Several alterations of brain functioning may increase the risk for committing sexual offences. Similarly, physiological abnormality may limit the amenability of sexual offenders to treatment interventions aimed at reducing the risk of reoffending. Based on an overview of research on cerebral responses associated with sexual interest and arousal, this chapter pulls together findings from case studies, electrophysiology, and brain imaging. Both structural and functional brain‐imaging studies are reviewed, with a focus on paedophilia and sexual offences against children, as most studies available to date concerned this area. In a more applied sense, findings on general cognitive ability and neuropsychological functioning are highlighted that may prove helpful to structure the psychological assessment of sexual offenders. Finally, genetic, connatal, and hormonal peculiarities are described that can be associated with a greater risk of sexual offending. In conclusion, a thorough examination of possible somatic risk factors is recommended. This assessment should comprise both neurological/psychiatric and psychological assessment. Such an assessment should be dependent on the indication in a given case, however, and not be applied indiscriminately.