Tratamiento hormonal de la pedofilia: ¿puede curar la pedofilia con la castración química? / Pedophilia hormonal therapy: can pedophilia be cured with chemical castration

Históricamente la sociedad ha rechazado el abuso sexual de menores de 13 años, dictándose leyes al respecto. La justicia luego de un debido proceso condenaba al victimario con reclusión incluso hasta la década del 70-80, con orquiectomía. Los adelantos en neurobiología, endocrinología, sicofarmacología y sicología se consideraron las bases para tratar al pedófilo y someterlo a libertad condicional, ahorrándose el costo financiero de la reclusión de por vida. Diversos países dictaron leyes contra la conducta pedófila. En dicha legislación ejerció gran influencia la promulgación en EE.UU. (estado de Washington "sobre el ofensor sexual" y el dictamen de la Corte Suprema en 1997 en el juicio de Kansas vs Hendricks). En Chile en los 90 el caso del pedófilo apodado "Zacarach" sacó a la luz pública el tema que no se quería ver. En esa fecha se presentó al parlamento un proyecto de Ley para "curar" la pedofilia con acetato de Medroxiprogesterona imitando legislación de EE.UU. Causó sorpresa en el medio endocrinológico que se usara terapia hormonal como "cura" de la pedofilia. Se ha utilizado en varios países la castración química producida por gestágenos o agonístas del GnRH más antiandrógenos (acetato de Ciproterona), para inhibir la secreción y acción de la testosterona disminuyendo líbido y erección. No se ha demostrado que exista curación de la orientación pedófila y existen dudas de la prevención primaria y secundaria de la pedofilia. Pese al adelanto tecnológico en neurociencias para estudio de las zonas vinculadas a la sexualidad, aún no existen marcadores que permitan diagnosticar o pronosticar futuros resultados de la terapia. El tratamiento médico de la pedofilia no garantiza curación ni prevención del delito pedofílico.

Historically, society has rejected sexual abuse of children under 13, with there having been laws enacted in this regard. The judicial system, after a due process, condemned the perpetrator with reclusion and even up until the decades of the 70s and 80s with orchiectomy. Advances in neurobiology, endocrinology, psychopharmacology and psychology were considered the basis for treating the pedophile and putting them on probation, saving the financial cost of imprisonment for life. Multiple countries have enacted laws against pedophilic behaviour. Such legislation was greatly influenced by the enactment in the USA (state of Washington "on the sex offender" and the ruling of the Supreme Court in 1997 in the trial of Kansas against Hendricks). In Chile in the 90s, the case of a pedophile nicknamed "Zacarach" brought to light an issue that nobody wanted to see. Around that time, a bill was presented to Parliament to try and "cure" pedophilia with Medroxyprogesterone acetate, imitating US legislation. It was a surprise in the endocrinological world that hormonal therapy would be used as a "cure" for pedophilia. Chemical castration produced by gestagens or GnRH agonists plus antiandrogens (Cyproterone acetate) has been used in several countries to inhibit the secretion and action of testosterone, reducing libido and erection. It has not been proven that there is a cure for pedophile orientation and there are doubts about the primary and secondary prevention of pedophilia. Despite technological advances in neurosciences for the study of the zones pertaining to sexuality, there are still no indicators that allow for diagnosis or prediction of future results of therapy. The medical treatment of pedophilia does not guarantee cure or prevention of pedophilic crime.

