Shifting attention now to the offenses in which physical contact occurred, and examining first the heterosexual offenses, the obvious distinction is between offenses in which coitus occurred or was attempted, and those in which it did not occur or was not attempted. (Coitus here, as before, is defined as penile penetration, at least partial, of the vaginal orifice.)

As might be anticipated, the proportion of offenses in which coitus was reported became greater with the increasing age of the female. This held true, but to varying degrees, among the nonaggression and aggression cases, as well as among the father-daughter incest offenses.

In all three offense types it is clear that the sharpest increase in the proportions of completed coitus occurred in the offenses with minors when compared to those involving children. The offenses with adult females tend to show the highest percentages, the exception being the group in which force was used. Here there was doubtless a strong factor of ability to resist as well as increased experience entering into the picture which in some of-the cases may have prevented the coitus. This can be inferred from the high percentage of the instances in which coitus was attempted but not completed. If the figures representing attempted coitus are added in and the total percentages taken as a measure, the pattern of an increase in coital behavior with an increase in age-of-object is more consistent with that shown in the other categories. The failure of the cases of attempted coitus with children is doubtless accounted for not So much by the child’s resistance as by the offender’s inability to enter the immature vagina.

A second observation is that with adult objects there is a much higher degree of coitus in the voluntary eases than in those in which force was employed, and a still greater degree in the incest cases. This is true whether or not the attempts at coitus that were not completed are included. The same is true in the offenses vs. minors, but to a somewhat lesser degree. On the other hand, where young children were concerned there was a small amount of coitus in the nonforce cases, a somewhat higher level in the incest cases, and the highest percentage (constituting almost a fourth) in the aggression cases. In short, in the present sample sexual contacts with children are more likely to consist of completed coitus when force is used than when it is not. The opposite holds true for minors or adults, since coitus in these cases is completed much more often in the consenting relationships.

This is of note particularly in the cases vs. children in which one might have assumed the opposite results. In fact, the use of force in some instances was the very element that led to the termination and disclosure of the incest relationship. Since force must be discounted, one is tempted to seek other explanations for the comparatively high level of coital behavior in all three incest groups. The most likely factor appears to be the one of frequent opportunity. The typically long-term aspect of incestuous relationships probably allows and even promotes a degree of sexual intimacy which is not found in the parallel heterosexual nonforce groups.

When attention is focused on the remaining heterosexual offenses in which there was physical contact, but no coitus or attempted coitus, a varied pattern is found. Since coital activity occurred least often in the groups with the youngest objects, it is here particularly that the most extensive use of petting techniques as a sex offense is reported. In the heterosexual offenses against children a fourth consisted of simple or nongenital petting, a half of genital petting, and an additional sixth of mouth-genital contacts, altogether accounting for well over 90 per cent of these offenses. Among the aggression offenses it is also in the youngest age group that by far the highest incidence of petting as the offense behavior is reported, but here it totals somewhat less than half of the cases. Nongenital petting accounts for less than 10 per cent, and genital petting and mouth-genital contacts are each reported in about a fifth of the offenses. In the father-daughter incest cases we find again that among the youngest group petting is the primary behavior in the offense. In this group it is understandable that there is only a single case with a report of nongenital petting as final behavior in the offense, since this is not likely to be cause for complaint between a father and a young daughter. But more elaborate petting was the basis of the charge in four fifths of the 69 cases in this group, about equally divided between genital petting and mouth-genital contacts, either cunnilingus or fellation. Thus, while these three kinds of offenses involving children all show a high amount of petting as offense behavior in comparison to offenses vs. older objects, there is a marked difference in the degree. Heterosexual pedophilic offenses rank highest, incest about 10 per cent lower, and force offenses by far the lowest.

