When the official record is examined there is a considerable change in this general interpretation, especially toward a greater recognition of resistance in aggression offenses and in those involving children. The authorities are not at all concerned with the degree of encouragement that a naive seven- or eight-year-old girl gives an offender. That the child did not resist, discourage, or may even have encouraged the offender is ignored in light of the moral and legal implications of his behavior. Not surprisingly the official reports show no record of objects in the “mixed” response category shifting from resistance to encouragement. The opposite picture, that of encouragement shifting to resistance, is authenticated by the records in a few scattered cases spread out over several categories, but they appear much less frequently than reported by the offender. They total only nine cases in all categories, in strong contrast to the 47 so described by the offender.

The motif of “only encouragement” is represented strongly in heterosexual nonforce offenses vs. minors and adults (88 per cent and 88 per cent) and in homosexual offenses in the same two age groups, but again not quite to the extent reported by the subject. The frequency with which the official reports recognize that cooperation existed is one of the most remarkable aspects of the present table. However, since the records contain large no-data gaps on this point (well over a half in some instances), direct comparisons with the subject’s report must be made with considerable reservation, for the cases summarized in the percentages are far from identical.

An attitude of passivity is not emphasized in the official version of the offense in any categories. It appears to a small degree in the heterosexual and homosexual offenses vs. children, in the incest and homosexual offenses vs. minors, and with a final high of almost a quarter of the cases in incest offenses vs. adults. This last represents only three offenses, however. It is clear that passivity can be discounted as a feature which while sometimes recognized is not considered deserving of much attention in the official report of the offense circumstances.

Resistance by the object is strongly supported in the official reports of the aggression offenses, and ranges from 95 to 100 per cent of the cases in the three categories. This is roughly a third higher than in the offenders’ accounts. While the percentages naturally run highest in these cases of aggression, they are also massed in several other offense types, notably in pedophilic offenses and incest cases.

It is clear that the official accounts minimize the degree of encouragement and maximize the degree of resistance encountered in comparison to the offenders’ stories of similar events. In an attempt to examine this relationship in a more orderly fashion, cases in which both accounts were available were cross-tabulated. Incomplete reporting of offense circumstances by one source or the other reduced considerably the number of cases available for analysis.

While some categories are cut to half or less of the original numbers, notably those involving children, two show up with double reports for as many as 80 per cent of the cases. Support for the offender’s account is strongest in the nonforce offenses vs. minors and adults. Here the discrepancies on object response were only 4 to 5 per cent in the two accounts. From this supporting evidence one gathers that the offenders’ accounts of the offense behavior and circumstances are not too far from the truth. Disagreement is also low in homosexual offenses. There is little aggression in these offenses, and divergence between official and offender’s reports ranges from 2 to 14 per cent. Coverage is again less than adequate, but in the oldest group this can be partly accounted for by police-entrapment cases, for which such an item as the response of the object is not included in the official reports since it is immaterial to the case. It might well be assumed that the decoy officer in these cases was encouraging, but we have not assumed it here.

The pedophilic offenses rank rather high in disagreement, but the data here are sparser than in any other categories, doubtless because, as mentioned earlier, the authorities are not concerned with object response in such cases. The coverage is reduced to a third or even a sixth of the cases in some categories. In the cases remaining, disagreement runs over 25 per cent, except for homosexual pedophilia. Incest double-data are spotty; contradictory data are high, about equal to that in the force cases, ranging from 30 to 60 per cent.

Considered in terms of relative moral turpitude, it appears that the more reprehensible the offense, the more the offender endeavors to bend the account in his favor. Thus his description of object response in incest, aggression, and pedophilic offenses shows the greatest disagreement with the official accounts. In his account of other offenses, notably those without aggression and against minors and adult females, there is much less disagreement. One could also premise an interpretation that is at direct variance to this. It is possible that the official account is distorted the other way when the offense is one that is more highly condemned by society. In any case, whether the distortion is on one side or the other, or somewhat on each, the discrepancies clearly reflect the varying pressures of our social mores.

