Medical management of problematic sexual arousal for people with a sexual conviction in England and Wales: challenges, learning, and progress

Winder, B ORCID: https://orcid.org/0000-0002-9118-679X, Grubin, D, Underwood, M ORCID: https://orcid.org/0000-0001-8239-6616, Antoniadis, Z ORCID: https://orcid.org/0009-0005-3453-7118, Carvalheiro, M ORCID: https://orcid.org/0000-0003-2749-578X, Marshall, E, Norman, C ORCID: https://orcid.org/0000-0003-3317-8545, Bourne, R and Kaul, A, 2026. Medical management of problematic sexual arousal for people with a sexual conviction in England and Wales: challenges, learning, and progress. Criminal Behaviour and Mental Health. ISSN 0957-9664

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Abstract

Background: In England and Wales, the primary treatments for individuals convicted of sexual offences are psychological. However, Medication to Manage Problematic Sexual Arousal (MMPSA) is gaining importance as an alternative. This article reviews the current evidence surrounding the MMPSA approach.

Aim: This paper synthesises challenges encountered, advancements achieved, and learnings accumulated over 16 years of the MMPSA treatment pathway from 2009 to 2025 in England and Wales.

Methods: Drawing on a programme of mixed-methods research including cohort studies, case studies, qualitative interviews with patients and professionals, and implementation evaluations, this paper seeks to bring together key findings to present a consolidated picture of the research on the MMPSA pathway to date. The focus is on synthesising findings and identifying implications for service delivery.

Results: Evaluations of treatment outcomes showed promising results regarding the effectiveness of the MMPSA service. Qualitative analyses and case studies provided insightful details regarding patient and staff concerns that may hinder the efficiency and reach of the treatment pathway. Research with community clinicians highlighted issues regarding the ‘off-label’ use of medication for this purpose.

Conclusions: The MMPSA treatment service is available in a limited number of prisons in England and Wales. Supported by promising service evaluations and existing literature, a larger population could benefit from MMPSA treatment. Furthermore, the MMPSA service would benefit from improvements to create smoother transitions for individuals leaving prison and entering the community, and it should ideally be expanded to ensure that those in the community can also access the MMPSA service.

Item Type:	Journal article
Publication Title:	Criminal Behaviour and Mental Health
Creators:	Winder, B., Grubin, D., Underwood, M., Antoniadis, Z., Carvalheiro, M., Marshall, E., Norman, C., Bourne, R. and Kaul, A.
Publisher:	Wiley
Date:	21 March 2026
ISSN:	0957-9664
Identifiers:	Number Type 10.1002/cbm.70030 DOI 2589274 Other
Rights:	This is the peer reviewed version of the following article: Winder, B., Grubin, D., Underwood, M., Antoniadis, Z., Carvalheiro, M., Marshall, E., Norman, C., Bourne, R., & Kaul, A. (2026). Medical management of problematic sexual arousal for people with a sexual conviction in England and Wales: challenges, learning, and progress. Criminal Behaviour and Mental Health which has been published in final form at https://doi.org/10.1002/cbm.70030 This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.
Divisions:	Schools > School of Social Sciences
Record created by:	Laura Borcherds
Date Added:	13 Mar 2026 16:06
Last Modified:	08 Apr 2026 11:20
URI:	https://irep.ntu.ac.uk/id/eprint/55415

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