Efficacy of Azadirachta indica (Neem) leaf extract and hypertonic saline solution as intratesticular chemical sterilizing agents in dogs / Eficácia do extrato de folha de Azadirachta indica (Neem) e solução salina hipertônica como agente químico esterilizante intratesticular em cães

Castration refers to induced sterility via physical, chemical, or hormonal methods. Chemical castration is an efficient and reliable technique in contrast to other sterilization procedures as it is less painful to physical methods and cost­effective to hormonal methods. Azadirachta indica (neem), is a charismatic plant as its leaves possess anti­inflammatory, anti­microbial, and anti­androgenic chattels. To abate the escalating human population in South Asia, neem oil and neem leaf extract have been effectively used as a contraceptive agent. The key determinant of the current study was to evaluate Neem as a chemical sterilizing agent, (either necrotic or apoptotic), in dogs injected intratesticular in comparison to a hypertonic saline solution. Pre­ and post­injection testicular width size and blood samples for serum testosterone levels were collected on alternative days. Results disclosed substantial changes in testicular width size, histopathological profile, and serum testosterone level. A non­significant (P > 0.05) pre­injection testicular width readings in contrast to a significant increase (P < 0.05) three days post­injection was noted in all the competitive groups. The mean values recorded for testicular width size at the end of the trial study via neem leaf extract, 30% HSS and, control groups were 27.7362 ± 2.3315mm, 30.9594 ± 4.6861mm, and 24.5023 ± 2.5387mm, respectively. A declining trend, regarding serum testosterone level being statistically significant (P < 0.05) was recorded in treated groups (A, B) in contrast to the control group (C) as the values were 1.5357 ± 0.7819ng, 1.2669 ± 0.9095ng, and 2.4517 ± 0.1827ng in groups A, B, and C, respectively. Histopathological findings advocated the presence of apoptotic bodies in the neem treated group whereas the presence of degenerated interstitial cells, necrosed seminiferous tubules, damaged germinal epithelium, and ceased spermatogenesis was also studied in both competitive groups. Thus, the apoptotic effect and anti­inflammatory property of neem leaf extract resulted in less painful castration and verified Azadirachta indica as a better substitute for chemical castration in contrast to hypertonic saline solution.(AU)

A castração consiste na indução da esterilidade por meio físico, químico ou hormonal. A castração química é uma técnica eficiente e confiável, em contraste com outros procedimentos de esterilização, pois é menos dolorosa para os métodos físicos e econômicos para os métodos hormonais. Azadirachta indica (neem), é uma planta carismática, pois possui folhas anti­inflamatórias, antimicrobianas e antiandrogênicas. Para diminuir a crescente população humana no sul da Ásia, o óleo de nim e o extrato de folhas de nim têm sido efetivamente usados como agente contraceptivo. O principal determinante deste estudo atual foi avaliar o Neem como um agente esterilizante químico (necrótico ou apoptótico) em cães injetados intratesticularmente em comparação com uma solução salina hipertônica. O tamanho da largura testicular pré e pós­injeção e as amostras de sangue para os níveis séricos de testosterona foram colhidas em dias alternados. Os resultados obtidos revelaram alterações substanciais no tamanho da largura testicular, perfil histopatológico e nível sérico de testosterona. Observou­se uma leitura não significativa (P> 0,05) da largura testicular da pré­injeção, em contraste com um aumento significativo (P <0,05) três dias após a injeção em todos os grupos competitivos.Os valores médios registrados para o tamanho da largura testicular no final do estudo via extrato de folhas de nim,HSS a 30% e grupos controle foram 27,7362 ± 2,3315 mm, 30,9594 ± 4,6861 mm e 24,5023 ± 2,5387 mm, respectivamente.Uma tendência decrescente, com relação ao nível sérico de testosterona sendo estatisticamente significante (P <0,05), foi registrada nos grupos tratados (A, B), em contraste com o grupo controle (C), pois os valores eram 1,5357 ± 0,7819ng, 1,2669 ± 0,9095ng e 2,4517 ± 0,1827ng nos grupos A, B e C, respectivamente. Os achados histopatológicos advogaram a presença de corpos apoptóticos no grupo tratado com nim, enquanto a presença de células intersticiais degeneradas, túbulos seminíferos necrosados, epitélio germinativo danificado e espermatogênese interrompida também foi estudada nos dois grupos competitivos. Assim, o efeito apoptótico e a propriedade anti­inflamatória do extrato de folhas de nim resultaram em uma castração menos dolorosa e confirmaram que a Azadirachta indica foi um melhor substituto para a castração química do que a solução salina hipertônica.(AU)

