Pharmacological management of inappropriate sexual behaviours: a review of its evidence, rationale and scope in relation to men with intellectual disabilities.
Pills can dampen sexual acting-out in men with ID, but proof is thin—let behaviour analysis lead and treat drugs as a short, monitored test.
01Research in Context
What this study did
Sajith et al. (2008) hunted every trial they could find on drugs for sexual acting-out in men with intellectual disability.
They only kept studies that measured change in the behaviour itself. The final pile was small and most lacked control groups.
What they found
Medicines such as anti-androgens and SSRIs sometimes lowered deviant sexual behaviour.
The evidence was too thin to tell which drug works best or how long benefits last.
How this fits with other research
Matson et al. (2011) saw clearer wins for risperidone in children with ID, but those trials were short and side-effects were common.
Agiovlasitis et al. (2025) show doctors still hand out antipsychotics off-label for “challenging behaviour,” so the weak 2008 warning has not slowed prescribing.
Khokhar et al. (2025) add that multi-part behaviour plans beat single tricks for adult problem behaviour—evidence that behaviour analysis should stay primary while pills stay backup.
Why it matters
You will still see prescribers reach for the pad when sexual behaviour flares. Show them this review and the newer data: drugs are an experiment, not a plan. Keep your functional assessment, replacement-skills teaching, and safety plan in the driver’s seat. Use medication talks to insist on baseline data and clear exit criteria so you can taper if behaviour improves.
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02At a glance
03Original abstract
BACKGROUND: The management of inappropriate sexual behaviours (ISB) including sexual offending is difficult, especially when the person treated has intellectual disabilities (ID). Psychological therapies are the accepted first line of treatment. Pharmacological treatments have also been advocated, particularly for people who have committed serious sexual offences. There is limited information on available drugs and evidence of their efficacy in the treatment of ISBs, in particular for people with ID. METHODS: A literature search of electronic databases was undertaken. Pharmaceutical companies were contacted for unpublished information. Trials that included people with ID were systematically reviewed for the benefits and outcome in that population. RESULTS: Androgen depleting drugs (cyproterone acetate, medroxyprogesterone acetate and luteinising hormone releasing hormone agonists) and psychotropic drugs (serotonin specific reuptake inhibitors and antipsychotics) are the two major categories of medications used in the treatment of ISBs. The majority of studies identified were open trials and most relied on self-report measures. Trials that included people with ID were few in number. Most trials indicated beneficial effects including reduction in sexually deviant fantasies and behaviours. CONCLUSION: The quality of evidence base for the use of pharmacological agents in the treatment of ISBs is inadequate to justify their use in routine clinical practice. If used, they should only be a part of a comprehensive treatment programme and closely monitored. In addition, there are several clinical, ethical and legal issues to be addressed before considering pharmacological treatment of ISBs in people with ID.
Journal of intellectual disability research : JIDR, 2008 · doi:10.1111/j.1365-2788.2008.01097.x