Abstract

Introduction: Regarding women, little research is available about the prevalence of sexual interest in children (SIC), especially in nonclinical samples.
Aim: The present study aimed to investigate the extent to which adult women from 2 nonclinical and nonrepresentative samples indicate sexual interest in prepubescent and/or pubescent children.
Methods: Participants took part in an online survey either via general websites or via websites directed toward individuals with a SIC.
Main Outcome Measures: The self-report survey included questions about the use of online abuse material including children and teenagers as well as about sexual fantasies involving prepubescent and pubescent children.
Both measures were included as main outcome measures.

Results: Results showed that few women reported having used online abuse material including

• children
  • (total sample: n = 7 [0.8%],
  • general websites: n = 3 [0.4%],
  • SIC websites: n = 4 [9.5%])
• or teenagers
  • (total sample:n = 44 [5.0%],
  • general websites: n = 37 [4.4%],
  • SIC websites: n = 7 [16.7%]).

Results further revealed that some women reported sexual fantasies involving

• prepubescent
  • (total sample: n = 98 [7.0%],
  • general websites:n = 92 [6.8%],
  • SIC websites: n = 6 [11.1%])
• or pubescent children
  • (total sample: n = 136 [9.6%],
  • generalwebsites: n = 129 [9.5%],
  • SIC websites: n = 7 [13.0%]).

Conclusions: The samples included are nonrepresentative and therefore not generalizable to the female population.
Nevertheless, they strongly suggest that SIC is a phenomenon also found in women. We therefore recommend professionals in the field of sexual medicine to increase their attention and engagement for women with SIC. Based on the present results, the development of preventive treatment services specifically tailored to women with a SIC has to be strongly encouraged in the near future.

Here below are: quotes from the article.
The article in full text, including the Tables and the References [* Foot notes] are here: < sexual_interest_in_children_among_women.pdf >.

Introduction

Sexual Interest in Children

In the Diagnostic and Statistical Manual of Mental Disorders [*1], pedophilic disorder is described as recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children. This means that the diagnosis is intended for individuals who are sexually attracted to children generally aged 11 years or younger. In contrast, sexual interest in pubescent children (ie, aged 11e14) is called “hebephilia”. [*2]

Currently, hebephilia is not included in diagnostic classification systems. In the present study, the term “sexual interest in children” includes both pedophilic and hebephilic sexual interest but does not necessarily imply that diagnostic criteria are met.

Most empirical research on sexual interest in children has been conducted with men who have sexually offended against children and detected, and, consequently, incarcerated. Only few studies have investigated the prevalence of sexual interest in children in the general population. Also, most of these studies have only included men. [*3 - *6]

Focusing only on men is probably based on the widely accepted notion of sexual interest in children being an exclusively male phenomenon.

However, the fact that research has hardly included women compared to men may reinforce this view in the absence of actual empirical data on the lack of female sexual interest in children.
Recently, studies have examined the extent to which women in general population report any sexual interest in children. [*7, *8]

The present study adds to this new line of research by providing empirical data from an online survey assessing the prevalence of sexual interest in children among adult women in nonclinical online samples.

Sexual Interest in Children vs Child Sexual Abuse

As mentioned previously, most of what is known about sexual interest in children among adults is based on studies with child sexual abusers detected by the criminal justice system. [*9] These samples consist mostly of men. [*10]

Such forensic samples are not necessarily representative for the population of adults who have sexual interest in children, and they are not helpful in assessing the prevalence of the phenomenon. In fact, research has consistently demonstrated that men who sexually abuse children are not necessarily sexually attracted to children meaning they would have a pedophilic or hebephilic sexual preference (for a review, refer to the article by Seto1[*11].

Child sexual abusers sometimes have a preference for adult sex partners but choose to act on their sexual desires by abusing children “because they are available and vulnerable” (p. 221). [*12]

Because of these problems, recent research on pedophilia and hebephilia has focused on samples of individuals with a selfidentified sexual interest in children. [*13 - *18]

From this research, it is now evident that there are individuals who are sexually interested in children but report abstaining from acting upon their sexual interests by committing sexual offenses against children. For such individuals, a rare example of a treatment program designed to help the participants copewith a sexual interest in children is the German Dunkelfeld Project ( www.dont-offend.org ). The primary goal of the project is to hinder potential future sexual offences. [*13]

In sum, even though sexual interest in children contributes to child sexual abuse [*19] and has been proven to be the most important risk factor for sexual offence recidivism, [*20] sexually offending against children cannot be regarded as a reliable indicator of pedophilic or hebephilic sexual interest. [*21] Individuals with sexual interest in children were shown to be a stigmatized group who risk being the
target of intense discrimination. [*22] Thus, we clearly separated between child sexual abuse and sexual interest in children as the former is a criminal act while the latter is not. We consciously decided to not go into further detail on the topic of child sexual abuse.

