n. recurrent, intense, sexually arousing fantasies, sexual urges or behaviors involving sexual activity with a prepubescent child --American Psychiatric Association's Diagnostic and Statistical Manual

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But if we have punished our way out of the problem somewhat, we still don't have a long-term solution. Many people assume that not only priests but also teachers, Boy Scout leaders and other adults who work with kids are responsible for most child sexual abuse, but that's a misconception. Half of child sexual abusers are the parents of the victims; other relatives commit 18% of the offenses. And the sad truth is that preventing incest is nearly impossible. Less than one-third of perpetrators know their victims from outside the home. But non-family abusers may be easier to pick out--many are adults who shower uncommon attention on children--and thus easier to stop.

Although news reports focus on horrific serial offenders, experts say it's possible, with treatment, to prevent pedophiles from abusing kids. States have incarcerated many child sexual abusers, but most eventually get out (average sentence: 11 years). Active pedophiles who find their way into the few treatment programs around the country turn out to be less of a risk than those who are locked up for a while and released.

Berlin runs one of the largest such programs in the nation. Since 1991 hundreds of pedophiles have gone to the creaky Victorian building that houses his clinic. Berlin sees their condition as similar to alcoholism--incurable but treatable--and some of his methods sound similar to those of Alcoholics Anonymous. The pedophiles must admit their urges and confront them in group therapy. Counselors help them restructure their lives so that they don't come into contact with children. Berlin prescribes medication to reduce sex drives for the 30% of his patients who don't respond to nondrug therapy.

There is nothing new or scientifically subtle about these drugs: they squash testosterone levels and therefore suppress sexual hunger. (High, long-term doses of the drugs are known as "chemical castration," a misnomer because sex drive returns if the injections stop.) But together, drugs and counseling can be effective. Contrary to popular perception, a raft of studies has shown that once in treatment, few pedophiles relapse. In 1991 the American Journal of Forensic Psychiatry published a study of 400 of Berlin's patients; only 1.2% of those who had complied with his 2 1/2-year treatment were known to have molested kids again three years after finishing the course. Surprisingly, only 5.6% of those who were discharged for noncompliance offended in that period. Similarly, a 2002 study by St. Luke Institute, a psychiatric hospital outside Washington, followed 121 priests for one to five years and found that after treatment only three had relapsed, according to the Rev. Stephen Rossetti, who runs St. Luke. "People don't grow up and say, 'I want to be a pedophile,'" says Rossetti. "All the people I've ever talked to hate it."

Other studies that look back over longer periods--five to 10 years--find higher percentages of pedophiles who strike again, as high as 58% for those who refuse treatment. Such disparities highlight how uncertain the study of pedophilia is, but even the higher figure belies the popular notion that if a pedophile is allowed to go free, he will almost always molest again. "It's very easy to say, 'Throw away the key,'" says Berlin. "But many of these people are tortured by these temptations, and they are relieved that we can do something for them."

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