In every one of the six sex-offense types a larger proportion of sexual psychopaths had had sexual contact with animals than had the other offenders. The differences were modest in four instances—a matter of three to six percentage points—but very great in the remaining two. Among the aggressors vs. adults the incidence of animal contact was 43 per cent for the sexual psychopaths (a large figure by any standard) as opposed to 14 per cent for the other offenders. Among the incest offenders the equivalent figures were 36 vs. 10 per cent. In the other sex-offense types the proportions for both the sexual psychopaths and other offenders are essentially one fifth to one quarter.

This trend toward animal contact shown by the sexual psychopaths may reflect a greater experimental interest and/or a certain sexual polymorphy and lability.

*406\161\2*

“In what sorts of places are sex offenses most likely to take place?” is a question often asked by parents, police officials, and legislators, as well as by the general public. Table 144 summarizes our findings and shows clearly that the various classes of offenses differ rather widely in the types of places in which they occurred. Some of the findings might be expected, such as the high frequency with which incest takes place in the home; other findings are less foreseen.

In this final category there are a variety of places, none of which fit into the six standard classifications of residence, outdoors, automobile, theater, public toilet, and school. Into this leftover group fall from 0 to 10 per cent of the offenses. The highest percentages—from 7 to 10 per cent—appear in the three homosexual groupings, which occurred chiefly in such places as Turkish baths and other places of business, especially bars and taverns. Among other sites in this final “catchall” class were a coliseum, a firetower, and a hospital. Several offenses took place in empty houses, garages, or barns. One happened in a jail, another in a barracks room, and, finally, one in a house of prostitution.

*368\161\2*

Persons with more than incidental homosexual experience were generally asked a whole series of specialized questions concerning homosexuality. Feeling that the answers to some of these questions might be significant in a study of sex offenders, we decided to select from this sample those with extensive experience (which we define as having over a score of male partners outside institutions) and analyze the answers they gave.

Only four groups, the homosexual offenders and the prison group, included enough cases of extensive homosexuality to warrant study: in the other groups no more than 7 per cent were eligible, and in the incest offenders none. Approximately one eighth of the prison group, one third of the homosexual offenders vs. children, one half of the homosexual offenders vs. minors, and three quarters of the homosexual offenders vs. adults had had extensive homosexual experience.

Strangers as partners

Half of the prison group and homosexual offenders vs. adults, and one third of the other homosexual offenders, reported that the great majority (over 80 per cent) of their partners were “pickups”—men they had never seen before and usually never saw again. This means that many of the men with extensive homosexuality sought partners in public places and were correspondingly vulnerable to arrest. This matches our data on the circumstances surrounding the offense behavior of the homosexual offenders vs. adults who frequently “cruised” bars, public toilets, parks, theaters, and streets.

Initiative

The foregoing brief analysis raises the question of who takes the initiative in homosexual approaches. Two variables here are of prime importance. First, the age of the partner sought in large measure determines who makes the approach. Adults interested in children or minors must take the initiative most of the time. Almost two fifths of the homosexual offenders vs. children and one quarter of the homosexual offenders vs. minors reported being almost always the initiator, in contrast to 8 to 10 per cent of the homosexual offenders vs. adults and the prison group.

The second variable is the degree of emotional involvement. All the homosexual offenders with extensive histories were deeply interested in sexual activity with other males and hence many more often than not took the initiative. The offenders vs. adults did not have to be as habitually aggressive as men who seek younger males; nevertheless, twice as many of them as the prison group reported they more often made than received an approach. This lack of enterprise by the prison males reflects the fact that a goodly number of them were more interested in homosexuality as a source of funds than as a source of emotional gratification. While the young delinquent may not actively seek homosexual partners, he often welcomes a man who will not only fellate him but pay him too. Somewhat over one quarter of the prison group stated that they were almost always approached (the homosexual groups never exceed 7 per cent) and nearly another quarter said that more often than not the other man made the approach.

Prostitution

Sixty per cent of the prison-group males with extensive homosexual experience accepted money often enough to merit the label of prostitutes, whereas this was true of only 14 to 16 per cent of the homosexual offenders. Looking at the reverse of the coin—the percentage who had ever paid cash for a homosexual act but had never themselves received payment—one finds in this category very few of the prison group (3 per cent), but from 20 to 29 per cent of the homosexual offenders.

