Mens Health Blog. Medical Blog

In the majority of states that have sexual psychopath laws the individual must be convicted of some offense, usually but not necessarily a sex offense, before he is subject to examination. In seven states an arrest alone suffices as ground for examination. In four other states the statutes are so vague that apparently a person could be examined and adjudged to be a sexual psychopath without being charged with a specific misdemeanor or felony.”

While the laws have had considerable popularity, they are marked primarily by their disuse. For example, in Indiana the annual number of persons judged sexual psychopaths can be counted with the fingers of one hand. Some of the disuse may be attributed to inertia and some to the disinclination of the offender to request an examination which might stigmatize him as being “crazy,” but some seems to be a reluctance arising from basic legal concerns. There is in the minds of many attorneys the question of double jeopardy, since in many jurisdictions the sexual psychopaths after incarceration and treatment are returned to court where they may, at the judge’s discretion, be sentenced to prison on the basis of the original charge. To put it simply, a man may be convicted, judged a sexual psychopath, locked up for months or years during treatment, returned to court as “cured,” and then imprisoned to begin a sentence for his offense. In addition to this matter of double jeopardy, some legal scholars feel that the reports of clinicians and therapists derived from conversations with the man examined constitute a form of self-incrimination.

One state, California, has made extensive use of the sexual psychopath statute, and it is from this state that we have derived nearly all our data regarding persons labeled sexual psychopaths. In California after a person has been convicted of an offense (either misdemeanor or felony), that person, his attorney, the prosecutor, or certain other persons involved in the case may request that the offender be examined for sexual psychopathy. The judge may then appoint two psychiatrists who examine the offender, generally in jail, and report to the judge whether or not there is evidence of sexual psychopathy. On the basis of this report the judge then decides either to sentence the offender or send him to an institution for a 90-day observation period during which it will be determined whether he is a sexual psychopath an whether he is amenable to treatment. If the man is judged to be not a sexual psychopath or if he is judged to be a sexual psychopath but not amenable to treatment, he is returned to court for ordinary sentencing.

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Alcohol. The drug and alcohol histories of the men we interviewed have been discussed earlier, and it was pointed out that alcohol was definitely not a minor consideration. At this point the problem can be explored further and given a sharper focus by examining the individual offenses and recording the degree of alcohol use at the time. Table 142 indicates the percentage of offenses that were committed when the offender had had little to drink, and those in which he was classed as intoxicated. The present definitions for these two categories are as follows. If a man had one or two ounces of alcohol, it is considered that he was probably not recognizably intoxicated, although his behavior may have been influenced by a loosening of controls. This is classed as “alcohol present.” On the other hand, any degree of recognizable intoxication was tabulated as “offender drunk” at the time of offense. This is a very rough categorization, but considering the confusion of terminology which can be applied to degrees of intoxication it seemed advisable to make a simple dichotomy. These data were drawn both from the police and court records as well as from the account of the offense provided by the subject during the interview. Since recognizable intoxication at the time of a sex offense is likely to be a matter of official concern and hence invariably recorded in the police and court records, the data are somewhat weighted in the direction of positive records.

For offenses for which alcohol data were not available from either official records or interview, answers to standard questions about the offender’s general drinking habits provided a secondary source of information. In the cases of nondrinkers we assumed that there had been no drinking associated with the offense. On the other hand, the offenses committed by men with admitted drinking patterns for which data were similarly deficient were put into the “no data” category. Such an interpretation probably minimized the role of alcohol, and percentages calculated on a base of known cases only might have further distorted the picture. For this reason percentages were calculated on both known and total cases as a check. The extent to which alcohol accompanied aggressions vs. children is the most striking figure in the table. It is involved to a marked degree in two thirds of the cases, and to some degree in an additional tenth of the data-known cases. No other group approximates this level, and this generalization also holds true when the percentages are calculated with the total N as a base instead of the “data-available” cases. Next to this group comes another aggression group, that against adult females, with two fifths of the cases showing a strong alcoholic involvement. From the peak of these two groups there is a drop to a cluster of seven types of offenses in which the factor of intoxication ranged from 20 to 30 per cent. This includes the three incest groups, the remaining aggression-offense category (that vs. minors), the exhibitionists, and the heterosexual and homosexual pedophilic offenses. At the lower extreme of about 9 per cent are the heterosexual offenses against minors and adults, and just above them, the homosexual offenses involving adults and minors. Thus we can observe here a clear-cut picture: drunkenness is a greater factor in the more aberrant crimes, such as those that involve children or the use of force.

