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Phallometry is an objective method of assessing male sexual arousal. The main applications in forensic psychiatry concern the evaluation of men charged with or convicted of sexual offences, the evaluation of those with suspected paraphilias not subject to the criminal justice system, risk assessment and measurement of response to sex offender treatment. In some jurisdictions, phallometry is incorporated into legal decisions about release from custody or discharge from secure hospitals. This paper provides a brief overview of the international development of phallometry, considers challenges to its broader adoption and discusses future directions for research and clinical practice. [ABSTRACT FROM AUTHOR]

Penile plethysmography (PPG) is the primary physiologic assessment method used to gauge sexual responses in adult men. Depending on the country or jurisdiction of assessment, stimuli used to elicit arousal can include videos, still images, and audio materials. It can depict a variety consenting and non-consenting sexual scenarios as well as neutral, non-sexual scenarios. Models in visual stimuli can be clothed, semi-clothed, or nude. Variation in stimuli modality and the type of sexual interest being tested can have a large impact on PPG outcomes. This paper reviews research on types of PPG stimuli, the different sexual interests being assessed, reliability and validity, and the impact of anonymizing models depicted in assessment materials. Innovations in stimuli development in three labs located in Canada, the United States, and the Czech Republic are also discussed. The work done in these three labs and the broader range of research on assessment stimuli are presented to highlight the need for a unified, multi-site, standardized approach to assess problematic sexual interests and their change in response to treatment. [ABSTRACT FROM AUTHOR]

The current study examined the extent to which 1136 men were able to inhibit their sexual arousal on a phallometric assessment, when instructed to do so. Although the observed changes between the two conditions (i.e., Normal and Suppression) were small to moderate in magnitude, the change was not more than what would be expected by measurement error for most participants (e.g., 83% of pedophilic sex offenders against children did not successfully inhibit their sexual arousal in the Suppression condition). There were very few variables that were associated with the ability to suppress. Higher Pedophilia Index scores in the Suppression condition predicted a greater likelihood of sexual recidivism among sex offenders (hazard ratio = 1.17, 95% CI [1.04, 1.32]), but the ability to suppress sexual arousal was not found to predict sexual recidivism. The current study highlights the importance of accounting for measurement error and found that, when doing so, most sex offenders against children are unable to successfully inhibit their sexual arousal to children when instructed to do so, and that the ability to suppress sexual arousal is not associated with recidivism. [ABSTRACT FROM AUTHOR]

Introduction The phallometric test has been examined most widely in the literature with regard to its ability to detect pedophilia; however, it has become of increasing interest to clinicians and researchers to ascertain to what extent the test accurately detects hebephilia: Whereas pedophilia refers to an adult's sexual interest in prepubescent children (age 10 or younger, on average), hebephilia refers to an adult's sexual interest in pubescent children (ages 11-14, on average). Aim The aim of this study was to estimate the accuracy of volumetric phallometry in distinguishing pedophilic men and hebephilic men from men who are teleiophilic (primarily sexually interested in adults, age 17 or older). Methods A retrospective chart review was conducted on the cumulate database of a large phallometric laboratory and clinic to identify a group of 239 men who committed sexual offenses against extrafamilial adults age 17 or older and a group of 996 men who committed sexual offenses against extrafamilial children age 14 or younger, all of whom professed a greater sexual interest in adults over children. Main Outcome Measures The sensitivity and specificity of the phallometric test is calculated for its accuracy in distinguishing sexual preferences for children spanning various age ranges. Results Receiver operator characteristic curves were highly significant for each classification decision: Using its previously established cut-point of +0.25 standard deviation ( SD) units, the phallometric test detected hebephilia with a sensitivity and specificity of 70.0% and 90.7%, detected pedophilia with 46.9% and 100%, and detected pedohebephilia with 75.3% and 90.7%. At a new cut-point of +0.0 SD units, the sensitivity and specificity of the test for pedophilia was 71.9% and 95.3%. Conclusions Volumetric phallometry significantly distinguishes teleiophilic sex offenders from each of pedophilic, hebephilic, and pedohebephilic sex offenders and can serve as a reliable diagnostic test of sexual age preference among men who deny sexual interest in children. Cantor JM, and McPhail IV. Sensitivity and specificity of the phallometric test for hebephilia. J Sex Med 2015;12:1940-1950. [ABSTRACT FROM AUTHOR]

Phallometric assessments of single-victim sexual offenders against children have suggested that only about 50% of these men are more attracted to children than they are to adults. This has raised the question of what motivates the other 50% of men to approach young girls for sex. Freund et al. showed that gynephilic men (i.e., men preferentially attracted to adult women) evidenced greater arousal to images of prepubescent girls than to images of males of any age or to nonerotic images, arguing that gynephilic men may approach prepubescent girls as a "surrogate" for their preferred erotic targets (i.e., adult women). One might argue that these phallometric results are artifactual, given that they were obtained in a time period during which images of nudity were far less common than they are today (thus any female nudity might have elicited arousal). To address this issue, the authors examined the sexual arousal patterns of 214 contemporary men who, based on self-report, offense history, and phallometric responses, were purely gynephilic. Results showed the "classical control profile": the greatest arousal to adult women, systematically decreasing arousal as the female stimuli became younger, and essentially no arousal to any age categories of males or to neutral (nonerotic) stimuli. Arousal to both pubescent and prepubescent girls was significantly greater than to neutral stimuli (p < .001 for both). Thus, Freund et al.'s results still appear to be valid, and the explanation for child molesting that they suggest still seems to be feasible. [ABSTRACT FROM AUTHOR]