The percentages of those whose homosexual lives had never involved payments in cither direction require some explanation. The least commercial are the homosexual offenders vs. children, of whom about half had never paid or been paid. This is in part due to the extreme youthfulness of some of their partners. No money was involved for nearly two fifths of the homosexual offenders vs. minors. For the homosexual offenders vs. adults the figure is somewhat less than one third; these men were dealing not only with adults, who are apt to be mercenary, but with many more partners than were other offenders and hence were more open to prostitution. Lastly, again due to the predilection toward prostitution, only about one fifth of the prison group bad never paid or been paid.

Love

The converse of prostitution is love, and the men with extensive homosexual experience were asked if they had ever loved another male. Affirmative replies were received from about half of the prison group, two thirds of the homosexual offenders vs. children, three quarters of the homosexual offenders vs. minors, and four fifths of the homosexual offenders vs. adults. This sequence parallels the degree of homosexual orientation of these same groups even when one includes those with little or no homosexual experience. The same sequence obtains with regard to multiple love affairs, the prison group reporting the fewest and the homosexual offenders vs. adults the most.

Obviousness

One important item in homosexuality is of especial significance in connection with surveillance and arrest—the recognizability of a person’s homosexual orientation. In our culuture a minority of individuals with (usually predominant) homosexual interest have, for a variety of complex reasons, adopted certain characteristics of behavior and dress which identify them as homosexual. In a few cases these characteristics are blatant and often grotesquely exaggerated copyings of female behavior and dress; it is unfortunate that this tiny minority has, because of their obviousness, misled the public into the belief that they epitomize homosexuality. The truth is that in many cases the identifying characteristics are extremely subtle and can be recognized only by people who are not only knowledgeable but also especially perceptive, and even they not infrequently misjudge.

The men with extensive homosexual histories were questioned about mannerisms and dress and, in addition, the interviewer made private judgments on this matter. Taking both sets of data into account, we find that only a few (14—16 per cent) of the homosexual offenders vs. minors and children with extensive homosexual experience were highly recognizable as being homosexually inclined. In the prison group there were substantially more (23 per cent) such individuals, and among the homosexual offenders vs. adults the most (31 per cent).9The small proportion of easily recognizable individuals among the homosexual offenders vs. children and minors is probably due in part to their interest in young partners, with whom homosexual mannerisms have little or no functional value in terms of recognition, solicitation, or establishing rapport. The larger proportion among the prison group is probably chiefly due to age: the average prison-group male is about ten years younger than the average homosexual offender, twenty-one vs. thirty-one, and we assume a similar age discrepancy among the members of these groups with extensive homosexual experience. Easily recognizable mannerisms are found far more frequently in the young adult; the older adult has usually abandoned the more obvious manners after learning through experience that they bring more trouble than reward. Even in homosexual circles obviousness, which may be condoned in the young, is looked upon as a defect once a man nears or reaches his thirties. The relatively large proportion of clearly homosexual males among the homosexual offenders vs. adults seems the product of a selective process in arrest, the obvious male being identified and watched and hence more often arrested, and also the product of a certain kind of fatalistic rebellion—an attitude of “All right, I admit I’m homosexual and so I’m going to behave as society expects homosexuals to behave.” It is probable that the men interviewed in homosexual segregation units in prison—and we interviewed extensively in these units—are more prone to this kind of fatalistic rebellion than they would be if they were not in prison or not segregated. In brief, putting men in homosexual segregation causes some of them to become more obviously homosexual in manner. Certainly nowhere near one third of the men outside prison with extensive homosexual histories could be labeled as easily recognizable; the figure would more likely be in the vicinity of 10 to 15 per cent. Regret

Asking males with extensive homosexual experience as to whether or not they regretted their homosexuality involves many complications when one attempts to interpret the answers, and an additional complication arises when one asks the question of a man who has been convicted of a homosexual offense. Between one quarter and one third of the prison group regretted their homosexuality, nearly one half of the homosexual offenders vs. adults, about three fifths of the homosexual offenders vs. children, and almost two thirds of the homosexual offenders vs. minors. This same sequence is found in the percentage of those who expressed a high degree of regret, although the figures are smaller. The minimal regret expressed by the prison males undoubtedly reflects the homosexual prostitute’s lack of emotional involvement and the generally amoral character of the prison group. The considerable regret of the homosexual offenders vs. children and minors may be largely an expression of remorse for their pedophilia added to regret about homosexuality in general.

