Decisions to engage in child sexual abuse (CSA) are not motivated solely by sexual/romantic interest in children. Given the complex interplay of personal, relational, and societal factors involved, we explored the narratives men constructed around their subjective motivations for offending, situated within the post-structuralist constructs of desire, power, and ethical subjectivity. Qualitative interviews were conducted with 25 men charged/convicted of CSA. Offenses were often contextualized as attempts to satisfy sexual and/or emotional desires. While some participants reported a persistent interest in children, others attempted to satisfy these desires through CSA in response to negative experiences with adults, including sexual overregulation, sexual objectification, and demoralization. Participants’ subversion of social and ethical norms was aided by offense-supportive narratives that stemmed from their interactions with/interpretations of the world. Interventions to prevent CSA may benefit from a post-structuralist perspective of the social and cultural mechanisms by which men’s decisions to engage in CSA are shaped.

Pramipexole is a dopaminergic pharmacologic agent with reported adverse effects that include hypersexuality, shift in sexual interests, pathological gambling, compulsive shopping, and binge eating. Pramipexole is indicated in the treatment of Parkinson's disease and restless leg syndrome and has been used as adjunctive or add-on treatment in major depressive disorder. This report describes the successful treatment of a series of 4 adult men who presented with concerns about problematic sexual interests and behaviors that began after treatment with pramipexole related to Parkinson's disease or restless leg syndrome.

This chapter focuses on the laboratory measurement of penile response in the assessment of sexual arousal. Changes in penile tumescence, as measured by penile plethysmography (PPG), is a widely recognized means of measuring male sexual arousal in response to the presentation of various stimuli. Although not part of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or International Classification of Diseases (ICD) criteria for any paraphilias, PPG is widely considered by researchers and clinicians to be an important contributor in the assessment and treatment of males with paraphilic interests and/or males who have committed sex crimes. PPG, also referred to as phallometry, phallometrics, or penile tumescence testing (PTT), contributes to clinical assessment of paraphilic interests, appraisal of risk of recidivism, and provides an objective measurement of changes in sexual arousal in response to treatment. Before the development of PPG techniques, clinicians assessing individuals to learn their sexual arousal patterns relied primarily on self-report for the evaluation of treatment needs and outcomes.

Penile plethysmography (PPG) is an objective measure of male sexual arousal in response to the presentation of a series of erotic and neutral stimuli. This measure is now widely recognized as the most reliable means of objectively measuring male sexual arousal to specific stimuli. Many clinicians and researchers consider PPG to be a vital contribution to the assessment and treatment of adult men with paraphilic interests and men who have committed sex crimes. PPG contributes to the clinical assessment of paraphilic interests, appraisal of risk of recidivism, and provides an objective measurement of changes in sexual arousal in response to treatment. There is strong support for the utility of PPG within clinical and legal contexts. This article addresses ways in which PPG has been utilized in the courts as part of expert clinical opinion. History of its use, details regarding admissibility in court, and case law are explored within the legal systems of Canada, the UK and the USA. Support for the inclusion of PPG as expert evidence is provided and judicial misunderstandings on the rationale for PPG use and its clinical utility in forensic assessments are discussed.

The role of the facial images in arousal and attraction has been examined before but never via penile plethysmography (PPG). This retrospective chart review aimed to determine the significance and magnitude of differences in arousal measured by PPG in 1,000 men exposed to slide stimuli with or without facial blurring in subjects of various ages. Arousal in response to blurred stimuli was significantly higher than nonanonymized stimuli with modest effect sizes for slides across age and gender categories. Facial blurring increased differences in arousal between adults and adolescents with a modest effect size. Our findings support the use of facial blurring to further protect the anonymity of models and limit the ethical and legal challenges of using slide stimuli with child models.

