Health news blog

A variety of more sophisticated mechanical and electrical measurement instruments have been used with increasing frequency in the past decade. In one way or another, these procedures measure changes in blood flow or volume in the genital areas, a technique called plethysmography. For the measurement in penile changes, instruments have been developed which are attached around the penis. One such device consists of an airtight container (Freund, Sedlacek, and Knob, 1965), with changes in penile volume causing changes in the air pressure in the surrounding instrument which can be measured. Another type of device consists of a small loop of hollow, elastic tubing filled with mercury (Fisher, Gross, and Zuch, 1965). As the penis enlarges and the tubing is stretched, the diameter of the tube interior, containing the mercury, is reduced. This reduction changes the electrical conducting capacity of the mercury, and these changes in electrical resistance can then be monitored.
Measures of vaginal changes have generally been measured by some form of optical plethysmography (Geer, Morokoff, and Greenwood, 1974; Cerny, 1977). These devices consist of a transparent tube, somewhat like the artificial penis developed by Masters and Johnson. Contained in the tube are both a light source and a photosensitive recording apparatus. The light source produces a steady illumination which is reflected from the walls of the vagina and recorded by the photosensitive cell. The reflective characteristics of the vaginal walls change as blood flow increases or decreases during sexual arousal, and these differences are measured through the photosensitive cell.
While these new procedures are innovative and show promise, the art of direct measurement of genital changes is still in its infancy. Many problems have arisen with these measurement techniques.   For  example,   McConaghy   (1974)  made simultaneous penile recordings by two different types of measurement instrument and found the relationship between the two to be quite variable. While the responses did parallel each other much of the time, on several occasions one device indicated a penile volume increase while the other indicated a decrease. Finally, external variables such as sexual experience (Mosher and Abramson, 1977) or alcohol (Rubin and Henson, 1976) can affect arousal; however, these variables have rarely been controlled and very likely have confounded in unknown ways many if not most of the studies utilizing direct genital measurement.
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Sometimes there’s a clear cause-and-effect relationship at work in prostatitis— the insertion of a urinary catheter, for example, during a medical procedure. This causes more trauma in the urinary tract for some men than for others.

Other risk factors include a recent bladder or kidney infection; an enlarged prostate (BPH, in which the prostate grows to constrict the urethra and can have a harmful effect on the urinary tract); and rectal intercourse, also associated with trauma to the urinary tract.

In bacterial prostatitis, the question is, how did the bacteria get into the urinary tract? In the instances mentioned above, bacteria may be able to invade the prostate from the urethra when infected urine “backs up” into the prostate ducts. (During unprotected rectal intercourse, too, rectal bacteria can be picked up by the penis and drawn into the urethra, and then can make their way into the urinary tract.)

But for nonbacterial prostatitis, and prostatodynia, the basic answer is that nobody knows. There have been severe cases in which men have had their prostates removed—and yet the symptoms failed to go away. Which leads to the question of whether nonbacterial prostatitis and prostatodynia are really happening in the prostate at all? “Prostatitis is a catch-all term,” says the University of Maryland urologist. “Too often, any time a patient comes in with pelvic pain, rectal pain, lower back pain—the doctor says, ‘You’ve probably got a touch of prostatitis.’ But a lot of men are told they have prostatitis when they’ve really got something else.”

And, because the disease—in all its forms, particularly the nonbacterial kind—is poorly understood, “a lot of patients get shrugged off by their doctors,” the urologist continues.

There are as many different reactions to prostatitis as there are cases of it; how men cope depends, in large part, on their response to illness and discomfort in general. “Some men can’t seem to stand it,” the urologist says. “But other men, as long as they know it isn’t cancer, can live with it.”

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In a contact laser prostatectomy, the laser probe actually touches—and immediately vaporizes—the BPH tissue, producing temperatures between 500 and 700 degrees. So—poof! The obstructing tissue is gone immediately. Tissue touched by the laser probe instantly turns to steam. Energy from a kind of laser known as Neodynium (Nd):YAG, which penetrates deeply into tissue, is conducted through a flexible fiber (a fiberoptic pipe that conducts the light energy) and is used through a standard cystoscope. This energy can produce temperatures well over 60 degrees, which can either “cook” (and thus kill) tissue or vaporize it altogether. Yet, as powerful and as hot as the contact laser is, it barely penetrates tissue even one millimeter beyond the point of vaporization. There is no delayed sloughing; only the tissue touched with the probe is affected. Essentially, “What you see is what you get.” In other words, only the tissue removed the day of surgery is going to be gone from the prostate—no other tissue will die and be sloughed off days or weeks later. This is a key difference between the contact and non-contact laser techniques.