In scanning the figures on marginal drinking it can be noted that while they stay at a fairly steady level—3 to 15 per cent—the bracket of offenses in which they range the highest is again the force offenses, adding weight to the interpretation already presented.

Drugs. Turning to the degree of drug usage at the time of the offense, presented in Table 143, one sees a very different picture. The findings are clearly minimal, and the small percentages stand for a total of only 22 cases out of a total of 2,022 offenses with data available. Four of these involved the use of heavy drugs such as heroin or morphine; in ten instances light drugs such as dexedrine or benzedrine were employed, and a final eight cases involved marijuana. On an overall basis this represents very slightly over 1 per cent of the total offenses, and the only points at which this low general average is exceeded is in the 2 per cent incidence of the use of marijuana in the aggressions against adults and the 6.4 per cent usage of light drugs in the incest offenses vs. minors.

In short, unlike alcohol, drugs are a. minor factor in the commission of sex offenses.

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Homosexuality in the physically mature male has, in Western culture, been one of the most hidden aspects of human sexual behavior. Only in the last decade or so has it been considered an area for respectable scientific investigation. Now that the barriers have been somewhat lowered and more factual data on such behavior are being accumulated, the presence and extent of some homosexual elements in almost every walk of life is gradually being recognized. Exactly how broad the incidence is in this or that segment of the population is still a moot point, but certain facts have become clear.

Many males with strong homosexual preferences have been able to follow their inclinations and at the same time to keep free of legal entanglements.

The idea that persons with homosexual preferences are “sick,” “abnormal,” or “perverted” has been severely challenged from many sources, and the fact that many homosexuals are able to live useful, well-adjusted lives seems evident.

To a large extent the problems that homosexuals face arise fom the social stigma attached to this form of sexual behavior and from the homosexuals’ resulting alienation from the main stream of heterosexual society.

The fact that homosexual experimentation occurs most widely in early postpubescence and that a few isolated experiences at that time are typical of many otherwise heterosexually oriented males is now also commonly admitted. That some of these males are led into more extensive activity and that in turn a few of them become exclusively homosexual is an evident fact. Others may have only an intermittent interest in homosexual relations and may alternate between sexual contacts with males and with females.

Homosexual acts are defined here as physical contacts between two persons of the same sex, designed (by at least one of them) to produce sexual arousal and recognized by both as being sexually motivated. Latent or unconscious expressions which might be interpreted as homosexual in nature are not under consideration at this time. Overt homosexual behavior may be some form of petting such as unilateral or mutual masturbation (usually manual). More commonly it consists of fellation (either in the active or passive role) or anal intercourse. There is general recognition that being deprived of heterosexual opportunities, for instance during imprisonment, may bring forth homosexual activity that otherwise would not have occurred. For this reason we have ordinarily excluded from our tabulations any homosexual acts that took place in prison.

As is true of most human conduct, the significance of homosexual behavior depends upon its extent and its context. In one person it may be incidental and transitory, in another it may represent a lifetime pattern. In one man homosexuality may exist harmoniously with heterosexuality, whereas in another it may reflect an inability to deal with adult heterosexual relationships. Thus homosexuality should always be viewed relatively, in terms of the role it plays in the total life picture. In this chapter we shall attempt to gain such a viewpoint.

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The great majority of males fantasy while masturbating although they may not fantasy on every occasion. Males who have never had fantasies during masturbation are relatively uncommon. A tabulation of those who make this claim indicates that the control group, the peepers, and the nonforce heterosexual offenders against postpubertal females tend to fantasy least; from 11 to 18 per cent of these groups reported never having fantasied. Aside from the control group, these groups all contain relatively large proportions of persons rated as having inferior intelligence. The heterosexual aggressors were the most fantasy-prone; and the remaining groups, including the prison group, are intermediate.

More important than whether fantasy did or did not occur is the question of fantasy content. While it is true that, broadly speaking, fantasy accords with the individual’s overt experience, it does embody a great deal of wish fulfillment that often exceeds the actual experience. Thus an average heterosexual male will fantasy coitus, which he has experienced, but he may also fantasy coitus in some group activity, say with famous Hollywood actresses—something he has not experienced. In brief, fantasy generally remains akin to experience but may be highly elaborated.

On the other hand, in certain individuals a repressed desire that has never permitted overt expression is a prime theme for a fantasy. This makes fantasy a most useful psychological tool for research purposes.

