule might suffice, especially if longer acting medication was developed.
Pedophiles have always been the most reviled members of society, despite the fact that most people realize such people are, in some fashion, ill. A further speculation may emerge regarding other compulsive sexual crimes -- so called "sex addition" or sexaholics, serial rapists, te al--could these subjects be controlled by this or similar medication. Time will tell -- for the present it is certainly warranted to pursue further studies.
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Copyright © Dr. Charles A. Bertrand.
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