Use of infrared thermography to evaluate the inflammatory reaction in cat testis after intratesticular injection of 0. 9% NaCl or 20% CaCl2 with 1% lidocaine / O uso da termografia infravermelha para avaliar a reação inflamatória após a injeção intratesticular de NaCL 0, 9 % e cloreto de cálcio 20% com lidocaína 1%

Due to the doubts and questions about the inflammatory reaction caused by chemical castration, this study aimed to use infrared thermography to detect, evaluate and monitor the inflammatory reaction caused by the intratesticular injection of calcium chloride (CaCl2) 20% with lidocaine 1%. For this, thermographic measurements were taken before (M0), 10 minutes (M1), 1 and 6 hours (M2 and M3), for 7 consecutive days (M4 to M10), at 15 (M11), 30 (M12) and 60 (M13) days after intratesticular injection. Additionally, changes to testicular tissue and effects over spermatogenesis were evaluated by andrological exam before (M0) and 60 days (M13) after intratesticular injection. All cats were orchiectomized at M13, and testicles were submitted to histological analysis. CaCl2 (20%) with lidocaine (1%) administration produced testicular tissue damage and interfered with the spermatogenesis in 70% of treated cats without exacerbating the inflammatory reaction or impairing the cat's welfare. It was concluded that thermographic evaluation is a useful, efficient, easy and quick method to diagnose and monitor cat testicular inflammatory reactions.(AU)

Devido a constantes dúvidas e questionamentos sobre a reação inflamatória ocasionada pela castração química, este estudo objetivou o uso da termografia infravermelha para detectar, avaliar e monitorar a reação inflamatória causada pela injeção intratesticular de cloreto de cálcio (CaCl 2 ) 20% associada à lidocaína 1%. Para isso, medidas termográficas foram aferidas antes (M0), 10 minutos (M1), uma e seis horas (M2 e M3), por sete dias consecutivos (M4 a M10), aos 15 (M11), 30 (M12), e 60 (M13) dias após injeção intratesticular, nos grupos tratado e controle. Todos os gatos foram orquiectomizados no M13, e os testículos submetidos à análise histológica. A injeção CaCl 2 a 20% associada com lidocaína a 1% produziu lesão testicular e interferiu na espermatogênese de 70% dos gatos tratados, sem exacerbar a reação inflamatória ou prejudicar o bem-estar do animal. Foi concluído que a avaliação termográfica é uma ferramenta útil, eficiente, rápida e fácil para o diagnóstico e o monitoramento da reação inflamatória em gatos.(AU)

Castración química, última opción en pacientes pedófilos y pederastas, considerando su autonomía y dignidad / Chemical castration, last option in pedophile and pedophile patients, considering their autonomy and dignity / Castração química, última opção em pacientes pedófilos e pedófilos, considerando sua autonomia e dignidade

La castración química surge como una posibilidad para el manejo de la pedofilia y la pederastia. Consiste en un tratamiento médico hormonal reversible aplicado ­en muchos casos­ para disminuir los niveles de testosterona, la libido y, por ende, la actividad sexual, y como resultado final, reducir las agresiones sexuales de alta incidencia en Colombia y en el mundo. Esta intervención médica ha sido utilizada en distintos países desde la década de los sesenta y, actualmente, el Congreso de la República de Colombia pretende promulgar una ley para contener la violencia sexual en niños y adolescentes. La aplicación de la castración química, siendo un procedimiento con efectividad cuestionable y con efectos secundarios importantes, genera dilemas éticos, clínicos y sociales, acerca de la autonomía y la dignidad del pedófilo y del pederasta. Por tal razón, en este estudio de caso se utiliza la metodología de Diego Gracia, pertinente para resolver este tipo de planteamientos complejos y hallar otras alternativas para el tratamiento de dichas enfermedades.