In our interviews, fantasy during masturbation was covered in only a crude fashion. Furthermore, the subject was not routinely covered until after 1942. Consequently it is possible to construct only five categories of fantasy content: heterosexual, homosexual, sadomasochistic, sexual contact with animals, and a residual category. Taking only those individuals who reported some sort of masturbatory fantasy, we have calculated the percentages of individuals with the five categories of fantasy just mentioned.

Essentially all (99-100 per cent) the men in all groups except the prison and homosexual offenders had had heterosexual fantasies. For the prison group, because of a strong homosexual subgroup, the percentage was only 95. The homosexual offenders had percentages ranging from 61 (the homosexual offenders vs. adults) to 90.

In homosexual fantasy, as one would expect, the three homosexual-offender groups exceed all others by far (69-91 per cent). Moreover, they are nicely arranged in order of the strength of their homosexual orientation. The prison group occupies fourth rank with a substantial 35 per cent having had homosexual fantasy, a percentage double that of the fifth-ranking group. This homosexual emphasis among the prison group reflects their actual experience. One cannot wholly explain this high percentage of homosexual fantasy and homosexual experience by saying that it is a by-product of incarceration, since the prison group showed the same proclivity toward homosexual activity prior to puberty. Those with the least amount of homosexual fantasy (0-6 per cent) are the three incest-offender groups, and the control group also occupies a low position.

Fantasy of sadistic or masochistic situations was commonest among the heterosexual aggressors vs. minors (17 per cent) and aggressors vs. adults (9 per cent). The fact that not one of the heterosexual aggressors vs. children reported this sort of fantasy does not spoil this picture since they seem to be primarily deteriorated seniles and/or alcoholics whose behavior is more disorganized than motivated by sadistic impulses. In addition, we feel that they were more likely than other offenders to deny or erroneously report certain circumstances connected with their offenses. The control group and the heterosexual offenders vs. minors and adults had few members with sadomasochistic fantasies—a noteworthy fact, since these three groups would be considered by the layman as the three most normal.” The prison group is intermediate.

Fantasy of sexual activity with animals is equally uncommon, but scarcely a rarity. The rank-order of percentages of those with this type of fantasy is rather puzzling. First of all, the tripartite groups occur not all together, but tend to be in pairs: two of the heterosexual-aggressor groups occupy the two lowest ranks; two of the homosexual groups are adjacent in the low area; and two of the incest-offender groups are adjacent in the intermediate area. In the case of all but the incest offenders, the aberrant third group is the group whose offenses involved children under twelve. These pedophiles tend to have more members with zoophilic fantasies than their brother offenders against older individuals. Young children, like animals, are relatively vulnerable. In the case of the incest offenders, conversely, it is the incest offender vs. adults who ranks highest. This we feel has a simple explanation. The incest offenders vs. adults are our most rural group; 48 per cent had spent their formative years in rural surroundings and 12 per cent had always been rural; no other group matches these figures. The fact that they had relatively little actual sexual contact with animals is of no consequence, for in fantasy the wish is in many ways more important than the deed, especially in a group as sexually restrained as the incest offenders vs. adults. The wish, however, can scarcely have been too strong, for none of them reported dreams of animal contact.

Secondly, the peepers head the rank-order of those: who had animal fantasies (11 per cent). No rural life can explain this, since they are a strongly urban group. Furthermore, no especial tendency toward zoophilia is evident in their dream content or in their overt behavior. Yet despite a lack of objective evidence, it seems somehow logical to suppose that those who are strongly voyeuristic would obtain gratification from observing sexual activity not only in humans but also among other animals, and that this interest in animal activity might engender similar fantasy.

Our last category of fantasy—”other” or residual (i.e., a catchall category)—provides more information than one might suppose. Classed as “other” are fantasies of exhibition, hence the exhibitionists head the rank-order with 26 per cent. Fantasy of peeping explains the second rank position of the peepers. The tendency for the incest offenders and the offenders against children under twelve to concentrate in the upper half of the rank-order is the result of our classifying as “other” any fantasies of sexual contact with young children or with close relatives.

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The six offenders vs. nieces were, at the time of offense, aged twenty-two, thirty-two, thirty-three, forty-five, fifty, and fifty-two. The niece of the eldest male was nearly thirty, but the nieces of the other males ranged from seven to fourteen. While not beyond what is generally considered (erroneously) “middle age,” these males were curiously ravaged by their years.1 In four of the six cases the interviewers felt obliged to comment on the discrepancy between seeming and actual age. The man who was thirty-two at the time of the offense was, at forty, described as “toothless, somewhat deteriorated”; the man of thirty-three (at offense and interview) was labeled “old!” by an interviewer more than a decade his senior; the forty-five-year-old (forty-seven at interview) was similarly called “old”; and the fifty-year-old (fifty-one at interview) was described as “too old—senile.”

