Nowadays, experts distinguish very clearly between pedophilic disorder as a psychiatric disorder (characterized by intense sexual interest in children accompanied by distress, interpersonal difficulty, and/or a risk of sexual offenses against children) on the one side and the criminal offense of child sexual abuse on the other. Most child sexual abuse offenses are not committed in relation to a pedophilic disorder. However, for people who have already committed a child abuse offense, pedophilic interest is a significant risk factor for reoffending.¹

In the past 15 years, in addition to therapeutic offers in the context of offender treatment, primary or secondary preventive treatment of patients with pedophilic disorders who have not offended or have not been criminally sanctioned yet has become a focus of efforts. Unfortunately, in both contexts, randomized clinical trials (RCTs) with the inclusion criterion pedophilic disorder and the primary outcome of a reduction of risk for child sexual abuse were missing, both in the field of psychotherapy and pharmacotherapy² research. Claims that therapy is effective have therefore repeatedly been called into question.² Furthermore, it has been stated that it might not be possible to carry out RCTs for ethical reasons because it might be unethical to withhold therapy from high-risk participants and thus risk sexual assaults on children in a control group. With the Landgren et al³ study, published in this issue of JAMA Psychiatry, the situation has changed, which marks a milestone in clinical sexual science and the field of forensic psychiatry. Landgren et al³ have solved the problem with an elegant design and at the same time introduced a new drug into the therapeutic field. The innovative potential of this study should therefore not be underestimated.