The neurobiology, neuropharmacology, and pharmacological treatment of the paraphilias and compulsive sexual behaviour

There has been increasing interest in the treatment of sexual disorders in recent years. Sexual disorders are classifies in DSM-IV as sexual dysfunctions, paraphilias, and gender identity disorders. The sexual dsyfunctions are nondeviant or nonparaphillic. The sexual dysfunction disorders should include "hyperactive sexual desire disorder" under sexual desire disorders. Further there should be a specifier for paraphilias of "with hypersexuality" or "without hypersexuality". There is still incomplete understanding of the neurobiology of sexual disorders although functional neuranatomy and neoropharmacological research has exposed the neurotransmitters, receptors, and hormones that are involved in sexual desire. Various pharmacological agents including serotonin reuptake inhibitors, antiandrogens, LHRH agonists, and others have been documented as reducing sexual desire. An algorithm for the use of these drugs in the treatment of the paraphilias as well nonparaphilic hypersexuality is outlined. The modes of action, dosages, aims of treatment, and usual methods of prescribing these agents is reviewed in this article. Some future directions of research in pharmacological treatment is also discussed.