Health news from around the world.

In general, the sexual psychopaths, during their middle teens, got along with their fathers less well than did the other offenders. This relatively bad adjustment is particularly noticeable in the figures to be found in the category of “bad adjustment”: here the proportions of sexual psychopaths exceed those of the other offenders in every instance, sometimes by as much as 11 percentage points.

A similar situation existed regarding their adjustment with their mothers, except that the sexual psychopath exhibitionists go counter to the trend. Some of the differences are quite large, both absolutely and proportionately. For example, among the aggressors vs. adults only 30 per cent of the sexual psychopaths reported getting along well with their mothers, whereas the equivalent figure for the other aggressors vs. adults is 63 per cent.

All in all, it is evident that a relatively poor adjustment with both parents is characteristic of the sexual psychopaths.

Another measurement of early adjustment to other individuals is the number and ratio of boys and girls the subject had as companions at ages ten to eleven. In this respect, only one over-all generalization can be made: sexual psychopaths tend to have had fewer companions of either sex than the other offenders. However, within certain offense types great differences exist between the two samples. In both homosexual-offender groups the sexual psychopaths had markedly large proportions of persons who had had no female companions and smaller proportions of persons who had had many. This suggests that they were, even at that early age, much more homosexually oriented than the other homosexual offenders. Very few of the exhibitionists who were sexual psychopaths had many female companions at ages ten to eleven (7 per cent of the sexual psychopaths vs. 38 per cent for the other exhibitionists); moreover, very few had many companions of either sex.

In summation, it appears that fewer sexual psychopaths than other offenders were able to make good adjustments with their parents and their peers.

*403\161\2*

Theaters and movies are often considered particularly vulnerable places for the occurrence of sex offenses. The easy anonymity of a darkened auditorium, coupled with stories about the sudden groping hand from the adjoining seat, has led some parents of young children to associate movies with the dangers of a sexual approach. This possibility appears more likely during the matinee and early evening hours, when, with seats half empty, sexual overtures are not too conspicuous, and it is easy to shift from one location to a more favorable one—an activity sometimes described as “playing checkers” by those who try it. The present data substantiate this suspicion to a fair extent. Thirteen per cent of the heterosexual offenses against girls under twelve years of age took place in motion-picture houses, and 10 per cent of the offenses against the next higher age group. Movies were a negligible factor as a location, however, with the females sixteen or over, as only two of the 169 such cases fall in this category. All the offenses committed in theaters involved physical contact, and most of them were in fact attempts to grope for or fondle the female in the next seat. To help control this problem, metropolitan theaters sometimes employ matrons to cast a supervisory eye over the younger patrons, and ushers are often alerted to report suspicious actions to the manager.

A somewhat smaller percentage of homosexual offenses occurred in motion-picture theaters. The three age-of-object groups, in the usual order, show a 3 per cent, 7 per cent, and 4 per cent incidence. It might be recalled that in these cases there may not have been physical contact between the two males, since merely an approach or solicitation constituted the offense in about 13 per cent of the total homosexual offenses. Five cases of exhibition also took place in movies, representing an incidence of 2 per cent. No force or incest cases occurred there. All told, a total of 74 offenses, spread through seven subtypes of offense, were reported as having occurred in motion-picture theaters.

*365\161\2*

Concerning ourselves with only the statistics based upon individuals with homosexual activity, we see that there are huge differences in number of homosexual partners not only between the homosexual offenders as opposed to other groups, but also between the three homosexual-offender groups. Excluding the latter, the average (median) individual of most of the sex-offender groups and of the control group had had sexual contact with about four males outside prison, whereas the average prison inmate with homosexual experience had nearly twice that many outside the prison walls. These figures are dwarfed by those of the homosexual offenders, the average homosexual offender vs. children having had 19 partners and the offender vs. minors 45. It was impossible to arrive at a figure for the homosexual offenders vs. adults, since their promiscuity was such that they were frequently unable to give precise estimates, but we know that the median would be closer to 200 than 100 partners.