*382\161\2*

Among the various sex-offender groups there are substantial differences in the importance of sex offenses in their total criminality. Some individuals were convicted only for sex offenses. In eight of the 14 groups of sex offenders about half to two thirds of the men were convicted for sex offenses only. Of the remaining six offender groups, three had percentages nearly reaching half (45—47 per cent). The only three groups with a smaller proportion of “pure” sex offenders were the three aggressor groups. About one third of the aggressors vs. adults, only about one quarter of the aggressors vs. minors, and a mere one eighth of the aggressors vs. children had been convicted solely for sex offenses.

This heavy involvement of certain sex offenders in other than sexual crimes will come as a surprise to people who look upon sex offenders as specialized creatures somehow set apart from other criminals.

The proportion of total convictions that were sex-offense convictions varies from about two fifths to three quarters; for most groups it ran about 50 to 60 per cent. The only exceptions are the aggressors vs. children, of whom only two fifths were convicted for offenses of a sexual nature, and the exhibitionists, with nearly three quarters of their convictions stemming from their sexual behavior. The proportions do not otherwise seem to correlate with type of offense.

*344\161\2*

One important aspect of marriage is how well a couple knew one another beforehand, and one measure of this is how long they knew each other before marrying. If an individual were married more than once, we calculated only the briefest acquaintance. Questioning showed that the average (median) control-group male had by far the longest acquaintance with the girl he married, having known her for over 16 months prior to the ceremony. The briefest was that of the aggressors vs. minors: less than two months. In this range of two to 16 months, six months is about the midpoint. Below the midpoint one finds all but one of the offender groups vs. children, the peepers, the exhibitionists, and all the aggressors. The prison group is at the midpoint; above are all the offenders against females aged twelve and over. From this one gains the impression that impetuous marriage is, a bad omen, indicating inability to postpone the gratification of impulse, an inability foreshadowing pedophilia and aggression.

*306\161\2*

Having discussed how prepubertal contact with adult males and females correlates with postpubertal homosexuality and heterosexuality, we should also examine the continuity of prepubertal sexual activity with other children with subsequent postpubertal behavior.

First of all, we limited the study to those who had prepubertal physical sexual contact, omitting those who had none or whose prepubertal sex play consisted only of genital exhibition. Secondly, we omitted those with only one experience either before or after puberty. We then defined continuity as the presence of a given type of sexual activity beginning before puberty and continuing past puberty without a break (a period without such activity) of more than one year. Thus a boy who had petted from, say, age nine to puberty at age thirteen would be considered to have shown continuity even if he had stopped petting during age fourteen but resumed it at age fifteen. This one-year leeway we feel is not excessive, particularly in view of the factor of memory error. We know from comparing the histories of siblings that people are prone to forget early sexual activity, and our interviews with children bear this out.

In continuity of heterosexual activity the prison group and the heterosexual offenders vs. minors and adults lead all others. The least continuity is displayed by the peepers and the control group.

When the heterosexual activity is divided into petting and coitus, roughly the same picture is seen. In petting, the prison group occupies third rank with a figure of 69 per cent having continuity. The heterosexual offenders rank first, second, and eighth (56 to 81 per cent). At the bottom of the order are the homosexual offenders vs. adults (44 per cent), the control group (41 per cent), and the peepers (32 per cent). The three groups with the largest continuity percentages—the prison group and the offenders vs. minors and adults—are groups with above-average premarital heterosexual activity in adult life. In continuity of coitus the same three groups lead: the offenders vs. minors with 78 per cent followed by the offenders vs. adults and the prison group. The three groups with least continuity are the peepers and the incest offenders vs. children and minors.

There does not seem to be much correlation between the incidence of prepubertal heterosexual activity and the percentage who continue it beyond puberty. If we had adequate frequency data, some strong correlation might well be found. However, one interesting correlation did come to light. The heterosexual offenders vs. adults and minors, who had the largest proportions of individuals with coital continuity, also occupy first and third ranks in the percentages with prepubertal coitus and again first and third ranks in the percentages whose first prepubertal orgasm was derived from coitus. In other words, substantial involvement rewarded often with orgasm tends to promote continuity.

