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Abstract:
To date there are few treatment options to reduce high sexual drive or
sexual urges in paraphilic patients with a risk for sexual offending.
Pharmacological therapy aims to reduce sexual drive by lowering
testosterone at the cost of severe side effects. We hypothesize that
high sexual drive could also be reduced with deep brain stimulation
(DBS) of circuits that generate sexual drive. This approach would help
to avoid systemic side effects of antiandrogenic drug therapies. So far
the best investigated target to reduce sexual drive is the ventromedial
hypothalamus, which was lesioned unilaterally and bilaterally by
stereotaxic interventions in paraphilic patients in the 1970s. Here, we
discuss DBS as a treatment strategy in patients with severe paraphilic
disorders with a serious risk of sexual offending. There are profound
ethical and practical issues associated with DBS treatment of paraphilic
patients that must be solved before considering such a treatment
approach.
