To date, psychiatry's approach to sexual assault victims has been to treat them after victimization in order to reduce the emotional consequences of sexual assault. Although victims certainly need help, victim assistance programs and therapies cannot be expected to reduce the rate of sexual violence because they are implemented after a sexual attack has occurred. Sexual violence must be diminished by reducing the occurrence of the pathogen, the deviant sexual interests of the paraphiliac or sex offender. A preventive approach to sex offender treatment should become a major focus of psychiatry and psychology. In this regard, consideration is given to what the psychiatrist or psychologist can do to prevent sexual violence, what should be known about paraphiliacs, how potential paraphiliacs should be interviewed, treatment needs, treatment effectiveness, and the role of medication in treatment. 17 references