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There are some differences between the sexual psychopaths and the other offenders in age at report. In all but one instance the sexual psychopaths are younger, the difference ranging from as little as three years (among the incest offenders) to as much as ten (among the exhibitionists). Among the offenders vs. children the two groups were the same age. This youthfulness of the sexual psychopath is probably due to the fact that younger males were selected as more amenable to treatment.

The sexual psychopaths also tend to be better educated: among all except the exhibitionists they have a larger proportion of persons with some college education, and in five of our six comparative cases they also had a larger proportion with eleventh- and twelfth-grade education. Once again this situation is probably the result of selection on the basis of treatability, those with more education being on the whole more intelligent than those with less. In addition, other factors may be involved: the better educated may more often request psychiatric examination, and there is a tendency for clinicians to feel an increased obligation to try to salvage someone with greater education and social status.

The same picture prevails when one examines intelligence ratings. In all but the exhibitionists the sexual psychopaths reveal far larger proportions of men with above-average intelligence.

In terms of the person’s previous history of treatment for mental disturbance, there were no consistent differences between the sexual psychopaths and other offenders regarding institutionalization: relatively few (never over 8 per cent) had ever been in a mental institution prior to the sex offense that labeled them. However, more sexual psychopaths than other offenders had received private treatment—a not unexpected finding—but this was true of only a few individuals. When one considers either the proportion of married men or their ages when first married, a number of interesting phenomena come to light. In four of our six offense groups essentially the same proportions of sexual psychopaths and other offenders had been married. However, in the other two groups there are radical differences: among the exhibitionists 76 per cent of the sexual psychopaths married as opposed to 62 per cent of the other offenders, despite the fact that the latter were, on the average, nearly ten years older than the former. This should not be construed to mean that the exhibitionists who were not sexual psycho paths had a less or more difficult heterosexual development. On the contrary, more of them had premarital coitus, and with more females, than did the sexual psychopaths. The reason for this difference in proportion ever married remains unknown. The other group displaying a marked difference is the homosexual offenders vs. minors: 24 per cent of the sexual psychopaths had married in contrast to 44 per cent of the other offenders. The difference in this instance may be that the sexual psychopaths were more strongly homosexual; note that 29 per cent had no premarital coitus, a figure nearly double that of the other homosexual offenders vs. minors.

The accumulative incidence figures of age at first marriage show that in earlier adult life, from age eighteen up to twenty or twenty-three, the sexual psychopaths generally have larger proportions of men marrying. This trend ceases or is even reversed later in life for four groups, and only among the exhibitionists and incest offenders do the sexual psychopaths maintain their “lead.” This tendency among the sexual psychopaths toward early marriage is more in keeping with the prison group’s behavior than with that of the control group.

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There is much speculation about how widely an automobile is used for, or as a chief means of, committing a sex offense. Included in this tabulation are offenses that involved the use of a car but that actually took place outside the car. This happened particularly in some of the cases involving force. When all auto offenses are combined, regardless of whether they happened in city, country, or in an unrecorded location, we find that the three aggression groups rank the highest. From 21 to 30 per cent of them are associated with autos. But these aggression offenses still occur less often in cars than they do “in the open,” and residences are also ahead of autos in two of the three subclasses. In the nonforce offenses we find the automobile playing a relatively important role only in the offenses involving young teenagers (twelve to fifteen), and this is evident in both heterosexual and homosexual offenses. It would seem that interest in cars and willingness to go for rides in them is a strong factor here. These young people generally are not licensed drivers and do not have the use of a car, but the automobile and the culture surrounding its use are important elements in their lives. In the remainder of the heterosexual and homosexual offenses, those involving either young children or adults, the use of the auto drops to between 7 and 15 per cent. The other offense in which a car figures fairly frequently is exhibition. The incidence is 19 per cent here, representing 44 cases. It is usually reported that the exhibitionist had parked by a sidewalk curbing and waited until he caught the eye of a likely female in order to get his own erotic reaction from the exhibition behavior. In other instances he had driven along, trailing a chosen female, and then pulled his car up to the curb near her. Incest occurred in cars in only six cases out of the 169 father-daughter incest convictions on which data were available. If offenses occurring in automobiles are classed on the basis of a rural or urban location when identifiable, it is clear that once on wheels the sex offender generally tends to gravitate to less populated areas with his partner or victim. This is most marked in the aggression groups, in which the rural auto offenses outstrip the urban ones.