Phallometric testing is widely considered the best psychophysiological procedure for assessing erotic preferences in men. Researchers have differed, however, on the necessity of setting some minimum criterion of penile response for ascertaining the interpretability of a phallometric test result. Proponents of a minimum criterion have generally based their view on the intuitive notion that "more is better" rather than any formal demonstration of this. The present study was conducted to investigate whether there is any empirical evidence for this intuitive notion, by examining the relation between magnitude of penile response and the agreement in diagnoses obtained in two test sessions using different laboratory stimuli. The results showed that examinees with inconsistent diagnoses responded less on both tests and that examinees with inconsistent diagnoses responded less on the second test after controlling for their response on the first test. Results also indicated that at response levels less than 1 cm³, diagnostic consistency was no better than chance, supporting the establishment of a minimum response level criterion. [ABSTRACT FROM AUTHOR]

There are at least two different criteria for assessing pedophilia in men: absolute ascertainment (their sexual interest in children is intense) and relative ascertainment (their sexual interest in children is greater than their interest in adults). The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III) used relative ascertainment in its diagnostic criteria for pedophilia; this was abandoned and replaced by absolute ascertainment in the DSM-III-R and all subsequent editions. The present study was conducted to demonstrate the continuing need for relative ascertainment, particularly in the laboratory assessment of pedophilia. A total of 402 heterosexual men were selected from a database of patients referred to a specialty clinic. These had undergone phallometric testing, a psychophysiological procedure in which their penile blood volume was monitored while they were presented with a standardized set of laboratory stimuli depicting male and female children, pubescents, and adults. The 130 men selected for the Teleiophilic Profile group responded substantially to prepubescent girls but even more to adult women; the 272 men selected for the Pedophilic Profile group responded weakly to prepubescent girls but even less to adult women. In terms of absolute magnitude, every patient in the Pedophilic Profile group had a lesser penile response to prepubescent girls than every patient in the Teleiophilic Profile group. Nevertheless, the Pedophilic Profile group had a significantly greater number of known sexual offenses against prepubescent girls, indicating that they contained a higher proportion of true pedophiles. These results dramatically demonstrate the utility —or perhaps necessity —of relative ascertainment in the laboratory assessment of erotic age-preference. [ABSTRACT FROM AUTHOR]

The term pedophilia denotes the erotic preference for prepubescent children. The term hebephilia has been proposed to denote the erotic preference for pubescent children (roughly, ages 11 or 12–14), but it has not become widely used. The present study sought to validate the concept of hebephilia by examining the agreement between self-reported sexual interests and objectively recorded penile responses in the laboratory. The participants were 881 men who were referred for clinical assessment because of paraphilic, criminal, or otherwise problematic sexual behavior. Within-group comparisons showed that men who verbally reported maximum sexual attraction to pubescent children had greater penile responses to depictions of pubescent children than to depictions of younger or older persons. Between-groups comparisons showed that penile responding distinguished such men from those who reported maximum attraction to prepubescent children and from those who reported maximum attraction to fully grown persons. These results indicated that hebephilia exists as a discriminable erotic age-preference. The authors recommend various ways in which the DSM might be altered to accommodate the present findings. One possibility would be to replace the diagnosis of Pedophilia with Pedohebephilia and allow the clinician to specify one of three subtypes: Sexually Attracted to Children Younger than 11 (Pedophilic Type), Sexually Attracted to Children Age 11–14 (Hebephilic Type), or Sexually Attracted to Both (Pedohebephilic Type). We further recommend that the DSM-V encourage users to record the typical age of children who most attract the patient sexually as well as the gender of children who most attract the patient sexually. [ABSTRACT FROM AUTHOR]

We report the development of a technology for measuring sexual arousal in the natural environment. Experiment 1 demonstrated that levels of sexual arousal obtained in the laboratory when a participant was wearing underwear and trousers were similar to arousal levels obtained without underwear and trousers. In Experiment 2, four sexual offenders' arousal was measured in the natural environment using a portable penile plethysmograph. Measures were taken in three different settings: a setting in which only adults were present, a setting with children present, and a setting with no person other than the data collector present. In each setting, arousal was measured when the data collector was both near and away from the offender. For three of four offenders, patterns of arousal were consistent with previous laboratory assessments and/or previous offenses. Moreover, arousal was greatest when the data collector was away from the participant. [ABSTRACT FROM AUTHOR]

Research on phallometric assessment has accumulated in recent years. This research can inform and enhance the use of phallometric measures of sexual preferences among sexual offenders. In this short essay we suggest empirical answers to common clinical questions regarding the application of this technology. [ABSTRACT FROM AUTHOR]

Plethysmographic testing was completed on 100 research participants from the same medium-security prison population, 50 of whom were incarcerated for nonsexual offenses. In order to strengthen the validity of the research, only participants who achieved full arousal were included in the sample, and the percentage of full erection scores, as well as the Rape Index, were examined. The resulting sexual arousal profiles revealed striking similarities between rapists and control participants, indicating that deviant arousal alone did not distinguish these sexual offenders from nonsexual offenders. The only marked difference between the two groups was in the almost-perfect ability of control participants to inhibit deviant arousal and the weak ability of sexual offenders to accomplish this. The suggestion was advanced that a determination of an offender's ability to inhibit deviant arousal may be the only aspect of plethysmographic testing which has practical application in the assessment of rapists. [ABSTRACT FROM AUTHOR]