title: Sex Offenders Seeking Treatment for Sexual Dysfunction--Ethics, Medicine, and the Law.
abstract: BACKGROUND
  The treatment of sexual dysfunction in patients with prior sexual offenses poses ethical and legal dilemmas. Sex offenders are not obligated by law to disclose this history to medical professionals. Over 20% of sex offenders experience sexual dysfunction; however, the number of sex offenders seeking evaluation for sexual dysfunction is unknown.
  
  
  OBJECTIVE
  The aims of this study were to determine the incidence and characteristics of sex offenders seeking treatment in our clinic; and to review data regarding sex offender recidivism and ethics pertaining to the issue as it relates to treating physicians.
  
  
  METHODS
  Sex offenders were identified via three methods: new patient screening in a dedicated sexual medicine clinic, chart review of those on intracavernosal injection (ICI) therapy for erectile dysfunction (ED), and review of patient's status-post placement of penile prosthesis. Charts were cross-referenced with the U.S. Department of Justice National Sex Offender Public Website. Patient characteristics and details of offenses were collected.
  
  
  METHODS
  The main outcome measures used were a self-reported sexual offense and national registry data.
  
  
  RESULTS
  Eighteen male sex offenders were identified: 13 via new patient screening; 3 by review of ICI patients; 1 by review of penile prosthesis data; and 1 prior to penile prosthesis placement. All were primarily referred for ED. Of those with known offenses, 64% were level 3 offenders (most likely to re-offend). The same number had committed crimes against children. All those with complete data had multiple counts of misconduct (average 3.6). Ninety-four percent (17/18) had publicly funded health care. Twelve (67%) were previously treated for sexual dysfunction.
  
  
  CONCLUSIONS
  Registered sex offenders are seeking and receiving treatment for sexual dysfunction. It is unknown whether treatment of sexual dysfunction increases the risk of recidivism of sexual offenses. Physicians currently face a difficult choice in deciding whether to treat sexual dysfunction in sex offenders.
authors.affiliation: Department of Urology, Boston Medical Center, Boston, MA, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Phillips
authors.affiliation: Department of Urology, Boston Medical Center, Boston, MA, USA.
authors.forename: Archana
authors.initials: A
authors.lastname: Rajender
authors.affiliation: Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Douglas
authors.affiliation: Urology of Virginia, Virginia Beach, VA, USA.
authors.forename: Ashley F
authors.initials: AF
authors.lastname: Brandon
authors.affiliation: Department of Urology, Boston Medical Center, Boston, MA, USA.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Munarriz
mesh_terms: D000293:Adolescent; D002648:Child; D057237:Criminals / Q000523:psychology*; D007172:Erectile Dysfunction / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D015917:Penile Prosthesis; D011613:Psychotherapy / Q000941:ethics; D012042:Registries; D012307:Risk Factors; D057566:Self Report; D012742:Sex Offenses / Q000941:ethics* / Q000331:legislation & jurisprudence / Q000523:psychology / Q000706:statistics & numerical data; D012725:Sexual Behavior; D014481:United States
keywords: Ejaculatory Dysfunction; Erectile Dysfunction; Rape; Registry; Sex Offender; Sex Offense; Sexual Dysfunction