EXHIBITIONISTS: CIRCUMSTANCES OF THE OFFENSE

The average exhibitionist was nearly thirty at the time of his first conviction for exhibition. A large number of exhibitionists were married at the time of the offenses—a total of 31 per cent, including 6 per cent whose wives were temporarily absent. Forty per cent had never married and 29 per cent were separated, divorced, or widowed. Having a sexual partner available apparently does not seriously lessen their exhibition. Like the peeper, the exhibitionist seldom chooses his wife or girl friends as objects of his offense behavior. The statistics are as follows: 92 per cent strangers, 5 per cent acquaintances, 2 per cent friends, and 1 per cent relatives.

They frequently had committed other sex offenses prior to their exhibition. Only 38 per cent of the exhibition convictions were their first sex offenses. Slightly over one quarter were second offenses; 13 per cent, third; 7, fourth; 6, fifth; and 10 per cent were sixth or more. Despite the exotic and symbolic nature of exhibition, only a relatively small proportion (3 per cent) of the exhibitionists had previous histories of mental difficulty. On the other hand, a substantial proportion (nearly one third) of the offenses involved drunkenness, and an additional 8 per cent involved mild to moderate intoxication.5 As usual, drugs were of no consequence. Only three offenses involved drug-users and none of them were using “heavy” drugs.

Like peeping, exhibition is virtually always done by one lone male. In only one offense were other males involved.

While a few (7 per cent) of the exhibition offenses were committed in a state of extreme drunkenness or other mental confusion, the great majority (86 per cent) were clearly premeditated. The remainder were to some degree opportunistic, the individual not having planned to expose himself but acting on sudden impulse.

Exhibition in nearly three fifths of the offenses took place out-of-doors. In almost another fifth the exhibitionist exposed himself from an automobile. In 11 per cent of the offenses the exposure was from a residence, the man generally standing before a window. The remaining places of offense are diverse and numerically unimportant.

Ordinarily data concerning the ages of the females involved are not available. Only when the females are subadult is age likely to be mentioned. We have a record of 30 offenses where the man exposed himself to girls aged eleven or under, and another 19 cases in which the girls were twelve to fifteen. All other cases of the total of 288 offenses may be presumed to involve chiefly adult females. The matter is, of course, complicated by the fact that some exhibitionists are exposing to the world in general or to the female sex in general. These are the men who the psychiatrists might say were attempting to prove their masculinity through genital display or who were expressing their hostility toward people or toward one sex. Even the exhibitionist who is aiming (in some cases literally) at a specific sort of female often must simultaneously expose himself to other nearby individuals or forego the opportunity completely. In this sense he is like the peeper who looks into a room and by definition is peeping upon whoever is in the room regardless of age or sex, although he would much prefer to find himself viewing a female of suitable age and physique. Again, like the peepers, most of the exhibitionists, except those with pedophilic interests, wish to and do expose to females whom society would construe as suitable sexual partners.

These offenders are singularly likely to be caught because they so frequently expose themselves in public and populous places; some even expose themselves from their own residences. We estimate that in slightly over one third of the offenses arrest was probable. In 44 per cent it was possible but not probable, and in 11 per cent arrest was unlikely.

The individual reporting the offense was predominantly the object or one of the objects of the exposure (48 per cent of the cases). In second place are persons to whom exposure was not made but who witnessed it (24 per cent). Friends or relatives of the females reported the offense in 12 per cent of the cases, and in a scattering of instances the police themselves were the original witnesses (7 per cent) or discovered the matter in the course of other investigation (8 per cent).

Our data are not so complete as we would like, but it would seem that the great majority of exhibitionists are in (or achieve) a state of penile erection while exposing their genitalia. A small but still substantial number reach orgasm through self-masturbation while exhibiting.

Almost two thirds of the offenses were fully admitted to the authorities, and nearly three quarters were so admitted to our interviewers. Slightly over 2 per cent of the offenses were allegedly so beclouded by drunkenness or emotional upset that the man could neither affirm nor deny his guilt. Seventeen per cent of the offenses were denied to the authorities and 7 per cent to us. Qualified admissions constituted a uniform 16 to 17 per cent.

