Mens Health Blog. Medical Blog

For acute bacterial prostatitis, doctors approach first things first—they get the fever down and stabilize the patient; some men may need to be hospitalized for a few days. Other treatment may include bed rest; drinking plenty of fluids (to keep the body well hydrated—this helps the body’s defense mechanisms); analgesic drugs such as aspirin to relieve pain; temporarily abstaining from sex; stool softeners (because the prostate is directiy in front of the rectum, straining to have a bowel movement could make the already tender prostate hurt even worse); and, in some cases, the temporary insertion of a catheter (a flexible, lubricated tube inserted in the urethra via the dp of the penis) to drain the bladder, if a man is unable to urinate, or if he’s retaining urine.

The good news: The intense inflammation of the tissue gives many drugs ready access to the normally not-so-accessible prostatic fluid. That’s why this condition responds so dramatically to antibiotics. The bad news: Many men are undermedicated; they are not prescribed an adequate dose of antibiotics.

Many doctors prescribe antibiotics such as ciprofloxacin (one of a new class of antibiotics called fluoroquinalones) for a week to ten days. This is not long enough. Ten days of treatment may ease all signs of infection, and a man may feel “back to normal” within that time. But infections in the prostate are insidious. This is due in part to something called the blood-prostate barrier; it serves the same function as a bouncer at a bar—it’s designed to protect the prostate from harmful substances. Yet despite its good intentions, it often keeps out the very drugs needed to stop infections in the prostate. This barrier breaks down during bacterial prostatitis—acute as well as chronic. And while these defenses are weakened, says a University of Maryland urologist who is an expert in prostatitis: “This is the time to hit hard, to knock it out the first time.”

The University of Maryland urologist tells his patients that having nonbacterial prostatitis is like having arthritis or bursitis: “It’s a chronic condition; we can treat the symptoms, even if we can’t figure out what causes it.” Muscle relaxants, such drugs as alpha blockers (originally marketed as antihypertensive drugs, also used to treat BPH—see Chapter 10), have been helpful in alleviating the muscle tension in the prostate, and making urination easier. Some doctors recommend anti-inflammatory drugs and the use of hot sitz baths, where the patient sits in (or sometimes over a fine spray of) soothing, warm water. Also, many men have found that diet has an effect on nonbacterial prostatitis, and that some foods—particularly, spicy dishes, red wine and caffeine—seem to aggravate their symptoms.

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Comments (0) Mar 30 2009

This form of treatment uses microwaves to produce temperatures hotter than 50 degrees and “zap” the tissue in the prostate’s innermost core, thereby creating space around the urethra. These temperatures are hot enough to do some good; they are able to destroy the smooth muscle and glandular cells in BPH tissue. What grows back over the next few months is a different mixture of cells that include collagen.

TUMT works by miniature remote control: A tiny antenna that targets BPH tissue surrounds a catheter that goes through the penis and into the urethra. The microwave generator is situated nearby, in the rectum. (The device is called the Prostatron.) The degree of power is controlled by different software programs that can produce a range of temperatures.

At Temperatures below 60 Degrees C. The technique produces significant improvements in urinary symptom scores and in urinary flow rates, but litde change in pressure-flow urodynamic studies—which suggests that the ultimate improvement in obstruction may not be great. The procedure can be performed under local anesthesia.

At Really Hot Temperatures—from 60 to 75 Degrees (this may be needed in cases of severe obstruction)—the treatment can create gaping cavities where tissue used to be. This can cause irritative symptoms that last until the tissue in the prostatic urethra dies and then is sloughed and reabsorbed by the body, or washed away by urine. (When all the dead tissue is gone, the prostatic urethra should be much less constricted.) The treatment causes inflammation and may require stronger pain-killing medication. Swelling and urinary retention (usually temporary) are also common after the procedure and can be eased with a catheter. Preliminary results are encouraging. However, how long these results will last—and whether or when a repeat procedure will be necessary—is not yet known.

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Comments (0) Mar 30 2009

BPH affects the urethra first, then the bladder. As BPH begins to impede urine flow, men may experience symptoms that can be broken down into two categories: Obstructive and irritative. The first category is just what it sounds like—symptoms resulting from a mechanical obstruction, from the prostate squeezing the urethra. These include the following: A weakened urinary flow or stream; hesitancy in starting urination and difficulty in stopping; intermit-tency, when the urinary stream starts and stops repeatedly; “dribbling” after urination; a sense of not being able to empty the bladder completely; and occasionally, urinary retention—when the bladder stays completely or partly full.