Another useful measurement is the percentage of individuals with homosexual experience who had had such experience with over 75 males. The homosexual offenders cluster at the top of the rank-order with 63, 42, and 22 per cent. Following a gap of over 11 percentage points the prison group is next with 10 per cent, after which there is a gradual seriation down to about 2 per cent. Clustered at the bottom with 0 per cent are six groups, including all the incest offenders, the peepers, and the exhibitionists.

Aside from the clustering of the homosexual offenders at one end of the rank-orders and the incest offenders at the other, and the tendency of the control group to fall in the middle, no other patterns are evident.

*327\161\2*

This measurement parallels our frequency data. Nocturnal orgasms were far more important to the single control-group males than to the members of any other group. From puberty to age forty such orgasms accounted for 11 to 14 per cent of all their orgasms. At the other extreme, this particular outlet seems to have been unimportant to the aggressors, among whom it usually constituted 1 to 4 per cent of their outlet. Five of the sex-offender groups maintained essentially uniform percentages (1-6 per cent), but nine groups and the prison group displayed a tendency toward larger proportions as they aged. This increase ended in the late twenties or early thirties for all groups except the homosexual offenders vs. minors who attained their maxima in their forties.

Among married males die picture is less clear and the range of variation much more restricted (0.2 to 7.4 per cent). The married control-group males display only moderate percentages, and the married aggressors vs. adults, as before marriage, derived only a minimal proportion of their outlet from orgasm during sleep.

When men are separated from their wives, divorced, or widowed, their nocturnal orgasms do not resume the importance they had in premarital life, and in many instances the proportions of total outlet these orgasms constitute are not dissimilar to those found among die married. This situation is not due to age—a factor held constant in this comparison—nor due to a habituation to coitus and an accompanying increased facility for obtaining it, since, as we have seen, masturbation in many postmarital groups rebounds to or even exceeds premarital levels. One is left with the impression that nocturnal emissions constitute a “weak” outlet—quantitatively not important and especially subject to diminution by age—and that marriage deals it a blow from which it never recovers. One cannot say the emissions are “drowned out” by increased sexual activity of other types in postmarital life, for in most groups the premarital frequency of total outlet exceeds that of the postmarital of the same age. Perhaps if total outlet is reduced, the weakest of the constituent outlets will suffer most.

*289\161\2*

Our society maintains sharply dichotomous views on the wearing of the clothing of the opposite sex. On one hand transvestism (crossdressing) is considered acceptable humor, and as such it has a history running from Greco-Roman times up to the latest production of Charley’s Aunt or of the Harvard Hasty Pudding Club. The cross-dressing theme ranges from true drama, as in Shakespeare and opera, to amateur improvisation found amid parties where drinks are served. On the other hand, cross-dressing is viewed with extreme suspicion when it cannot be linked with festivities and entertainment. Disguise is basically antisocial in the eyes of society, and to disguise oneself as a member of the opposite sex is to add a note of sexual abnormality to an already disapproved act.

There are basically four major categories of cross-dressing which can, but usually do not, overlap.

Homosexual “drag.” A person dresses in the garb of the opposite sex to more easily attract persons of the same sex. On some occasions the clothing may be worn chiefly to symbolize the wearer’s attitude toward his or her sexual role. The clothing has no attraction or sexual value to the wearer—it is but a means and not an end.

Professional impersonation. The individual earns or supplements his or her livelihood by masquerading as a member of the opposite sex in a theater, nightclub, or similar locale. The clothing is not worn as bait (as in “drag”) or for its own sake; it is worn for business purposes.

Transvestism. The true transvestite, by our definition, is one who wears the clothing of the opposite sex for the emotional and/or sexual gratification it gives him. Cross-dressing is an end in itself.

Transsexualism. The transsexualist4 is one who wishes to become a member of the opposite sex or who feels that he or she is already a member of the opposite sex but exists in an inappropriate physical body. For example, one might say, “I am a man, but I want to become a woman”; another might say, “I am psychologically and spiritually a woman, but I have a man’s body.” The transsexualist is interested in clothing only as it symbolizes the social and sexual role to which he or she aspires.

While various combinations do occur, virtually all cross-dressers fall primarily if not wholly in one of these four categories. A professional impersonator may, if he is homosexually inclined, sometimes “go in drag”; a transvestite who is fortunate enough to look feminine may pick up a few dollars singing or acting; a transsexualist may derive some emotional thrill from donning female clothing—but usually an individual is readily classified.

