Assessment of Problematic Sexual Interests With the Penile Plethysmograph: an Overview of Assessment Laboratories

Abstract

Phallometric testing, or penile plethysmography (PPG), is an objective measure of sexual arousal for males. While extensive research on the reliability and validity of PPG has promoted its reputation as the "gold standard" of objective measurement of sexual arousal, there is a lack of standardization of stimulus sets and interpretation of results between sites. This article describes the laboratory protocol employed for PPG at the Royal Ottawa Mental Health Centre's Sexual Behaviours Clinic (SBC) in Ottawa, Ontario, as well as those used by the Sexual Behaviors Clinic and Lab (SBCL) in the Community and Public Safety Psychiatry Division (CPSPD) of the Department of Psychiatry and Behavioral Sciences at Medical University of South Carolina (MUSC) in Charleston, South Carolina. The need for standardization in both testing protocol and stimuli use across sites are highlighted.

Use of penile plethysmography in the court: A review of practices in Canada, the United Kingdom and the United States

“…Increase in circumference (as measured by change in mm) resulting from an increase in blood flow to the penis reflects the degree of sexual arousal that the stimuli elicit. Sexual response patterns can be compared to determine sexual interest in the consenting and non‐consenting materials presented (Fedoroff et al, ; Murphy, Ranger, Stewart, et al, ; Murphy, Ranger, Fedoroff, et al, ).…”

“…Penile plethysmography contributes to the clinical assessment of paraphilic interests, appraisal of risk of recidivism, and provides an objective measurement of changes in sexual arousal in response to treatment (Barker & Howell, ; Fedoroff et al, ; Fernandez, ; Johnson & Listiak, ; Marshall, ; Murphy, Ranger, Stewart, et al, , Murphy, Ranger, Fedoroff, et al, ). Prior to the development of PPG techniques, clinicians assessing individuals concerning their sexual interests and arousal patterns relied primarily on self‐report for evaluations of risk, treatment needs, and assessment of outcomes.…”

“…First, not all countries use PPG for clinical assessments. Even within countries, some assessment laboratories use PPG for both clinical and research purposes, while other laboratories do not (Demidova, Murphy, Dwyer, Klapilova, & Fedoroff, ; Murphy, Ranger, Stewart, et al, ; Murphy & Fedoroff, ). Compared with their European counterparts, PPG is used on a much wider and more frequent scale in North America (Demidova et al, ; Murphy, Ranger, Stewart, et al, ).…”

“…Of the laboratories that use PPG, there are variations in terms of modality, duration, quality, content, and theme of the stimuli presented (Demidova et al, ; Murphy et al, ). One difficulty is that different countries and jurisdictions are governed by different legal regulations concerning the types of stimuli that are permitted for forensic clinical assessments (Demidova et al, ; Murphy, Ranger, Stewart, et al, , Murphy, Ranger, Fedoroff, et al, ; Murphy et al, ; O'Shaughnessy, ; Rosetti, Curry, Murphy, Bradford, & Fedoroff, ). For example, within Canada, the Criminal Code permits the use of nude images of children in clinical assessments where it “has a legitimate purpose related to the administration of justice or to science, medicine […] and does not pose a risk of harm to persons under the age of eighteen years” (Criminal Code, R.S.C., , c. C‐46, 163.…”

“…Despite variation in international regulations and limitations, there is strong support for the utility of PPG within clinical and legal contexts within some countries (Fedoroff et al, ; Murphy, Ranger, Stewart, et al, ). PPG remains a significant contributor to clinical and forensic assessments in which each examinee who participates in PPG assessment acts as his own control subject.…”