Early on in BPH, men experience few symptoms because the powerful bladder muscle compensates for the narrowed urethra by making more vigorous contractions and forcing urine through the prostate. But over time, this extra effort takes its toll on the bladder. The mechanical obstruction means the force is diminished for each length of muscle fiber—the bladder becomes less efficient, thus the decreased flow rate and obstructive symptoms.

But as this is happening, the muscle hypertrophies—it gets larger—and there’s a marked increase in the smooth muscle tone. Here’s where the second category of symptoms comes in. The bladder wall becomes thick and doesn’t stretch like it used to; the bladder itself doesn’t hold as much, becomes unstable and overly reactive, and causes a need to urinate more often—unfortunately, sometimes spontaneously. These irritative symptoms can include urge incontinence (when a man knows he has to urinate, but can’t make it to the bathroom in time); and nocturia, which is frequent urination during the night. The major cause of nocturia from BPH is a thickened bladder that doesn’t hold as much as it once did. Another cause is leftover urine from a never-emptied bladder, which gready reduces the bladder’s functional capacity. (Imagine a glass that’s capable of holding a pint of fluid, but which is always half-full. This means the glass must be emptied every half-pint—twice as often as before!)

When the prostate’s pressure on the urethra gets to be too great for the bladder’s compensatory muscle power, a man loses the ability to empty his bladder completely during urination. Sometimes this leads to symptoms that go beyond merely annoying and require treatment—such as repeated urinary tract infections (UTIs) caused by stagnant urine; or damage to the bladder and kidneys from the backup of urine. Sometimes, in acute urinary retention, a man suddenly becomes unable to urinate at all.

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Comments (0) Mar 30 2009

“Pain is very closely associated with quality of life,” says a Johns Hopkins oncologist. “People in pain have a reduced appetite; they lose weight. They’re often depressed. Sometimes they’re bedridden, the pain is so bad. If we control the pain aggressively, we often see patients getting stronger and eating better. Aggressive pain management is clearly to the patient’s benefit.”

It’s not only beneficial, it’s your right as a patient not to suffer. Far too many men with advanced prostate cancer endure excruciating pain in the course of their disease. Several studies have shown that an average of 72 percent of men with advanced prostate cancer are in pain. In one recent study of 201 men with prostate cancer, 47 percent reported feeling pain that ranged from “moderate to very bad”—despite the use of painkillers. This tells us several things. One is that, as diseases go, prostate cancer is more painful than most. Its particular patterns of spreading—metastases to bone, and particularly to the spine— make it second only to cervical cancer in terms of severe pain. But this study also shows us something else: These 201 men were on analgesics—painkillers —yet they still hurt. Some of them even felt miserable pain. Does this mean that painkillers don’t work? No. It means the doctors treating these men weren’t giving them enough medication to make them comfortable.

There is no excuse for that. And often, both sides—doctors as well as patients—are at fault. A recent article by University of Colorado scientists cited some reasons why prostate cancer patients often are under-medicated.

Here are some of the reasons why doctors may not give enough pain medication: One is that many doctors just don’t learn enough about pain medication in medical school and in their subsequent professional training; they learn how to save or prolong lives, but not always how to make their patients comfortable. (This is improving as medical schools and continuing education courses are doing a better job teaching doctors how to manage patients’ pain.)

But perhaps a bigger problem—and this also has to do with the way health care professionals are educated—is the very real fear that patients will get addicted. This is hogwash. The sole purpose of these drugs is to alleviate pain, and frankly, few patients need these medications more desperately than people with cancer—especially men with metastatic prostate cancer whose pain is extreme.

And yet every day all over this country, this study showed, some doctors prescribe painkillers at inadequate dosages; some nurses withhold doses of painkillers; and some pharmacists refuse to provide drugs.

In addition, some doctors worry about controlling the side effects of analgesics (see below). They worry about inadvertently precipitating a patient’s death—or worse, being an unwitting part in a patient’s suicide attempt—if he overdoses.

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Comments (0) Mar 30 2009

Craig, a retired internist, was 78 years old when his prostate cancer was diagnosed. He had recentiy undergone a TUR procedure to alleviate symptoms of BPH; no cancer was found at that time, when a pathologist examined the chips of tissue taken from his prostate. But within a year, Craig’s urologist found a nodule during a routine digital rectal exam, which turned out to be cancer localized to the prostate, with a Gleason score of 6.

Because of his age, Craig agreed with his doctors that external-beam radiation therapy was his best option. (Also, because of his age, he received treatment only in the prostate and seminal vesicles.) Craig began receiving doses of radiation every day. After a few days of treatment he began experiencing severe bowel problems, including debilitating diarrhea. These symptoms got better after Craig’s radiation oncologist changed his treatments to four times a week, which gave his lower gastrointestinal tract a chance to recover. The new treatment schedule helped considerably, he recalls, and “things subsided fairly well.”

