Therapeutic sex drive reduction.

Sex drive reducing therapies are employed in those cases of anomalous erotic preferences in which the patient's sexual behaviour is dangerous (certain forms of sadism, or a preference for forcing intercourse or similar interaction) or while not really dangerous, is utterly unacceptable to the community (pedophilia and pedohebephilia) or is an embarrassment to the patient himself (exhibitionism). Three sex drive reducing therapies are in use, all designed for male patients, (1) pharmacological reduction of circulating testosterone, (2) orchidectomy, (3) deletion of certain brain structures by stereotaxic surgery. The main indication for pharmacological sex drive reduction is exhibitionism but here it should be used only temporarily, as a first emergency measure, and after that only intermittently, during periods when the patient can not manage his urges by techniques he should be taught by a behaviour therapist. In cases of unmanageable and dangerous sadism, orchidectomy is the method of choice--and the same would appear to be true for particular cases of pedohebephilia. Brain surgery in this realm is not yet based on sufficient knowledge and should be thoroughly studied on infrahuman primates, before use with humans could be seriously considered.