*330\161\2*

The average (median) individual in each of our groups had his first postpubertal sexual contact with a female somewhere between the ages of fourteen and seventeen. The more inhibited (e.g., the incest offender vs. adults), those whose later lives are marred by difficulties in heterosexual adjustment (as the exhibitionists and peepers), and the most homosexual (the homosexual offenders vs. adults) tended to begin petting late, while some of those whose later heterosexual activity was extensive (e.g., die prison group) began early.

It is instructive to note the difference between the median age at puberty and the median age at the time of the first heterosexual experience. Those with the greatest gap—at least two years—between puberty and petting are the homosexual offenders vs. adults, the incest offenders vs. minors and adults, and the peepers. Next come the exhibitionists. All these groups later either had restrained premarital histories or, in the case of the exhibitionists, a definite problem in heterosexual adjustment. Those with die smallest gap—one year or slightly less— between puberty and heterosexual experience include the prison group and the three heterosexual-aggressor groups, all of whom later had considerable heterosexual activity. The heterosexual offenders vs. minors and adults, who also are typified by extensive heterosexual experience, did not start so soon after puberty—there was a hiatus of a little over a year, although this is less than for most of our comparative groups. Perhaps the very aggressiveness of the heterosexual aggressors led to their beginning sooner than the heterosexual offenders vs. minors and adults.

Heterosexual petting is ultimately an almost universal experience; even among the homosexual offenders 85 per cent or more petted after reaching puberty.

In our calculation of the percentages who had petting experience with companions or prostitutes by a given age, a number of trends are seen. The prison group and the heterosexual aggressors vs. minors soon lead all the rest, with over 87 per cent of their members having petted by age sixteen, and by age eighteen 93 per cent or more. This foreshadows their subsequent above-average heterosexual activity. The homosexual offenders by age twelve occupy an intermediate to low position in a rank-order of boys experienced by that age, and they rank even this high because of their previous good social relations with girls. Subsequently they gravitate to the lower portions of the rank-orders as the more heterosexually oriented groups overtake and surpass them. Other groups whose members also have difficulty in making sexual adjustments with adult females, as for instance the exhibitionists and incest offenders vs. adults, are likewise to be found in the lower half of the rank-orders.

The control group occupies what may be termed a low-intermediate position through age sixteen, and intermediate positions thereafter, beginning with 28 per cent who were experienced by age twelve and grading up to 93 per cent by age twenty.

In calculating age-specific incidence, the percentages with petting activity within a given age-period, we excluded all activity with prostitutes, an exclusion that, unfortunately, was not made in accumulative incidence. Nevertheless, the two incidence calculations may be meaningfully compared, since prostitution only rarely constitutes a man’s sole heterosexual behavior and is still more rarely his first heterosexual experience.

In the earliest age-period (puberty-15) there is but one salient feature: the heterosexual aggressors occupy three of the top four rank-order positions with from 74 to 88 per cent of their members petting. Such precocity among males all subsequently convicted for sexual aggression suggests some relationship between early sexual activity and aggression.

The years from sixteen to twenty constituted a period of the greatest participation in petting, and the percentages are so high as to make meaningful differentiations difficult. However, we see the homosexuals becoming a unit at the bottom of the rank-order, just below the exhibitionists, the incest offenders vs. adults, and the heterosexual offenders vs. children—all forming a block of groups whose members typically have unusual difficulty in working out sexual adjustments with adult females. These groups have from 76 to 88 per cent of their members involved, the control group is intermediate with 91 per cent, and the heterosexually more active groups range on upward to 100 per cent.

