Tous les auteurs s’accordent pour dire que l’incarcération seule ne règle pas le problème de la violence sexuelle. La loi du 17 juin 1998, prévoit la possibilité d’un suivi médical et psychologique des auteurs d’agression sexuelle sous le contrôle d’un médecin coordonnateur. Cette étude est la première évaluation de l’activité des médecins coordonnateurs. Dans notre échantillon de 100 sujets soumis à une injonction de soins (99 % d’hommes, 60 % d’agressions sexuelles sur mineurs, 14 % de cas d’exhibitionnisme), les victimes mineures d’agression sexuelle sont à 78 % de sexe féminin, dans 90 % des cas, elles ont moins de 14ans, dans 60 % des cas, il s’agissait d’inceste. Le suivi sociojudiciaire a contribué à la réduction du risque de récidive (trois sur 100 sujets, période moyenne de cinq ans de suivi), même s’il demeure difficile de l’évaluer sur une période aussi courte. Un diagnostic de paraphilie a été retenu dans 19 % des cas (pédophilie et exhibitionnisme). Un diagnostic psychiatrique a été retenu dans 57 % des cas et des troubles de la personnalité dans 65 % des cas. Des antécédents de maltraitances physiques et/ou sexuelles sont observés dans 56 cas. Près de la moitié des sujets ont des antécédents de délits non sexuels ou sexuels, (dans 16 cas, au moins trois, souvent au moins dix ans, auparavant). Les médecins coordonnateurs interrogés sont satisfaits de leur activité et ont le sentiment de contribuer à l’amélioration de la prise en charge des patients ayant commis des délits à caractère sexuel. Cependant, il ressort de cette étude la nécessité de création d’un centre de référence national qui pourrait permettre une évaluation multidisciplinaire des sujets difficiles et impulser la mise en place de projets de recherche car de nombreuses incertitudes demeurent, en particulier en ce qui concerne les déterminants de ce comportement déviant et les facteurs de risque de récidive.

Most people recognize that incarceration alone will not solve sexual violence. Treating the offenders is critical in an approach to preventing sexual violence and reducing victimization. The Law of June 17, 1998, on the prevention and repression of sexual offences, as well as the protection of minors, makes a provision for the possibility of medical and psychological monitoring adapted to these particular individuals. Sex offenders may well be constrained, after their incarceration, to social and judicial follow-up, which may include coerced treatment in order to reduce the risk of recidivism. In order to control this follow-up, the legislature has created the position of medical coordinator, who acts as an interface between justice and care in conjunction with the treating physician. This study is the first attempt to evaluate the activity of physician coordinators conducted in France since the implementation in 2004 of the 1998 law on monitoring sex offenders.

An interview of all the physician coordinators in Upper Normandy was conducted. The files of all sex offenders subjected to coerced treatment were studied.

In our sample of 100 sex offenders who were subjected to coerced treatment (any kind of treatment) (99% men, 60% of sexual assaults on minors, 14% of cases of indecent exposure), minor victims of sexual assault were: 78% females; in 90% of cases the victim was aged under 14 years (under 10 in 52% of cases), 60% of cases were intrafamilial incest; the victim was an unknown aggressor in only one case out of 60. The constraint follow-up contributed to reducing the risk of recidivism (three cases of recidivism in 100 individuals over an average duration of follow-up of five years), although it remains difficult to assess the recidivism over a duration of time as short as five years. A diagnosis of paraphilia was only applied in 19% of cases (in 10 cases pedophilia, exhibitionism in nine cases). Only six subjects were receiving antiandrogen treatment. A diagnosis based on Axis I DSM was established in 57% of cases. Personality disorders were mentioned in the medical records in 65% of cases. An antisocial personality disorder was not prominent (20%). In 56 cases, the individuals had been victims of physical, psychological or sexual abuse. Nearly half of the individuals had a past history of sexual or non sexual offences, among those, 16 subjects had previously been convicted at least three times. The seniority of the prior conviction was more than 10 years in 43% of cases. Physician coordinators interviewed were satisfied with their work and felt they had contributed to improving the care of patients who had committed sexual offences.

However, this study shows the need to create a national reference centre, which could enable a multidisciplinary evaluation of difficult cases and could also boost the development of research in this area where many questions remain unanswered, particularly regarding the determinants of deviant sexual behaviour and risk factors for recidivism.