Introduction: Pedophilic sexual interest is an important risk factor in sexual offender recidivism and remains a key component in the clinical assessment of child sexual offenders and people diagnosed with pedophilia. Despite concerns about the absence of universally accepted standardized clinical assessment methods, there are a number of established techniques aimed at assessing people with sexual interest in children. Aim: To provide a foundation from which to understand existing methods available for the assessment of people with pedophilic sexual interests, including strengths and limitations of each approach. Methods: A group of clinical experts provide a clinically oriented, narrative review on assessment methods for pedophilic sexual interest, including the rationale behind each method and its implementation. Evidence on validity supporting the techniques, limitations, and ethical issues is also discussed. Results: The assessment methods were grouped according to the following categories: self-report, genital psychophysiological assessment, indirect measurement, and behavioral measurement of pedophilic interest. Although most techniques performed well in discriminating child sexual offenders with pedophilic interest from distinct comparison groups, there are several limitations, including the current lack of standardization and the ethical challenges posed by this sensitive area. Clinical implications: An understanding of the different measures available for the assessment of problematic sexual interests plays a vital role in forensic clinical determinations of risk of recidivism and in the identification of treatment targets for men who have committed sexual offenses. Several independent but complimentary methods exist to assess sexual interest. Ongoing work on the international standardization of assessment based on methodologically sound research aimed at determining best practices will address some of the shortcomings of these assessments while improving their reliability. Strengths & limitations: This article provides a general review on a number of methods aimed at assessing pedophilic interest. However, these methods mirror clinical practice largely used within North America and parts of continental Europe. As a result of cultural differences, opposing paradigms on assessment and treatment of pedophilia, and diverse legal regulation between jurisdictions and countries, these practices may not be applicable on an international scale where other special procedures may be required. Conclusion: A number of techniques have been used within clinical and research settings that vary from self-report to objective measures. Most methods have demonstrated efficacy. Continued work to combine evidence and experience from diverse populations and multiple countries will improve the quality of the methods available. Copyright (C) 2019, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

The terms sadism and masochism were coined by German psychiatrist Richard von Krafft-Ebing in his book Psychopathia Sexualis. He described sadism as deriving sexual pleasure from inflicting pain on another person and masochism as obtaining sexual pleasure from receiving pain and cruelty inflicted by another person. British psychologist Havelock Ellis promoted the idea that sadism and masochism are actually closely related concepts as they describe complementary forms of behavior. This new interpretation formed the basis of the modern conception of sadomasochism (SM). The Kama Sutra, which is one of the earliest descriptions of human sexuality, not only compares sexual intercourse to a quarrel but also discusses a range of embraces including scratching, biting, and striking, and gives advice about where and how to administer these embraces, as well as the different sounds that will result. Research has found that SM practitioners are typically well-adjusted and comfortable with their sexual preferences.

This chapter explores sex offender registries (SORs) and public notification (PN) in the United States and Canada. The process of maintaining a balance between protection of the public and an individual’s right to privacy becomes increasingly difficult when the offender is considered to be dangerous or “morally tainted.” Mechanisms, such as SORs and PN, have been implemented as a political response to highly publicized cases of sexual victimization. Supporters of these interventions claim that such supervisory methods will deter sexual offenders from reoffending while providing information on which the public may act to protect its children and others who may be vulnerable and at the same time giving an investigative tool with which police can more efficiently “solve” sexual offenses. In contrast, opponents of SORs and community notification stress concerns about a discriminatory aspect to the regulations that specifically targets sex offenders when there is an absence of evidence that sex offenders, as a general category, are at a greater risk to reoffend than other categories of offenders. Additionally, critics have raised concerns about the ethics and legality of infringing on the rights of a segment of the population who have already served their sentence and paid the penalty for their misconduct.

Nematode infection is one of the principal diseases suffered by sheep and the class II region of the MHC has been repeatedly associated with differences in susceptibility and resistance to infection. The aim of this study was to examine the association of MHC class II haplotypes in a flock of Texel sheep with faecal egg counts and antibody responsiveness. Two haplotypes carried the DRB1*11:01 allele which has previously been associated with reduced egg counts in Scottish Blackface and Suffolk sheep. One of the two haplotypes was associated with reduced egg counts in the Texel breed, and both haplotypes were associated with reduced IgA activity against an extract from fourth-stage larvae. The reduced IgA activity is probably a consequence of reduced numbers of fourth-stage larvae in sheep carrying the resistance allele. The association of specific MHC alleles with reduced egg counts, reduced worm numbers and decreased IgA activity provides a mechanism for the density-dependent regulation of parasite growth and fecundity.