In the following age-period (21-25) a most interesting phenomenon occurs: a small decrease in percentages for most groups. The amount is usually trivial—a percentage point or two—but the reality of the decrease is emphasized by the fact that the next age-period (26-30) also shows a decrease. This falling off in the number of persons having premarital petting activity must be due to disinterest and/or to their confining their activity to prostitutes. Disinterest is probably the more important of the two factors: we know that beginning in age-period 21-25 a selective process occurs whereby the more heterosexual men marry and remove themselves from the premarital picture, leaving an increasing residuum of confirmed bachelors of whom some are apathetic or homosexually inclined. The homosexual offenders vs. adults show the most marked drop-off, the percentage falling from 76 to 59 between the ages of sixteen and thirty. The other homosexual offenders declined quite sharply between thirty-one and thirty-five; one is left with the impression that in later life unmarried homosexual offenders tend to abandon even experimentation with women.

Between the years of twenty-one and twenty-five the control group somewhat increases the figure it had for age-period 16-20, and consequently rises to fourth rank. Two of the incest-offender groups also rank high, but for a special reason: by definition all of them married, and marriage is almost inevitably preceded by a period of petting. The typical restraint of the incest offenders vs. adults, however, holds them lower in the rank-order.

We have been discussing petting per so; now let us turn to permarital petting that results in orgasm for the male. From 16 to 54 per cent of the males in the various groups had had this experience. Those groups fewest of whose members had petted to orgasm are groups characterized by trouble in heterosexual adjustment—homosexual offenders vs. adults, peepers, and last of all incest offenders vs. adults (16 per cent). At the high end of the scale are the; incest offenders vs. children, with the aggressors vs. adults second and aggressors vs. minors and the control group third. Otherwise there seem to be no trends or clusterings; indeed, the groups constituting the tripartite categories are usually widely scattered—for example, the first and last ranks are occupied by incest offenders. Nor does age appear to be a significant variable: the peepers, our youngest group, are next to the incest offenders vs. adults, our oldest group.

In age-specific incidence one sees that in the first two age-periods there is a tendency for those groups that are distinguished for their large amount of heterosexual activity to rank high in petting to climax, and those notable for their difficulties in heterosexual activity to rank low. Examples of the former are the aggressors vs. minors and adults and the prison group. Examples of the latter are the incest offenders vs. adults, die peepers, and the homosexual offenders vs. adults. This simple logical picture becomes complicated after twenty, when we see the control group, which is not famous for its heterosexual prowess, occupying first or second rank routinely, and the previously low-ranking incest offenders vs. adults and peepers rising to intermediate position. Evidently the explanation is that in early postpubertal life the more aggressive and sexually motivated plunge into heterosexual activity chiefly oriented toward coitus and, as a by-product or “spillover” phenomenon, also have more than average experience in reaching orgasm in petting—sometimes by accident rather than design. Later the individuals who were less successful in obtaining coitus begin to appear increasingly among those who petted to orgasm. There seem to be several reasons for this. The males who refrain from premarital coitus, or who are unable to obtain it readily, will consequently find in petting the bulk (if not the total) of their heterosexual activity, and there is a correspondingly increased probability of their reaching orgasm in petting either by accident or design. While petting to orgasm is deliberately used as a substitute for coitus by many college men and women, it is rather rare among the groups we are currently examining. Another factor that helps to account for the shift in position in rank-order is the increasing sophistication of the coitally more successful groups. Many of these people have become expert both in selecting cooperative partners and in persuading others to become cooperative. Therefore, most of their heterosexual activity results in coitus, often with a minimum amount of time spent in preliminaries. As a result there is less possibility of their petting to orgasm. Thus we see the incidence figures for these groups drastically decreasing with age, and their rank-order positions becoming correspondingly lower.

*292\161\2*

In terms of their social and economic status, the parents of the sex offenders occupy a low position in society. A low status is typical of people in prison, and the bulk of our sample of sex offenders had been imprisoned at one time or another. However, it is surprising to find that, on the whole, the sex offenders’ parents occupied a lower socioeconomic position than did the parents of our prison and control groups.

We routinely questioned each person interviewed about the economic status of his parents when he was aged fourteen to seventeen, and our impression is that there was not much change in it over the years: what was true when he was fourteen to seventeen was, generally speaking, also true when he was younger. On the basis of the answers, the parents were assigned to categories ranging from “extremely poor” up to “rich.” Since in this particular study there was virtually no one whose parents were wealthy, we need not concern ourselves with any economic category above “upper middle class.”