That was twelve years ago. The radiation treatment worked, and he has been cancer-free ever since. “I went to see my urologist last year, and he joked with me, ‘I don’t know why you’re coming back, because your ten-year warranty is up!’” Since his treatment, Craig has traveled extensively with his family.

They’ve been, among other places, to London, Copenhagen, Prague, and Vienna; they’ve taken ocean cruises and flown to South America.

This is particularly remarkable because a few years after his treatment Craig began to be plagued with episodes of severe diarrhea, infection, and bowel problems that his doctors have been largely at a loss to explain. “I’ve had cultures, searches for parasites, everything you can think of, and they can’t find any explanation.” (One set of problems, including blood in his bowel movements, was attributed to some large polyps in his intestinal tract; these were removed several years ago, however, and the episodes of diarrhea have continued.)

The conclusion reached by a number of doctors, including a urologist, a radiation oncologist, an internist, and a gastroenterologist, is that Craig has what’s called an “irritable bowel” (a spastic, overly reactive colon prone to diarrhea) and that it is “secondary to”—a delayed effect of—his radiation treatment.

This is not uncommon; many men have delayed effects of radiation treatment, but these usually begin within a few months of treatment. In Craig’s case, his bowel problems may have been made worse by some of the antibiotics he’s been given over the years to combat infection. Craig’s self-diagnosis? “I think very probably the radiation made the colon irritable, and then the prolonged treatment with the mycins (antibiotics) might have been a contributing factor.” ”

Despite the episodes of bowel problems over the years, Craig does not seem to have slowed down too much over the last decade. In between their globetrotting expeditions, he and his wife are restoring an old family home on Maryland’s Eastern Shore. For Craig, radiation treatments have meant a gift of time and—bowel problems aside—good health. He has made the most of both.

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Comments (0) Mar 30 2009

Homosexual offenders vs. adults are adult males who made homosexual overtures to, or had sexual contact with, males aged sixteen or more. As in the case of other homosexual offenders, the number of incestuous or forced cases is so small that they have not been made into separate categories of offenses, but are included and identified within die group of homosexual offenders vs. adults.

The social problem posed by the homosexual offender vs. adults is the same as that of the heterosexual offender vs. adults—namely, what jurisdiction has society over a sexual relationship between consenting adults? In the case of homosexuality, where there are no reproductive consequences to form a legitimate concern of society, this question is especially acute. Rather than launch into a lengthy discussion at this point we may summarize by stating that the law against adult homosexual activity is designed not for the protection of person or property but for the enforcement of our cultural taboo against homosexuality.

While all homosexual behavior, even if it does not involve physical contact, is illegal in most states, we are aware that there is a strong selective factor that determines who among those with homosexual behavior are arrested and convicted. This selective factor is not evident in the statutes or in the courts; it is operative primarily among the police. It is, in essence, our cultural concept that sexual techniques indicate who is a “real” homosexual and who is not. This concept has become a part of psychology and psychiatry, giving rise to the distinction between “active” and “passive” homosexuals. If a policeman discovers individual A masturbating individual B or with B’s penis in his mouth, individual A is certain to be arrested and charged; however, there is a fair possibility that B will not be arrested, but released after a scathing reprimand. The police attitude seems to be that individual A is a proven “fairy” or “queer” because he was stimulating B, whereas B is simply an ordinary person with a regrettable but understandable tendency toward sexual opportunism. Yet, illogically, if the policeman finds B inserting his penis in A’s rectum, this attitude is unshaken and A is still considered the homosexual. Apparently the crux of the matter is this: the man who is bringing the other man to orgasm is the “real” homosexual; the man being brought to orgasm is not. To put it another way, the policeman may feel that seeking an orgasm is not really blameworthy even in a homosexual situation, but that being interested in bringing another male to orgasm is unmitigated perversion. Since alternate stimulation is commonplace in homosexual relationships, the question of who is arrested often depends upon the moment at which the officer appears on the scene.

This attitude is widespread. We have interviewed many men who disapproved of homosexuality and hotly denied homosexual activity, but freely admitted that they had been brought to orgasm by other males. Such men felt that since they made no attempt to bring the other man to orgasm they could not be said to have displayed any homosexual behavior.

In the heterosexual sex-offense categories we have ordinarily differentiated between behavior involving physical contact and behavior not involving contact, the latter constituting a discrete group. In the homosexual-offense categories, however, both contact and noncontact behavior have been considered together. Explanation of this seeming inconsistency has been delayed until now, since it is only in the homosexual offenders vs. adults group that noncontact cases constitute any appreciable percentage of the total cases (21 percent).