This general picture of deterioration is paralleled by their mental status—not one was rated average or above. The youngest was feebleminded and the others were listed variously as “dull,” “low average,” “borderline,” and “inferior.” Like the offenders vs. sisters, these men were below par in sexual response to visual stimuli; four had little or no response.

The combination of young objects, subnormal mentality, and premature senility makes these men similar to the stereotype of the old, deteriorated child-molester. Indeed they fit the public image of the child-molester better than do the offenders vs. children.

Their heterosexual lives are, on the whole, not extraordinary, and all but two (one being the young man) ultimately married. Four had had some homosexual experience: for two it had at one time been of more than incidental significance, and perhaps this was also true of the feeble-minded young man.

As with the offenders vs. sisters, drunkenness was not an important factor, and neither were these men disposed toward additional sex offenses or other criminality. Of the six, only one man had an additional sex offense (one other man was convicted of multiple charges all stemming from one offense involving his niece). Nonsexual criminality was reported in three men: one violated some minor ordinances, another was convicted of loitering and assault and battery, and the third was incarcerated for what appears to have been petty larceny.

All in all, this group is very similar to the offenders vs. sisters: a mentally inferior group seeking sexual gratification, usually without force, from prepubescent or just-pubescent female relatives.

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NGU is transmitted through sexual contact with a partner who is infected: genital (penis to vagina), oral (penis to throat), or anal (penis to rectum). Men who perform anal sex may become infected with stool bacteria in the urethra. Correct use of a condom during sexual contact should be effective in preventing transmission of NGU, although condoms only decrease the risk of transmitting the herpes virus by about 50 percent (see the section on herpes). Condoms should be used for genital, oral, or anal intercourse with a partner who has not been tested, since a person can be infected but have no symptoms. Although many men believe otherwise, there is caused by allergic reactions, masturbation, too much caffeine, too little water, too much alcohol, spicy foods, or too much or too little sex.

TESTING FOR NONGONOCOCCAL URETHRITIS

To test for NGU, a urethral swab may be taken and examined for white blood cells. A small swab is inserted a short distance into the urethra (this may cause momentary discomfort). If examination under a microscope reveals a certain number of white cells, then the diagnosis of urethritis is made. If a man has urinated within the past four hours, the results may not be accurate, because the urine can wash away the signs of infection and the results would be falsely negative. For the urethral swab test to provide the most accurate results, the man should not urinate overnight before this examination.

If the results of the urethral swab test are negative but symptoms persist, the examination is usually repeated after the man has not urinated overnight. Alternatively, the man is instructed not to urinate overnight, and then the first part of the morning stream is examined under the microscope.

If a partner has been exposed to NGU in the throat or anal area, tests can be performed in these areas for specific organisms such as chlamydia and herpes virus, but not for all the bacterial organisms that can cause NGU, since some of them are difficult to culture.

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Both herpes simplex viruses are transmitted by skin contact with an area of a partner that is infected, or with secretions that are infected with the virus, such as semen, vaginal secretions, and saliva. The most vulnerable areas for acquiring herpes infections are mucosal surfaces, such as the mouth and throat, genital skin, or conjunctiva of the eye. Women acquire genital herpes more easily than men, probably because women have a larger area of mucosal skin surface in the genital area than men, which means that there is a larger area vulnerable to infection. Anywhere on the body where the skin is broken is also a vulnerable area.

Herpes is not transmitted through inanimate objects such as towels, drinking glasses, and toilet seats, but it can be transmitted through the use of shared sex toys, if they are immediately exchanged between partners. The virus is inactivated when secretions dry, and it doesn’t last long outside the body. (Theoretically, if someone with a genital lesion or oral lesion had direct contact with an object, such as a towel, which was then immediately put into contact with a vulnerable area of another person, such as the genitals, eyes, or mouth, then transmission could take place. But the likelihood of this actually happening is very remote, and there are no documented cases of herpes being transmitted in this way.) Herpes cannot be transmitted through the water or surfaces of a hot tub or a swimming pool. The only way to get herpes in a hot tub is to have sex with an infected partner in a hot tub.

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Infection of the prostate is evaluated by performing a rectal examination to feel the prostate and by evaluating fluid from the prostate under the microscope. This fluid can also be cultured to look for bacteria and other potential causes of prostatitis.

