The Health Blog

Because masturbation is so common after puberty, the incidence figures are useless for comparisons, but certain other aspects may be profitably studied. For example, the men in four of the six groups of patterned offenders spent more years worrying about their masturbation than did the incidental offenders, the proportion being about one third for the latter and one half for the former.

Every person who had masturbated was asked what was the greatest number of times they had done so in any seven-day period. Without exception the patterned offenders reported higher figures. The average incidental offenders reported maxima of from 2.8 to 4.8 per week, while the patterned reported 4.1 to 8.1. The greatest difference existed among the peepers (2.8 to 8.1) where masturbation was a frequent accompaniment of peeping. One may speculate that high maxima may be indicative of strong sex drive and of compulsion, and one would expect the patterned offenders to exceed the incidental in these two attributes.

While the presence or absence of fantasy during masturbation proved insignificant in differentiating patterned and incidental offenders, three sorts of fantasy did reveal definite differences. In five of the six groups, more patterned than incidental offenders had sadomasochistic fantasy; the percentages were generally small except in the case of the patterned aggressors, of whom one fifth had such fantasies. Again the patterned offenders led in five of six groups in fantasies of sexual activity with animals, though the percentages were generally small. In bizarre fantasy—often fantasy related to the offense behavior—the patterned offenders exceed the incidental in all six groups and frequently by large margins. This is one of our most clear-cut findings and one which could be logically anticipated: the habitual exhibitionists have fantasies of exposing themselves, the chronic peepers fantasies of peeping, etc. With one exception, from about one fifth to one third of the patterned offenders had such bizarre fantasies as opposed to no more than 10 per cent of the incidental offenders.

*391\161\2*

The use of drugs of all types has long been taboo in American society although formal control, first through medical prescription and then through traditional criminal sanctions, has had a shorter history. The complex of psychological and social resistances to the use of drugs is not a matter to enter into here, but it is important to recognize the emotional and intellectual horror that use of drugs invokes in the citizen who does not use them. The general climate of opinion among the public is often one of hostility and anger when the subject is broached.

Thus the combination of drug use and sex offenses provokes a stronger emotional response than either event singly. The “dope-crazed sex fiend” is a traditional figure in the mass media, and the drug-provoked “sex orgy” is a traditional event in our newspapers and magazines. Personifications of such steretoypes are actually very infrequent.

The chief drugs of interest here may be grouped into three classes.

First are the opiates, both natural and synthetic. These are clearly addicting drugs to which there is major physiological adjustment and whose absence in the addicted individual causes an identifiable syndrome of withdrawal. Such physiological involvement may be taken as the distinguishing aspect of addicting as opposed to habituating drugs. The natural opiates range from smoking opium to the chemically extracted or refined products such as morphine and heroin (diacetylmorphine). The synthetic opiates which have comparable analgesic effects and addiction liability may be used as substitutes for the natural opiates.

Opiate users in the various sex-offender and control groups are of two types. Aside from persons with no experience, there are those with experimental experience, i.e., “joypopping” or “skinpopping,” and those who are truly addicted or “hooked.” From the best evidence available, and it is none too good, it is fairly clear that persons addicted to opiates seldom fully refrain from future use. Recidivism is marked and proceeds at a very high rate.

The second class of drugs consists of a single item, marijuana. This drug is smoked in cigarette form and is nonaddicting. The use of this drug is often claimed to be a precursor of opiate use and addiction, but the data in this area are very poor. There is surely more experimentation with marijuana than there is with the opiate drugs, and it is unlikely that most marijuana users go on to opiate addiction. The patterns of marijuana use are often considerably different from the patterns of the opiate users, being more sporadic and involving less criminal activity. For the purposes of this study marijuana users have been divided into experimenters and habitual users.

The third class of drugs is a heterogeneous one containing a variety of drugs with a variety of effects. They are nonaddicting but habituating. The barbiturates, the amphetamines, and other prescription drugs ordinarily used as either sleeping tablets or stimulants are part of this group. Use of these drugs for their ostensible licit purpose is not included here. Our concern is with use of the drugs for their euphoric, stimulant, or escape effects known in the argot of the user as “kicks.” Also included in this group of drugs is cocaine. A strongly hallucinatory drug, it is nonaddicting, and presently its use is rather rare. It has been employed by some sophisticated addicts when available as a part of “speedball,” i.e., a mixture of heroin or morphine with cocaine, but such use is not frequent and given its nonaddicting characteristics cocaine is included in this miscellaneous category. Certain esoteric drugs are not included, such as peyote, mescaline, or LSD-25.