There are several reasons why, in the homosexual groups, the non-contact cases have been considered with the contact cases. In the first place, homosexual solicitation is usually given some vague label (e.g., “disorderly conduct,” “public indecency,” or even simple “vagrancy”) which gives no clue to whether or not there was physical contact. The brief official record is also frequently no more helpful than the charge itself; it will simply be a statement that the subject made a homosexual approach to someone. The subject himself, while satisfactorily explicit in instances where specific sexual activity had begun, often neglects the details of a solicitation that did not result in specific activity. A typical subject’s description of a solicitation would be, “I propositioned this guy in a subway toilet, and right away a cop grabbed me.” Since we know that some physical contact is common in homosexual solicitation (e.g., a hand on the thigh or on the clothed genitalia), and since we know that were it not for interruption a high percentage of solicitations would have led to physical contact, we are not disturbed at the necessity for combining contact and noncontact cases.

Further justification for combining them exists in the social philosophy behind the law and its enforcement. Society is not interested in curbing heterosexual solicitation unless it is of an unsuitably young person or unless it is offensive in being overly explicit, repetitious, or involves physical contact. The latter is an important point: ordinarily a stranger will not be arrested for saying, “Hey, beautiful, what are you doing tonight?” but if in addition he touches the female he is immediately open to arrest. On the contrary, in homosexual solicitation society is rather indifferent to whether the overtures include contact; the simple fact that the solicitation is a homosexual one makes the solicitor legally vulnerable. In brief, with regard to the heterosexual, society necessarily makes fine distinctions that we consequently follow in this study, but with regard to the homosexual, society is inclined simply toward a single all-inclusive prohibition.

Lastly, the combining of homosexual contact and noncontact cases has a psychological justification. In the heterosexual sphere there are some males who derive considerable satisfaction from noncontact behavior directed toward females. Exhibitionists and peepers are the best-known examples, but there are others who obtain gratification from making obscene telephone calls or remarks, or writing obscene letters. In the homosexual, however, individuals who obtain sexual gratification without physical contact are essentially nonexistent. Where, in the homosexual, sphere, is there the counterpart of the peeper or telephone caller? True, there may be exhibition of genitalia, but this is confined to toilets, locker-rooms, and other situations where genital exposure is socially sanctioned, and such deliberate genital exposure is not a source of gratification in itself (as is often true in the heterosexual), but is simply a mode of solicitation.

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Comments (0) Mar 27 2009

The incest offenders vs. adults constitute our oldest group, the average individual being nearly fifty years old. Almost three fifths of their years since puberty had been spent as married men—as is also true of the incest offenders vs. minors—and the average man married at age 22.6. Their marriages were rather stable: about two thirds had married once, and very few had brief marriages. The average incest offender vs.

adults had known his future wife six months before marrying her, a time span neither long nor short in comparison with the other groups. Very few (44 per cent, the second smallest proportion and even less than that of the control group) had premarital coitus with the girls who became their first wives, which is in keeping with their general sexual restraint. Furthermore, more incest offenders vs. adults than any other group strongly desired virginity in their brides. Those who did have coitus with their future wives shared with the other incest offenders a disproportionate number of premarital pregnancies, holding second rank with 28 per cent. In view of the relatively small number who had premarital coitus with their fianc?es and the low frequencies of such coitus, it is surprising to find one of every four brides pregnant. One possible explanation is naivet?: if one assumes the fianc?es were as unsophisticated, restrained, and inexperienced as their future husbands, it is likely that not even the most rudimentary contraceptive measures were taken.

If we are a bit surprised by this premarital fertility, it at least warns us of what occurs after the marital vows. The incest offenders vs. adults are by far our most fertile group, the average male fathering five children.

The incest offenders vs. adults spent very little time in petting with their wives before beginning coitus. Fifty-four per cent (first in rank) ordinarily spent only three minutes or less this way, while only 16.7 per cent (next to the smallest proportion) spent as much as 30 minutes.

While marriage broke down some of the restraints about sexual techniques, a certain constraint seems to have lingered. Only 28 per cent, a rather small proportion, had mouth-genital contact in marriage. Nearly one third (the largest proportion) never had marital coitus in any but the “standard” position.

The incest offenders vs. adults were as conservative in marriage as they were before: the average offender always is found in low to intermediate position in the rank-orders of frequency of marital coitus at different ages. They have the lowest mean frequency in three of the six age-periods between sixteen and forty-five and the second lowest in two. They are noteworthy in yet another way: whereas most groups contain some sexually very active individuals who cause the mean frequency to strongly exceed the median, the incest offenders vs. adults lack such extremists. Consequently we see an unusual situation wherein the mean and median frequencies of marital coitus are similar or even identical. Thus in age-period 21-25 the median is 2.4 per week and the mean 2.8, but by age-period 36-40 the difference has dwindled and identity prevails then and thereafter (1.75 vs. 1.73 at age-period 36-40 and 1.50 vs. 1.48 at age-period 41-45). One should also note that to have the median exceed the mean is extraordinary, and can occur only in a group typified by conservatism and a narrow range of activity.