In view of the power of conditioning and early experience, the question is not why continuity exists, but why it does not exist more often. Examining the groups with the least heterosexual continuity—the peepers, control group, and incest offenders vs. minors—we see that the peepers seem to have been handicapped sociosexually from the start; not many had prepubertal petting, very few had prepubertal coitus, and a large proportion lacked female friends. We can only surmise that whatever caused these deficiencies also adversely affected continuity of activity. The control group’s relative lack of continuity appears to us to be largely a matter of their generally greater conformance to the mores of the middle and upper-middle class to which more of them belonged than was true of the sex offenders and prison group in general. The incest offenders vs. minors’ lack of continuity is an enigma. They suffered from some acute temporary repression of heterosexual activity around puberty and the average individual did not become active again until quite late—just past sixteen, the same age at which the average peeper began adult heterosexual behavior.

Turning now to the continuity of homosexual activity, one finds that it characterizes 75 per cent of the homosexual offenders vs. adults, 67 per cent of the homosexual offenders vs. minors, and 63 per cent of the homosexual offenders vs. children. All other groups had many fewer individuals (7 to 50 per cent) whose homosexual activity ran from prepubertal life into postpubertal life. Discontinuity of homosexual behavior is easier to explain than discontinuity of heterosexual behavior, since the former is subject to stronger social disapproval. Furthermore, society openly encourages heterosexuality although it bounds the encouragement with restrictions; society does not encourage homosexuality except indirectly through its restrictions on heterosexuality.

*268\161\2*

The commonest variety of peepers are the sociosexually underdeveloped: nearly one third of the peepers fit this description. They have much less heterosexual experience than is customary for their age and socioeconomic status, they are shy with females, and have strong feelings of inferiority. Intelligence does not seem a significant variable; these men range from dull to superior. As 6 have said, marriage does not remove a man from this category—it. \s no cure for peeping.

Among the sociosexually underdeveloped peeping often becomes a repetitive and important part of sexual life, frequently substituting for masturbation fantasy. The linkage between masturbation and peeping is mutually reinforcing, and for some men peeping-plus-masturbation becomes a truly compulsive activity carried on over lengthy periods of time.

A classic example is a man who was in his midtwenties when we interviewed him. He had begun petting at fourteen and had petted with a modest number of females, but had gone beyond above-the-waist stimulation with only two girls. When he was seventeen he had coitus three times with one girl and none thereafter. Timidity and an overwhelming fear of being rejected kept him from seeking more heterosexual activity which he strongly desired. His fear of rejection began, insofar as he knows, with a traumatic event shortly after he reached puberty and was experiencing the usual quick and intense sexual arousal at that period of life. Circumstances forced him to share a bed with his married sister and he became extremely aroused and desirous of coitus. Unable to express his wish he simply showed her his erect penis. She rejected him violently and harangued him at length on how vile he was. Ever since then he had felt extremely awkward and hesitant about approaching females sexually, and every rebuff was excruciating.

He began peeping regularly, first at his sister through a keyhole, and later at other women through windows, usually masturbating while doing so and reaching orgasm. The peeping became a compulsion which he was unable to resist despite repeated arrests. Heterosexual petting—in which he engaged to a mild degree—did not satisfy his sexual or emotional needs, and his sensitivity about being rejected was so great that he ceased trying for coitus after four rebuffs. He found the idea of coitus with a prostitute unappealing and, moreover, he was strongly afraid of catching a venereal disease.

Of the five peepers who exhibited fetishistic behavior (in every case female lingerie was the fetish), three belonged to the sociosexually underdeveloped variety.

Another variety, constituting perhaps one peeper in ten, is the drunk. In essence, these are men who would not, and did not, peep while sober, but when their control was weakened by alcohol they either deliberately set out to peep or else took advantage of an unexpected opportunity to do so. Of the six men whom we classed as of the drunken variety, three were chronic vagrants and one was a professional criminal. This leads us to suspect that the peeping may have had economic as well as sexual reasons.

About one fifth of the peepers may be regarded as of the situational variety—men who availed themselves, while sober or reasonably sober, of the opportunity to peep. This variety runs a wide gamut. At one end of the range is a virgin college freshman who had never seen a nude woman and who stopped to peep into a room where a woman was undressing. At the other end of the range is a married man with a grammar school education, in his thirties, who had spent nearly half of his life in juvenile homes, jails, and prisons, who evidently combined pleasure (peeping) with business (burglary) when the opportunity presented itself.