The contact method is more time-consuming than the non-contact technique; in this it is much more like a standard TUR than other laser prostatectomies. The potential advantages over TUR include less bleeding (and therefore a lower risk of a transfusion), no risk of TUR syndrome, less risk of incontinence and urethral stricture, and the possibility of shorter hospitalization and catheterization (a catheter is required for about three days after surgery). Also, symptoms appear to improve earlier than after non-contact laser surgery. One point to consider is the size of a man’s prostate: The probes currently being used are small and work best on smaller prostates (with a volume of less than 50 grams or slightly under two ounces). Because there is less bleeding, this form of treatment is ideal for men who are taking anticoagulants.

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Because by itself an enlarged prostate causes no problems, all of the symptoms of BPH are secondary, resulting from obstruction of the urethra and bladder and, occasionally, of the ureters and kidneys as well. Most likely, your doctor will begin by taking your medical history, and it’s critical that you give an accurate description of your symptoms. Now is not the time to be embarrassed or reticent about your urinary problems. Remember, BPH happens to most men; you are not alone.

To help you recognize how often a day you urinate, and the nature of your symptoms, you may want to keep a symptom diary for a few days before your appointment, noting when you urinate, how long it lasts, whether it’s characterized by a weak stream, hesitancy, and so on.

There are two important goals for this visit to the doctor: First is to get help for these bothersome symptoms. Second, and equally important, is for your doctor to rule out any other problems—such as a bladder infection, or a blockage (also called a stricture) in the urethra—that may be causing the trouble.

For example: As men grow older, many have trouble making it through the night without one or more trips to the bathroom. But this symptom has many possible causes; so by itself, this might not mean BPH. Among other things, it can be caused by the body’s need to eliminate excess urine that accumulates during the day. Many older people—for a variety of reasons—develop swelling in their legs. At night, when the legs are elevated, the fluid that caused the swelling is reabsorbed and excreted by the kidneys. Also, it’s recently been recognized that many of the symptoms associated with BPH simply happen because the bladder is aging. (In fact, many symptoms that previously were thought to be suffered only by men, and thus were attributed to BPH, are also present in women as they age.)

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Finally, the study showed a variety of reasons why the patients themselves didn’t ask for adequate pain medication. Some men aren’t very good at expressing their symptoms, or conveying the depth of their pain, the researchers found. Some men feel it isn’t “macho” to admit that their pain is intolerable. (If you have a problem with this, it may help to take along a family member who feels no such hesitation when you go to see the doctor.) Other men are afraid of becoming addicted—and some of these men aren’t helped any when zealous family members urge them to “just say no” to drugs!

Some men believe that the pain is just an inevitable part of having the cancer and that nothing car be done to help them. Others worry about the pain yet to come, and want to save the “big guns,” the strongest medications, until the pain becomes intolerable. (Actually, with heavy-duty painkillers like morphine, relief always comes when doctors boost the dosage, so there is nothing to be gained by seeing how much pain you can stand.) Some men don’t want to be labeled as “bad” patients because they complain about their pain. And finally, the study said, some men—ever the breadwinners—worry that costly pain medication will use up all their families’ resources. For these men, methadone may be a good option—at around $30 a month, it’s the cheapest narcotic.

The bottom line is that you—or a loved one with prostate cancer—do not need to suffer terrible pain. There is help available. Take it.

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Another concern is that, unlike most treatments for prostate cancer—or for any disease, for that matter—cryoablation is not backed up by years of solid, careful laboratory research. In this country, by the time almost any procedure is tried on humans, it’s been thoroughly tested, sometimes for decades, in laboratory studies and in animals to see if it even works, and to make sure it’s safe. There was little laboratory testing of this technique before doctors began using it in men. It has not been proven that cryoablation can completely destroy the prostate in a dog, much less a man.

