*370/197/1*

The first attempt to categorize consultations grew out of good counselling practice and concerned the different types of intervention doctors could make (Heron, 1975). Interventions were broadly grouped as either authoritarian or facilitative, the former representing the more traditional medical behaviour and the latter being more patient-centred. Authoritarian interventions comprised prescriptive (‘the IUCD is a good method for you’), informative and confronting categories. Facilitative interventions were grouped into: (1) cathartic, that is, allowing release of emotion; (2) catalytic, encouraging the client in his train of thought (‘Go on’, ‘Hmm’ and so on from the doctor); or (3) supportive (‘I understand’ or a nonverbal nod of the head).

*332/197/1*

Although psychogenic problems are often missed or ignored, it is just as serious to miss a physical or iatrogenic cause for a sexual problem. Oral contraceptives can occasionally cause depression, although other reasons are more common (Herzberg, Draper, Johnson et al., 1971). Sexual desire disappears early in depression, often before there are many other more obvious symptoms. An imbalance of hormones can cause vaginal dryness; it may not be lack of arousal but lack of mucus. Intrauterine devices can cause dyspareunia in either partner. Spermicides, diaphragms and condoms can sometimes cause or exacerbate genital soreness and irritation. Other problems not associated directly with contraception must also be borne in mind – infections, impotence due to medication, endometriosis, diabetes, arthritis; almost any medical condition can affect sexual functioning.

*293/197/1*

It is not only women who have difficulty accepting that their fertility is separate from their sexual feelings. Some men also have fears that the end of fertility is the end of all sexual feeling and even though they may realize intellectually that this is not so, unconscious doubts can cause difficulties. It is a wise doctor who listens to the man who says, ‘I just feel I would not be the same.’ A degree of reassurance is reasonable if doubts about a vasectomy are clearly related to the operation, but if the doubts are somehow more vague, or are connected to his feelings about himself as a man, they should be respected (Howard, 1982).

*255/197/1*

Regional Health Authority this goes up to 7.6%, and in Tower Hamlets District Health District Health Authority, to 13.2%. In 1991, 23% of the Tower Hamlets borough population were Bangladeshi, while 42% of the births were to Bangladeshi women (Census data, 1991).

The ethnic mix of patients in any doctor’s area is likely to be heterogeneous at any one time, and the balance may change rapidly. Looking at the most recent entrants to Tower Hamlets District Health Authority about whom figures are available, that is, for the 11 months from 1 September 1990 to 1 August 1991, the breakdown was as follows:

Total numbers: 960 Sex: 57% female

Age: 67% aged between 5 and 29 years

Type: 65% were immigrants, 21% refugees, 11% longstay visitors Country of origin: 61% Bangladesh, 22% Somalia, the rest from other SE Asian countries, other African countries, Vietnam, China.

Family dynamics: 63% were part of a family group, 9% of these families had seven or more members

These figures for just one year in one borough demonstrate that the majority of entrants are in their fertile years or are the children of women who are still fertile.

*217/197/1*

Again, there is a tendency for more of the incidental offenders to have had premarital coitus with prostitutes. From roughly one half to four fifths of both sorts of offenders had paid for coitus, but the incidental offenders exceeded the patterned offenders in three groups, while there were no appreciable differences in two groups. This same ill-defined trend is seen in the number of prostitutes with whom they had premarital coitus, the incidental offenders having greater numbers in four of the six groups. This premarital trend foreshadows subsequent behavior, since we find that in a count of the number of prostitutes with whom the patterned and incidental offenders had coitus not only before but during and after marriage, the incidental offenders exceed the patterned by substantial margins in five groups, and in the sixth group there was no difference.

A comparison of the degree to which either enjoyed their first coitus, whether with a companion or prostitute, showed no consistent differences between incidental and patterned offenders.

The various restraints upon premarital coitus, such as moral considerations, fear, and lack of opportunity, proved significant variables in our sex-offender study in general, and consequently we examined them in connection with the division of offenders into patterned and incidental. Contrary to expectations, little of significance emerged. The clearest difference was in their fear of disclosure and public opinion, offered as a reason by more patterned than incidental offenders. This sensitivity to opinion in a group later characterized by repeated offense behavior is rather unexpected, but may reflect a general insecurity about sexual matters. In this connection, it may be worth noting that in five groups more patterned than incidental offenders reported that moral restraint had been an important inhibiting factor. Lastly, in keeping with their lesser heterosexual activity, more patterned then incidental offenders reported that lack of opportunity was in part responsible for their not having had more premarital coitus.

