Something in this patient had provoked her two carers to treat her as a child, telling her what to do rather than exploring her feelings and the reasons behind her actions. No attempt had been made to discover why she used to miss Pills, or whether the situation was likely to be the same now. If there was a degree of immaturity in the patient that made it difficult for her to appreciate the possible outcome of her actions, that missing Pills could lead to pregnancy, how helpful was it to continue to treat her as a child? Is that the way to encourage maturity and self-care? If she was missing Pills because of an unconscious need to get pregnant, a recognition of that need might have helped her to better use contraception in the future.

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Individual therapy may be available from doctors accredited as members of the Institute of Psychosexual Medicine. The aim of this psychosomatic approach is to promote understanding of the unique nature of each doctor/patient interaction and the help it gives in unravelling the patient’s sexual problems. Patients who are referred should be clear that they are to see a doctor who will examine not just their sexual problem but also their physical body.

*328/197/1*

*290/197/1*

He had requested vasectomy in the belief that this would solve his disorder. He was quite unmoved by the fact that the operation was irreversible, but became interested when he was asked why he felt it necessary to hurt and punish himself? This patient finally agreed to postpone the request and to attend for psychosexual counselling.

Again, here is a patient seeking vasectomy for quite inappropriate reasons. It seemed that he had a feeling that he wished to hurt that part which had given him so much pain and disappointment.

Sometimes it can be very difficult to elicit the relevant history that might suggest that all is not well with the marriage. For some women it is not possible to admit that their sex life is not perfect, especially when the husband is present. Fear of hurting him, or of provoking his anger, can lead to a bland assurance that all is well. It is likely that such inhibiting feelings stopped the next patient from sharing her problems at the time of her pre-sterilization counselling.

*252/197/1*

*214/197/1*

Despite their earlier age at puberty, which suggests a well-nourished organism, the patterned offenders were, as children, less healthy than the incidental offenders. About three fifths to four fifths of the incidental offenders had enjoyed good health. The differences in those reporting good childhood health ranged up to as much as 19 percentage points, but were generally nearer ten.

In five of our six groups, considerably more of the patterned than incidental offenders engaged in prepubertal sex play, the difference being as much as 35 percentage. Dividing this play into homosexual and heterosexual, one finds that except for the incest offenders substantially more of the patterned offenders had homosexual activity before puberty. No consistent trends were found in a study of the techniques employed in this homosexual play, except that more patterned offenders had actual, or attempted, anal coitus.

Again with the exception of the incest offenders, more patterned offenders had prepubertal heterosexual play, the proportions ranging roughly from three fifths to three quarters as opposed to one third to one half for the incidental offenders. Aside from a small tendency for more of the patterned offenders to have had coitus, the techniques of the heterosexual activity show no significant differences.

Setting aside the aberrant incest offenders, it would appear in summary that a greater incidence of prepubertal sex play with both boys and girls is associated with patterned sex-offense behavior in adult life.

The percentages of those who, when they were children, had sexual contact with adults show no consistent differences between the incidental and patterned offenders. In only one instance does their contact with adults seem significant: among the homosexual offenders vs. children only 20 per cent of the incidental offenders, when they themselves were children, had sexual experience with an adult male, whereas 45 per cent of the patterned offenders did. Here one may rightfully suspect some causal relationship.

*390\161\2*

Gambling has a series of characteristic types. There are those who never gamble, those who gamble moderately as a social or leisure activity, and those who derive a substantial share of their income from gambling. Gambling as a social or leisure-time activity may be penny-ante poker among friends, a few dollars spent at the racetrack, or a wager on the outcome of some future and uncertain event. The stakes are small, the risk exciting and stimulating, and, win or lose, the life of the wagerer goes on. Gambling as a systematic source of income is something else again. Even as a professional gambler the individual runs against the odds and losses may be very serious. (The activities of the syndicated or corporately organized gambler are, of course, an entirely different matter.) Besides the professional gambler there are those who take large risks to the limit of their income and who either gain or lose a great deal. These two groups combined, even though different in motivation and skill, may be characterized as those for whom gambling is a major source of income.

For the purposes of this study the stock-market speculator and other risk-takers of a socially approved (or at least not disapproved) type will be eliminated from consideration as gamblers, and we shall focus our attention on those whose risk-taking is in the form of cards, policy, the racetrack, or handbook and other gambling paraphernalia. Roughly two fifths to three fifths of our comparative groups did not gamble. In three of the four tripartite groups there were more gamblers among those who offended or aggressed against children than among those who chose older sexual partners. The same is true not only of gambling in general, but of serious gambling—that is, gambling as a substantial source of income.