Perhaps one eighth of the peepers owed their trouble with the law to their mental deficiency. These men could not control their impulses adequately nor could they peep discreetly enough to avoid being caught. Many of these mental defectives tend to blend with the situational and drunken varieties of peepers, but the root of their trouble was their low intelligence rather than circumstances or alcohol.

After subtracting these four varieties, we are still left with about one quarter of the peepers unclassified. These men were neither drunken nor mentally deficient, their sociosexual behavior was generally within normal limits, and their peeping was not an opportunistic offense. Upon closer examination it was found that ten of these 14 men had been convicted of rape and three of exhibition. In the case of five rapists the peeping antedated the rape: these are the men who generate the popular notion that peepers become, in time, rapists. While it is true that an occasional peeper of one of our four varieties may rape, the use of force is generally uncommon—it happened in only three cases (all of the sociosexually underdeveloped variety) out of the 41.

We cannot determine from our data what behaviorisms differentiate the harmless peeper from the peeper who will subsequently rape, but we do have the impression that peepers who enter homes or other buildings in order to peep, and peepers who deliberately attract the female’s attention (tapping on windows, leaving notes, etc.) are more likely to become rapists than are the others.

From all this it is evident that the statistics on the heterosexual behavior of the peepers are the results of two major conflicting influences. On one hand are the men who had little heterosexual activity, the sociosexually underdeveloped plus some of the mental defectives and drunks. On the other hand there is an essentially equal number of persons with an average or above-average amount of heterosexual activity. This has unfortunate statistical consequences on occasion: confusing bimodal distributions, or meaningless averages.

*229\161\2*

Lymphogranuloma venereum (LGV) is an infection caused by three types of the bacterium Chlamydia trachomatis. Other types of this bacterium cause chlamydia infections (see the section on chlamydia).

HOW COMMON IS IT? Although some types of the bacterium Chlamydia trachomatis are very common in the United States, the types that cause LGV are not, and fewer than a thousand people are diagnosed with LGV each year in this country.

LGV is common in the developing world, especially in Africa, Asia, and South America, and most people who live in the United States and contract the disease do so when they travel to another part of the world and have unprotected sex with an infected person. Poor people living in urban areas of the United States are also at higher risk. Having multiple sexual partners is a risk factor for acquiring LGV as it is for other sexually transmitted diseases.

*339\213\8*

Hepatitis C can be transmitted from mother to child during pregnancy, although not as easily as hepatitis B. About 5 percent of children born to mothers who are infected with hepatitis C are infected at birth. It may also be possible for the mother to infect the child after delivery through close contact (about 3% of children who were not infected at birth, but whose mothers have hepatitis C, also develop infection), although hepatitis C does not appear to be transmitted through breast milk. So far we do not know how to prevent transmission from mother to child.

Clearly, in order to avoid acquiring hepatitis C it is essential to avoid needle sharing among injection drug users and to avoid exposure to infected blood. But even less-invasive activities, such as sharing straws to snort cocaine, have been linked to the transmission of hepatitis C. As for sexual contact with someone who is infected with hepatitis C, condoms can be used to decrease the risk of infection, but this is adecision every couple must make for themselves after being counseled about the risks. Each couple for each year that sexual contact continues. If an uninfected partner has genital herpes, it may be easier for him or her to acquire hepatitis C.

It does not appear that hepatitis C is transmitted through the kind of casual contact that normally takes place in households and in the workplace. Neither does saliva appear to pose a risk, unless it is contaminated with blood, in which case transmission may be possible. Hepatitis C does not appear to be transmitted through food or water, as is hepatitis A. Nevertheless, a person with hepatitis C should try to avoid having any contact with others in the household that could result in transmission, such as sharing razors, toothbrushes, or nail-clipping equipment.