The high prevalence rates and numerous consequences associated with child sexual abuse makes preventing these offences a societal priority. Prevention strategies have traditionally involved only tertiary interventions, implemented by the criminal justice system after an offence has occurred. More recently, some have argued for a public health approach to preventing child sexual abuse, which includes interventions at the primary and secondary levels. Secondary prevention aims to provide treatment and support to those at-risk of sexually offending before any involvement with the legal system. Increased demand for secondary prevention services and early results from current initiatives demonstrate that at-risk individuals are willing to seek treatment without external pressure from the legal system, and often report numerous treatment-related benefits. These findings support the need for widespread implementation of primary and secondary prevention initiatives. The safety of children requires that society stops merely reacting to sexual offences, and instead begins implementing proactive evidence-based strategies that can prevent even initial incidents of child sexual abuse. This article explores some of the many benefits and barriers associated with primary and secondary prevention, as well as strategies for overcoming these barriers. Recommendations for the development and implementation of prevention initiatives are also included.

Penile plethysmography (PPG) is the primary physiologic assessment method used to gauge sexual responses in adult men. Depending on the country or jurisdiction of assessment, stimuli used to elicit arousal can include videos, still images, and audio materials. It can depict a variety consenting and non-consenting sexual scenarios as well as neutral, non-sexual scenarios. Models in visual stimuli can be clothed, semi-clothed, or nude. Variation in stimuli modality and the type of sexual interest being tested can have a large impact on PPG outcomes. This paper reviews research on types of PPG stimuli, the different sexual interests being assessed, reliability and validity, and the impact of anonymizing models depicted in assessment materials. Innovations in stimuli development in three labs located in Canada, the United States, and the Czech Republic are also discussed. The work done in these three labs and the broader range of research on assessment stimuli are presented to highlight the need for a unified, multi-site, standardized approach to assess problematic sexual interests and their change in response to treatment.

This article provides a comparison and comprehensive analysis of varied approaches to the assessment of sexual interest and behaviours at different international sexual behaviour assessment labs. The assessment protocols are described for four sexual behaviour laboratories: the Royal Ottawa Mental Health Centre's Sexual Behaviours Clinic in Canada; the Medical University of South Carolina's Sexual Behaviours Clinic and Laboratory in the US; the Laboratory of Evolutionary Sexology and Psychopathology in the Czech Republic; and the Laboratory of Forensic Sexology in Russia. An overview of examinee demographics and types of cases assessed is provided for each lab. Assessment protocols, including psychometric measures and objective measures of sexual interest and arousal, such as penile plethysmography or eye-tracking, are also reviewed. The differences across labs may lead to interesting and productive cross-cultural investigations and studies about the efficacy of specific assessment methods.

