Evidence That Arousal to Pedophilic Stimuli Can Change: Response to Bailey, Cantor, and Lalumière

Abstract

We thank Drs. Bailey, Cantor, and Lalumiere for their careful reviews of Muller et al. (2014), hereafter referred to as ‘‘our study’’or‘‘our article.’’Our study reported on the results of a retrospective analysis of a group of men assessed at the Sexual Behaviours Clinic at the Royal Ottawa Mental Health Centre between 1983 and 2011, who fulfilled the following inclusion criteria: DSM-III, IV or IV-TR (American Psychiatric Association, 1980, 1994, 2000) diagnosis of pedophilia, an initial penileplethysmographytest (PPT) indicativeofsexual interest in children, and a second PPT test at least 6 months later. Because we were interested in testing the hypothesis that arousal topedophilic stimulicanchange,weselectedmenwhose PPT at Time 1 showed a greater increase in penile circumference in response to children compared to adults. Of this group, about halfshowedagreaterincreaseinpenilecircumferenceinresponse to adults (as compared to children) at Time 2. In the article, we noted that the men who changed PPT response profiles demonstrated both a decrease of penile circumference change in responsetoaudiotapesdescribingsexual interactionwithchildren and an increase in penile circumference change in response to audiotapes describing sexual interactions between adults. In our article, we suggested that the demonstration of a statistically significant decrease in sexual response toward children (p\.001), combined with a statistically significant increase in sexual response to adults (p\.001), presents a challenge to the claim that pedophilic sexual interest is unchangeable. We note that there was an error that has been formally communicated to the Editor of the Journal of Sexual Medicine, due to the misclassification of three of the men in the study. The removal of these cases and complete re-analysis of the data did not change the results or our conclusions. Bailey, Cantor, and Lalumiere each claimed that the notion of the immutability of pedophilic interest is not challenged by the findings of our study and attempted to offer some non-evidencebased support for their opinions. We are grateful for the opportunity to respond and do so below by reviewing each commentary in alphabetized author order. Bailey began his commentary by equating sexual orientation with sexual arousal,‘‘Because a man’s sexual orientation/ erotic interest is identical to his characteristic sexual response pattern...’’We disagree because sexual orientation is different from sexual arousal. Men who have sex with men are not necessarily gay, and a gay man is still gay even if he loses his sex drive or is unable to get an erection. In our article, we speculated that the reluctance of researchers to accept there is evidence that pedophilic sexual interest can change is due to confusion between sexual orientation and sexual interest. It should be noted that our study was never designed to investigate change insexualorientationandweexplicitlystated in thearticle thatour study does not support any recommendations aimed at changing sexual orientation. Equating orientation with interest confuses interpretation of the issue and may be clinically harmful. Bailey wrote that‘‘...sometimes men do not get sufficient erection during a PPT to be accurately classified.’’ We agree. This is why we selected men who initially produced more changein penile circumference in response tochild stimuli than to adults, as well as only those who demonstrated a change in J. P. Fedoroff (&) S. Curry R. Ranger J. Bradford Forensic Research Unit, University of Ottawa Institute of Mental Health Research, Royal Ottawa Health Care Group, 1145 Carling Ave., Ottawa, ON K1Z 7K4, Canada e-mail: paul.fedoroff@theroyal.ca