Pedophilia is the term used to describe the sexual preference for prepubescent children, who, in terms of bodily development, have not yet entered puberty. That means that they have no pubic and/or armpit hair, a small vulva, a small penis or no or minimal breast development, and are in general not older than 11 years old. People with pedophilia can be sexually attracted to girls` and/ or boys` bodies.

People with hebephilia feel sexually attracted to children whose bodily development shows first signs of puberty (e.g. beginning growth of pubic and/or armpit hair, vulva in early stage of development, penis in early stage of development, or an onset of breast development). The following self-observations can be indicators for pedophilia/hebephilia:

• sexual arousal while observing prepubescent and/or early-pubescent children, or during contact with them
• Sexually arousing fantasies involving children with a prepubescent and/or early-pubescent body scheme
• usage of child sexual abuse images online (commonly referred to as "child pornography").
• Sexual acts in front of or with children.

There are individuals, who suffer greatly as a result of their disposition, which causes clinically significant distress.

Having a sexual interest in children with prepubertal or early pubertal body schemes does not necessarily mean that these people commit sexual assaults or automatically consume child sexual abuse images (so-called child pornography) on the internet. That is why the expressions pedophilia and hebephilia need to be notably distinguished from child sexual abuse. Under criminal law, the designation “child sexual abuse” exclusively refers to sexual acts with/involving children, whereas pedophilia and hebephilia describe sexual arousal or excitation in relation to prepubertal or early pubertal minors.

A diagnosis of pedophilia or hebephilia can be made following an extensive clinical interview in which a multitude of information on sexual experience and behaviour is collected. The information gathered in this process can be supplemented with, for example, additional questionnaires and testing procedures.

However, questionnaires and tests as done on troubled desire only represent supplementary diagnostic processes and cannot reliably replace a diagnostic clinical interview.

To diagnose “pedophilia” certain criteria, established by internationally recognized diagnostic guidelines, must be fulfilled. Here, the most important criterion is the sexual arousability by a child/children with a prepubescent and/or early-pubescent body scheme.

The diagnostic investigation falls to specialists with qualifications established by a successfully completed course of study in medicine or psychology. From the point of view of various professional associations of sexology, however, further competencies in sexual medicine/sexual therapy are necessary, as neither the assessment nor the treatment of sexual disorders are yet a part of standard university education and medical or psychological training.

Sexologists are discussing a multitude of factors (e.g. development of the brain; hormonal and neurotransmitter related development; early childhood attachment and relationship experiences; personal histories of child sexual abuse) to explain the phenomenon of sexual arousal in adults towards children and early adolescents. Overall, there is as yet no clear picture of the development and progression of a pedophilic or hebephilic sexual preference; more research is therefore necessary and ongoing.

In surveys, between 3 and 6 percent of male participants in Germany, and between 3 and 9 percent of male participants internationally, indicated having had sexual fantasies about prepubertal children or contact with them. However, there no reliable data on how large a share of the population is made up of people with pedophilic or hebephilic sexual preferences, as no large epidemiological studies have been carried out on this topic. Further scientific investigations are ongoing.

The prevalence – according to empirical data – is estimated at 1 % of the male population.

According to the current state of knowledge, the great majority of all individuals with pedophilic or hebephilic sexual preferences are men.

The criteria that must be met in order to diagnose paedophilia are based on internationally recognised diagnostic guidelines. In this case, the most important diagnostic criterion is the sexual arousal of an adult for the pre- and/or early pubertal body pattern of minors.

No. A distinction can be made between persons who are aroused by pre- and/or early pubertal children and commit child sexual abuse and persons who are aroused by adults and commit child sexual abuse. The latter are not motivated by their sexual excitability by children and often commit acts of abuse in context.

No, definitely not.

The current state of research makes it impossible to conclusively assess to what extent the consumption of child sexual abuse material might strengthen the desire to experience hands-on sexual contact with a child and/or an early adolescent. However, given that consumption alone is a criminal offense and represents a serious form of child sexual abuse, refraining from the consumption of child sexual abuse images is a further goal of the therapeutic efforts.

Offences that are known to the judiciary in some form or other are referred to as offences in the light field through reporting, preliminary proceedings, conviction and so on (German: Hellfeld). However, a large part of the sexual assaults on children that are actually committed are not reported, are not recorded by the judiciary and law enforcement and are consequently not listed in any crime statistics. In criminology, this area is referred to as the dark field (German: Dunkelfeld).

The therapy being offered to individuals with a pedophilic or hebephilic sexual preference, who are aware of their problem and seeking help, is aimed at preventing sexual offenses against children and/or early adolescents and at avoiding the consumption of child sexual abuse images. In this way therapy programs as the Prevention Network “Kein Täter Werden” (Meaning: Don’t Offend)” actively contribute to the protection of children and early adolescents by addressing the problem before children become victims, thus preventing repeated abuse and counteracting their ongoing traumatization. TROUBLED DESIRE is an online tool that can not replace therapy but offers an accessible self treatment approach for people who are sexually attracted to children.

The therapy usually integrates psychological and sexological, as well as pharmaceutical approaches.

The therapeutic points of entry are oriented towards spheres of life that research has identified as decisive for the prevention of (further) sexual offenses:

• Strengthening of the motivation to be able to permanently control one’s own behavior
• Strengthening of resources
• Lowering risk factors associated with child sexual abuse (hands on) and the consumption of child sexual abuse images (internet). For instance: managing general and sexual self-regulation, acknowledging and disowning attitudes facilitating child sexual abuse.
• Taking responsibility for one’s own actions
• Working on problems of self-worth
• Obtaining the ability to control sexual impulses by successfully coping with emotions and problems
• Considering medication as an option to reduce sexual urges and enhance capability of emotional impulse control and problem coping mechanisms.
• Recognition and management of risky situations
• Development of social and cognitive capacities needed in a life without sexual offenses
• Improvement of relationship skills (e.g. building up or stabilizing social networks; strengthening of the capacity for intimacy)
• Development of visions and prospects for the future
• etc.

The online treatment approach of TROUBLED DESIRE is based on more than 10 years of treatment experience in the Prevention Project Dunkelfeld in Berlin and provides the basis for self management of sexual attraction to minors.

Successful therapy is primarily achieved when therapists and participants both carry out their designated tasks over the course of the therapy.

On the part of the participants, openness, regular participation, and the taking on of responsibility for making decisions significantly influence the goal of the therapy. Decisive is the motivation to not commit any sexual offenses towards children and to refrain from consuming child sexual abuse images.

On the part of the therapist, reaching the therapeutic goal is supported by the therapist’s own qualifications concerning the assessment and treatment of sexual disorders as well as regular supervision.

The use of child sexual abuse images (so-called child pornography) provides an opportunity to satisfy sexual needs without having direct physical contact with children. However, there is often no awareness of the inherent problem that the production and distribution of child sexual abuse images relies on the sexual abuse of the depicted individuals. Being aware of this, some consumers of child sexual abuse images feel bad about their behavior.