Clinicians and researchers alike have long stressed the need for a standardized approach to the assessment of people with problematic sexual interests, particularly regarding the use of penile plethysmography (PPG) (Fedoroff, Kuban, & Bradford, 2009; Fernandez, 2009; Marshall, 2014; Murphy et al., 2015a). Despite the continued call for standardization, few improvements have been made over the years. Significant challenges exist regarding implementation of standardization, both locally and internationally. The establishment of standardized assessment protocols and procedures across multiple labs enhances practical utility, decreases variability, inter-rater discrepancies, and provides the foundation for a more homogeneous comparison between competing sides in legal cases. Without a unified approach, each lab introduces significant variation between assessment protocols, including types of equipment, stimuli, data analysis, and interpretation (Murphy et al., 2015a). This makes comparison and generalizations of outcomes between labs and across countries difficult. In response to this problem, The Royal’s Sexual Behaviours Clinic in Ottawa, Canada, and the Medical University of South Carolina’s Sexual Behaviours Clinic and Lab in Charleston, South Carolina, United States (US), established a team to undertake joint clinical research projects including multi-site standardization. Members of both clinics have jointly presented extensively throughout North America and Europe. These international presentations reviewed each clinic’s innovative work in the areas of assessment and treatment of problematic sexual interests and behaviours, as well as the need for standardization between labs. Ongoing joint clinical research included improvement of the stimuli used in PPG (Burke & Murphy, 2017; Murphy & Fedoroff, 2017; Murphy, Ranger, Stewart, Dwyer, & Fedoroff, 2015b), sharing of specialized stimuli, alternative measures of sexual arousal, including simultaneous PPG and Functional MRI (fMRI) (Dwyer et al., 2016, 2017), and the assessment of forensic female populations with Vaginal Photoplethysmography (VPP) (Knack, Murphy, Ranger, Meston, & Fedoroff, 2015). In doing so, the team has taken steps to address concerns about the lack of standardization through activities such as education, clinical research, technical guidelines, and the linking up of clinical assessment labs. In the summer of 2015, a small group of sexual behaviour clinicians were gathered around the poster session at an international sex research conference. In the group were professionals from Canada, the US, and the Czech Republic (CR)—all of whom work in the areas of forensic psychiatry and sexology. There was discussion of our ongoing attempts to create a unified system of assessment and what steps we should be considering to internationalize the process. From this emerged the idea of hosting an international consensus meeting to bring together experts in the areas of both assessment and treatment of individuals with problematic sexual interests and behaviours. The idea was to not only provide a platform for information sharing, but also to develop a process of ongoing international collaboration that would facilitate multisite standardization. After 2 years of planning, the dream was realized. The first international consensus meeting took place in Prague, Czech Republic in May 2017. The host site was the Laboratory of Evolutionary Sexology at the National Institute for Mental Health. The countries that were represented included: Canada, CR, Russia, the UK, and the US. Delegates at the conference included at least two representatives from each of the participating countries; an expert on assessment and an expert on treatment. Each day of the 3-day meeting had a specific theme: assessment, treatment, and steps towards the future. Each day included an allotted time for general discussion of the theme of the day and a comparison of practices and practical applications between sites. The first day reviewed assessment protocols in which a representative from each country presented on the work being done in their clinics and labs. Clinical practices and research initiatives were addressed. Each speaker provided materials outlining the psychological and physiological measures used within the lab and (if applicable) how their findings were used for clinical and legal assessments. The assessment protocols, methods of analysis, and interpretation were discussed. The specific test stimuli used in PPG assessments were also reviewed. The second day focused on treatment options used within each location. Presenters reviewed the types of clientele seen and the types of treatment used, including psychological and pharmacological interventions. There was much discussion of barriers to treatment, including funding issues, access to medications, and the variability of treatment approaches between programmes. This led to dialogue about the varying perspectives around the treatability of paraphilias and Paraphilic Disorders.

Circles of Support and Accountability (CoSA) was initially developed in Canada as a community-based programme designed to assist in the community reintegration of individuals who are deemed at high or very high risk of sexual recidivism. This article outlines the historical foundations and frameworks of the CoSA model, and examines the recruitment and training of CoSA volunteers. It reviews the impact that CoSA has on recidivism, as well as the psycho-social implications of the model on the former offenders participating in CoSA (the 'Core Members'), volunteers, and the community at large. International implementation of CoSA is addressed by a review of project initiatives undertaken around the world. This article concludes by addressing the future directions of CoSA, both within Canada and internationally.

In the past three decades, there has been an exponential increase in the worldwide availability of Internet access and devices that are able to access online materials. This literature review investigated whether increased accessibility of Internet child pornography (CP) increases the risk of in-person child sexual exploitation. The current review found little to no evidence that availability of the Internet has increased the worldwide incidence or prevalence of in-person child sexual abuse. In fact, during the time period in which the Internet has flourished, international crime statistics have shown a steady decrease of in-person child sexual abuse. The only exception to this trend is an increase in Internet child pornography or luring offenses (e.g., Stats Can, 2014), which involves child abuse by definition. This article reviews the impact of the Internet on child sexual abuse. It also reviews the characteristics of online CP offenders. Treatment of these offenders and prevention of such offenses is also discussed.

Background The Positive Behaviour Support (PBS) is a multidimensional framework which aims to increase understanding of the function of a person’s behaviour. PBS consequently helps to develop effective support strategies (Allen et al., 2012; Carr et al., 1999). The PBS model was introduced in a low secure mental health hospital for females in order to maximise the support offered, increase feelings of safety, and reduce secondary gains from enhanced observations. Method Staff views on the implementation and effectiveness of the PBS model were evaluated using qualitative and quantitative analysis. The evaluation was based upon responses from 20 participants, who were regular Care Assistants and Nurses working on admission wards within the aforementioned clinical setting. Semi-structured interviews and short questionnaires were completed anonymously by participants. Results Overall, staff reported that the PBS model had a positive impact on the day-to-day running of the wards. The PBS model was identified as an effective tool to address challenging behaviour. Staff reported that PBS is a useful approach when working with patients with learning disabilities and personality disorders. Conclusion It has been suggested that further training and development of PBS strategies (e.g. functional analysis) would be beneficial.