*393\161\2*

In the tabular material on circumstances of the offense there are often instances where the desired information is lacking for a substantial number of cases. There are several reasons for this:

Some histories were taken in the early part of the research before our plans for the sex-offender study were formulated.

Sometimes the offender either concealed or did not volunteer data concerning offenses prior to the one known to the interviewer, and these did not come to light until prison files were examined later. At this point it was impractical to reinterview the subject for fuller details about his earlier offenses.

Sometimes the offenders history was obtained in a nonprison interview, and thus attention was not focused on his particular offense, which came to light only incidentally during the history taking. These histories were, for the most part, those of homosexually oriented males who had in the course of their lives been arrested, convicted, and perhaps put on probation or fined. In planning the present volume, the problem arose whether to include these cases in the sex-offender sample, since their histories had not been obtained through penal sources and they had not been interviewed in the framework of the sex-offender study. The decision was made to include them, and as a result the data on these cases is sometimes sadly incomplete.

Oversight on the part of the interviewer, or the lack of knowledge of the fact asked for on the part of the offender accounted for other gaps.

These cases of inadequate data posed a serious problem in how best to calculate the percentage figures in the tables. Because the number of cases with no data varied widely among offense types, and because in general there was no indication that the cases lacking data were different from those for which data were available, it was decided that percentages would be calculated on the basis of available cases. The proportion of cases where data are lacking in each group is indicated in each table, and the total Ns are constant.

Certain offenses tend to be repeated more often than others, and the circumstances of a crime that has been committed repetitively by the same person may distort the data slightly in the direction of his modus operandi. The exact contamination of the findings as a result of this fact are hard to evaluate. The number of times certain offenses are repeated by the same person are presented in Chapter 32 on criminality.

Four major aspects of the offense data will be examined in order; the status of the offender at the time of offense in terms of age, marital status, prior sex offense, and mental condition; the setting for the offense; the offense behavior; and the apprehension of the offender.

*355\161\2*

The lower part of the rank-order poses no problems and meets one’s logical expectations; it contains the groups characterized by difficulties in heterosexual adjustment. Lowest are the three homosexual-offender groups (31 to 42 per cent). Next lowest are the control group (47 per cent), the peepers (48 per cent), and exhibitionists (52 per cent). The peepers owe their position in part to the ineptitude in obtaining coitus which they displayed before marriage and which indubitably carried over into marital life; moral considerations, insofar as we can determine, were not serious deterrents. The exhibitionists’ position is more difficult to explain. However, we do know that their urge to exhibit does not appear to be one that can be gratified by coitus; note that they usually avoid exhibiting to females with whom they could have coitus (e.g., their wives or female friends). Consequently it may be that exhibition tends to reduce extramarital coitus by replacing it or by competing with it. To put it bluntly, a peeper might be deterred from peeping by providing him with numerous sexual partners, but this therapy would be less effective in the case or the exhibitionists. The position of the control group may be attributed chiefly to their relatively stringent mores.

The central part of the rank-order presents many problems since it contains some of the previously most sexually active groups—the heterosexual offenders vs. minors and adults and the prison group. The men in these groups demonstrably had the savoir faire to find sexual partners, and their premarital histories scarcely suggest any predilection toward monogamy. Neither have we any inkling that they suddenly adopted a more stringent moral code when they marched to the altar. However, one possibility comes to mind. Perhaps the 30 to 40 per cent who did not have extramarital coitus had sowed their wild oats and were content to lapse into a comfortable monogamy. This phenomenon is by no means rare and is sometimes explicitly expressed— for example, “I played the field until I got tired of it and decided to settle down and get married.”

The incest offenders vs. adults fall in this central area with 62 per cent of their members having had extramarital coitus. At first one may wonder why this seemingly inhibited and conservative group ranks this high, but one must remember that by definition some of them had extramarital coitus with a daughter or stepdaughter, and that they had been married longer than most groups. If we were to use the official records rather than the interview data, the incest offenders vs. adults would head the rank-order with about nine out of ten of diem having had extramarital coitus, this being the percentage judged to have had coital incest.

The upper portion of the rank-order (above 70 per cent) is also difficult to interpret. It contains the heterosexual aggressors vs. minors and adults; this is logical, since sexual aggressiveness coupled with an above-average amount of premarital experience and little moral restraint (remember that both had extremely few members deterred from premarital coitus by moral considerations) is almost certain to result in extramarital coitus. Marital fidelity arising from premarital promiscuity evidently does not significantly apply to those with pronounced aggressive traits. Moreover, these aggressors did not have so much premarital coitus that they became sated and blas? and inclined toward monogamy—which is what seems to have happened to the offenders vs. minors and adults and the prison group. The occupancy of first and second ranks by the incest offenders vs. children and minors cannot be explained on the basis of their offenses, since only a few had actual coitus with their daughters or stepdaughters. Nor does duration of marriage seem to play any great role. One can only surmise that the unfulfilled sexual desires that ultimately drove them to incest also drove them into other extramarital activity.

