Voyeurism is achievement of sexual arousal by observing people who are naked, disrobing, or engaging in sexual activity. When observation is of unsuspecting people, this sexual behavior often leads to problems with the law and relationships. Voyeuristic disorder involves acting on voyeuristic urges or fantasies with a nonconsenting person or experiencing significant distress or functional impairment because of such urges and impulses.
Voyeurism is form of paraphilia, but most people who have voyeuristic interests do not meet the clinical criteria for a paraphilic disorder, which require that the person's behavior, fantasies, or intense urges result in clinically significant distress or impaired functioning or cause harm to others (which in voyeurism includes acting on the urges with a nonconsenting person). The condition must also have been present for ≥ 6 mo.
Desire to watch others in sexual situations is common and not in itself abnormal. Voyeurism usually begins during adolescence or early adulthood. Adolescent voyeurism is generally viewed more leniently; few teenagers are arrested. When voyeurism is pathologic, voyeurs spend considerable time seeking out viewing opportunities, often to the exclusion of fulfilling important responsibilities in their life. Orgasm is usually achieved by masturbating during or after the voyeuristic activity. Voyeurs do not seek sexual contact with the people being observed.
In many cultures, voyeurs have ample legal opportunities to watch sexual activity. However, voyeuristic behaviors are the most common of sexual behaviors that may result in a brush with the law.
Up to 12% of males and 4% of females may meet clinical criteria for voyeuristic disorder; most do not seek medical evaluation and treatment .
When laws are broken and sex offender status is conferred, treatment usually begins with therapy, support groups, and SSRIs.
If these drugs are ineffective and if the disorder is severe, drugs that reduce testosterone levels and thus reduce libido should be considered. These drugs are referred to as antiandrogens, although the most commonly used drugs do not actually block the effects of testosterone. Drugs include gonadotropin-releasing hormone (GnRH) agonists (eg, leuprolide) and depot medroxyprogesterone acetate; both decrease pituitary production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) and thus reduce testosterone production. Full informed consent and appropriate monitoring of liver function and serum testosterone levels are required.
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