The use of opiate drugs is very rare among the control group. None of this group are addicted, and only around 2 per cent ever experimented with them. The figure for the prison group is much higher, with 8 per cent having used opiates at some time and an additional 9 per cent addicted. Between these two extremes are all the sex offender groups. Experimental use of the opiate drugs ranges from none in the case of peepers and incest offenders vs. children to 8 per cent in the case of the heterosexual aggressors vs. children. The percentage in this last case represents two persons. Most of the sex offenders never experimented with opiate drugs—not more than 2 to 3 per cent of any group. Addiction to opiates is even rarer, with six groups having no member addicted, six groups with 1 to 3 per cent addicted, and only two groups with higher proportions, these latter being the aggressors vs. minors and adults with around 4 per cent.

Opiate addiction is much less marked among the sex-offender groups than it is among the prison group, and although there is generally a little more experimentation with opiates and actual addiction in these groups than among the control group, it does not appear to be related in any Way to specific or generalized sex-offense behavior.

Use of marijuana is a more widespread phenomenon than use of opiates. A single experience or a few experiences with marijuana are not unusual among persons in certain subgroups in the general population. It is like experimenting with alcohol, and generally with less consequence to the individual. Marijuana is not easily come by, and its illegal status makes habitual use somewhat difficult and expensive.

Only 3 per cent of the control group ever tried marijuana, and only one person in this group could be called a habitual user. The figure for the prison group is 17 per cent, and an additional 10 per cent have histories of habitual use. All but one of the sex-offense groups vary between these two extremes as far as experimentation and use are concerned, the younger age-of-object offense groups usually having more experimentation with marijuana (except for the homosexual offenders), but this pattern does not appear among those who use it habitually. Nearly two fifths of the heterosexual aggressors vs. children have experimented with marijuana, but none of these ever used the drug habitually. As far as habitual use of marijuana goes, only the heterosexual aggressors vs. minors exceed the prison group.

While the sex-offender groups generally use marijuana more extensively than does the control group, only in two cases does their use surpass that of the prison group. Neither the experimental nor habitual use of this drug seems to be associated with any particular or general type of sex offense. Marijuana use, like opiate drug use, is not an agent in precipitating any specific sex offense, nor does it appear to be a long-term predisposing factor.

Use of other narcotic drugs of various types among the sex-offender groups again falls near or between the very low limits set by the control group and the upper limit set by the prison group, with ranges of 0.8 to 11 per cent for experimentation and 0.0 to 6 per cent for habituation. The heterosexual aggressors vs. minors are an exception, experimenting considerably with barbiturates and amphetamines, but this is not followed up by extensive habitual use.

None of the specific types of drugs seem to bear any weight in the analysis of the various sex-offense groups, but if the total proportion of any group who have ever used drugs of any kind, experimentally or otherwise, is examined, two groups appear sharply different from the others. Taking drugs for the purpose of stimulation is characteristic of only one in 20 of the control group, but of one in three of the prison group. Two groups that are very similar to the prisoners are the heterosexual aggressors vs. children and minors.

If drug use may be assumed to stand in some relation to the “try anything once” attitude, then it is clear that the aggressor groups in general, and the aggressors vs. children and minors in particular, have a highly experimental and possibly impulsive relationship to the world. In this search for “kicks” they are similar to the prison group and their attitude is probably more related to a general delinquency than to the specific type of offense.

The use of drugs of any type could be either an index of different attitudes and situations than are usual among persons in the lower social classes, or a precipitating factor in the specific offense. There is no evidence for this latter hypothesis as far as these data go. What is evident is that most of the sex-offender groups are more exposed to all types of drugs and are more often users than are their nondelinquent peers. But since their exposure is usually no greater than that of the nonsex-offender delinquents, it is not a special characteristic of the sex-offense groups. Thus drug use is here a measure of an attitude of experimentation and general delinquency.

*353\161\2*

The techniques and extent of extramarital and postmarital petting were not ascertained in the earlier case histories; consequently our data are seriously limited. Nevertheless, we found postmarital petting, like postmarital coitus, to be essentially universal. Extramarital petting, we know, considerably exceeds the incidence of extramarital coitus, but again precise data are lacking.