It seems clear that while automobiles were of some importance, they did not play a major role as a site for or as an aid in sex offenses. They were most used in the aggression offenses, in exhibition, and in acts against male or female minors. It might be suggested that our sample of convicted sex offenders came from an economic and social class that did not typically have cars available for their use. There may be some validity in this notion, but car ownership is so ordinary, even at lower income levels, that it seems doubtful. The once-held notion that cars furnish the chief means for sex offenses is just not substantiated by the present data.

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In all age-periods the homosexual offenders derive a greater proportion of their premarital orgasms from homosexual activity than do any

other offenders. These homosexual offenders not only occupy the upper three positions of the rank-orders, but a substantial gap separates them from the fourth-ranking group. From puberty-15 they drew about one sixth of their total outlet from contact with other males. This proportion increased with age until in later life the homosexual offenders vs. children and minors obtained about one quarter to two fifths of their orgasms in this way, and the homosexual offenders vs. adults about half to three fifths.

At the other end of the scale, the single males with the smallest proportions of total outlet derived from homosexuality—never more than 1 per cent—are the incest offenders vs. minors and adults. The majority of the unmarried offenders do not exceed the 5 per cent level, and the control group tends to be in the central portion of the rank-orders. However, the proportions tend to increase with age as the more heterosexual males marry and drop out of the calculations.

Homosexual experience during marriage accounts for only 1 per cent or less of the total outlet of all groups except the homosexual offenders and, in the earliest age-period only, the prison group. Among the homosexual offenders the percentages in general increase with age.

The data for separated, divorced, and widowed males are very difficult to interpret, and much of the variability may be a function of sample size. However, the homosexual offenders again head the rank-orders, with the homosexual offenders vs. adults usually deriving about two fifths of their outlet between twenty-one and forty-five from other males. Homosexual activity was much more variable in and also less important to the other homosexual offenders. All other groups never exceeded the 5 per cent level.

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As in the case of age-specific incidence, the control group heads the rank-orders of frequency (among single males) as measured by the median. Aside from this, little can be said since virtually all other groups have average frequencies of from 4 to 5 per year in every age-period—a tiny difference and useless for comparisons. Indeed, this uniformity is noteworthy. There is, however, an inexplicable rise in the median frequency for the unmarried males in age-period 31-35, followed by a decline to former or still lower levels.

Median frequencies of nocturnal orgasm among the married vary only from 3 to 5 per year among those who experience this involuntary activity. This narrow range and rarity coupled with small Ns makes further analysis useless.

The mean frequencies among single males experiencing nocturnal orgasm range ordinarily from roughly 8 to 25 orgasms per year.

We are left with one major finding: frequency of orgasm while sleeping is far greater among the single men of the control group than among any others. Discussion of the significance of this will be deferred until the section on proportion of total outlet.

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Our sample of sex offenders includes 16 males, in addition to the six discussed above, who had been convicted on the basis of obscene notes, pictures, gestures, or speech. None was a telephone caller. While some sexual element was involved in every case (otherwise they would not be classed as sex offenders), there is usually no evidence that they got any sexual gratification from the obscenity at the time of the offense—the obscenity was either used as a tool to achieve another purpose or the element of communication was absent or minor.

To be more specific, these 16 cases may be placed in two categories:

1.    Those who employ obscene pictures, gestures, or speech as a

means of soliciting others for sexual activity. While they may gain

some pleasure from this modus operandi, their main aim is to get an

immediate sexual partner; it is not “obscenity for its own sake” as is

typical of the “obscene telephoners,” although an occasional telephoner

may also obscenely solicit. In this category, which can be labeled (to

the confusion of the British) “obscene solicitors,” we can see two sub-

groups:

Those who display obscene pictures under the generally erroneous impression that the female will be sexually aroused by them.

