[Towards better management for sexual offenders: Presentation and conclusions of a public hearing concerning prevention, assessment, and care]. / Audition publique auteurs de violences sexuelles : prévention, évaluation, prise en charge des 14 et 15 juin 2018 : perspectives et préconisations.

In France, since the law of June 17, 1998, sexual offenders may be convicted to ambulatory mandatory care, articulated with the justice. Twenty years after the implementation of this law, while social and technological developments have redefined certain aspects of delinquency, reference documents and practice guidelines remain to be updated. This is why the professionals of the main structures and associations dealing with perpetrators of sexual violence organized a public hearing under the sponsorship of the French Federation of Resource Centers for Sexual Violence Perpetrators (FFCRIAVS) according to the methodology and with the accompaniment of the High Authority of Health. This article presents the global methodology of the public hearing "Sexual Offenders: Prevention, Evaluation and Care" which was conducted on June 14 and 15, 2018. Thirty-three experts replied to27 questions and presented their conclusions to an Audition Committee and an audience of 200 persons representative of the civil and professional society. After a public debate, the hearing committee prepared a report in which they proposed propositions in order to better care for sexual offenders.

[Deviant sexual behaviors, paraphilias, perversions]. / Pratiques sexuelles déviantes, paraphilies, perversions.

OBJECTIVE: To know the new concept of paraphilias, their clinical presentation and their link with a personality disorder as perversion, the French legislation concerning them and the different therapeutic options. MATERIAL AND METHODS: Review of guidelines published on this subject in the Medline database and a reflexion from our own clinical experience, especially in the judicial expertise. RESULTS: Deviant sexual behavior is, in current classifications, known as paraphilia. This clinical entity corresponds to any sexual behavior considered "abnormal" compared with sexual acts in the society where the person lives. It means precisely, firstly, suffering caused by this disorder or deterioration of social, professional, or family life. Paraphilia such as pedophilia have strict age limits. The victim must be aged below 16 years, with an age difference of at least 5 years with the author of the act. Sexual acts which are illegal are crimes or offences according to the degree, and are sanctioned by the law. In ordinary terms, they are known as perverts, committing perversions. This concept is different from that of paraphilia, a pervert can have, or not have, paraphiliac behavior. In order to diagnose a personality disorder such as perversion, all the criteria must be included: narcissism, use of a person as an object for pleasure, with, primarily, mechanisms of denial and a split personality which removes any feeling of guilt from the perpetrator. CONCLUSION: Medical treatment of paraphilia alone is not satisfactory for the denial mechanism is such that only the sex drive is affected with a high risk of recurrence. Only psychotherapy can modify the pathological element of a perverted personality.

[The treatment of erectile dysfunction: what are the objectives and the methods?]. / Le traitement de l'insuffisance érectile: quels sont les objectifs et les méthodes?

Despite considerable progress, the treatment of erectile insufficiency is often difficult due to its usually multifactorial aetiology and to the fact that the 3 components of a satisfying sex life are: 1) Sufficient penile rigidity with no other associated sexual dysfunction, 2) an adapted mental state, 3) a loving relationship with the partner. All of these parameters must be taken into account to ensure a lasting success, hence the need for a global approach rather than an approach localized to the organ. Consequently, there is not one, but several treatments which must be adapted to each case. The rarity of easily curable aetiologies explains the very widespread use of symptomatic treatments and the primordial place of clinical assessment. A consensus has currently been reached concerning: a) give the patient objective information, an essential prerequisite for the choice and success of treatment, b) start by proposing minimally invasive medical treatments, c) emphasize the value of a multidisciplinary approach in the case of failure, d) recognize the fact that achievement of a rigid penis is not necessarily synonymous with cure. In practice, two situations can be distinguished: 1) in the presence of predominantly psychogenic disorders, sex therapy and/or sexual advice can be used in all patients, either alone or in combination with drug treatments and/or a vacuum device (especially in the case of failure of either of these treatments), 2) in the presence of predominantly organic abnormalities which are not easily curable drug treatments and/or vacuum must be proposed first, but sexological management is always useful in these so-called "organic" patients. Prosthetic surgery, the only approach with demonstrated efficacy, is only indicated following failure of medical treatment, after rigorous selection. The release onto the market, in the near future, of promising new oral or intraurethral drugs used "on request" will certainly modify the treatment hierarchy. Due to their acceptability and efficacy, they will certainly be prescribed as first-line treatment, regardless of the origin of the erectile insufficiency. However, the therapeutic approach in the case of failure will remain unchanged. Erectile insufficiency can effectively be treated provided a rigorous assessment is performed.

[Peptic esophageal strictures. Dilatation with the Eder-Puestow's olives system (author's transl)]. / Sténoses peptiques de l'oesophage. Traitement par le dilatateur d'Eder-Puestow.

Esophageal dilatations under topical pharyngeal anesthesia with the Eder-Puestow's metallic olives system were performed 101 times on 30 patients presenting peptic strictures. This method uses first a metallic wire introduced into the esophagus and the stomach under endoscopic control. Then, the wire allows to guide dilatating olives through very tight strictures. Functional results were excellent 28 times out of 30; two patients only required repeated dilatations because of uncomplete treatment (stenosis on esojejunal anastomosis). Finally, surgical procedure was never indicated. The use of Eder-Puestow's material together with fiberoptic esophagoscope reduces the hazard of peroral bougienage: no complication occured in our series.