Nine men whom we interviewed had been arrested and convicted as a result of appearing in public in female clothing; they were not charged with any sexual misbehavior. All but one were convicted under municipal ordinances designed to prevent people from concealing their identities.

The masqueraders had, in general, highly atypical sexual backgrounds. Their family backgrounds were also unusual: four of the nine had no siblings and seven of the nine had no brothers. Also seven came from broken homes (including one who was illegitimate). Their health, as children, was relatively poor; less than half reported good health.

Their heterosexuality may be best described as either deficient or distorted. Five of the nine were deficient heterosexually in the sense that they had very little activity and few sexual partners. The heterosexuality of three was labeled distorted: one had very erratic activity; one confined himself almost wholly to prostitutes; and a third preferred elderly women many years his senior and, in addition, preferred anal to vaginal coitus. Despite the fact that two were in their mid- to late twenties, four were in their thirties, and two in their forties, only one male had ever married. This picture of generally unfortunate heterosexual development was, so to speak, forecast by their initial coitus: eight of the nine enjoyed it little or not at all, and five of the nine lost their virginity to a prostitute. Two failed to reach orgasm in their first coitus.

All nine masqueraders had had at least one overt homosexual contact as an adult. In four of the nine the homosexuality could be described as incidental, but in five it constituted a significant part of their sexuality.

The masqueraders do not, as a group, appear seriously criminal or delinquent. Some of those who were predominantly homosexual had had some trouble on this score, and three men had been convicted of exhibition, but this is the totality of their sex offenses. Three had been involved in nonsexual crime, but in two of these cases the crimes were petty and involved no violence. Only one man was an alcoholic, and while three had used “light” drugs (e.g., benzedrine, marijuana, etc.) none had habitually used “heavy” drugs such as morphine or heroin.

An outstanding characteristic is the fact that seven of the nine were definite transvestites: persons who derived a real (and often sexual) gratification from wearing the clothes of the opposite sex. Four of these seven were also transsexualists who wished to be converted into females through having their genitalia removed and other medical procedures undertaken. Of the seven transvestites, two had little homosexual experience and were primarily heterosexual, in another two both hetero- and homosexuality were minimal, and three were predominantly homosexual with moderately active sexual behavior. The homosexual individuals were authentic transvestites and not simply “in drag”—i.e., they were not wearing female garb and imitating females as a means of interesting other males.

We shall not here venture into the etiology and characteristics of transvestism and transsexualism; this will be the subject of a future volume. However, it should be mentioned that five of the seven transvestites reported that the transvestism began in childhood well before puberty. This early origin appears to be characteristic of transvestism. In the other two transvestite cases the interest and cross-dressing began at ages twenty-five and twenty-six; these two men differ from most transvestites in several important respects. In both, the female clothing was used chiefly in fetishlike fashion as a masturbatory aid and to increase sexual arousal in general. Moreover, the cross-dressing was associated with exhibition; the males while dressed as females exposed their underclothing to genuine females. This sort of bizarre behavior is foreign to ordinary transvestism and is more akin to clothes fetishism. Indeed, one of the men did steal female clothing and, had he been apprehended, would have been classified with our oilier fetish theft cases.

Of the two males who were not judged transvestites, one was a deteriorated, mentally retarded, alcoholic, whose transvestite and homosexual components could not be accurately ascertained. The second male donned female clothing in the midst of what appears to have been a psychotic episode complicated by drinking and drugs, and culminating in arson. This male had, however, worn female clothing in his youth as homosexual “drag” so this pseudotransvestism nearly 20 years later was not without precedent.

If one sets aside the matter of transvestism and transsexualism, the masqueraders still are a rather unusual group with bizarre traits, described briefly as follows:

Male No. 1 has a history replete with bizarre behavior including exhibition, sadism, peeping, psychotic episodes, and auditory hallucinations.

Male No. 2 is an exhibitionist who on one occasion combined exhibition with transvestism.

Male No. 3 is a fetishist with minimal sociosexual behavior. He masturbates by tying himself up.

