La pédophilie, trouble caractérisé par l’attirance sexuelle durable d’un adulte pour les enfants pré-pubères, a suscité des travaux en neurologie et, plus récemment, en imagerie cérébrale. Les études de cas de patients cérébrolésés suggèrent l’implication de régions frontales, temporales et sous-corticales dans ce trouble. Des études en imagerie par résonance magnétique structurale ont retrouvé une diminution de la matière grise dans ces régions, mais leur localisation spécifique varie d’une étude à l’autre. Les travaux en neuro-imagerie fonctionnelle suggèrent un pattern d’activation cortical et sous-cortical analogue chez les patients pédophiles en réponse à des photographies d’enfants et chez les témoins sains en réponse à des photographies d’adultes. Ces travaux sont en revanche discordants concernant les régions qui s’activent davantage chez les patients que chez les témoins en réponse à des images d’enfants. Cette discordance implique de conduire des études complémentaires sur les corrélats cérébraux de la pédophilie.

Pedophilia is characterized by a persistent sexual interest of an adult for prepubescent children. The development of neuroimaging techniques such as functional Magnetic Resonance Imaging (fMRI) is starting to clarify the cerebral basis of disorders of sexual behavior such as pedophilia, which had been previously suggested by case studies.

To review structural and functional neuroimaging studies of pedophilia.

An exhaustive consultation of PubMed and Ovid databases was conducted. We obtained 19 articles presented in the present review of the literature.

Case studies have demonstrated various changes of sexual behavior in relation to brain lesions, including the late appearance in adults of a sexual attraction to prepubescent children. In most cases of pedophilia associated with brain lesions, these lesions were located in frontal or in temporal regions. Structural neuroimaging studies have compared pedophiles with healthy subjects and tried to relate pedophilia to anatomical differences between these two groups. The location of structural changes is inconsistent across studies. Recent functional neuroimaging studies have also attempted to investigate the cerebral correlates of pedophilia. Results suggest that the activation pattern found in pedophiles in response to pictures of prepubescent nude girls or boys is similar to the pattern observed in healthy subjects in response to pictures of adult nude women or men. However, regions that become more activated in patients than in healthy controls in response to the presentation of pictures of children vary across studies.

Studies that have begun to investigate the cerebral correlates of pedophilia demonstrate that it is possible to explore them through neuroimaging techniques. These initial results have to be confirmed by new studies backed with objective measurements of sexual arousal such as phallometry.