The final legal pleas run as usual: 77 per cent guilty, 19 per cent not guilty, and 4 per cent no plea.

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STD: TESTING FOR MUCOPURULENT CERVICITIS

The symptoms of MPC may be vague, and it may be difficult to diagnose based on history alone. Therefore a pelvic examination is necessary to diagnose MPC. Many women mistakenly believe they are being tested for infections when they have a Pap smear, which is the screen for cervical cancer (see the section on genital warts). A Pap smear may sometimes reveal changes consistent with herpes or trichomonas infection, but the real purpose of a Pap smear is to screen for cervical cancer, and specific tests must be performed to determine the causes of MPC.

The diagnosis of MPC is made based on characteristic observations during the examination and under the microscope. On examination, a discharge may be noticed; it will be examined under the microscope to help determine if it is coming from the cervix or the vagina. The cervix may show some telltale signs of infection, such as easy bleeding when it is swabbed, emission of pus from the opening (the os), and excessive redness. On examination of the cervical discharge under a microscope, numerous white blood cells can be seen. Occasionally, gonorrheal organisms can also be seen under the microscope (as noted, gonorrhea is one cause of MPC). Cultures may be performed for specific bacteria. The health care provider will also determine whether there is infection higher up in the pelvic organs.

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STD HERPES: THE RANGE OF SYMPTOMS

Herpes symptoms range from no symptoms at all in some people to painful ulcers or blisters (the classic symptoms) in others. More subtle symptoms include red, itchy, or tingling areas; red bumps or pimple-like bumps; and tiny slits or “scratches.” First infections with herpes tend to cause more severe symptoms than recurrences, but as mentioned previously, some people have no symptoms when they become infected, so there are exceptions to this generalization.

Lesions on skin surfaces—such as the face; the penis, pubic area, buttocks, and scrotum for men; and the outer labia, buttocks, or pubic area for women—usually form a scab as they heal. However, lesions that are on mucosal surfaces—such as the anal area, inner labia, vagina, or urethra—do not form a scab as they heal. These lesions usually do not leave a scar. Symptoms usually last for a few days and then clear up.

Other symptoms may accompany the sores, or the sores may be the only symptoms of an outbreak. Lymph nodes in the groin may swell and be painful when a person has a genital herpes recurrence, or those in the neck may enlarge during an oral herpes recurrence. Other possible symptoms are headache, back pain, leg pain, stiff neck, sore throat, heightened sensitivity of the eyes to light, and a feeling of being tired and achy all over, similar to the experience of having the flu.

Some unusual symptoms that can occur in the genital area are numbness or increased sensation in the genital area or lower back, weakness or tingling in the legs, and constipation. These symptoms tend to be more common with the first infection, but they may also occur in future outbreaks. With genital herpes, a woman may experience a vaginal discharge or pain during urination. A man with a herpes infection may feel burning during urination, with or without discharge, and without lesions.

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STD EPIDIDYMITIS AND PROSTATITIS: WHAT ARE THE SYMPTOMS?

Epididymitis

The symptoms of epididymitis are scrotal pain, redness, and swelling, usually on only one side. The pain can be severe. There may be symptoms or evidence of urethritis, such as burning with urination and discharge. These symptoms may be subtle or not present at all, even if urethral infection is present, and they are more common in men whose epididymitis has a sexually transmitted cause. In older men there may be history of a change in the urinary stream and evidence of a bladder infection, such as pressure in the bladder and burning with urination. The symptoms are usually gradual in onset but can occur suddenly.

Prostatitis

Prostate infections are usually classified as acute or chronic. Acute infections produce severe symptoms of fever, chills, fatigue, difficulty urinating, increased frequency of urination, and sometimes the inability to urinate. Chronic prostatitis produces these same symptoms, but they are more subtle, and there may be no symptoms at all. Most men with chronic prostatitis experience difficulty urinating, “dribbling” after urination, and more frequent urination. Sometimes there is a dull pain between the scrotum and the anal area, in the region known as the perineum. Occasionally there are pain with ejaculation and blood in the semen.