Male No. 4 is a masochist who is sexually aroused by being tied up by either males or females.

Male No. 5 has a history that includes assaultive behavior, car-stripping, and theft of female clothing for fetishistic reasons.

Male No. 6 is the mentally retarded alcoholic case.

Male No. 7 is the gerontophile who prefers anal to vaginal coitus and who experienced a psychotic episode.

Male No. 8 is not unusual aside from being predominantly homosexual and having been a homosexual prostitute.

Male No. 9 was reared as a female by his insane grandmother who was also his sole sexual partner for many years.

In summary, one gains the impression of a distorted and confused sociosexual life marked by a poor development of heterosexuality and mental and emotional disturbances that favor the development of exotic sexual traits: transvestism, transsexualism, sadomasochism, and exhibition. It should be added, however, that the transvestism frequently appeared very early in life and cannot therefore be ascribed to pubertal or postpubertal social and sexual maladjustments.

It cannot be too strongly emphasized that these cases under discussion are very selective. The men were not only apprehended but displayed prior and subsequent behavior not typical of transvestites and transsexualists. The great majority of transvestites and transsexualists do not come into conflict with society, although there may be occasional distressing incidents resulting from the fact that society makes no provision for persons with these desires.

*251\161\2*

The bacteria that cause PID are usually transmitted through unprotected sexual contact with an infected person. Two common causes are gonorrhea and chlamydia. Other bacteria that can cause PID either are sexually transmitted (e.g., Mycoplasma hominis) or are vaginal bacteria that are not sexually transmitted (e.g., Gardnerella vaginalis).

Women with multiple sexual partners are at increased risk for PID. A woman who has unprotected sex with an infected partner while she is menstruating is also at higher risk, since at this time of the month the natural defenses of the cervix are less effective. Younger women may be more vulnerable because they are more likely to practice unsafe sex and may have more frequent exposure to partners who are infected with sexually transmitted bacteria.

For women who are sexually active with male partners, condoms and spermicide (nonoxynol-9) can help prevent transmission of PID-causing bacteria if they are used correctly and consistently and if the condom does not break or leak. Cervical caps and diaphragms, used with spermicide, may also help decrease the risk of infection, but they are not as effective as condoms. Whatever their sexual orientation, women who have had unprotected sexual contacts in the past and who have never been examined for sexually transmitted diseases should be tested for PID and other STDs, even if they are symptom free.

*361\213\8*

Clearly, it is not inevitable that a person who is sexually active with a partner who has herpes will contract herpes. Some couples have been together for years, and even after years of unprotected sexual contact only one of the partners has herpes. Then there are those who are sexually intimate with a person with herpes just once or only a couple of times and acquire herpes from that contact.

A few truths seem to hold for most people regarding transmission of the herpes viruses. First, a person who has had a past infection with one type of herpes virus will not get reinfected in that area of the body with the same strain of the virus. For example, a person with genital type 2 herpes will not be repeatedly infected with genital type 2 herpes on reexposure. Therefore couples in which both partners are infected with genital type 2 herpes, for example, do not need to worry about transmission to one another. They will not reinfect one another through genital sexual contact. Furthermore, the likelihood of acquiring a new infection with type 2 herpes in another area of the body is low, because the antibody that is produced following the initial infection, which circulates through the body, offers protection at other sites.

People with type 2 herpes will almost never acquire a new type 1 infection, because the antibody to type 2 offers nearly complete protection against a new type 1 infection. Therefore, neither oral nor genital sex for this couple poses a risk of reinfection. Although type 1 herpes offers some protection against acquiring type 2 herpes, the protection is not as complete, and someone with type 1 can acquire a type 2 infection if exposed. However, as discussed later, it is unlikely that a person will acquire type 2 herpes in the same area where he or she has the type 1 infection.

Similarly, two people who are infected with oral type 1 herpes will not reinfect one another through kissing. However, there is a risk that they could infect one another through oral sex, although this risk appears to be low If only one partner has oral HSV-1, then the uninfected partner can more easily acquire genital HSV-1 through oral sex, especially if it is performed while the infected partner has a cold sore.