There is a stepwise progression in evaluating a man for a prostate infection. Usually a urethral swab is done first to evaluate for urethritis. The bladder is then emptied, and a midstream urine sample is collected for routine urinalysis to determine whether a bladder infection is present. (Bladder infections are relatively uncommon in men.) After that, a prostate examination is performed. This is best accomplished by doing a rectal examination. A gloved, lubricated finger is inserted into the rectum, allowing the prostate gland to be felt. A normal prostate gland is firm, without any irregularity in shape or tenderness to pressure. An infected prostate is tender, inflamed, and enlarged. Pressing on the prostate during the examination sometimes causes secretions to be released from the prostate; these secretions can be collected and examined under the microscope. Or after the examination the man can be instructed to urinate again (even though he had already emptied his bladder for the urinalysis), and this small amount of urine, which contains prostate secretions, can be examined under the microscope for infection and sent to the laboratory for culture to see if any bacteria are present. Bacteria in these prostate secretions indicate infection.

Some problems of the prostate are not caused by bacteria. Nonbacterial prostatitis is a condition in which the prostate is inflamed but cultured prostate secretions reveal no bacteria. Prostatodynia is a condition in which there are prostate symptoms but no infection is seen in the prostate secretions and no bacteria are seen on culture of this fluid. Both of these conditions are best managed by a urologist. Anxiety has also been shown to stimulate prostate inflammation and lead to symptoms that may mimic bacterial infection.

Other problems that may or may not produce these symptoms include the following:

1. Enlargement of the prostate, called benign prostatic hypertrophy, which is more common among older men.

2. Prostate cancer, which is also more common among older men

3. Stricture or scarring of the urethra.

4. An irritation of the pelvic muscles called pelvic floor tension myalgia, caused by sitting for prolonged periods of time.

5. Problems in the anal and rectal area, such as infection or constipation.

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Let’s say that you and your partner have discussed sex and your sexual health, and you are ready to begin an intimate relationship. What’s next? Unfortunately, talking doesn’t guarantee safety. For one thing, just because a person doesn’t have any symptoms of a sexually transmitted infection doesn’t necessarily mean that he or she is not infected (see Chapter 2 and Part II). Another consideration is that, even if you and your partner agree always to use a condom, you are not 100 percent safe: condoms sometimes fail because they are improperly used, and sometimes they break. Certain sexually transmitted infections, such as herpes and genital warts, can be transmitted even when condoms are used.

The bottom line is that the only way to know for sure whether or not you are infected with an STD is to be tested. If both you and your partner are properly tested at the time intervals at which any infection is likely to show up, and you are both negative for all infections, and you are both mutually faithful, then you may want to consider not using condoms for STD prevention. (See Chapter 5 for an explanation of the time intervals required to ensure accurate testing.) Under any other circumstances, you may want to assume that your partner may be infected with a sexually transmitted infection and therefore keep yourself safer by using condoms. If you or your partner has not been tested, or if you or your partner has other partners, then it is best to use condoms.

One important note: Because of the media attention devoted to HIV, many couples consider getting screened for HIV before becoming sexually involved, which is a great idea. Of all the sexually transmitted infections, this is the one of which most people are aware, and the one that most people are afraid of because it is life-threatening and incurable. Although testing for HIV is very important tor any sexually active adult, testing for HIV alone is not a complete screen for all of the sexually transmitted infections. (See Chapter 3 for a description of what is involved in a complete STD screening.) You may actually be at higher risk for acquiring other STDs (such as chlamydia or herpes) than HIV so it is important to get a complete screening.

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Several studies have suggested that men who smoke may be at a greater risk of developing prostate cancer. There is no solid evidence that proves this. For now, there seems to be only a weak association between smoking and prostate cancer. (One study, however, did suggest that men who smoke and are exposed to cadmium are at higher risk.) Having said this, it makes sense to add that smoking, which brings tobacco, nicotine (which is a powerful insecticide), and a host of toxic chemicals into every cell of the body—not just the lungs and throat—probably doesn’t decrease a man’s risk of getting prostate cancer. Conflicting reports have suggested that smoking may elevate hormone levels in men, and that this may somehow affect the prostate.

Anything Else?

Still other factors have been suspected, and studied, as potential risk factors for prostate cancer, including sexual behavior, viruses, socio-economic factors, other aspects of diet, and even BPH, but no strong proof has been found to link these elements to the disease.

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