Often the pain of prostatitis is made worse by standing. In addition, depending on the underlying cause of the prostate inflammation, there may be symptoms of either a bladder infection or a urethral infection. Some men have epididymitis and prostatitis at the same time.

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WHY IT IS SO HARD TO TALK ABOUT SEXUAL HEALTH AND STDS: ALCOHOL AND DRUGS

Alcohol and drugs make it harder to make decisions and often lead to risky behavior—such as driving too fast or spending the night with a relative stranger. The combination of not thinking clearly and being in situation in which sex is involved can make a person very vulnerable. It’s hard, in such a situation, to ask questions or practice safe sex, or even to remember that a person can become infected with an STD from a single unprotected sexual contact. If you have a problem with drugs or alcohol, seek help and counseling.

pare yourself to respond in a way that produces the best outcome for you. If you are in a relationship with someone who contributes to remember that a person can infected with an STD from a single unprotected sexual contact. If you have a problem with drugs or alcohol, seek help and councellings.

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OTHER RISK FACTORS OF PROSTATE CANCER: LOCALE

Does where you live affect your chances of getting prostate cancer? Actually, yes—suggest the results of a recent study of prostate cancer and geography.

The theory behind the study was that insufficient levels of vitamin D, a hormone known to have anticancer properties, may increase a man’s risk of getting clinical prostate cancer. What’s the biggest source of vitamin D? Everyday exposure to the sun’s ultraviolet rays. The researchers looked at geographic distribution of the sun’s ultraviolet rays and the number of prostate cancer deaths throughout the country. Their results were startling. They showed a striking north-south pattern, with the heaviest areas of prostate cancer death in the north and the lightest areas in the south. (This despite the fact that the

south has a higher concentration of older men than other parts of the country. Data were age-adjusted; using this method, researchers can compare different groups as if the populations had the same underlying age distribution.) But when they looked at sunlight exposure, they found just the opposite—the heaviest exposure in the south, and the least in the north. Areasgetting the least UV radiation had the most prostate cancer, and vice versa. Their conclusion?

Ultraviolet radiation may protect men from getting clinical prostate cancer. And vitamin D, called a tumor inhibitor, somehow slows or prevents incidental prostate cancer from becoming clinical. (If you live in Alaska, or spend most of your time indoors, don’t panic. More work needs to be done to confirm this theory, and as yet, having an inadequate supply of vitamin D has not been established as a definite risk factor for prostate cancer.)

These findings might help explain why prostate cancer death rates are highest in Scandinavian countries, Canada, and the United States, and lowest in Hong Kong and Japan. Also, the Japanese diet is rich in fish that contain vitamin D.

These findings also might help scientists understand why black men in this country are so susceptible to prostate cancer: People with dark skin absorb less sunlight and thus have lower levels of vitamin D. African scientists compared blood levels of vitamin D in black men in Zaire with Zairian black people living in Belgium and found significantly lower levels of vitamin D in those who had left sun-drenched Zaire.

*29\201\8*

LAWS THAT AFFECT OUR SEX LIVES: CYBERSEX—SEX ON THE INTERNET

The old Comstock laws came back to haunt us again in the debate about using the Internet to send and receive pictures and writing that are “indecent or patently offensive.” The Internet links personal computers in homes, schools, libraries, museums, and other public places around the world. It also allows people to have sexually explicit conversations and exchange sexually explicit pictures and stories very quickly and with great freedom.

In June 1995, as a response to public concerns about children viewing pornographic materials on their home computers, the U.S. Congress passed the Communications Decency Act. The act was an attempt to regulate obscene language and images on the World Wide Web. The penalty for sending any “indecent” or “patently offensive” information over the Internet was two years in jail and a $250,000 fine.

In June 1996, the American Civil Liberties Union, Planned Parenthood Federation of America, and other organizations challenged the law and won a court injunction that postponed its enforcement. The federal court declared in its decision that existing laws that limit the kind of speech publicly broadcast over television or radio cannot be applied to electronic speech such as the Internet.