*268\213\8*

There is no evidence that repeated ejaculation, such as through masturbation, will help to “clear out” the infection any sooner, nor do dietary changes affect the course of prostatitis. It is recommended that partners of a man with prostatitis, if it is suspected to be caused by sexually transmitted bacteria, be treated as contacts. If the infection is not caused by sexually transmitted bacteria, then the decision about whether or not to treat partners must be made on an individual basis. Generally, all partners should at least be examined for evidence of infection and possibly treated as well.

The conditions mentioned previously that are not treatable by antibiotics are best addressed by a urologist. Any underlying structural problem that has caused the infection of the prostate—such as benign enlargement of the prostate or obstruction of the bladder for other reasons—should be treated by a urologist. Surgery can correct these problems and prevent future infections. A stricture or scarring of the urethra can occur after urethritis, and this can make it impossible to clear an infection from the genital tract, including the prostate. In addition, there can be stones in the prostate that prevent clearance of the infection, even if the antibiotics used are the right ones.

Even for prostatitis that is not thought to have a bacterial cause, most experts recommend a short trial course (one to three weeks) of an antibiotic in case bacteria are present and causing the infection. However, if this is not successful, then repeated trials of an antibiotic are not recommended. Follow-up with a urologist is recommended to treat symptoms of these usually benign conditions. Medications are available that ease the symptoms of prostate irritation that is not caused by bacterial infection.

*177\213\8*

What if, despite being very careful, you are diagnosed with an STD anyway? How could this happen? One possibility is that your partner has had another partner while he or she has been with you. Or, as was the case with Mandy and Alan, you or your partner may have had an infections without knowing it. When someone who is long-term relationships is diagnosed with an STD, it can lead to problems in the relationship. This is one reason why a health care provider must go over all the possibilities when you are diagnosed with an infection. Many people ask “Does this mean my partner has been with someone else?” Not always. It is occasionally difficult to tell who was infected first. The person who has been diagnosed with the infection is not always the person who brought the infection into the relationship and vice versa. In either case, the most important thing is for both parties to be treated.

If you are diagnosed with an infection, you need to talk honestly with your partner. Your health care provider can tell you whether or not your partner (or partners) must be tested and treated. Particular sexually transmitted infections—such as gonorrhea, chlamydia, and syphilis— are reportable in most states to the state health department, where a program is in place to notify and treat partners. Even if a partner does not have any symptoms of an STD, he or she could be infected and needs to be tested and possibly treated.

Do not avoid telling a partner because you are uncomfortable or embarrassed. Many sexually transmitted infections, even if they are symptom free, can progress to serious complications if left untreated.

*85\213\8*

How common is prostate cancer? Too common. In the United States, a man is diagnosed with prostate cancer every three minutes. Every fifteen minutes, a man dies of it. A boy born today has a 13 percent chance of developing prostate cancer, and a 3 percent chance of dying of it.

Scientists don’t know precisely what causes prostate cancer, but it’s clear that a number of factors are involved. First and foremost are age and hormones. Prostate cancer hardly ever develops before age 40; it becomes more common with every decade afterward. Also, it rarely develops in men who are castrated before puberty.

Genetic factors also play a role. Does prostate cancer run in your family? If your father or brother has prostate cancer, your risk of developing it is two times greater than the average American man’s. Families with prostate cancer in three or more first-degree relatives (father or brother), or prostate cancer in three generations (grandfather, father, son) have a hereditary form of the disease. The significance of this is that, in these families, men have a 50 percent risk of developing the disease. Also, it’s more likely to strike at a younger age—when a man might not even be looking for trouble or having yearly prostate exams.

What about environment? Clinically significant prostate cancer is rare in men who live in China or Japan. But when these men move to Hawaii or California, their rate of prostate cancer escalates—to the level of an American man’s. The high-fat Western diet looms as an obvious environmental culprit, but it’s not that simple. Other factors, such as vitamin A and exposure to ultraviolet light — which increases the body’s levels of vitamin D—are important in determining which men develop prostate cancer.

As scientists learn more about what causes prostate cancer, per someday we’ll be able to turn this knowledge into positive actions— so that, maybe, one day, prostate cancer will be preventable.

*33\201\8*