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Treatment of sexual offenders in Herstedvester Denmark. The rapists.

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    ABSTRACT: Hypersexuality is one of the most embarrassing behaviors for both patients and their families and there are no effective drug treatments for this sexual inappropriateness. To evaluate the efficacy and safety of a long-acting analog of gonadotropin-releasing hormone (triptorelin) in men with nonparaphilic hypersexuality (NPH). Primary outcome measure was the frequency of intercourse. The designated secondary outcome measures were the changes in International Index of Erectile Function (IIEF) questionnaire and responses to the questions from the IIEF in the preceding month: question 11, "How often have you felt sexual desire?" and question 12, "How would you rate your level of sexual desire"? Seventy-six men (mean age 44.4 years) with NPH were treated with monthly intramuscular injections of 3.75 mg of triptorelin for an indefinite period. During treatment, serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, testosterone (T), and free testosterone (fT), were measured monthly, and bone mineral density every 6 months. The mean sexual attempts decreased from 7.6 +/- 1.4 per day at baseline to 4.2 +/- 1.2 (P = 0.001), 1.2 +/- 0.4 (P = 0.001), and <1 per week (P = 0.0001), after 6-, 12-, and 24-month treatment, respectively. The mean scores for questions 11 and 12, improved from 6.8 +/- 1.1, and 6.6 +/- 1.2, at baseline to 0.7 +/- 0.4 (P = 0.0001), and 0.7 +/- 0.5 (P = 0.0001), at 24-month treatment, respectively. Positive response to triptorelin was significantly associated with severity of baseline hypersexuality (r = -0.62, P = 0.01), and treatment duration (r = 0.78, P = 0.001). These beneficial effects persisted 6 months in all men who were treated for at least 24 months. The serum LH and FSH concentrations begun to decrease after two doses of triptorelin. After 3 months, serum T, and fT levels decreased by 50% in 65 (85.5%) of patients (P = 0.01). Triptorelin was very effective and well tolerated in men with NPH. Further studies are needed to replicate our results.
    Journal of Sexual Medicine 12/2008; 6(4):1151-64. · 3.51 Impact Factor
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    ABSTRACT: The relationship of surgical castration to sexual recidivism in a sexually violent predator/sexually dangerous person (SVP/SDP) population is reviewed. A review of the literature on castrated sex offenders reveals a very low incidence of sexual recidivism. The low sexual recidivism rates reported are critiqued in light of the methodologic limitations of the studies. Better designed testicular/prostate cancer studies have demonstrated that, while sexual desire is reduced by orchiectomy, the capacity to develop an erection in response to sexually stimulating material is not eliminated. The relevance of this literature to SVP/SDP commitment decisions and ethics is discussed. Two vignettes of castrated, high-risk sex offenders illustrate how to address risk reduction. Two tables are presented: the first outlines individual case data from a difficult-to-obtain report, and the second summarizes the most frequently cited castration studies on sexual recidivism. Orchiectomy may have a role in risk assessments; however, other variables should be considered, particularly as the effects can be reversed by replacement testosterone.
    The journal of the American Academy of Psychiatry and the Law 02/2005; 33(1):16-36. · 0.93 Impact Factor
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