While incest offenders as a whole tend to have low frequencies of marital coitus, the incest offenders vs. adults exhibit this trait perhaps the clearest of all. Nevertheless, between ages twenty-one and thirty they derived a greater proportion (90-92 per cent) of their total sexual outlet from marital coitus than did any other group; at older ages the proportions become moderate to low-moderate.

With the general picture of inhibition and restraint one is prepared for the discovery that, according to their husbands’ reports, the wives of the incest offenders vs. adults did not experience orgasm in their marital coitus as often as the wives of others. Twenty-eight per cent of their married years were spent at a low level of orgasmic response (0 to 10 per cent); no other group comes near matching them in this misfortune. On the other hand, a moderate proportion (58 per cent) of their married years were passed at a high orgasmic level (90 per cent).

The incest offenders vs. adults gave their marriages higher happiness ratings than did most other offenders. Forty-eight per cent (third in rank-order) labeled their marriages “very happy,” while only 9 per cent (third from the bottom of the rank-order) said they were “very unhappy.” How this marital bliss fits, or fails to fit, with their incestuous behavior will be studied later when we take up the situation at the time of the offense.

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Comments (0) Mar 27 2009

The average aggressor vs. adults was twenty-four and one-half years old at the time of his offense. Between one quarter and one third were married at the time of the offense, one quarter had been separated,

divorced, or widowed, and 46 per cent had never married. As a group they were “less married” than their counterparts, the offenders vs. adults, but about the same proportion were currently married when they committed their offense.

For slightly more than half, the offense was their first sex offense; for about one quarter, their second; for 7 per cent their third; and 9 per cent had had three or more previous sex-offense convictions. This record is lower than for the aggressor vs. children, but somewhat greater than for the aggressor vs. minors.

About 5 per cent had either been institutionalized for mental or emotional disorders, or had been evaluated as neurotic by the interviewer. This is a modest percentage. However, the number who were drunk at the time of the offense is large: 39 per cent (the second largest percentage). An additional 15 per cent had been mildly to moderately intoxicated—a large proportion of the men in all the aggressor groups claimed they were intoxicated at the time of offense— and four men had been using an opiate, but drugs obviously are a minor factor. The “drug-crazed sex fiend” or the “sex-crazed drug addict” are figments of journalistic imagination.

In 12 per cent of the cases two or more men were involved, which is not unusual in aggression offenses; in fact, the aggressor groups rank first (aggressors vs. minors) and third (aggressors vs. adults) in this respect. A couple of young men cruising about looking for a girl or girls to pick up is a common thing in our culture. A relatively large number of the offenses were opportunistic (10 per cent, the third largest percentage) or committed while the subject was non compos mentis (8 per cent, second in rank-order). Only 70 per cent, the smallest proportion in any of the offense groupings, were premeditated.

The offenses occurred most often in residences (26 per cent), chiefly in the home of the female, and outdoors (38 per cent), mainly in urban areas such as parks, vacant lots, and alleys.

The average girl involved was twenty-four years old, the same age as the average aggressor at the time of his conviction. Between one quarter and one third of the girls, however, were under age twenty. Older women are definitely more immune to rape: only 3 per cent of the victims were fifty-one or over. As one would anticipate, a high percentage of the females (72 per cent) were strangers to the offender. However, 17 per cent of the cases (a relatively small number) involved friends and 9 per cent involved acquaintances. These percentages of strangers, acquaintances, and friends present, we realize, a false picture of rape and other sexual aggression. It is known that many rape cases go unreported, especially if the two people concerned have been dating. No girl likes to advertise her misfortune through court action, and she is especially loath to do so if the defendant is someone with whom she has been friendly, lest there may be some question about the validity of her charge. To be raped by a stranger makes one a martyr; to be raped by a friend makes one an object of suspicion.

Nearly half of the aggression offenses resulted in coitus, and in one fourth coitus was definitely attempted. In comparison to other groups the aggressors include large percentages of males who unsuccessfully attempted coitus; they occupy the first three ranks in this respect with the aggressors vs. adults in first place. All aggressors also rank high in a category we label “general attack.” This term describes violent and aggressive activity which, while presumably sexually motivated, appears aimed not at obtaining coitus, but at inflicting physical damage. More aggressors vs. adult offenses were general attacks (13 per cent) than was true for any other offense category.

