The Brain, Androgens, and Pedophilia

Abstract

Pedophilia is a major public health problem because of its frequency and its severe consequences on themental health of victims. Estimates of the prevalence of child abuse vary from 7% to 53% in girls and from3% to 37% in boys. The incidence of child sexual abuse in France and Germany has been estimated to be as high as 100 and 550 cases per day, respectively. Adults with a history of child sexual abuse have a substantially increased risk for developing a wide range of psychiatric disorders. In human beings, the brain is amajor determinant of sexual orientation, sexual fantasy, sexualmotivation and sexual behavior. Studies of healthy male volunteers and of hypogonadal patients have demonstrated that sexual fantasy, motivation and behavior are largely dependent on plasma testosterone. Although pedophilia is not characterized by increased levels of testosterone, reduction of plasma testosterone levels through antiandrogens or GnRH agonists has been shown to be effective in controlling sexual fantasy, sexual urges and sexual behavior in these patients. This pharmacological treatment is always used in combination with a psychotherapeutic approach and only in severe cases for which the latter approach is not sufficient to control the disorder. Antihormonal treatment of pedophilia is not, however, targeted to the etiology of the disorder. Future studies should focus on understanding the determinants of pedophilic orientation in an effort to develop improved preventive and therapeutic measures.