There are no long-term studies on how well cryoablation works. But we do know that at two years after treatment, 20 percent of men have positive biopsies, and a large percentage of patients have elevated levels of PSA.

Currently, cryoablation is used to treat men with localized prostate cancer as well as men who have undergone unsuccessful radiation treatment. Again, we come back to the critical question: Does it work? As more men opt for this therapy, this question is becoming increasingly important. To answer it, we need thoughtful studies that not only determine the risks of late complications, but that demonstrate cryoablation’s long-term success in controlling cancer.

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All but one of the homosexual offenders vs. adults in our sample had masturbated after the age of puberty, and in the case of this lone individual the record is incomplete in this regard. These offenders also have the youngest median age (13.3) for the beginning of postpubertal masturbation, but it must be recalled that they reached puberty earlier than the members of other groups. In age-specific incidence—the percentage of individuals who masturbated in any given five-year age-period from puberty on—the single homosexual offenders vs. adults invariably occupy first to third rank with percentages ranging from 88 to 96. Even among those whose heterosexuality was sufficient to cause them to marry, masturbation continued to loom relatively large: the married homosexual offenders vs. adults rank first in incidence of masturbation in age-period 21-25 with 67 per cent, and second in the next age-period with 62 per cent. In short, of all the comparative groups, the homosexual offenders vs. adults are, except possibly the homosexual offenders vs. minors, the most given to masturbation. This again may be seen in a study of accumulative incidence, the percentage who had masturbated after puberty by a given age. By age twelve, some 94 per cent (the second largest percentage recorded) of the homosexual offenders vs. adults had such experience—in part the result of their extensive prepubertal sex play, which was chiefly homosexual. Indeed, the homosexual offenders vs. adults show the highest accumulative incidence figures from age eighteen on as far as our calculations have been carried.

This statement is borne out by the maximal masturbation records (maximum rate of masturbation in any one week) of the various groups. Again the homosexual offenders vs. adults rank first. No less than 24 per cent had masturbated more than a dozen times in one week, which is by far the largest percentage; the peepers, who occupy second rank in this frequency category, account for only 17 per cent. A substantial number (13 per cent) had achieved 20 or more times per week, a figure once more far surpassing that of any other group (only 2 per cent of the control group matched it). The average maximum was 7.6 per week, the highest figure recorded.

Without exception, the average (median) homosexual offender vs. adults had the highest premarital masturbation frequencies in any age-period. The frequency difference between him and the average individual of the next highest group is often most substantial, for example, 3.3 per week as against 2.1 (between puberty and age fifteen), and 2.7 per week as against 1.7 (between ages sixteen to twenty). From ages twenty-one to twenty-five the frequency was 1.7 and thereafter slowly declined to 1.0 in the early forties. The average (mean) frequencies give us the same picture: the homosexual offenders vs. adults are the highest in all age-periods except possibly one other group. Again the differences are often large, not infrequently double those of the control group. Even among the married homosexual offenders vs. adults the frequency of masturbation is high; they rank first to third in this regard in the various age-periods, whether computed as medians or means.

High frequencies are, of course, the best evidence for interest in and desire for an activity. The high masturbatory frequencies of the homosexual offenders vs. adults probably should not be viewed as compensatory for some lack of sociosexual outlet; their homosexual frequencies are quite in line with the frequencies other groups derive from heterosexual activity. One explanation for the correlation between homosexuality and masturbation is simple: the homosexual has die genitalia of the gender in which he is interested. If heterosexual males had, in addition to their own genitalia, suitably located female genitalia they too would have high masturbation (in this case auto-coitus) frequencies. Moreover, many homosexuals masturbate themselves while fellating other males. This practice, which we have not considered masturbation, since it is intimately associated with a sociosexual act, reinforces masturbatory behavior patterns.

While the unmarried homosexual offender vs. adults masturbated frequently, he also engaged in a great deal of homosexual activity; consequently, the proportion of his total outlet derived from self-masturbation is, while large, not dramatic. These offenders rank second in age-period 16-20 with 64 per cent of their outlet masturbatory, fourth in age-periods 21-25 and 26-30, and third in age-period 31-35 (43 per cent). In later age-periods the number of groups available for comparison is sorely reduced so that rank-order position is less meaningful, but the homosexual offenders vs. adults seem to occupy intermediate positions insofar as proportion of total outlet from masturbation is concerned. For all homosexual offenders masturbation is of decreasing significance as they grow older, but the decrease is more marked in the homosexual offenders vs. adults who have established patterns of successful sexuality with other adult males. Indeed, they are the only homosexual offenders who obtained a greater proportion of their total outlet (even after age twenty-five) from homosexuality than from masturbation.