Those whose solicitation involves words or gestures regarded as obscene.

We have 11 “obscene solicitors” in our sample, and eight solicited females under age sixteen; in fact, seven solicited girls under twelve. Before one assumes that this is an activity associated specifically with pedophilia, one must realize that a powerful selective factor is involved: obscene solicitations directed toward adult females are almost always adequately handled by the woman herself and the law is less often brought into the matter. Six of the 11 males had been convicted of a sex offense other than that of obscenity.

2.    Those who were, in essence, guilty only of possessing obscene

material and who were not, insofar as is known, utilizing it for solicitation. We have three such cases. Two of the men were being investigated for some nonsexual behavior and the obscene material was discovered accidentally. In other words, the police “frisked” them and

found some erotica and used this discovery as a convenient excuse for

arrest and incarceration. The third case was one in which some boys discovered obscene material in a roomer’s suitcase and told their parents, who called the police.

The remaining two cases are miscellaneous: a man who decorated his jail cell with a drawing that the authorities found offensive and because of it prolonged his stay by an additional sentence, and secondly, a man who sent obscene material through the mail to a former girl friend.

Just as with the obscene telephone communication cases, this category of “other obscene communication” cases does not constitute an entity: the obscenity is just one minor symptom of social and psychological disorders that in most cases manifested themselves in more important and dramatic ways. Thus we find that of the 16 men, half were also convicted of more serious sex offenses, chiefly offenses vs. children and exhibition. Note that while exhibition was found in half of the histories of the males who made obscene telephone calls, there was no evidence of pedophilia. Of the remaining eight other obscene communication cases, we find:

Three males who solicited female children and who, in two of the instances, would probably have had overt sexual activity with them had they not been interrupted.

One male with a history of delinquency and crime including a juvenile sex offense.

One intelligent, educated, but highly neurotic man.

One male whose only other known undesirable behavior was vagrancy and drunkenness.

One male whose solicitation was well meant but foolishly crude.

One male who solicited by means of obscene notes left in cars and telephone booths. This male was akin to the “obscene telephoners” in that he obtained sexual pleasure in observing the women as they read his notes and in tensely waiting for women to find them. However, his main aim seems to have been obtaining a sexual relationship. Interestingly enough, in background this man was like the “obscene telephoners”—unbroken home, reasonable family life, an adequate hetero-sexuality, and an incidental homosexual experience.

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The most common symptom of PID is pain in the pelvis and lower abdomen. The pain is usually dull, and it can occur on one side or both sides of the pelvis. Other symptoms—discharge and an odor from the vaginal area, burning with urination, and spotting between periods or after sexual intercourse—may also be present. A woman may notice heavier than usual periods and pain during intercourse. With more severe infection, there can be fever and chills, and nausea and vomiting. In addition, PID can sometimes spread into the abdominal cavity and cause infection around the liver, experienced as pain in the upper right part of the abdomen. This condition is known as Fitz-Hugh Curtis syndrome. In other cases there may be no symptoms with PID, and the infection may go undetected until it is discovered during a pelvic examination.

Symptoms generally occur within a few days to a few months after infection, but they may take longer to show up. With each episode of PID, a woman undergoes a 20 percent reduction in her future fertility and runs a 20 percent risk of being subject to chronic pelvic pain and an increased risk of an ectopic (tubal) pregnancy.

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Many people want to know the likelihood of getting herpes from a partner who is infected with genital herpes. For a couple who abstain from sex during an outbreak but have sex without a condom between outbreaks, the average risk is 10 percent for the uninfected person to acquire herpes from the infected partner over the course of a year.

90 people out of 100 will remain uninfected.