In terms of the proportion who gamble, and particularly the proportion who gamble seriously, the prison group outstrips the sex offenders, most of whom in turn exceed the control group. In all but three of the sex-offender groups the proportions of serious gamblers fall between the control group’s 10 per cent and the prison group’s 29 per cent, and these three exceptions are at the low end of the scale.

Measurement of gambling reveals some curious variations: some tripartite groups are homogeneous while others are quite heterogeneous in this respect. For example, all three aggressor groups have nearly the same proportions of serious gamblers. On the other hand, the homosexual offenders vary widely, the percentage of serious gamblers ranging from about 7 per cent up to 20 per cent.

It appears that gambling, like the use of drugs, is not directly related to specific sex-offense behavior.

*352\161\2*

However, from our later, more detailed case histories it is clear that the men we interviewed had less mouth-genital contact with their postmarital or extramarital partners than with their wives. With regard to the balance between cunnilingus and fellation we see a compromise between the premarital situation and the marital. In three groups the percentage with cunnilingus exceeded the percentage with fellation experience, while in five the percentages were essentially equal. One may speculate that while marriage had relieved much of the inhibition regarding cunnilingus, some males still balked at applying the technique to a female less familiar than a spouse.

In postmarital and extramarital life the incest offenders vs. children and adults had the largest numbers of individuals with mouth-genital activity. The offenders vs. minors and adults as usual are at or near the bottom of the rank-orders and are joined there by the control group. The high ranking of the incest offenders vs. children is no surprise. After being restrained and/or inhibited about mouth-genital contact with companions prior to marriage, we see them become quite active in this technique with their wives, and this sexual emancipation seems to carry over into their post- and extramarital behavior. The high ranking of the incest offender vs. adults, however, has no visible precedent.

The above statements are made with caution, for our calculations regarding extra- or postmarital activity were, obviously, based on males who had married, and we are aware that in different groups varying proportions of men were divorced or had engaged in extramarital behavior. A rough check , indicates, however, that these differences did not exert a powerful influence. For example, the peepers, who rank first in cunnilingus with extramarital or postmarital companions, rank eleventh in the proportion who had ever had extramarital coitus.

*314\161\2*

There is, however, an interesting positive correlation between the incidence of gonorrhea and the number of premarital coital companions. Among the control group, 5 per cent of those with one premarital companion had had gonorrhea; 14 per cent of those with from two to five companions; 20 per cent of those with from six to 20 companions; and so on until we find that of those with 76 or more coital companions about one third had contracted gonorrhea. The prison group exhibits the same trend only the percentages are always larger by roughly ten percentage points. The sex offenders, taken as a whole, have figures paralleling those of the prison group up to a point and then there is an unexpected plateau in the incidence: any increase in number of coital companions beyond the category of 21 to 75 does not increase the incidence of infection, which stabilized at nearly 40 per cent.

There was a much lower incidence of syphilis than gonorrhea among the comparative groups, the range being from 3 per cent for the control group to 18 per cent for homosexual offenders vs. adults. The highest figures were shown by our two most premaritally promiscuous groups, the heterosexual and homosexual offenders vs. adults, but aside from this the number of coital (or homosexual) partners seems unrelated to the incidence. Multiple syphilitic infections were rare: only three groups had as many as 1 per cent of their constituents with this misfortune. The only relationship between type of offense and incidence of syphilis is a tendency for all three homosexual-offender groups to cluster at the “high” end of the range, ranking first, fourth, and fifth. The promiscuity of the homosexual offenders vs. adults explains their position, but the position of the other two groups may be due to the fact that both sexes were sources of exposure.

Syphilis, like gonorrhea, is more common among those who have been more frequently exposed to infection by having larger numbers of premarital coital companions. The relationship, however, is not as clear-cut as it was for gonorrhea. In part this lack of clarity is owing to the fact that syphilis is a much less common disease and hence, like all statistical rarities, subject to great fluctuation when small samples are involved. Thus, for example, in the control group the incidence of syphilis drops to zero in our most promiscuous categories. Other complications involve female prostitution and male homosexuality, but a volume on sex offenders is no place for an extended analysis of venereal disease transmission; such a study may constitute a later journal article.

*276\161\2*