The men who married, despite this evidence of heterosexuality, maintain uniformly high positions in the rank-orders, never falling below third place and twice being first. In other words, they derived a relatively large proportion, from 6 to 35 per cent, of their total outlet from masturbation.

In postmarital life they drew moderate proportions of their total orgasms from masturbation—considerably smaller proportions than those of the other homosexual offenders.

The masturbatory fantasy of the homosexual offenders vs. adults is also unusual. As one would anticipate, they rank first in the percentage (91 per cent) of those with homosexual fantasy—a figure almost 12 times that of the control group, and even well above the second rank homosexual offenders vs. minors. Conversely, they have the least number (61 per cent) of persons who ever had heterosexual fantasies. In other categories of fantasy—sadomasochistic, animal contact, and bizarre—the offenders vs. adults tend to have comparatively low percentages.

Their masturbatory fantasy accords with their general psychological orientation: 85 per cent were sexually aroused by thinking of or seeing other males. Conversely, a high percentage (35 per cent) found no arousal in dunking of or seeing females. Despite (or perhaps because of?) their extensive masturbatory histories, the homosexual offenders vs. adults display little concern over the possible ill effects. In only about one third of the years during which they masturbated did they worry about it. Part of this lack of concern is because our sample of homosexual offenders vs. adults contains a relatively large number of men with some college education, and it is within this social stratum that masturbation is least taboo.

As in the case of the other homosexual offenders, a comparatively large number first learned of masturbation by being masturbated (47 per cent, the highest percentage recorded) or through self-discovery (20 per cent, the highest percentage within this category). As we pointed out in the discussion of homosexual offenders vs. minors, the first figure is the result of extensive prepubertal sex play (chiefly homosexual), and the second figure is the consequence of the large number who began to masturbate before puberty, especially at quite young ages when self-discovery is a more probable phenomenon. Again like other homosexual groups, relatively few learned from talking or reading of masturbation, or from observation.

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Tire incest offenders vs. adults, since they tended to begin coitus later in life than many other groups, had correspondingly older partners in their first coitus. None had their initial coitus with girls under fourteen, and only 10 per cent with companions aged fourteen to fifteen. This is the smallest percentage recorded in this particular age-category. In the following age-category 16-17 the incest offenders vs. adults occupy an intermediate position in rank-order, but in age-category 18-20 they are in first place (32 per cent) and are again in first place (37 per cent) among those whose first partners were twenty-one and over. In brief, these offenders are sharply distinguished from all other groups in having for their first heterosexual coitus older females and no very young ones.

As for their expressed age preferences for coital partners, no incest offender vs. adults mentioned any age below sixteen, and only a rather small number (8 per cent) mentioned girls of sixteen to seventeen. Altogether, one has the impression that incest offenders vs. adults were a sexually restrained and frustrated group whose restraints broke down in later life, the breakdown resulting in a moderate number of extramarital partners, a relative lack of age discrimination, and the incest offense itself.

Aside from the incestuous behavior with a daughter or stepdaughter, the incest offenders vs. adults seem to rate high in incest with their sisters and sisters-in-law, but the number of cases is too small for any concrete statement

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The second commonest variety of aggressors vs. adults are the amoral delinquents previously described under aggressors vs. minors and offenders vs. children. These men pay little heed to social controls and operate on a level of disorganized egocentric hedonism, and consequently have numerous brushes with the law. They are not sadistic— they simply want to have coitus and the females’ wishes are of no particular consequence. They are not hostile toward females, but look upon them solely as sexual objects whose role in life is to provide sexual pleasure. If a woman is recalcitrant and will not fulfill her role, a man may have to use force, threat, weapons, or anything else at his disposal. The amoral delinquent may or may not have previously known his victim, but this too is a minor point to someone who regards women as mere pleasantly shaped masses of protoplasm for sexual use. It appears that one eighth to one sixth of the aggressors vs. adults may be classed as amoral delinquents.