We have 146 cases in which the degree of the victim’s participation was described both in the official records and by the offender. In about two thirds of the cases both the records and the offenders agree that the females resisted; in another 9 per cent the offenders claim that resistance was preceded by encouragement. In one fifth of the cases the records state that the females resisted, while the offenders say that the women were encouraging or acquiescent. By no means were all these men consciously lying; we believe that normal male conceit led some of them to mistake the passivity of fear for acquiescence. Still others evidently encountered females who paid heed to the general admonition that it is wiser to cooperate in the rape than to resist, be beaten up, and raped anyway. The rapist in these instances often looks upon grudging and reluctant cooperation as evidence of enthusiasm. Often we heard the plaint, “It wasn’t rape—she took her clothes off” In only about 4 per cent of the offenses does there seem to have been initial encouragement by the female followed by a change of heart.

In half of the offenses the offender had made at least some of the overtures males customarily make in attempting to obtain a sexual relationship, or, to put it another way, half of the time there were attempts to gain a voluntary rather than a forced relationship. When these preliminaries failed, the men resorted to force and threat. In two fifths of the offenses considerable physical force was employed; in slightly more (45 per cent) only moderate to little force was exerted; and in a small number of cases (7 per cent) threat alone sufficed. In the few remaining offenses we know that force was used, but we do not know to what degree.

Although differentiation is not always easy, there appear to be two major varieties of aggressive offenses: (1) those in which the aggression is a means to an end, and no more force is used than is necessary to achieve the end (coitus, usually), (2) those in which violence is an end in itself or at least a secondary goal; in these cases the female is either subjected to more force than is necessary or she is mistreated after coitus or other direct sexual activity has ended. The first variety of aggression is by far the more common.

In slightly over half of the offenses threats were made or implied in order to coerce the females. Threats of a major sort, e.g., threats of serious physical damage or threats of injuring the victim’s children, were involved in two fifths of the cases. In about the same number of cases no threats were made at all, and in only a few instances (10 per cent) were minor threats employed.

At this juncture it is worth noting that the aggressors vs. adults used physical force to a markedly greater degree than the other aggressors, and employed threat less often than the aggressors vs. minors. These facts reflect not so much the habits of the offender, but the differences in the victims: older females are not so readily intimidated by threats and, therefore, the offender must resort to force. Moreover, with mature females he must employ a greater degree of physical force.

Because of our cultural attitudes toward fighting and because physical aggression is particularly discouraged in females, the great majority of girls and women do not know how to fight effectively. In addition, the few who do know how sometimes fear to try lest they fail and only infuriate their attacker, or in other instances they simply cannot bring themselves to commit the effective brutalities. For instance, in most rapes there are moments when the offender’s eyes and genitalia could easily be damaged. At any rate, the aggressors we have interviewed emerged from their rapes either unscathed or with only scratches. They were seldom even bitten. The ineffectual resistance put up by most victims is sometimes taken as an indication that they have a conscious or unconscious desire to submit. This is undoubtedly true in some undetermined number of cases, but we feel such cases constitute a definite minority. It is more probable that the ineffectuality results from fright or from a realistic appraisal of the danger involved in making a determined resistance.

The aggressors vs. adults are more vulnerable to arrest than any other type of sex offender. We estimate that in nearly three fifths of the offenses apprehension by the police was probable rather than merely possible. In the first place, since the female did not willingly participate, she is not going to assist the offender in evading punishment; on the contrary, she is interested in having him captured. In over three quarters of the cases it was the female herself who reported the matter to the authorities—by far the largest percentage of offenses reported by the object of the offense. Secondly, the offender is not involved with a juvenile whose naivet? may facilitate his escape, but with an adult who often has enough presence of mind to look for identifying marks, license plate numbers, etc. Thirdly, the screaming and struggling often associated with rape or attempted rape is likely to attract attention. Lastly, a number of aggressors vs. adults delude themselves into believing their victims have become sexually interested in them and the aggressor therefore agrees to subsequent meetings.

Only about half (52 per cent) fully admitted their aggression to the authorities and a few more (57 per cent) to us. This is a relatively small percentage, as is usual among aggressors. Another 18 per cent made qualified admissions to the authorities, and 24 per cent to our interviewers. Twenty-five per cent flatly denied their guilt to the authorities, and 14 per cent to us. Roughly 4 per cent were so drunk or upset at the time of offense that they could neither confirm nor deny the act with which they were charged. Despite the relatively small number who made full admissions, about two thirds pleaded guilty when they came before the court, but this is not a large percentage compared to other groups.

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Comments (0) Mar 27 2009

At the time of their offense almost one third of the men had never married, slightly fewer were married, and the majority (39 per cent) had once been married but were no longer. To find such a high proportion of divorced or widowed males in a fairly youthful group (the average man was twenty-eight at the time of his offense) is unusual.