*246\213\8*

Chlamydia is completely treatable with antibiotics, but the consequences of the disease, such as scarring, may not be treatable. The antibiotics most commonly used for uncomplicated genital chlamydia infections in men and women are doxycycline, ofloxacin, and erythromycin (which are taken for a week) and azithromycin (which is taken as a single dose by mouth). Azithromycin may be the best choice for some people in the long run, since many do not take the full week-long course of the medication, and as a result do not receive adequate treatment and can still have infection and complications later. A medication that treats the infection with just a single dose can avoid this problem. However, it is important to abstain from sex for a full week after taking the single-dose treatment of azithromycin, because it stays in the system for quite a while (actually up to a week) and is actively treating the infection during that time. Resuming sexual activity sooner than this can reinfect partners.

It is especially important for someone being treated for sexually transmitted infections to take the medication as prescribed and take all of it. If a woman with infection is found to have PID from chlamydia, or a man is found to have infection of the epididymis or prostate from chlamydia, then a longer course of antibiotics must be used (see the specific entries for these STDs).

Any partners within the past two months should also be treated as contacts to infection, even if they do not have symptoms or evidence of infection on examination. Talk with your health care provider about whether you need to follow up after treatment to make sure the infection is gone. In most cases, it is not necessary. However, pregnant women should always have a follow-up test to make sure the treatment for chlamydia has been effective. Erythromycin is the medication best suited for the treatment of chlamydia during pregnancy; the others may be harmful to an unborn child.

It is best to wait about four weeks after finishing treatment to test whether the infection has, cleared. Killed bacteria may show up on testing up to a month after treatment, which would falsely indicate infection. After four weeks, a continued positive chlamydia test demonstrates persistent, untreated infection, which could possibly be due to reinfection.

*155\213\8*

CT (Computed Tomography) Getting a CT scan basically means having a circular series of X-ray pictures taken by a machine that goes around the body.

Then a computer puts the pictures together, generating images that, as in MBI, are like slices of anatomy. The CT tube, where a patient lies, is bigger than the tube in an MRI machine, so claustrophobia is not a problem, and this technology is faster than MRI. However, the pictures aren’t as good. (One way doctors can enhance CT images is to give patients an intravenous dye; however, this can cause an allergic reaction in some people.)

When it comes to imaging the prostate, CT has turned out to be something of a dud. It can’t visualize cancer in the prostate, and it’s not very good at showing cancer that has spread beyond the prostate. This is mainly because CT looks for sizeable masses. It can’t spot tiny invasions; and this is how most prostate cancers spread to new territories. (For example, the overwhelming majority of metastases to the lymph nodes start out on a microscopic level.)

In detecting localized spread of prostate cancer (beyond the prostate wall, or into the seminal vesicles), CT has been found to have a sensitivity of 50 percent at best. It also has an unfortunate false-positive rate in diagnosing prostate cancer in the seminal vesicles.

Chest X-ray. In 6 percent of men with prostate cancer, bits of the tumor break off and establish themselves in the lungs. In late-stage disease, this figure rises to 25 percent. So the presence or absence of cancer in a man’s lungs can help doctors stage the disease.

*68\201\8*

Another reason why more cases of prostate cancer are being diagnosed is improved diagnostic techniques. In the 1970s, more men underwent a procedure called TUR (transurethral resection of the prostate) for treatment of BPH, so more cancer was detected as a result. In a TUR procedure, excess prostate tissue is removed in fragments through the urethra; these leftover chips of tissue are routinely sent to pathologists for examination. More cases of cancer were detected as more men underwent TUR procedures.

The 1980s saw a breakthrough in biopsy techniques—the biopsy gun, a tiny, spring-loaded needle guided by the urologist’s finger during a rectal exam. This development meant that a doctor could take microscopic tissue samples throughout the prostate during a routine outpatient visit. (Before this, getting a biopsy meant a patient had to be admitted to the hospital and given an anesthetic. The biopsy gun can be used without anesthesia.) And today, the

PSA blood test and transrectal ultrasound are being used more often to diagnose cancer in the prostate.

In any event, the undeniable truth is that prostate cancer is on the rise. Who’s at risk? That’s a trickier set of statistics. Some factors, such as age, family history, and diet, clearly are very important. The roles of others, such as environment and occupation, are less certain.

*22\201\8*