However, from our later, more detailed case histories it is clear that the men we interviewed had less mouth-genital contact with their postmarital or extramarital partners than with their wives. With regard to the balance between cunnilingus and fellation we see a compromise between the premarital situation and the marital. In three groups the percentage with cunnilingus exceeded the percentage with fellation experience, while in five the percentages were essentially equal. One may speculate that while marriage had relieved much of the inhibition regarding cunnilingus, some males still balked at applying the technique to a female less familiar than a spouse.

In postmarital and extramarital life the incest offenders vs. children and adults had the largest numbers of individuals with mouth-genital activity. The offenders vs. minors and adults as usual are at or near the bottom of the rank-orders and are joined there by the control group. The high ranking of the incest offenders vs. children is no surprise. After being restrained and/or inhibited about mouth-genital contact with companions prior to marriage, we see them become quite active in this technique with their wives, and this sexual emancipation seems to carry over into their post- and extramarital behavior. The high ranking of the incest offender vs. adults, however, has no visible precedent.

The above statements are made with caution, for our calculations regarding extra- or postmarital activity were, obviously, based on males who had married, and we are aware that in different groups varying proportions of men were divorced or had engaged in extramarital behavior. A rough check , indicates, however, that these differences did not exert a powerful influence. For example, the peepers, who rank first in cunnilingus with extramarital or postmarital companions, rank eleventh in the proportion who had ever had extramarital coitus.

*315\161\2*

One standard question in our schedule concerns erectile impotence. This seemingly simple question was actually fraught with various qualifications. For example, one should not count as erectile impotence a penile detumescence brought about by some strong external stimulus such as a knock on the door. If a man reported impotence due to the use of drugs or alcohol, the explanation was noted, but we did not routinely inquire about the cause of rare or infrequent impotence, and thus “lost” some unknown additional number of instances due to these causes. Consequently we have combined our categories of “infrequent impotence” and “impotence only when drunk or using drugs.”

In our previous volume on males we found the most important correlate of impotence to be age. In this present study, however, where we are dealing chiefly with persons under fifty, the effect of age is scarcely seen. It is visible only in that our second youngest group, the peepers, had fewest individuals reporting any erectile impotence (31 per cent), whereas our oldest group, the incest offenders vs. adults, reported approximately twice as many (61 per cent). The second oldest group, the incest offenders vs. minors, ranked second highest with 58 per cent reporting any degree of impotence. Here the correlation ceases, for the group with the third largest proportion of men who had experienced impotence is our youngest group.

Aside from this rather vague but anticipated relationship with age, tabulation reveals two trends. First, all incest offenders tend to have a high incidence of impotence, ranking first, second, and fifth. Secondly, in the five groups with the least impotence are the four whose sexual behavior most closely approximates cultural norms: the control group, the prison group, and the offenders vs. minors and adults. At this juncture the reader should be warned not to place much reliance upon the figures for the homosexual offenders, since it was not always clear in the records whether the data referred to heterosexual or homosexual impotence.

The proportions reporting infrequent impotence or impotence resulting from overdosage of alcohol or drugs range from one fifth of the control group to one half of the aggressors vs. minors. The heterosexual offenders and the control group, who had few alcoholics among them, had the fewest individuals reporting infrequent or toxic impotence. The four groups with the largest numbers were two incest and two aggressor groups. Of the latter, one may suspect some psychologic impotence due to the response of the females upon whom they forced themselves; of the incest groups, age may explain the incest offenders vs. minors (our second oldest group), while the large number of alcoholics among the incest offenders vs. children may explain their standing.

A rank-order of those reporting occasional erectile impotence displays all but one group with percentages of from 2 to 10; the exception (with 28 per cent!) are the incest offenders vs. adults. It is best once again to refrain from using age as a causative factor since our second oldest group, the incest offenders vs. minors, occupies the bottom of the rank-order with 2 per cent.

A rank-order of those who reported serious and/or frequent impotence has a range running fairly smoothly from 0 to 14 per cent. The aggressors, peepers, and prison group cluster at the bottom of the scale as befits their relative youthfulness. The top three ranks (10 to 14 per cent) include our second and third oldest groups. The control group is centrally located with almost 8 per cent reporting serious impotence. The presence of all three homosexual-offender groups within the upper five ranks is, despite our previous warning, probably indicative of conflict between their heterosexuality and homosexuality.