In June 1997, the U.S. Supreme Court delivered its decision in ACLU and Others è Reno/Communications Act and found that restrictions on Internet communication were unconstitutional.

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PLANNING OUR FAMILIES: HOW EFFECTIVE WILL A METHOD BE?

The key to contraceptive effectiveness is consistent and correct use. When you are looking for an effective contraceptive, it is crucial to choose one that fits the reality of your lifestyle. A condom, for example, can be 98 percent effective, but only if it is used correctly— every time.

Effectiveness rates for contraceptive methods are based on clinical studies, survey data, and scientific estimates. Clinical studies are now mandatory for methods that require a prescription and for over-the-counter methods that require approval from the U.S. Food and Drug Administration (FDA). Couples who volunteer for clinical studies report to the researchers how consistently and correctly they used the methods and whether or not they have experienced an unintended pregnancy.

Researchers use a variety of survey data to develop estimates for methods that are based on behavior and for methods whose use predates current FDA requirements for approval.

The rates of contraceptive effectiveness are measured in two ways:

• “Method-effectiveness” is the reliability of a method itself— when it is always used consistently and correctly. This is also called perfect use—the way it is intended to be used, every time.

• “Use-effectiveness” is the reliability of the method as it is usually used—when it is not always used consistently or correctly. This is also called typical use—the way it is used by most people.

The longer a method of contraception is used, the more effective “typical use” becomes—typical users usually become more effective as they become more experienced. However, the standard measure for the effectiveness of methods is the number of unintended pregnancies experienced by 100 women using the method during their first year of use.

For example, the failure rate of the condom with “typical use” is 12 percent—of every 100 women whose partners use the condom, 12 will become pregnant during the first year of typical use. On the other hand, the failure rate of the condom with “perfect use” is 3 percent—of every 100 women whose partners use the condom, only three will become pregnant with perfect use.

Carefully consider the level of effectiveness and failure you can live with as you choose your method.

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SEXUAL INHIBITIONS AND CONFLICTS. INHIBITED SEXUAL DESIRE AND SEXUAL AVERSION

We live in a culture that has been fearful and repressive about sexuality for thousands of years. Because of its emphasis on the dangers of sex and sexuality, we may feel many inhibitions that clash with our sex drives. The clash between sex drive and inhibition is called sexual conflict. It can interfere with our self-esteem, our sexual pleasure, and our sexual relationships.

We are in conflict with ourselves whenever our sexual impulses and desires don’t match what we feel is okay according to our family values and social norms. For example, we may not know its okay to enjoy sex as older adults. We are much more likely to believe that sex is for the young and beautiful. If we accept this common myth, we may inhibit our natural sexual impulses as older adults. This sexual conflict can cause us to become less happy with our lives. Sexual conflicts within ourselves about what is okay and what is not okay can occur at any age.

The sexual conflicts most people feel are somewhere in between sexual discomfort and sexual dysfunction. But even the discomforts caused by these conflicts can have an enormous impact on our sex lives. The following are some of the common sexual dysfunctions that may be caused by negative feelings about sex or by other people’s feelings about sex. Although we may not have these dysfunctions, understanding them may help us understand some of the discomforts that we do have.

Inhibited sexual desire

An uninhibited, positive appreciation of various erotic and sexual behaviors is called erotophilia, which means “liking the erotic.” Fear and anxiety about the erotic is called erotophobia. Most of us are somewhere in between.

Many people, however, feel such fear and anxiety that they seem to turn off their sex drives. They lose interest in sex. They don’t seek opportunities for sex, and they don’t take advantage of opportunities that they have. This is called inhibited sexual desire or hypoactive sexual desire.