Prevalence of Sexual Interest on Children in the General Population

Research has so far arrived at differing estimates of the prevalence of sexual interest in children among men. The prevalence estimates may differ as a function of the type of question participants are asked. For example, Wurtele et al [*8] found differences between responses to questions referring to sexual fantasies, masturbation, and sexual attraction involving children, the likelihood of having sex with a child if participants were guaranteed they would not be caught or punished as well as the likelihood of using online abuse material. [*8] Among their online sample, men reported prevalence rates ranging from a low of 3.5% to a high of 9.2%. [*1]

Another reason for differing prevalence estimates may be that studies vary regarding the age at which a person is defined as a child. Wurtele et al [*8] did not report their survey including a clear definition of what is meant by the term “child”. Participants may differ in their interpretation of undefined terms that probably affect prevalence estimates. As a result, the authors were not able to report separate prevalence rates for pedophilic and hebephilic interest. Owing to recent research on the differences between pedophilia and hebephilia, [*2] this might be considered relevant.

Within an online-sample of 8,718 German men, Dombert et al [*4] specified children as persons aged 12 or younger and found that

• 358 (4.1%) men reported sexual fantasies including prepubescent children, whereas only
• 0.1% specified that they had a pedophilic sexual preference. [*4]

Santtila et al [*5] provided a population-based estimate of the incidence of sexual interest in children among adult men by investigating 1,310 Finnish male twins.

• Sexual interest in children aged 12 or younger was reported by 0.2% (n ¼ 3) participants.
• Children aged 15 or younger were sexually interesting to 3.3% (n = 43). [*5]

As prevalence estimates depend on sample composition as well, other non-representative studies, in contrast, suggest a prevalence of up to 5% for pedophilia in the general population (for a review, see the article by Seto [*11]).

In sum, research results on the prevalence of sexual interest in children among adult men from nonclinical samples range from 0.1 to 5%. [*4, *11, *23 - *25]

Regarding women, little research is available about the prevalence of sexual interest in children. Early studies asking women about their sexual interest in children revealed prevalence rates ranging from 1 to 4%. [*3, *26, *27]
Recent research also demonstrates variety.

Baur et al [*7] investigated 3,898 Finish women (twins aged 18-33 years) including questions about sexual interests, masturbation fantasies, and sexual partners across 2 specific age groups (0 - 6, 7 -12 years). Results showed that only 17 females (0.4%) reported pedophilic sexual interest.

Wurtele et al [*8] investigated 262 females of whom

• 0.8% reported some likelihood of masturbation and sexual attraction regarding children,
• 1.5% reported some likelihood of having sex with a child if they were guaranteed they would not be caught or punished, and
• 3.4% stated some likelihood of viewing child pornography on the Internet.

Overall, 4.2% of 262 women responded positively to at least one of the sexual interest in children items. [*8]

In other online surveys, between 3.4% and 5.5% of female respondents admitted the use of online abuse material including persons under the age of 18 years. [*28, *29]

Most of the studies on women cited previously aimed at assessing sexual interest in children aged 12 years or younger, which implies a pedophilic interest (ie, sexual interest in children up to 11 years), or did not provide a clear definition of what is
meant by the term “child”.

The Present Study

The present study aimed to investigate the extent to which adult women from 2 non-clinical and non-representative samples indicate sexual interest in prepubescent and/or pubescent children.
We analyzed data from an online self-report survey conducted in Germany, Finland, and Sweden that aimed to investigate social and sexual online behaviors among adults. [*30, *31]
The survey included questions about the use of online abuse material including children or adolescents as well as about sexual fantasies involving prepubescent and pubescent children.

Method

Participants

A total of 1,808 adult women completed the online survey, of which

• 50.7% were located in Germany,
• 45.5% in Finland, and
• 3.9% in Sweden.

A total of 874 women (48.3%) provided information on the use or nonuse of online abuse material including children or adolescents. [*]

Assessment of sexual fantasies involving prepubescent and/or pubescent children were made by 1,411 women (78.0%). The overlapping subsample includes 871 women (48.2%) who answered questions on both online abuse material and sexual fantasies involving children.