The age-specific incidences of extramarital coitus with companions are amazingly uniform for some groups. Between age twenty-one and age forty-five the prison group had 46 to 36 per cent of its constituent members with such coitus in any five-year age-period. The control group was even more stable, with from 23 to 27 per cent involved. Such uniformity is also seen in some sex-offender groups— e.g., the exhibitionists (31 to 37 per cent between ages twenty-one and forty-five). While other groups fluctuate, it is interesting to note that they rarely show sudden marked increases at any time and never after age thirty, though sudden, marked decreases are not uncommon and occur chiefly in the thirties. The twenties appear to be the decade of life during which the most men in any group had extramarital coitus with companions; the largest figure is the 63 per cent. By the early forties the largest percentage is but 36. In premarital coitus with companions we saw that the range among groups of age-specific incidence tended to increase with age, but in extramarital coitus it decreases from a 47-percentage-point spread (age-period 16-20) to a range of 13 (age-period 41—45). This contraction of range is probably the result of the fact that the older male finds less time and inclination to pursue extramarital affairs. He now has children, heavier financial obligations, his military service (a fertile field for extramarital activity) is behind him, and his sexual drive has lessened.

Unlike premarital coitus for which every homosexual offender is eligible and hence is used in the calculations, extramarital coitus presupposes marriage, and only the more heterosexually inclined marry. This requisite heterosexual interest scatters the three homosexual-offender groups widely in die rank-orders and they do not regroup (at the lower end of the rank-orders as anticipated) until the late thirties and early forties. The homosexual offenders are unique among our comparative groups in that their age-specific incidence figures sometimes approximate, or even surpass, those of ever-never incidence. For example, 31 per cent of the married homosexual offenders vs. adults had extramarital coitus, yet in age-period 26-30 some 41 per cent engaged in this activity. The answer to the seeming paradox is that many of the homosexual offenders (and especially the homosexual offenders vs. adults) had one brief marriage; the brevity reduces the ever-never incidence of extramarital coitus. However, of those who remained married longer a large number engaged in extramarital coitus, which raised die age-specific incidence to or beyond the level of the ever-never incidence.

Aside from the tendency for the homosexual offenders to have had relatively little extramarital coitus later in life, the only other trend may be that heterosexual aggression links with high age-specific incidence. On the basis of the aggressors vs. adults (too few of the other aggressors married), this appears to be the case.

Turning now to extramarital coitus with prostitutes, one finds the age-specific incidence range much more uniform, and the range does not tend to increase with age as it does for coitus with prostitutes before marriage. In all age-periods between 16 and 45 no more than one quarter to one third of the men in the various groups had commercial extramarital coitus. Moreover, the percentages remain more stable than for extramarital coitus with companions. For instance, from age sixteen to age forty the prison group varies only from 22 to 28 per cent and the exhibitionists from 14 to 17 per cent.

The scattering of the homosexual-offender groups throughout the rank-orders caused by the heterosexual interest inherent in marriage is even more pronounced in extramarital coitus with prostitutes. Indeed, between thirty-one and thirty-five the homosexual offenders vs. adults head the rank-order with 29 per cent of their members involved, while the homosexual offenders vs. children are at the bottom of the rank-order with zero.

While extramarital coitus with companions flourished chiefly between ages twenty-one and thirty, that with prostitutes is not linked to youth. The percentages of husbands involved in their thirties is quite like the percentages involved in their twenties, and two groups actually reach their age-specific maximum in their forties.

*317\161\2*

Since learning is more often a gradual process than a sudden complete comprehension, many of those whom we interviewed could not say they had learned of masturbation from one specific source; rather they had learned from several. We have differentiated the following sources:

Independent self-discovery Talking or reading Observing others masturbating Being masturbated by someone else

Since many men reported several sources of knowledge, we devised four categories based on the: degree of social interaction involved:

I.    Independent self-discovery only. No interaction.

II.    Talking or leading about masturbation. Mild interaction. Included are those who reported .self-discovery as an additional source.

Thus we might call this category II plus I.

Observing others masturbate. Generally fairly strong interaction is involved. Included are those who listed talking, reading, or self-discovery as secondary sources—i.e., this category is III plus I and II.

Being masturbated by someone else. Maximum interaction. Included are those who also listed other sources of knowledge. This category is therefore IV plus I, II, and III.