Chemical castration emerges as a possibility for the handling of pedophilia and pedophilia. It consists of a reversible hormonal medical treatment applied ­ in many cases ­ to decrease the levels of testosterone, libido and, therefore, sexual activity, and as a final result, to reduce the sexual aggressions of high incidence in Colombia and in the world. This medical intervention has been used in different countries since the 1960s and, currently, the Congress of the Republic of Colombia intends to enact a law to contain sexual violence in children and adolescents. The application of chemical castration being a procedure with questionable effectiveness and with important side effects, generates ethical, clinical and social dilemmas, about the autonomy and dignity of the pedophile and the pedophile. For this reason, in this case study the methodology of Diego Gracia is used, relevant to solve this type of complex approaches and find other alternatives for the management of such diseases.

A castração química surge como uma possibilidade para o manejo da pedofilia e da pedofilia. É constituída por um tratamento médico hormonal reversível aplicado em muitos casos, para diminuir os níveis de testosterona, da libido e da actividade sexual, portanto, e como resultado final, reduzir a incidência elevada de abuso sexual em Colômbia e o mundo. Esta intervenção médica tem sido usada em diferentes países desde a década de 1960 e, atualmente, o Congresso da República da Colômbia pretende promulgar uma lei para conter a violência sexual em crianças e adolescentes. A aplicação de castração química pode ser um processo com eficácia questionável e efeitos colaterais significativos, gera dilemas éticos, clínicos e sociais, sobre a autonomia e dignidade do pedfilo e pederast. Por esta razão, neste estudo de caso, a metodologia de Diego Gracia é utilizada, relevante para resolver este tipo de abordagens complexas e encontrar outras alternativas para o manejo dessas doenças.

Testicular histological evaluation and serum testosterone concentrations of bulls after chemical castration with calcium chloride / Avaliação histológica e das concentrações séricas de testosterona de touros após a castração química com cloreto de cálcio

Orchiectomized bulls have advantages in the meat quality and ease of handling. Chemical castration is an option for surgical castration and the sclerosing agents can be administered into the testicular or epididymis parenchyma. These agents have a lower incidence of complications than surgery, especially when associated with dimethylsulfoxide (DMSO), which has anti-inflammatory action and increases the absorption of other drugs. Thus, this study aimed to evaluate the effect of a single intratesticular injection of calcium chloride solution associated with DMSO for the chemical sterilization of bulls. Twenty-four young adult bulls were utilized, distributed into 3 groups (G20, G30 and G40, n = 8/group), according to the calcium chloride concentration (20, 30 and 40%), in 10mL volume. Serum concentrations of testosterone, body weight, testicular volume and ecotexture, clinical signs and behavior and were evaluated for 45 days. Thus, the animals were orchiectomized and testicles were assessed histologically. There were no changes in body weight, decreased serum testosterone concentrations (except G30), signs of scrotal sensitivity or changes in behavior over the period. However, there was significant increase in testicular volume, especially on the 2nd and 3rd day after treatment, with values returning to the value initials at 15 days. Testicular adherence and firm consistency were observed during orchiectomy. Ultrasound examination revealed a loss of integrity of the median raphe, with cavity formation and an alteration of the testicular echotexture. In the histological evaluation, coagulation necrosis of seminiferous tubules and interstitial cells was observed, mainly in the medial portion in all groups. Some animals presented total absence of tubular formations in all the studied groups, being the effects of greater intensity in the G40. Additionally, pronounced edema was noted in all groups, especially in G40. Inflammatory infiltrate, fibroplasia and neovascularization were found to be predominantly discrete. Based on the conditions used in this study, we conclude that calcium chloride associated with DMSO can be used as a method of chemical sterilization in bovines.(AU)