One case is that of a semiskilled man of twenty-two with a tenth-grade education. The descriptions of him contain terms such as “lazy,” “drifter,” “reckless,” “restless,” and “a chronic nuisance in his area.” Almost half of his brief army career was spent in the stockade for having been absent without leave. About two years later, by which time he was tattooed and running with local gangs, he and two companions picked up two girls and, instead of giving them the promised ride to their destination, took them to a rural area where they forced sexual activity by threatening the girls with a knife. After serving slightly more than a year for this offense, the young man was released on parole. Shortly thereafter he was arrested along with a large group of males and females who were engaged in some sort of street fight. He was also suspected of encouraging a girl to write bad checks. In the year he came of age his parole was revoked when he and a friend broke a window and stole several hundred dollars worth of tools.

An example of an older amoral delinquent is a thirty-seven-year-old in our sample. There was nothing unusual about his life until impending fatherhood forced his marriage at age nineteen. He made his living through semiskilled labor and also got into the entertainment world. His first marriage ended in divorce after three years and his second marriage, when he was in his early twenties, lasted only one year. His wife, complaining of his too frequent sexual demands, made the following highly significant remark, “. .. he treated me as though I were a child,” i.e., not as a real person, but as an inferior of use only as a sexual object. Soon after the collapse of this second marriage the man held up a number of stores, in one of which he found a young saleswoman and opportunistically forced her to undress and have coitus. These acts resulted in a long prison term. He was paroled in his early thirties and within about a year was back in prison for petty theft. Paroled again, he supported himself by managing an eating place staffed by waitresses who doubled as prostitutes while he served as the pimp. This remunerative situation came to an end when his attempts to persuade a woman to have coitus resulted in some sort of struggle during which the woman fell, or was pushed, down a flight of stairs, at least partially forced coitus occurred, and the man was injured in his left eye. In any event, he returned to prison on a charge of assault with intent to commit rape.

About as common as the amoral delinquent variety of aggressor is the drunken variety. The student of sex offenders soon comes to realize that drunks are omnipresent, appearing in all offense categories to a greater or lesser degree. The drunk’s aggression ranges from uncoordinated grapplings and pawings, which he construes as efforts at seduction, to hostile and truly vicious behavior released by intoxication.

The simplest and least aggressive sort of drunken offense is exemplified by a nineteen-year-old farm laborer of borderline intelligence. The case is summed up in the words of the prison psychologist: “The subject is a dull boy of nineteen. . . . While drunk, he tried to force the young wife of his former employer into a bedroom in an attempt to have sexual intercourse. She resisted and later told her husband. . . .” This resulted in a 90-day sentence for assault and battery. The boy was under the impression that the wife was more amenable than she actually was.

A more bizarre, but still relatively harmless case is one of a forty-two-year-old, previously married man of average intelligence who was living in a motel and was feeling sexually deprived. He had in the past once forced coitus on a girl friend with whom he had had a mutually voluntary coital relationship and also had once forced coitus on his ex-wife. Both women had resisted, wrestling ensued, and both had finally yielded in order to get it over with and get rid of him. It seems probable that the man looked upon the use of minor force as both effective and safe. He became intoxicated and recalled that a young, unmarried woman lived in a motel cabin nearby. He decided to peep in her window to see if she was with a man, his logic being that if she were with a man this would be evidence that she was sexually loose and, hence, worth cultivating. He peered in and saw her alone asleep in bed and at this moment conceived the idea of having coitus with her then and there. He cut the window screen and then with drunken logic recalled that he was not properly clothed for bed, so he returned to his own cabin and changed into his pajamas. Thus properly dressed, he went back to the girl’s cabin, removed the cut screen, opened the window, and crawled in. He tiptoed to the bed, turned off the bed lamp which had been left on, and tried to slip unobtrusively into the bed. The girl awoke and screamed. The man, frightened, clapped his hand over her mouth and the girl became quiet and immobile— possibly fainting. He then crawled on top of her and removed his hand from her mouth in order to kiss her. The girl galvanized into action, screaming and scratching. The man was severely scratched before he managed to get out of bed and stumble out of the door into the grasp of a man attracted by the screams.