*277\161\2*

Of those who married, 52 per cent had extramarital coitus, which places them in a low-intermediate position in the rank-order, just above the peepers. In the case of the latter, the youthfulness of the sample was a factor in the paucity of extramarital coitus, but this cannot be true in the case of the exhibitionists whose average (median) age is nearly thirty-five. The age-specific incidence figures for extramarital coitus with companions are always moderate, though well above those of the control group. From ages twenty-one to forty-five, between 31 and 37 per cent of the exhibitionists were having such coitus within any five-year age-period. Aside from one aberrant figure based on a small number of cases in age-period 41-45, the age-specific incidence for extramarital coitus with prostitutes is similarly moderate, holding between 14 and 17 per cent. The frequencies of extramarital coitus tend to be low or intermediate except from thirty-one to thirty-five; where one high-rating individual strongly affects the mean frequency. There is a strong emphasis on prostitution; these men had extramarital coitus with prostitutes almost as often as with companions. The average (median) exhibitionist who had extramarital coitus had it with five females—a moderate number and the same as that recorded for the control group. The proportion of total sexual outlet constituted by extramarital coitus with companions parallels what we have seen in frequencies: it is rather small (usually 1 to 3 per cent, except in age-period 31-35 when the effect of the one deviant individual is felt. The proportion of total outlet derived from extramarital coitus with prostitutes reflects the importance of commercial sex to these offenders— I hey manifest relatively large proportions, usually ranking first or second, just below or just above the prison group.

The exhibitionists whose marriages broke up continued to have coitus in a high percentage of cases; indeed, between ages thirty-one and forty all the separated, divorced, or widowed exhibitionists had post-marital coitus. The frequency, however, tended to be low. This combination of high incidence and low frequency results in their having derived moderate proportions of their total outlet from postmarital coitus. The difference between coitus with companions and with prostitutes is especially important here: the proportion of outlet derived from companions is moderate up to age thirty-five (61 per cent, declining to 46 per cent) but small thereafter (16-24 per cent); the proportion derived from prostitutes is always relatively large, in fact, the exhibitionists rank first to third, and the figures increase progressively with age from 4 per cent between twenty-one and twenty-five to 57 per cent between forty-one and forty-five. This same emphasis on commercial sex in later life is seen in age-specific incidence of post-marital coitus with prostitutes, in which the exhibitionists rank first from age thirty-one on, with a figure of from 67 to 90 per cent having such activity in a given period.

*238\161\2*

As noted previously, if left untreated, the lesions eventually disappear on their own, but the process may take several months. To speed up this process, there are two treatment options. The first is freezing the lesions with liquid nitrogen—which is also the standard treatment for another sexually transmitted skin infection, genital warts. Another common treatment for warts, topical liquids such as podophyllin (10-25% solution) or trichloroacetic acid (80-90% solution), can be used either alone or in addition to the liquid nitrogen. These treatments basically destroy the virus as well as the skin cells containing the virus. The second treatment option is to nick the skin of the lesions with a sterile needle and then express the central core of virus.

This is easier if the lesions are larger. The lesions tend to be well vascularized, so bleeding can occur with this method. Patients can be taught to perform this procedure themselves.

Treatment may not be successful in people with such underlying immune system problems as AIDS.

The lesions are usually not red, tender, or filled with pus. If these features are noted, it may be a sign that there is a secondary bacterial infection, most often with the common bacteria found on the skin, such as staphylococcus and streptococcus. Such infections occur in about 40 percent of those with molluscum infection. If a secondary bacterial infection is suspected, antibiotic treatment may be necessary.

*349\213\8*

As discussed previously, the classic symptoms of blisters and ulcers do not occur in everyone who has herpes. If symptoms do develop, however, they usually do so within two to twenty days of first infection. After infection with herpes, whether or not a person develops symptoms, the virus moves from the skin into the nerve endings that supply the area of the skin that was infected. It migrates along the nerve endings to the nerve root body, or ganglion, which is near the spinal cord. Here the virus remains quiet, or dormant, and then periodically migrates back out to the surface of the skin.

