BACKGROUND: There is a presumed yet untested connection between sexual compulsivity and pedophilic interest among sexual offenders against children, which has driven the widespread use of anti-libidinal treatments for high-risk offenders. AIM: To test the hypothesis that compulsive sexual behavior (CSB) and pedophilic interest are related. METHODS: A group of 95 prisoners in treatment for sexual offenses was administered questionnaires measuring CSB, and their self-reported offense history analyzed in order to assess their level of pedophilic interest. OUTCOMES: All subjects were able to provide valid details of their sexual behavior and of their previous sexual offending, and there was a wide distribution of scores on both measures. RESULTS: Contrary to the main hypothesis, the findings revealed a negative relationship between CSB and pedophilic interest. Further analysis indicated that the main factor of CSB underlying this relationship was a lack of negative affect, together with non-significant negative trends toward the unwanted consequences and affect dysregulation components of CSB in relation to pedophilic interest. CLINICAL IMPLICATIONS: These results challenge the assumption that targeting CSB through anti-libidinal medication should be the primary intervention for offenders with elevated sexual interest in children. Instead, multifactorial approaches to sexual offending may yield more meaningful long-term effects on offender risk. STRENGTHS AND LIMITATIONS: This study is the first to explore the relationship between CSB and pedophilic interest in convicted offenders, providing valuable insights into their management and treatment. However, its findings are limited by treating pedophilic interest as a continuous variable, despite evidence suggesting it may be a taxon, potentially restricting the broader applicability of the results. CONCLUSIONS: The study concludes that compulsive sexual behavior and pedophilic interest are not inherently linked in incarcerated offenders. This underscores the need for nuanced, individualized treatment approaches that align with multifactorial models of sexual offending. Clinically and at the policy level, this calls for a shift away from a sole focus on anti-libidinal treatments toward interventions tailored to address the complex and varied needs of this population.