The sample characteristics for the 3 subsamples are presented in Tables 1 - 3. [See the PDF file mentioned here above - Ipce]

In all subsamples, a subgroup of women participated via one of 2 German websites associated with individuals with a selfidentified sexual interest in children (SIC websites).

• One website is directed to individuals with a self-identified sexual interest in children offering anonymous treatment opportunities (< www.kein-taeter-werden.de >, online since 2005).
• The other website is a forum for individuals with a self-identified sexual interest in children with no other specified thematic focus ( < www.krumme13.org >, online since 2003). [*30]

Differences between participants who took part in the survey via one of the general websites and those who participated via websites directed to individuals with sexual interest in children were expected. [*31] We, therefore, present all variables for the total sample as well as for the 2 groups (general websites and SIC websites) including tests of comparison between them.

[... ...]

Procedure

The online survey was conducted between July and December 2012.
[... ... ... ...]

Measures

[...]

Use of Online Abuse Material Including Children or Adolescents

Online abuse material including children or adolescents involves sexual online material (ie, videos, pictures, or texts) representing child sexual abuse. [*]

• [* Remark: the concept "abuse" is not defined in the article. Thus, supposeedly, each respondent has used her own definition of the concept - Ipce.]

The use of online abuse material including children or adolescents has been suggested to be a reliable indicator of sexual interest in prepubescent and/or pubescent children. [*33]

Sexual Fantasies Involving Prepubescent or Pubescent Children

Self-report measures of sexual fantasy can be viewed as direct indications of one’s level of sexual interest. [*34]
[... ... ...]
In the present study, participants were presented with 10 pictures showing different undressed bodies. The pictures were computer-generated stimuli validated for the assessment of pedophilic interest. [*39] Each of the bodies represented a Caucasian person in 1 of 5 female and male Tanner stages of secondary sex characteristic development. [*40]

• Tanner stage 1 indicates a prepubescent developmental stage with no secondary sex characteristics.
• Tanner stages 2 and 3 represent a pubescent status with the beginning of pubic hair growth in girls and boys and the start of breast development in girls.
• Tanner stages 4 and 5 indicate maturity of secondary sex characteristics. [*40]

[...]
For each of the 10 Tanner pictures, participants were aske bodies they have sexual fantasies about.
[... ...]

Data Analyses and Presentation

[... .... ....]
To calculate an overall indicator of any sexual interest in children, we summarized the use of online abuse material including any minor and sexual fantasies involving any children.
[...]

Additional Analyses

As both use of online abuse material and sexual fantasies involving children are intended to assess the same construct, that is, sexual interest in children, statistical relations between these 2 variables can be reasonably assumed. [...]
We therefore generate a correlation matrix [... ... ...]

Results

Use of Online Abuse Material Including Children or Adolescents

The subsample including female participants who answered the questions on the use of online abuse material (n =874) [... ... ....]

• mainly indicated the use of sexual online videos (83%) and
• reported less frequently the use of sexual online pictures (51%) and
• sexual online texts (64%).

• A proportion of 0.4% (n = 3) of those women who participated via general websites stated that they use online abuse material including children within the last year,
• whereas 9.5% (n = 4) of those women who participated via websites that were directed at individuals with a sexual interest in children (SIC websites) did so.

The use of online abuse material including adolescents was reported by

• 4.4% (n = 37) of women from general websites and by
• 16.7% (n = 7) of women from SIC websites.

Taking together,

• 4.4% (n = 37) of women from general websites indicated the use of online abuse material including any minor, whereas
• 19.0% (n = 8) of women from SIC websites reported doing so.

[...]

Sexual Fantasies Involving Prepubescent or Pubescent Children

[... ... ...]
Group comparison [...] demonstrated significant differences between women from SIC websites and women from general websites regarding sexual fantasies involving

• prepubescent girls
  • general websites: n = 27 [2.0%],
  • SIC websites: n = 5 [9.3%] and
• pubescent girls
  • general websites: n = 58 [4.3%],
  • SIC websites: n = 7 [13.0%].

Among the total sample, the proportion of women who reported having sexual fantasies involving prepubescent children (n = 98 [7%],

• general websites: n = 92 [6.8%],
• SIC websites: n ¼ 6 [11.1%])

was slightly smaller than the proportion of women who reported having sexual fantasies involving pubescent children (n = 136 [9.6%],

• general websites: n = 129 [9.5%],
• SIC websites: n = 7 [13.0%]).

