In the area of sexual offending, the presence of deviant sexual interests is a central feature of both clinical and theoretical understandings. At the theoretical level, many influential theories of sexual offending consider the presence of deviant sexual interests as a key element in explaining both sexual offending behaviors onset and reoffending. The Integrated Theory of Sexual Offending (ITSO), which incorporates and articulate most of the notions suggested in other theories, has gained considerable popularity over the past decade. Understanding sex offending through ITSO has concrete implications on a practical level. First, sexual interests assessment requires that the necessary ecological conditions be present to trigger sexual arousal. Second, the assessment procedure should identify risk factors by combining measures on different dimensions of sexual interests. Finally, the procedure should provide information on how sex offenders regulate their continuous interactions with a given environment in the light of their specific risk factors. This chapter conducts a narrative review of eight studies using virtual reality (with or without eye-tracking) for sexual interest's assessments. Studies will be sorted according to whether they essentially addressed procedure validation or combined physiological indicators.