When the virus migrates back to the surface of the skin, a person may develop symptoms, such as a sore or itching or tingling on the skin, or he or she may remain completely symptom free. The condition in which there are symptoms is called an outbreak; when the virus comes to the surface of the skin and doesn’t cause symptoms, the condition is referred to as asymptomatic or subclinical shedding of the virus. Sometimes there is a warning that the virus is reactivating; this warning, called a prodrome, may consist of itching, tingling, or pain in the area where the outbreak takes place, but before there is any evidence on the skin. However, not everyone experiences prodromes.

Everyone who has oral or genital herpes, whether type 1 or type 2, will shed without symptoms at some point. How often this occurs varies from person to person. Why some people shed more than others, and why some people have more outbreaks than others, is not clear.

Two things are clear, however: people who are newly infected (for less than a year) have more asymptomatic shedding than those who have been infected for a longer time, and people who experience more frequent symptomatic outbreaks also tend to shed the vims more often without symptoms than those who rarely have outbreaks.

*256\213\8*

This bacterial infection is treated with antibiotics. In the United States, the first choices are doxycycline or trimethoprim-sulfamethoxazole. Ciprofloxacin and erythromycin are second choices.

Although treatment is only successful if it is continued until the infection has been cleared—usually in about three weeks—and the infection may recur if the antibiotics are stopped sooner, it is sometimes difficult for various reasons for people to take the full course of antibiotics. Studies are under way to determine whether medications such as azithromycin, which remain in the body longer (and thus require fewer doses to be taken), are a reasonable alternative.

Scarring may persist despite adequate treatment, but it is usually minimal if medical attention is sought early in the infection. If a secondary bacterial infection develops on top of the donovanosis, it may need to be treated with different antibiotics.

Treatment may not be as successful in a person who has a compromised immune system, such as one with HIV infection. In this case, the medications are taken for a longer period.

All sexual partners of a person with donovanosis for a period of up to sixty days before the infected person developed symptoms must be treated with antibiotics, even if they are symptom free.

*164\213\8*

As enzymes go, PSA is kind of a tough guy. Like a feisty slugger always looking for a fight, it actively attacks proteins at every opportunity. In the bloodstream, however, PSA is usually restrained by inhibitors that prevent it from breaking down proteins; like a member of a chain gang, it is tied up, or bound.

In one promising new area of research, scientists are working to characterize the forms of PSA in the bloodstream. Is the PSA bound to the inhibitors, or is it on the loose—is it free? Currently, the tests doctors use to measure PSA detect both the bound and unbound molecules. But it might be helpful if we could tell which was which; new evidence indicates that the amount of bound PSA in the blood may be higher in men with prostate cancer than in men with BPH. If this proves to be true, one day soon it may be possible to distinguish between the PSA arising from prostate cancer and the PSA arising from BPH by measuring both its bound and free forms.

In the future, we’ll see a new, more specific generation of PSA assays, tests capable of quantifying different forms of the molecule in the bloodstream. Such tests may provide useful clinical information, not only for diagnosis of prostate cancer, but also for evaluation and follow-up.

*73\201\8*

Believe it or not, diet even has an effect on hormones such as testosterone. A diet that’s low in fat and high in fiber lowers the amount of testosterone in the blood, and hormones such as testosterone play a big role in the growth of prostate cancer. One study found blood testosterone levels in young black men to be about 15 percent higher than those of young white men; a similar study found that Dutch men had higher levels of male hormones than Japanese men. Also, studies of American men have found that they have higher levels of DHT (dihydrotestosterone) metabolites than Japanese men. (DHT is the active form of male hormone in the prostate.) Some investigators interpret this to mean that more DHT may be the cause of the cancer. However, DHT is produced by the secondary organs of reproduction (such as the prostate), and Oriental men tend to have smaller hair follicles and prostates. Which is the cause and which the effect? The lower DHT may simply reflect the fact that Japanese men have inherendy smaller secondary organs of reproduction, which contribute less DHT to the circulation.

Other studies found that black and white American men had higher amounts of these male hormones in their urine than black South African men, and that the level of these hormones had a lot to do with diet. When the black South African men ate a Western diet, instead of their usual vegetarian diet, their hormonal levels went up. And when black American men ate a vegetarian diet, their hormonal levels went down. Again, this seems to be more proof that a low-fat, high-fiber diet can lower any man’s risk of prostate cancer.

*27\201\8*