As the overlapping group among these 2 variables only included 54 women who reported on having sexual fantasies involving both prepubescent and pubescent children, the proportion of women among the total sample who indicated having sexual fantasies involving any children (ie, girls or boys at Tanner stage 1 or 2) reached 12.7%,  n = 180,

• general websites: n = 173 [12.7%],
• SIC websites: n = 7 [13.0%].

Overall Indicator of Any Sexual Interest in Children

Women in the present study who provided data on both the use of online abuse material and the assessment of pictures presenting female and male children at Tanner stage 1 and 2 [counted] n = 871 [...].

Almost 18% (n = 154) of this subsample specified at least some sexual interest in children by responding positive to at least one of the variables included in the present study:

• (general websites: n = 145 [17.5%],
• SIC websites: n = 9 [21.4%].

Correlation Analyses

All the 6 indications of sexual interest in children are positively correlated to each other (Table 4).

• The strongest correlation is between sexual fantasies involving prepubescent girls and the use of online abuse material including children (rxy = 0.58, P < .001);
• the weakest between sexual fantasies involving prepubescent boys and the use of online abuse material including teenagers (r = 0.12, P < .01).

Discussion

[... ... ...]
Results showed that 7 women of the total sample (0.8%) report using online abuse material including children (...) indicating a sexual interest in children.
[...]
Table 1 further demonstrates that more women reported using online abuse material including children or adolescents (...), indicating a sexual interest in children or adolescents.
[... ...]

Our results also show (...) that 180 female participants of the total sample (12.7%, ...) have sexual fantasies involving prepubescent children at Tanner stage 1 (...) or pubescent children at Tanner stage 2 (...). Compared with general websites participants, SIC website participants showed a higher proportion of having sexual fantasies involving prepubescent (...) and pubescent girls (...).
This difference is quite likely the result of the differences in sexual orientation between these 2 groups. SIC website participants specified almost twice as frequently as general websites participants on being homosexual (...2) or bisexual (...). [...]

Finally, results [...] revealed that 154 female participants of the total sample (17.7%, ...) specified any sexual interest in children as indicated by the use of online abuse material including children and/or adolescents and/or by sexual fantasies involving prepubescent and/or pubescent girls and/or boys.

The present study design offers some advantages that enhance the reliability and validity of results. Most importantly, the present study is based on a relatively large sample of female adults (N = 1,808) leading to a more precise estimation of sample statistics and a greater statistical power. [*50]
In addition, data analyses included multiple indicators of sexual interest in children (use of online abuse material and sexual fantasies involving children) which implies a certain degree of triangulation and facilitates validation of data. [*51]
Indeed, correlation analyses revealed significant relationships between the different indications of sexual interest in children (Table 4).

[.... statistical explanation ...]

In sum, the correlation pattern gives reason to assume consistency of the present data.

A further advantage of the present study was that data were collected online which implies a high degree of anonymity. This may have foster participants’ readiness to respond truthfully.
Finally, we chose a rather conservative approach when solely including the assessments of Tanner stages 2 as an indication of sexual interest in pubescent children. Actually, a pubescent status is represented by Tanner stages 2 and 3. [... ]

The fact that the prevalence of sexual interest in children among women reached almost 18% despite a conservative procedure justifies the assumption that pedophilic and hebephilic sexual interest may not be a phenomenon exclusive to men.

Previous studies on the prevalence of sexual interest in children among female adults in the general population reported rates up to 4%. [*3, *7, *8, *26, *27]
The present results demonstrate an even higher proportion of women who appear to be at least partly sexually attracted to children and/or adolescents with prevalence rates up to 17.5% for women who participated via general websites which have not been associated with the topic of sexual interest in children (Table 3).
Our higher rates compared to previous studies may have been due to the fact that previous studies mainly focused on indicators for pedophilic interest. That is, most studies on the prevalence of sexual interest in children among women aimed at assessing sexual interest in children aged 12 years or younger which rather implies a pedophilic interest (ie, sexual interest in children aged up to 11 years).
The present study aimed at assessing sexual interest in children and adolescents
which implies a pedophilic or a hebephilic interest (ie, sexual interest in children up to 14 years).
Thus, the broader range of ages might have revealed further groups of females being interested in older children that might have been neglected in other studies by limiting the age range to 12 years.

[... ... ...]

Limitations and Further Research Questions

Although the study was not meant to be representative, [*31] the fact that the present data were not population-based has to be mentioned as a strong limitation.

