Treat sex offenders for impotence to keep them out of trouble: doctor
A Canadian forensic psychiatrist says he regularly treats sex offenders for impotence, and advocates the practice as a way to keep them out of trouble.
Dr. Paul Fedoroff’s comments come as a new American study raises legal and ethical questions about helping convicted sex criminals overcome erectile dysfunction (ED).
The paper’s authors worry that doing so might help some perpetrators re-offend, while U.S. law bars government health-insurance from covering the treatment.
Dr. Ricardo Munarriz, one of the Boston University urologists, says he inadvertently placed a penile implant in a serious offender and now “it’s like he’s carrying a weapon.”
But in a response to their article, Fedoroff says Viagra-type drugs or other ED treatment can be part of a strategy to shift offenders from criminal behaviour — such as assaulting children — toward more normal sex.
Some pedophiles actually target children because they are afraid they will not be able to perform if they try to have sex with an adult, he argues.
“Which sounds like the more dangerous person?” asks the Royal Ottawa Mental Health Centre psychiatrist. “A person who is engaged in fulfilling, healthy sexual relations with a consenting partner, or someone who has no legal sexual outlets?”
Despite popular belief, sex crimes have little to do with the ability to become physically aroused, Fedoroff and other experts say. Exhibitionists and even many rapists do not have erections when they commit their crimes, he says.
The issue was raised recently, though, in a study by the three Boston-based urologists, who noted in the Journal of Sexual Medicine the U.S. Medicaid program banned coverage for anti-impotence drugs in 2005 after public “outrage” tax dollars were being spent on them.
To determine what has happened since, the doctors crossreferenced sex-offender registries with lists of patients treated for ED in their clinic over two years. They identified 18 offenders, some of whom had spent years in jail for their crimes. And some still had their drug costs reimbursed.
The doctors say they’re not in favour of denying care to all sex offenders, but complain they lack the expertise to make that decision, and say the science around the effects of impotence treatment on recidivism is unclear.
Some of the offenders the urologists unknowingly treated had multiple convictions for raping children; the penile implants and drug injections they received actually left them more able to get an erection than healthy men, said Munarriz.
“I feel horrible now that I have a patient out there who is a level-3 sex offender and has an implant,” he said. “I would feel horrible personally if something happens to a child or a woman.”
In fact, there is no evidence that the ability to get an erection influences whether someone commits a sex crime; offenders do what they do because of abnormal sexual interests, called paraphilia, says Fedoroff.
His treatment approach tries to direct them into consensual, adult relationships. If erectile dysfunction is a barrier — and he has seen “hundreds” with such problems — he will sometimes prescribe drugs or provide other treatment.
“Virtually everyone has some improvement,” the psychiatrist says. “Most find a girlfriend, boyfriend or appropriate partner.”
James Cantor, a scientist at Toronto’s Centre for Addiction & Mental Health who studies sexual abuse, said whether to treat impotence in sex offenders is a nonissue. Most pedophiles engage in inappropriate touching, kissing or genital contact, and an erection is irrelevant.
Sexual predators and offenders who rape child victims — though often making the news headlines — are extremely rare, Cantor says.
At the same time, Cantor says there is no empirical evidence supporting Fedoroff’s contention that providing drugs like Viagra or other impotence treatment can help direct sex offenders into healthier behaviour, although he calls it plausible.
Even a spokesman for Beyond Borders, a Canadian group dedicated to combating child sexual exploitation, says it would be inappropriate for doctors to refuse impotence treatment because of sex crimes.
Trying to prevent offenders from committing more assaults is the job of law enforcement and the courts, not physicians, says David Matas, the organization’s lawyer.
“I don’t think you can say to any doctor that you can deny a medically indicated treatment for criminal-justice reasons. It’s two separate worlds.”