Pharmacotherapy of sexual offenders

To review the definition, sociology, pathogenesis, diagnosis, medicolegal aspects, and pharmacologic treatment of sexual offenders, with emphasis on the antiandrogens, the luteinizing hormone-releasing hormone (LHRH) antagonists, and the serotonergics.

An English-language literature search using MEDLINE (1966-1991) yielded clinical trials, case reports, editorials, and review articles.

Emphasis was placed on comparative trials and case reports discussing pedophilia, rape, and exhibitionism.

Data from controlled human studies were evaluated. The trials were assessed for sample size, duration of therapy, therapeutic response, and incidence of recidivism.

The pharmacologic management of sexual offenders is controversial, and treatment is presently focused on psychotherapy and the use of antiandrogenic medications. Few well-controlled, blinded, efficacy trials with adequate sample sizes have been conducted. The populations studied are heterogeneous, and the subjects enrolled present with different sexually coercive behaviors. Consequently, the results of these studies are difficult to extrapolate to the treatment of other sexual offenders. No convincing evidence exists that pharmacologic treatment decreases the recidivism rate. Case reports describing the use of serotonergic drugs and LHRH antagonists hopefully will promote controlled clinical trials. A social consensus must be reached concerning the ethics of using these agents as a part of the treatment of sexual offenders.