Moreover, the present sample includes users of websites that were identified as directly addressing individuals with a sexual interest in children (SIC websites). Thus, the results for the total sample are probably distorted by a higher rate of individuals being sexually attracted to children which is represented by the differences between general and website participants in using of online abuse material [... ... ...].

Mentioned previously as an advantage of the present study, data were collected online implying a high degree of anonymity. From a different perspective, this anonymity may be regarded as a limitation because there is a certain degree of unknowingness about participants. [... ... ...]

A further limitation of the present data is that all measures are based on participants’ self-reports. A social desirability scale was not applied. Thus, distortion of the present data owing to social desirability cannot be excluded.
In addition, participants were offered with the opportunity to skip questions they did not wish to answer. The use of online abuse material is a criminal behavior
in all the 3 countries participants came from [...] As participants might not dare to
report criminal activities, this have possibly led to a systematic bias in the data.

Compared to the proportion of sexual fantasies involving prepubescent or pubescent children in the present study, the reports on using online abuse material including children or adolescents were less frequent. This may indicate that having sexual fantasies about children is easier to disclose as it does not imply the anticipation of criminal prosecution.

Furthermore, sexual interest in children is strongly stigmatized by public [*52] and therefore possibly difficult to disclose by affected individuals. Consequently, the present results might underestimate the prevalence of sexual interest among adult women.

[... ... ...]

Another uncertainty relates the fact that the present study did not include precise questions about the exact content of the sexual online material that included children or adolescents. In the present study, we considered every sexual online material that included children or adolescents to be online abuse material.

The use of online abuse material has been shown to be an indicator not only of sexual interest in children but also of compulsive sexual behavior. [*54] [...]
Thus, it might be that the women in the present study who reported the use of online abuse material including children or adolescents do not have a sexual interest in children but need online abuse material because ordinary sexual online material lost its effect.

To reach better clarity and understanding of the data, we dichotomized the sexual fantasy categories by computing the response categories “not at all” and “(2)” into the category “no” and “(3)”, “(4)”, and “absolutely” into the category “yes”.
This specific methodological approach need to be taken into account when interpreting the present data. This means, other ways of dichotomization are indeed possible changing the percentages of women indicating a sexual interest in children [... ...]
Our methodological approach only represents one possibility of data presentation.

Moreover, research so far suggests that pedophilia and hebephilia are 2 relatively distinct but also overlapping constructs. [*2]
Strictly speaking, individuals with pedophilic interest and those with hebephilic interest should not be considered as one homogeneous group when investigating individuals’ specific characteristics.
As the present study was not intended to investigate specific characteristics but to examine the amount to which women indicate pedophilic or hebephilic interests, we combined the 2 constructs of pedophilia and hebephilia. [...]

Owing to these limitations, the validity and generalizability of the present results are presumably restricted to a certain degree.

Further empirical research on how common sexual interest is among adult females is deemed necessary, especially in population-based samples.

Although being sexually attracted to children cannot be equated with sexually abusing children, research among men has shown that sexual interest in children
constitutes a risk factor for sexual child abuse. [*20]
In particular, the use of online abuse material has been demonstrated to be related
to sexual offences against children in male perpetrators. [*55]
Even if male and female perpetrators were shown to have different risk factors for committing child sexual abuse, [*56  - *58] future research proposals need to be focused on using online abuse material as a risk factor that might also lead female adults with a sexual interest in children to sexually offend against children. [...]

The results of the present study suggest that quite a few women are, at least to some extent, sexually interested in children and may be at a risk for abusing children and/or maybe are in need of professional help.

Conclusion

The present sample is nonrepresentative, and the present results are therefore not generalizable. However, the results clearly demonstrate that there are women who report using online abuse material and having sexual fantasies about children.

Thus, professionals in the health-care system need to be aware that sexual interest in children may be a phenomenon also found in adult females. We strongly advise professionals in the health-care system to increase their attention and engagement for women with sexual interest in children. A stronger representation of the existence of such women in the professional’s mind is deemed necessary to prevent adult females who are perhaps even struggling with their sexual interest in children from remaining unseen.

We recommend clinicians and researchers in the field of sexual medicine not to wait until women seek help in the healthcare system to cope with their sexual interest in children. Instead, we suggest pursuing an active approach toward women who are
sexually attracted to children and might be at risk to sexually offend against them.

Projects such as the German Dunkelfeld Project [*13] appear to be directed toward male individuals with a sexual interest in children. Based on the present results, the
founding of preventive treatment services specifically tailored to female individuals with a sexual interest in children has to be strongly encouraged in the near future.