In contrast to these two examples which involved no physical harm of any consequence and which were not without some humorous aspects, the cases where intoxication releases a violent pathological response are extremely serious. One of the best illustrations is the case of a young man who up to the time of his offense seemed in no way unusual except for his above-average intelligence, his hatred for his abusive father, and a tendency to want to bite his sexual partners as he reached orgasm. Following graduation from high school he enlisted in military service where he served well and had just re-enlisted before his offense. He had gone on a drunken binge and was frequenting bars in order to pick up girls. He finally found one; they drank and left together. They went into an alley and began petting. According to the man, while they were deep-kissing she suddenly bit his tongue severely, and subsequent medical examination disclosed a deep cut nearly halfway through his tongue. This intense pain coming on top of erotic arousal and extreme intoxication precipitated a sadistic assault in which he not only beat the woman but repeatedly bit her face, breasts, and genitals. Portions of flesh were actually bitten off. He claimed only vague memory of this and had no memory of taking the woman’s wristwatch and dental plate when he left her. The psychologists and psychiatrists who examined him reported deep underlying hostile impulses which were released during intoxication, and one psychologist believed that he had “displaced his hostility toward his father on to women.”

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Heterosexual aggressors vs. children are adult males convicted of sexual contact, accompanied by force or threat, with female children under the age of twelve who are not their daughters. In addition to being dissimilar to other men in choosing prepubescent partners, the aggressor vs. children is doubly atypical in using force or threat. Whereas the offender vs. children can sometimes plead, and not infrequently with justification, that his partner was at least not unwilling, the aggressor vs. children can seldom validly make this claim, since the use of force or threat is proof that the child resisted at some stage. The degree of force or threat does not separate the extreme from the minimal cases, since some unknown proportion of the offenders in the latter category would presumably have resorted to greater force or threat had this been necessary; furthermore, in such a division one would have to take into account the age and size of the child in order to evaluate the force or threat. “I’ll take away your dolly” might be a more horrible threat to a three-year-old than the threat of a spanking to a nine-year-old; likewise a slap that would constitute minor physical violence to a nine-year-old could be a head-over-heels blow to a much younger child.

We have not considered bribery as threat or as a part of a forced relationship, even though a child may accept unwanted activity for the sake of reward. Candy for the juvenile may well be equivalent to a mink coat for the adult. The possibility of being deprived of something one already has or of one’s just due is a true threat; a bribe, if rejected, does not adversely affect the status quo.

The use of force or threat in a sexual relationship is generally condemned by all the human societies of which we have knowledge. Under exceptional circumstances it may be socially permissible—as in cases where it is directed against enemies or during brief periods of ceremonial license. The combination of a forced relationship and the fact that a child is involved makes the aggressor vs. children, in the eyes of most people, the most heinous of all sex offenders.

While one can find among other mammals almost any sexual behavior encountered in humans, it is extremely rare that one hears of an adult animal forcing a sexual relationship upon an immature one. True, adult male animals not infrequently show some sexual interest in young animals and sometimes attempt to mount them, but if the young animal is averse to the activity, the adult eventually ceases his attempts. Scarcely ever does there appear to be a case where the immature female is overpowered despite its struggles and forced into sexual activity. Of course, in the case of very heavy animals, such as cattle, an attempted mounting can be as physically damaging as a violent human rape, but this is a matter of accident rather than the result of an onslaught designed to overcome resistance.

The vast majority of our aggressors vs. children used only enough force or threat to achieve the sexual contact they desired. While a sadistic element may have been consciously or subconsciously present, we have no cases in which violence was clearly the predominant goal; we interviewed no modern Sade. There are, of course, some persons who receive sexual stimulation through deliberately inflicting violence upon children, but clear-cut sadists of this sort are quite rare. Their rarity is emphasized by the fact that in our total of roughly 18,000 interviews no man or woman reported being victimized, as a child, by a sadist.

Child murders in connection with sexual activity receive great publicity, which gives the impression that they are not infrequent; actually they are extremely rare. It is our impression that these murders are often accidental or result from an attempt to prevent the child’s attracting attention. Some may stem from a combination of guilt and panic following the sexual act. However, the murder of a child as an integral part of sexual gratification is a one-in-a-million phenomenon. We discovered no such murders, but a few of the aggressors vs. children whom we interviewed had inflicted injuries that might easily have led to death.

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