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Aggressive sexual behaviour: management is difficult and has not been thoroughly evaluated

Managing aggressive sexual behaviour is difficult. While psychotherapy has not been thoroughly evaluated, it seems to be the best option to try first, with patients prepared to cooperate.

A new indication has been authorised for cyproterone in the treatment of some sexual behaviour disorders.

Human sexual behaviour includes countless variants, some of which constitute crimes: exhibitionism, harassment or rape. The perpetrators are usually men. These disorders generally seem to be linked to a fundamental emotional deprivation in early childhood. The aim of treating such people, when they request it, links in with the legal requirement to prevent them from harming others. Treatment of such patients is difficult, due to the lack of evaluation of the various options.

Psychotherapy is likely to improve behavioural disorders in the long term, but its effectiveness has not been proven.

At the very most, the various drug treatments available, including cyproterone, reduce the degree of sexual arousal, but not enough is known about what happens when treatment stops.

Evaluation must continue in order to fulfil the need for improved treatment of aggressive sexual behaviour.

©Prescrire March 2007

Source: "Auteurs d’agressions sexuelles : une évaluation indigente des prises en charges" Rev Prescrire 2007 ; 27 (281) : 207-209.

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