Rather few are in category I, pure self-discovery; the percentages range from 3 to 20, with most (12 out of 16 groups) being between 9 and 16 per cent. The homosexual offenders cluster at the top of the rank-order with from 16 to 20 per cent. We suspect that since the homosexual offenders reached puberty earlier than the other groups, there may be a positive correlation between self-discovery and early puberty. To put it simply, perhaps the younger a boy is at the time of attaining puberty, the fewer pubescent friends he has to instruct him in the joys of masturbation. The third rank of the control group, whose members did not reach puberty particularly early or late, is probably due to another factor: social inhibition. “Good boys,” whose parents discourage associating with “bad boys,” are apt to receive sexual information and misinformation at a later date and, in consequence, have more time during which to discover independently the sexual facts of life.

More persons appear in category II, that of talking and reading as sources of knowledge, the range being from 13 to 42 per cent, with the control group at the top of the list. The three incest-offender groups rank third, fourth, and fifth—a curious consistency as yet inexplicable. The homosexual offenders cluster near the bottom, most of them having learned of masturbation more directly.

Category III displays the largest percentages of any, ranging from 19 to 54. The salient thing about observation as a mode of discovery is its commonness among most of the sex offenders and die prison group. We do not know to what degree observation stemmed from group discussion and exhibition. In an unknown number of instances the boy may simply have happened upon the scene or he may have been deliberately peeping. Nevertheless, group demonstrations (including two individuals as a group) were the rule rather than the exception. Male masturbation and heterosexual petting are the only two classifications of sexual activities in which a large proportion of people learn of them via observation. Within category III the most interesting phenomenon is the clustering of the homosexual offenders at the bottom of the rank-order, just below the control group. These offenders, as we shall see, learn of masturbation through direct physical action and not vicariously. The controls owe their relatively low rank, we suspect, to their being “good boys” who feared to engage in any open sexual situation.

Lastly, category IV consists of those whose initial knowledge of masturbation was derived in whole or in part from being masturbated by someone else. This other person was almost always about the same age as the subject (i.e., child-adult contacts were a minority) and was far more commonly another boy than a girl. The three homosexual-offender groups head the rank-order with from slightly over one third to nearly one half of them having learned of masturbation in this way. The other groups are scattered in rather meaningless fashion throughout the rest of the range. The control group, as one would anticipate, is rather low in rank. For most groups, being masturbated was the third commonest way of learning of masturbation: only the controls and one other group (aggressors vs. children) contained more men who had learned through self-discovery alone than through being masturbated.

While we did not question each interviewee about the age at which he first learned of self-masturbation, we do know that such knowledge is virtually universal among males within a few years, plus or minus, of puberty.

*279\161\2*

A moderate number, one quarter, had more than incidental homosexual experience. Incarceration seems to have had no pronounced effect, since 44 per cent had homosexual activity outside institutions, which puts them in an intermediate position compared to other groups.

Age-specific incidence, the number who had homosexual activity during a specified age-period, reveals nothing unusual about the single exhibitionists except that the percentages are remarkably stable, varying only from 17 to 22 per cent in the years between puberty and age forty. The figures for the married exhibitionists, on the other hand, are very low, ranging from 0 to 4 per cent. Similarly the separated, divorced, and widowed had low incidences of from 5 to 14 per cent.

If one divides the number of postpubertal homosexual experiences outside prison by the number of postpubertal years outside prison and thus derives a frequency, the unmarried exhibitionists are seen to have a low frequency—twice a year; only the incest offenders had lower. In our other measures of frequency (the mean and median frequencies of homosexual activity during five-year periods), the exhibitionists who do have homosexual activity have it with quite moderate frequencies, the average (median) individual having 5 to 6 orgasms per year with another male. The mean frequencies are between once in three weeks and once in two, less than those of the control group.

Among married exhibitionists the incidence of homosexuality is too low to permit calculation of meaningful frequencies; never more than one individual was ever involved in any of the age-periods.

The proportion of total outlet derived by the unmarried exhibitionists from homosexual activity is moderate up to age twenty-five and small thereafter.

The average exhibitionist had sexual contact with only a moderate number (four) of males. One cannot, as in the case of the peepers, attribute their moderation to youthfulness—the exhibitionists are not one of the younger groups. Lastly, no exhibitionist had over 75 male partners, whereas ten of our comparative groups contained some persons who had more.

They were inclined to be neutral when queried about their attitudes toward male homosexuality. Some 33 per cent were neutral (fourth in rank-order), and 20 per cent (third in rank) were mildly disapproving. In voicing strong approval or disapproval, the exhibitionists are intermediate in rank-order.

*240\161\2*