For nine out of ten of the men this was their first sex offense; the type of male who seeks a voluntary heterosexual relationship with an adult female is usually not given to sexual behavior that places him in jeopardy. Furthermore, his offense does not require that he be psychotic or neurotic to facilitate its commission, which is apparent in the very small percentage with a history of emotional disorder. Similarly, alcohol and drugs play a very minor role in these offenses against adult females.

To point out that 91 per cent of the offenses were premeditated is to stress the obvious. In the average male, and particularly in the unmarried male, interest, hope, and premeditation are inextricably fused when he is confronted with a socially suitable female who does not fall outside his rather wide (and also elastic) range of preferences. Only 4 per cent had the situation thrust upon them so that they acted without thinking. Another 5 per cent of the situations were a mixture of both opportunism and premeditation.

Nearly three fifths of the females involved were sixteen- or seventeen-year-olds, 10 per cent were eighteen to twenty, 15 per cent were twenty-one to twenty-five, and the remainder were distributed fairly evenly at older ages. We have here a picture of society’s age-graded concern for their protection. The younger female is nearly always viewed as a victim rather than as a consenting partner, and females below the varying ages of consent are labeled with a justifiably grim humor as “jail bait.” If a male is arrested for mutually voluntary sexual activity with a woman over twenty-one, Iris arrest almost always stems not from his sexual behavior but from some indirectly related (or even unrelated) factor. This statement will be enlarged upon later.

Some three quarters of the females were, at the time of the offense, already friends of the offenders; only 17 per cent were strangers. “Pickups” account for most of the latter. The sexual activity usually (72 per cent) occurred in a residence, and a surprisingly large number of the persons involved were living together, at least temporarily. An additional 15 per cent of the activity was in automobiles.

As one can see from the above figures, the sexual activity was primarily voluntary coitus. In a small number of cases (16 of the 183 on which official records were available) the female resisted and discouraged some of the male’s behavior, but her resistance and his persistence did not exceed the bounds of the customary male vs. female contest. There was no threat and no violence. Included are a few cases where female consent was completely absent, but force or duress were absent also. These cases represent the blurred border between heterosexual offenders and heterosexual aggressors. These are the men who obtain sexual contact not through persuasion or force, but through surprise or stealth. For example, one man, while drunk, surprised a girl by hugging her (“grabbing” from her point of view) and asking for a kiss. Another male could not resist touching females’ legs even in inappropriate situations. Both of these men were arrested and convicted for this behavior, which could easily be duplicated at many a party. In brief, there was nothing especially antisocial in the behavior per se, but the circumstances of the situation (particularly the fact that the men were not known to the females) constituted grounds for punitive action.

In addition to the cases of consent and those described above where consent was not sought, there are some instances wherein the female at first consented but later changed her mind and resisted. One example concerned a male of twenty and his girl friend aged, seventeen. They had had coitus on previous occasions, but one night he was drunk and she found his advances offensive. She refused him, he slapped her, she complained, and he was arrested and convicted for rape. However, the court obviously recognized some of the essentials of the situation, for he was sentenced for only 90 days and court costs. Some other cases of resistance occurred where more than one male had, or attempted, sexual activity with one female: in one tenth of the cases there was this situation. Only two other sex-offender groups exceed this figure. Usually there was only one other male (5 per cent), less often two (4 per cent), and rarely more. Generally speaking these polyandrous situations arise either when a lone female is picked up or an evenly matched dating arrangement is subsequently unbalanced by the departure of one or more females. It is not uncommon for two couples to double-date, for the consequent petting to reach a rather ardent level, and then for one girl to become upset and depart, leaving her sexually aroused girl friend with two sexually aroused males—one of whom is now also disgruntled. This not unusual situation contains great potentialities for trouble: the remaining girl may be coerced into activity she does not desire, the males may fight over her, and the girl who departed may spread a lurid tale of how she escaped rape but left her friend in the clutches of the sex-mad males. Concerning the “pickup” situation, many males firmly (and wishfully) believe that a girl who allows herself to be “picked up” by strangers has thereby entered into a contractual agreement to have coitus with them, regardless of their numbers. Such males often express righteous indignation at what they construe as breach of promise when the female attempts to evade coitus.