As noted earlier, women have a higher risk of becoming infected. An uninfected man having sex with an infected female partner in the above scenario has about a 4 percent risk of getting genital herpes

In other words, 10 people out of 100 in such a relationship will, after a year, have contracted herpes from their partners via asymptomatic shedding, but after a year, whereas a woman having unprotected sex with an infected male partner has about a 10 percent chance of getting herpes after a year if she already has type 1 herpes orally, but about a 32 percent risk of getting herpes after a year if she is completely negative for herpes. These statistics are derived from studies of discordant couples (one person has herpes and the other doesn’t) over a specified period of time. Whether these statistics hold for every year a couple has been together, or whether they change with time, is not yet known. Usually the longer a person has herpes, the less active that person’s virus becomes, so for any specific couple these numbers may decrease over time. Studies are under way to evaluate further the risk of infection.

Statistics for men who have sex with other men or women who have sex with other women are not yet available. For a woman having unprotected sex with a female partner, the risk is probably lower overall, although transmission may still take place through genital rubbing and through oral sex.

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Prostatitis of bacterial etiology is also treated with antibiotics. Treatment is usually initiated once the infection has been diagnosed, before the actual organism causing the infection is known. The appropriate antibiotic depends on the person’s age and history and what is found on examination and through testing. How long the antibiotics are used depends on whether the infection is acute (a new, very symptomatic infection) or chronic (characterized by less severe symptoms of a longer duration).

If the cause of acute prostatitis is thought to be a sexually trans: mitted bacterium, then treatment for infections such as gonorrhea, chlamydia, and nongonococcal urethritis should be started. (See the sections on these specific infections.) However, the course of antibiotics is usually longer (lasting two weeks) for an infection of the prostate than for urethral infection alone. One possible treatment program includes ceftriaxone along with doxycycline. Prompt treatment of urethritis caused by sexually transmitted bacteria decreases the likelihood that the infection will progress to a prostate infection. Chronic infection rarely occurs following acute prostatitis from a sexually transmitted infection.

For men who have acute prostatitis, who are older, or who perform anal sex on partners, a different antibiotic is commonly used; ofloxacin is usually administered for two weeks or sometimes longer. For chronic prostatic infection of any cause (sexually transmitted or otherwise), a much longer course of antibiotics is prescribed. The antibiotics of choice are ofloxacin, ciprofloxacin, or trimethoprim-sulfamethoxazole, often for four weeks or longer.

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When you talk with your partner, make sure you are alone in a quiet place with little chance of being interrupted. Explain as calmly as you can what your health care provider told you. Explain what your diagnosis was, how you are being treated, and what your provider recommended for your partner. You may want to talk with your partner about whether or not he or she has been with someone else. You may need to tell your partner that you have been intimate with someone else. If there has been another partner, the discussion may be very emotional and almost certainly will be difficult. Try not to make things worse by adding blame and guilt, tempting as this may be. If the idea of facing your partner with this information is overwhelming, you can ask your provider to talk to both you and your partner together, to explain what is going on.

Being diagnosed with an STD does not mean that you are a bad or immoral person. STDs are caused by germs with which people can become infected while having sex. Some are curable; some are not. If you are diagnosed with an STD, you may want to evaluate your sexual practices and think about how to make yourself safer in the future. Being diagnosed with an STD causes many people to become more open in their discussion of STDs with new partners, and this frankness can lead to safer sexual relationships and, often, better relationships. It does not mean you can never have sex again, even if you are diagnosed with a chronic STD. You may need to take more precautions, but for most people it does not mean the end of their sex life.

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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 may cause a discharge from the urethra. There may also be pain between the scrotum and the anal area, frequent urination, pain with urination and ejaculation, and blood in the semen. Prostate infections may be caused by sexually transmitted bacteria or by other bacteria. A sexually transmitted urethral infection that is not promptly treated may progress to infection of the prostate.

Reiter’s syndrome. Reiter’s syndrome is a condition that can result after chlamydial infection or NGU or after certain intestinal infections. Men with Reiter’s syndrome complain of an inflamed urethra, discharge, and burning with urination, as well as joint pain and inflammation of the conjunctiva of the eyes. Symptoms usually start one to four weeks after the infection that triggered the advent of Reiter’s syndrome, whether or not the infection was treated.

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