Health: Can castration cure paedophiles?

Roger Dobson on why there are no guarantees that such extreme treatment can provide a solution

CONVICTED paedophile Keith Robinson believes he is safe to go back on the streets. Sent to jail for 20 years in Oklahoma for abusing his five-year-old niece, Robinson has been physically castrated, an extreme treatment which is now expected to become more widely available in the US, and which a growing number of campaigners want made available here.

The call for castration has increased with the imminent release of Sidney Cooke, jailed in 1989 after running the gang which raped and strangled Jason Swift, a 14-year-old runaway. But many doctors are opposed to the idea, believing that mutilation on whatever grounds is not acceptable.

Evidence is also emerging that castration is not guaranteed to cure deviant sexual behaviour. Researchers found that one in three sex offenders who had been castrated were still able to have intercourse, partly because glands other than the testes, particularly the adrenals, provide the necessary male hormones.

The alternative is chemical castration, a reversible treatment where the male sex drive is diminished by injections of female hormones. In the US, some states are drawing up laws which could be used to require convicted paedophiles to be treated as a condition of getting parole. In Britain, more doctors are said to be in favour and last year the Prison Service said it was "exploring" how to treat sex offenders with anti- libidinal drugs. So-called "chemical castration" would be part of the already established Sex Offenders Treatment Programme for rapists and paedophiles, and would run alongside psychological programmes.

No offender has been physically castrated in Britain and permission for such an operation is thought unlikely. Chemical castration, however, can be based on an arrangement between patient and doctor, and just how many men have been treated is not known.

Treatment for sexual offending and deviant behaviour usually starts with counselling and psychotherapy, where the offender tries to recognise the problem and change, but that is unlikely to work with repeat offenders and those exhibiting obsessive abusive behaviour.

"Chemical treatment with a fairly massive dose of female sex hormones is not as grim as castration, which I and many others are opposed to. Just how many people are treated with hormones in this way, we don't know, but my guess is that it is used more widely than we realise," says Dr Sidney Crown, a leading psychiatrist who specialises in treating sexual behavioural problems.

With chemical castration, there are three commonly used mediums for blocking production of the male hormone testosterone: cyproterone acetate, which is an antiandrogen taken orally; goserclin, a synthetic hormone injected under the skin; and medroxyprgester acetate, a progesterone given intramuscularly.

"These can be highly effective in suppressing libido, though none are without side effects. The use of chemical agents to suppress libido in sexual offenders who are judged to be at risk of committing serious crimes is an established practice, provided the offender gives his consent," says psychiatrist Dr David Cook, who took part in a debate in the British Medical Journal about whether a sex offender should be able to seek castration.

But in several US states there are campaigns to oppose plans for legislation that would require convicted sex offenders to undergo treatment before getting parole when they have committed two or more offences against children.

Dr John East of the University of California says there is no evidence that it will work in offenders forced to have the treatment: "People who volunteer for the treatment are driven and want it, but if the person does not want it who says it will work?"

The American Civil Liberties Union of Florida is also opposed to the idea of chemical castration. "Society has an overwhelmingly important interest in keeping our citizens safe from sexual battery, but mandatory chemical castration is a simplistic and ultimately ineffective response to the problems. The complex reasons that impel people to commit sexual battery cannot be eliminated by giving them a shot," says ACLU's Larry Spalding.

Some anti-paedophile campaigners favour non reversible physical castration, but doctors opposed to it point out that if chemical castration does not work, neither will surgery, because they are both designed to have the same effect.

"If the [hormonal] treatment produces sufficient behaviour change then surgery is clearly unnecessary. If it does not, then castration will not either," writes Professor John Gunn of the Institute of Psychiatry in the British Medical Journal.

Research in Germany found that among 33 castrated men, 11 were still able to have intercourse, while a study in Denmark, where surgical castration was common until 1972, found that re-offending was dramatically reduced.

Robinson chose to be castrated because he believes paedophiles are likely to re-offend: "Things I found stimulating don't cross my mind any more. I am not the same man."