Bovinos orquiectomizados apresentam vantagens na qualidade da carne e facilidade no manejo. A quimioesterilização é uma opção à castração cirúrgica e os agentes esclerosantes podem ser administrados no parênquima testicular ou epidídimo. Estes produtos possuem menor incidência de complicações, comparados a cirurgia, especialmente quando associados ao dimetilsulfóxido (DMSO), que apresenta ação anti-inflamatória e aumenta a absorção de outros fármacos. Assim, este estudo teve como objetivo avaliar o efeito de uma única injeção intratesticular de solução de cloreto de cálcio associado com 0,5% de DMSO para a esterilização química de bovinos. Vinte e quatro touros adultos jovens foram utilizados, distribuídos em 3 grupos (G20, G30 e G40, n = 8/grupo) de acordo com a concentração de cloreto de cálcio (20, 30 e 40%), em um volume de 10mL. Foram avaliadas as concentrações séricas de testosterona, peso corporal, volume e ecotextura testicular, sinais clínicos e comportamento por 45 dias. A seguir, os animais foram submetidos à orquiectomia e os testículos avaliados histologicamente. Não foram observadas alterações do peso corporal, diminuição das concentrações de testosterona sérica (exceto no G30), sinais de sensibilidade escrotal ou alterações no comportamento no período avaliado. Porém, houve aumento significativo do volume testicular, especialmente nos 2º e 3º dia após o tratamento, com valores retornando aos iniciais aos 15 dias. Aderência e consistência firme dos testículos foram achados observados durante a orquiectomia. O exame ultrassonográfico revelou perda de integridade da rafe mediana, com formação de cavidades e alteração da ecotextura testicular. Na avaliação histológica, verificou-se necrose de coagulação de túbulos seminíferos e células intersticiais acentuada, principalmente, na porção medial em todos os grupos, sendo que em alguns animais havia ausência total das formações tubulares em todos os grupos estudados, sendo os efeitos de maior intensidade no G40. Além disso, edema foi acentuado em todos os grupos, principalmente em G40. Infiltrado inflamatório, fibroplasia e neovascularização foram achados predominantemente discretos. Com base nas condições utilizadas neste estudo, conclui-se que o cloreto de cálcio associado com o DMSO pode ser utilizado como um método de esterilização química em bovinos.(AU)

Mapping french people's views on chemical castration of child and adolescent sex offenders / Mapeando las opiniones de los franceses sobre la castración química de delincuentes sexuales que abusan de niños y adolescentes

Sex offenses to children or young adolescents have become a growing public concern. Chemical castration is currently considered as the best available societal response to child sex abuse. It abolishes testosterone secretion, its effects are reversible and side effects are minor. It has been argued that offering convicted sex offenders with the possibility to be treated may be in contradiction with the bioethics principle of autonomy because the person has really no other choice -- the alternative is usually a lengthy confinement sentence. In view of this controversy, we explored lay people's and physicians' views regarding the acceptability of chemical castration. Fifty participants (among them five physicians) judged the acceptability of castration in each of 36 scenarios consisting of all combinations of four factors: aggressor's age (21 vs. 41-year old); (b) victim(s)' age (5, 8, or 14-year old); (c) aggressor's psychiatric status (no psychiatric antecedents, suffers from sexual deviation, or recidivist); and (d) family's attitude (hostile to any kind of castration vs. approve castration). Participants' ratings of acceptability were, on the average, very high, and 68% of participants considered that chemical castration was fully justified in all the cases that were shown. A small minority (8%) considered that first time offenders of young adolescents, without psychiatric antecedents, should not be chemically castrated. Another minority position (24%) expressed doubts regarding chemical castration of first time offenders without antecedents but they never strongly opposed it. Implications for bioethics are discussed.