In a consensual situation such as typifies the offenders vs. adults, one wonders how the matter came to the attention of the law enforcement officers. By far the commonest (47 per cent) was the reporting to the authorities by disturbed relatives and friends of the girl. The complaint usually arose from the failure of the girl to come home or come home early enough. The motive for the parents’ complaint is often obscure in our records, but in many cases it seemed to be a desire to break up an alliance between their daughter and a particular male. In other instances it may have been a form of projection—it is easier to blame someone else’s son than one’s own daughter. This attitude makes for ready acceptance of the girl’s excuses such as, “He made me do it.” Complaints filed by relatives of women of legal age are, naturally, not so frequent, but they still occur. One example was a situation in which an unmarried man of twenty-nine began living with a married woman of twenty-three whose husband was away in military service. The woman’s brother was shocked by her behavior, and when she ignored his protests he reported the matter to the police. The twenty-nine-year-old was convicted of adultery, sentenced to 60 days, and fined $15 and court costs.

Eighteen per cent of the cases were what may be termed the byproduct of police investigation. For instance, the police may be investigating a man for failure to pay alimony, or they may be hunting for a runaway girl and stumble upon the illicit sexual relationship. If the girl is still in her teens or if the police have reason to dislike the male, arrest on a sex charge is very likely to follow. A fairly typical case is one of a man of thirty-three living with a woman thirty-six; neither was married to anyone. The man had caused the police some trouble previously and the woman was suspected of being a prostitute. The matter was temporarily cleared up by convicting them both of adultery (sic); the man got 60 days, a $50 fine, and court costs.

Third commonest source of complaint (16 per cent) was the female herself. An example of this is the case in which a cab driver received the impression that his female passenger, a stranger, would welcome his attentions. This sort of thing, while uncommon, is not rare in the experience of taxicab drivers. However, in this instance, when he stopped the cab and entered the back seat section, the woman indignantly stormed from the cab and hailed a passing squad car, with the result that the cab driver got a 180-day sentence on an assault and battery charge.

Fourth were the cases in which there was an accidental witness who was disturbed enough to report the matter (11 per cent). Fifth was the outraged and jealous wife of the offender (7 per cent) who usually wanted only to “give him a scare” or “teach him a lesson” and who was subsequently distraught to find her breadwinner jailed.

Among the offenders vs. adults more than in any other sex-offender category the element of chance plays an important role. Because the behavior involved is on the borderline of social and legal acceptability, many minor and often fortuituous factors determine whether an arrest is made. A number of examples can illustrate this clearly. In 99 cases out of 100 a policeman who discovers an adult couple in coitus will either ignore them or simply tell them to “break it up” and admonish them to be more discreet. However, in the hundredth case the policeman may be extremely moral, or he may be under pressure because the city is in the throes of a cleanup, or he may get a vicarious thrill from making “sex arrests”—and consequently another man is added to the list of sex offenders. In other cases the difference between humble contrition and argumentativeness is the difference between going home or going to court on a sex charge.

Since they were involved in behavior which, while legally taboo, is socially acceptable or at least tolerable, the offenders vs. adults admitted their behavior freely, ranking near the top in this respect. In talking to us, only 10 per cent denied the acts for which they were sentenced.

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Of those who married, 54 per cent had extramarital coitus at least once; this figure is, relatively, neither high nor low but is somewhat above that for the control group (47 per cent).

The age-specific incidences of extramarital coitus, both with companions and with prostitutes, are always moderate. In all age-periods from sixteen to twenty-five about 30 to 40 per cent of these offenders had extramarital coitus with companions and 14 to 17 per cent with prostitutes. From thirty-six to forty-five these proportions decline to about 23-27 per cent for companions and 6-7 per cent for prostitutes. The frequency of extramarital coitus was relatively high; the average man who engaged in coitus outside of marriage did so roughly between once every three weeks to once every four from age twenty-one to age forty. As usual, the great majority of such coitus was with companions rather than with prostitutes. From 2 to 7 per cent of the total outlet of the married offenders derived from extramarital coitus with companions (these being moderate proportions), but 1 per cent or less from coitus with prostitutes. The latter figure is essentially the same for all groups.

While the offenders vs. children are a comparatively older group, age does not explain why they rank fourth in the number of extramarital partners (nine). Since all incest offenders and the married control-group individuals were on the average married more years than the offenders vs. children, the duration of marriage cannot be the chief explanation.

The incidence and frequency of postmarital coitus in this offender group is likewise unexceptional except for an emphasis on prostitution.

From 49 to 65 per cent of the separated, divorced, or widowed males had coitus with prostitutes in every age-period from sixteen to fifty; this earned them first rank twice, second rank four times, and third rank once. The coital frequencies with companions were understandably somewhat low, and, relatively speaking, only moderate to low proportions of their total outlet were derived from this activity. While the absolute figures are smaller, these offenders rank high in the proportion of total outlet derived from postmarital coitus with prostitutes, occupying first place from age sixteen to forty with percentages grading up from 6 to 31 per cent. They again rank first in age-periods 46-50 and 51-55.

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Comments (0) Mar 27 2009