Far more of the sex offenders reported their parents as being “extremely poor,” “poor,” and “moderately poor” than did members of the prison and control groups. Conversely, they reported the lowest percentages in the categories “lower-middle,” “middle,” and “upper-middle.”

In addition to this generalization—that of the prison, control, and sex-offender groups the parents of the last were the poorest—one can note three other phenomena. First, the incest offenders seem to have come from the more financially deprived homes. Second, there is remarkable similarity in the parental economic status of the prison and control groups. Third, the homosexual offenders’ parents were financially better off than most. The reason for and the consequences of the relatively low financial status of the sex offenders’ parents are unknown. However, our data indicate that financial deprivation does not significantly correlate with sexual deprivation.

Aside from money, educational achievement plays a strong role in determining social status, but our data on this point are weakened by many instances in which the information was not obtained. Using only the cases where the father’s (or surrogate father’s) education is known, we find the control group and most of the sex offenders essentially the same: about two thirds to three quarters had fathers with grammar school education, parents of one fifth had some high school, and one tenth had some college education. The fathers of the prison group were somewhat better educated: slightly over half had not gone beyond grade school, one quarter had gone into high school, and nearly one fifth had gone into or beyond the first year of college. The similarity of the control group and the sex offenders is reasonably certain since the proportion of cases in which the father’s education was not recorded is about the same for each group. However, information concerning the father’s education is lacking in over half of the prison-group case histories; hence the findings are somewhat suspect.

Essentially the same picture is seen in the mother’s (or surrogate mother’s) educational attainment, the sex offenders and the control group being very similar, and the prison group’s mothers being better educated. Interestingly, more mothers than fathers attended high school; about 30 per cent of the mothers of the sex offenders and control group had from nine to 12 years of schooling (as opposed to one fifth of the fathers), and only about three; fifths never went beyond grade school (as opposed to two thirds of the fathers). This same trend is visible in the prison group. It probably represents the result of what was once a prevalent education vs. economics philosophy—a boy can be put to gainful work after graduation from grade school, but a girl is better kept in school and out of trouble for a few years until she is old enough to be married. As with the fathers’ education, the unknowns in these data are usually large.

A comparison of the parental education of the various types of sex offenders reveals nothing outstanding except that the educational achievement tends to be low for parents of incest offenders and high for homosexual offenders. Considerable intergroup variation occurs.

*254\161\2*

About seventy-two hours after outpatient treatment has begun, a follow-up visit is usually scheduled; if things have improved, another follow-up visit is scheduled after treatment. If her condition is not improving, the woman may be admitted to the hospital so that intravenous antibiotics can be administered. Any woman with PID must abstain from sex during treatment. Even if the cause of the infection is suspected to be a nonsexually transmitted organism, any sexual partner within the past two months must be treated as a contact, regardless of whether or not he has symptoms or shows evidence of infection on examination. Further follow-up visits after treatment has been completed are essential to make sure the treatment was effective.

A woman with an IUD usually must have the device removed, since the infection is very difficult to treat if it is left in place. An alternative plan for contraception must then be discussed.

A single episode of PID changes the anatomy of the pelvic organs, so that a woman is at high risk for developing PID again if she is infected with these bacteria. Thus it is especially important that she protect herself from becoming reinfected in the future.

Very rarely, and only in cases of severe infection, a hysterectomy (removal of the pelvic organs) must be performed to eliminate the infection. Fortunately most women respond well to the antibiotics, although the complications, such as scarring, can sometimes still occur, especially if the woman delayed in seeking treatment.

*364\213\8*

Couples in which one partner has herpes and the other one does not should abstain from sex during outbreaks, since the risk of transmission is greater at this time. Between outbreaks, condoms help reduce the chance of transmission of virus by about 50 percent (as noted earlier, this protection is not total because shedding in an area outside that covered by the condom can transmit virus). For nonpenetrative intercourse for which a condom can’t be used, another barrier method, such as a dental dam, should be used.