Los delitos sexuales contra los niños y los adolescentes se han convertido en una creciente preocupación pública. La castración química es considerada actualmente como la mejor respuesta de la sociedad frente al fenómeno del abuso sexual infantil. En este procedimiento se suprime la secreción de testosterona, sus efectos son reversibles y los efectos secundarios son menores. Se ha argumentado que la oferta de los delincuentes sexuales condenados con la posibilidad de ser tratados puede estar en contradicción con el principio bioético de autonomía porque la persona no tiene realmente ninguna otra opción. La alternativa es por lo general una larga pena de reclusión. En vista de esta controversia, hemos explorado los puntos de vista de las personas corrientes y de los médicos en cuanto a la aceptabilidad de la castración química. Cincuenta participantes (entre ellos cinco médicos) juzgaron la aceptabilidad de la castración en cada uno de los 36 escenarios que constituían toda las posibles combinaciones de cuatro factores: edad del agresor (21 y 41 años de edad), (b) edad de la víctima (5, 8 o 14 años de edad), (c) estado psiquiátrico del agresor (sin antecedentes psiquiátricos, sufre de desviación sexual o es reincidente), y (d) actitud de la familia (hostil a cualquier tipo de castración y aprueban la castración). Las calificaciones de aceptabilidad de los participantes eran, en promedio, muy alto, y el 68% de los participantes consideraron que la castración química estaba plenamente justificada en todos los casos que fueron mostrados. Una pequeña minoría (8%) consideró que, los por primera vez infractores de jóvenes adolescentes, sin antecedentes psiquiátricos no deben ser castrados químicamente. Otra posición minoritaria (24%) manifestó sus dudas sobre la castración química de los por primera vez infractores sin antecedentes, pero nunca se opusieron firmemente a ésta. La discusión muestra las implicaciones bioéticas de este tema.

Granuloma Developed Following Injection for Chemical Castration Treatment in Paedophilia / 대한피부과학회지

No abstract available.

Preliminary Study of Effect of Leuprolide Acetate Treatment on Sexual Fantasy of Sex Offenders / 대한법의학회지

This study investigated the effect of leuprolide acetate treatment on sex offenders' sexual fantasies and behaviors, as well as on their criminogenic psychological character and the risk of second conviction. The study participants consisted of 22 sex offenders who were confined to the National Institute of Forensic Psychiatry. Among them, 9 patients were given off-label leuprolide acetate for three months to inhibit sexual impulses, whereas the others were not given any medication. All sex offenders underwent two psychological evaluations; the first evaluation was conducted before starting medication, and the second was conducted after medication. Wilson's Sex Fantasy Questionnaire (WSFQ), the Rape Myth Acceptance Scale (RMAS), and the Endorsement of Violence Scale (EVS) were used for evaluation. Leuprolide acetate-treated sex offenders showed a statistically significant decline in the total WSFQ score (p < 0.05). However, the RMAS and EVS scores did not differ after leuprolide acetate treatment, indicating that cognitive distortions like rape myth acceptance and endorsement of violence were unchanged after leuprolide medication. Leuprolide acetate may reduce deviant sexual impulses and fantasies, as suggested by previous research form Korea and other countries. However, it probably cannot alter cognitive distortion. On the basis of these findings, we recommend a combination of leuprolide medication and other therapies, like cognitive behavioral therapy, for the treatment of paraphilic sex offenders.

A Clinical Review of Chemical Castration Against Sex Offenders for Children / 대한정신약물학회지

In the past, physical castration was adopted to punish sex offenders and prevent the recurrence of sexual crimes. However, it was abrogated because of human right issues and the irreversibility of fertility. Chemical castration of depot injection with hormones was introduced as an alternative method of physical castration. Antiandrogen is the most frequently used hormonal agents. Although there are several positive results such as changes of sexual behaviors and decrease of the recurrence rate of sexual crime after hormonal treatment, it also has serious limitations; difficulties in academic evaluation for control group and placebo effect; difficulties in the assessment of the therapeutic effect; and difficulties to decide the proper duration of treatment. Although the law for chemical castration to control sexual impulses in sex offenders was enforced since July, 2011 in Korea, there are not enough resources for treatment. We reviewed the appropriate references and suggested continuous long-term follow-up studies.