Fear of sex is one of the major causes of inhibited sexual desire, but it is not the only cause. Other causes include depression, anger with a sex partner, divorce and other losses, stress, illness, and difficulty accepting one’s sexual orientation. No matter the cause, inhibited sexual de is considered a sexual dysfunction. Like other sexual dysfunctions, it can be diagnosed and treated with professional counseling that includes psychotherapy and sex therapy. This combined therapy is called psychosexual therapy. Anti-anxiety medications may be helpful in some cases.

Sexual Aversion

Some people feel such fear and anxiety about sex that the very idea of having sexual contact is repelling. They will avoid sex and certain kinds of sexual contact, even though their sexual desire may be uninhibited. They can be repelled by any kind of touch. Their disgust can make them ill. Their fear of sexual contact can sometimes cause sweating, nausea, vomiting, or diarrhea. The fear of sexual contact is called sexual aversion disorder. People with sexual aversion disorder may be able to enjoy certain sex acts, on certain occasions, and under certain circumstances.

Sexual aversion disorder can be caused by sexually fearful or repressive parenting, sexual abuse, pressure from sex partners, or gender identity problems. Problems with self-esteem and body image can open us up to developing sexual aversion. Psychosexual therapy may be very beneficial for women and men who have sexual aversion disorder.

Although most of us do not have a sexual aversion disorder, many of us may have anxieties and inhibitions that make sexual contact less pleasurable for us than it might be.

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SEXUAL CHARACTERISTICS IN EARLY ADOLESCENCE

The average timing of pubertal events in European and North American girls and boys has been graphically depicted by Marshall and Tanner. Even within this relatively homogeneous group, there are wide age variations: in girls, for instance, the onset of breast budding varies from age 8 to 13 years, and menarche ranges from age 10 to 16.5 years. In boys, the acceleration of testicular growth may start anywhere from age 9.5 to 13.5. The penile growth spurt starts between age 10.5 and 14.5 and the penis reaches adult size between age 12.5 and 16.5. The development of pubic hair may continue into adulthood. In contrast to the age at which the pubertal events occur, the sequence of events is much less variable. However, the sequence is not identical for all boys or all girls; also the rate of passing through the whole sequence varies considerably between individuals, and some sexual characteristics may mature relatively faster than others. Both adolescent girls (especially between the ages of 11 and 14 years) and boys (particularly the age group from 13 to 16 years) show a tremendous variation in somatic developmental status, which is one of the important factors explaining the typical problems of adolescent self-image and behavior.

The age at onset of puberty varies because of many factors, genetic as well as environmental. There are differences even between Western European countries. For example, the current mean age at menarche is 12.5 years in Germany, 13.0 years in England, and 13.4 years in Switzerland (Bierich). Socioeconomic status also has a strong influence: menarche occurs several months earlier in girls of a higher social class than in girls of a lower social class. This has been demonstrated in as different geographic regions and racial groups as Danes or African Bantu (Burrell and others), Indians (Israel) or Rumanians (Stukovsky and others). Higher social class usually implies better living conditions, including nutrition, sleep, and exercise, and these may be the major factors accounting for class differences in rates of growth in childhood as well as in timing of the growth spurt and of menarche.

Increased growth in childhood and early onset of menarche may be tied together by the critical weight hypothesis according to which menarche occurs in females who have reached a “critical weight,” associated with a decline in metabolic rate and with achievement of a characteristic body composition. More recent studies have shown that menarche correlates more closely with body composition than with the critical weight (e.g., Frisch and others) which suggests that menarche requires a critical level of fat stored in the body. There are corresponding standards for predicting the minimum weight, at a given height which is necessary for menarche to occur. The theory is not yet generally accepted, however. The direction of the causal relation between body composition and menarche is under investigation; the validity of the findings and conclusions have been questioned on statistical and other grounds.

A particularly interesting phenomenon is the acceleration of puberty. In Western countries, the onset of puberty seems to have gradually dropped in age over the last 150 years. For example, the age of menarche has fallen from seventeen to thirteen years during this period. Acceleration of puberty has also been demonstrated in non-Caucasian populations, for instance, in China or in Japan. Most likely, this secular trend is due to the complex changes in nutrition, social conditions, and public health, brought about by the technological development of the modern industrialized society.

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