Whether nonoxynol-9 helps to prevent transmission of herpes is not clear. In the test tube, this spermicide has strong antiviral properties, including against herpes viruses. However, a significant minority of people who use it experience allergic reactions to it, and breaks in the skin caused by these reactions may actually make herpes transmission easier. Studies are under way to evaluate the use of this spermicide in preventing herpes transmission.

*271\213\8*

For women, yeast infections usually cause redness and itching of the genital area and a clumped discharge that looks like cottage cheese, though it may be thinner in consistency. The itching can be intense, and it can be internal (in the vagina) or external (on the vulva and anal area). There may be a burning sensation in the genital area, pain with intercourse, and burning with urination when the urine hits the raw skin. There may be a bread-like “yeasty” odor from the genital area. Breaks in the skin may develop if there is significant inflammation,- these breaks are sometimes mistaken for other genital infections that cause lesions, such as herpes. The outside of the cervix may appear raw and irritated on examination. The symptoms seem to be especially bothersome before menstruation. Male partners of women with yeast infections may feel a temporary burning or notice redness on the penis after intercourse.

For men, fungal infections in the genital area usually cause itchy red patches of skin, which may occur in the groin area and on the penis and testicles. The red patches are usually flaky in appearance, and they usually (although not always) itch.

The lesions of a fungal infection in men can be difficult to distmguish from those caused by other skin conditions, such as herpes and psoriasis.

*180\213\8*

John met Sandra a few months after he broke up with Susan, and he told her before they became intimate that he had herpes. Sandra didn’t know much about herpes, so John spent a lot of time discussing herpes and his history with the virus. He gave her reading material about herpes and gave her time to digest it. However, he still viewed the virus as his responsibility, and his alone, in the relationship. “The last thing I want to do is give this to Sandra. I don’t want her to have to go through what I went through.”

But Sandra would not have to go through what John went through, because John had informed her before they became sexually active that he had herpes, and she had made the decision to proceed with the relationship. She knew that the responsibility was a shared one, and she reassured John that she wanted them to deal with this issue together. Making decisions together, as a team, helped Sandra and John lay a solid foundation on which to build other aspects of their relationship.

When you do decide to tell someone, be well informed about the infection and have literature available for your partner so that any questions can be answered. How you present the infection will have much to do with how your partner views it. If you tell your partner, “This is the worst thing that has ever happened to me,” he or she will view it that way, too. It may take your partner a few days to process all the information. Give your partner time. He or she may not see the infection as a big deal or may even tell you that he or she also has the infection. About one-fourth of sexually active adults have genital herpes, for example, so there is a good possibility that your partner may also be infected, even if he or she doesn’t know it. You may want to go together for counseling with a health care provider who is well informed about STDs. Or your partner may want to visit a health care provider alone to have some of his or her questions answered. It’s up to you and your partner. Thousands of issues make up a relationship, and an infection such as herpes is just one of them. By following the suggestions presented here, you increase the likelihood that your relationship will continue to grow and move forward.

*88\213\8*

Prostate infection. Infection of the prostate (called prostatitis) can be either bacterial or nonbacterial in origin. Bacterial prostate infection can be acute or chronic, and it usually causes pain in the area of the prostate (between the scrotum and anal area), increased frequency of urination, and interruption in the flow of urine, as well as other symptoms, such as fever and chills. There may also be irritation inside the urethra, as well as discharge.

Urinary tract infection. Although UTIs are not very common in men, they can occur. The symptoms include burning with urination and an increased frequency of urination. If the kidneys are infected as well (a condition called pyelonephritis), there may be fever, chills, and back pain in the area of the kidneys. When a man does develop a UTI, an assessment is usually made to determine whether there is an anatomical problem that would make it more likely for him to develop infection; the presence of kidney stones is another possible promoting factor. Men who perform unprotected anal intercourse on a partner may also get a UTI from the bacteria that are in stool. The most common cause of burning with urination in men, however, is not a UTI but a urethral infection from a sexually transmitted infection.

Warts in the urethra. Warts are one of the most common STDs, if not the most common. They usually appear as flesh-colored bumps on the skin that are harder than the surrounding skin, but sometimes they occur inside the urethra and may cause irritation, discharge, and a disruption in the flow of urine. A thin scope is inserted into the urethra so that the doctor (usually a urologist) can see the warts and treat them.

*34\213\8*