The large number of instances in which nothing more than nongenital or simple petting took place in the nonforce offenses against children suggests how easy it is to run afoul of the law with very young girls, whereas the same activity with minors or adults might well be ignored or laughed at, unless it progressed to further stages. The fact that the incidence of nongenital petting as offense behavior in this category is so far in excess of the small percentages found in aggression and incest cases involving children can probably be explained in the following way. In the force cases the aggression factor soon pushed the activity beyond this limit, while in the incest cases simple petting alone could scarcely be a basis for charges. Furthermore, the combination of opportunity, family intimacy, and authority on the part of the father provides a favorable atmosphere in which to further the sexual exploitation of the child.

While in the nonaggression, aggression, and incest offenses against minor girls the same three degrees of petting occur, they assume less importance, as coitus and attempted coitus play a larger role. Petting with adult females is still less often the chargeable offense. In fact, the incidence of petting as final behavior is recorded in about a third of the heterosexual offenses vs. minors and in only one sixth of those vs. adult women. The same two groups (i.e., vs. minors and vs. adults) in the incest cases reported a fourth to less than a tenth. This relationship holds true for the heterosexual cases involving force, as the percentage with charges based on petting activity, which stands at nearly half for the offenses against children, drops to about a quarter and further to a sixth for the next two older groups.

*377\161\2*

One of the major concerns of many persons has been the connection between sexuality and violence. A canon of the post-Freudian psychologies has been that suppression of sexuality may cause an outcropping of violence and sadism. A literary parallel is the allegedly puritan era of Queen Victoria and the concomitant flowering of sadomasochistic erotica. Today such literary and graphic forms as paperback novels, comic books, and television programs exploit violence as a means of entertainment, and many persons are concerned lest these influence the youthful reader or viewer toward similar behavior, or at least cause an insensitivity to the suffering of others.

In the early phase of our research questions concerning sadomasochism were not routinely asked. Later every person was queried about whether he was sexually aroused by seeing pictures of, or reading about, rape, flagellation, torture, and violence in general.

Half of our 16 major comparative groups, including both the control and prison groups, had over 90 per cent of their members who reported never having been sexually aroused by such noncontact sadomasochistic stimuli, and another four groups gave essentially the same figure (89 per cent). The remaining four groups contain the three aggressor groups: the aggressors vs. children (88 per cent), vs. adults (85 per cent), and vs. minors (79 per cent). The range of response among all groups is so small that the only significant finding is the clustering of these aggressors in the lower quarter of the range.

In examining degree of response to sadomasochistic noncontact stimuli, one is struck by the fact that in 11 of the 16 groups the same or nearly the same percentages of individuals within a group reported moderate and strong responses. This is curious, for with a stimulus to which the great majority have no response one would expect those with a moderate response to outnumber those with a strong one. This expectation is fulfilled in only three groups, including two of the aggressor groups. In the remaining two groups, including one aggressor group, the strong responses outnumber the moderate. What this equivalence between moderate and strong response in most groups means, and why the three aggressor groups lack this equivalence, is not known.

Of the sex offenders whose offenses included violence or duress, between one eighth and one fifth reported arousal from sadomasochistic noncontact stimuli. While it is probable that in a few cases such stimuli triggered an offense, it seems reasonable to believe that they do not play an important role in the precipitation of sex offenses in general, and at most only a minor role in sex offenses involving violence.

There is a rather disappointing lack of correlation between arousal from noncontact sadomasochistic stimuli and the content of dreams and masturbatory fantasy. In part this may reflect the haste with which we covered the latter two subjects; more probing might well have unearthed data resulting in a high positive correlation. At any rate, there are only two noteworthy coincidences: more aggressors vs. adults had sadomasochistic dreams than any other group, and they and the aggressors vs. minors head the list of those with sadomasochistic masturbatory fantasy.

*339\161\2*

Since coital incest occurs chiefly before marriage, we shall treat it in this chapter. Coital incest is defined as coitus had by a postpubertal male with a female whom he could not marry because of her familial

relationship (genetic or social) to him. All persons interviewed were asked concerning incestuous coitus; unfortunately, we did not inquire about petting without coitus. Under incest we have included coitus between first cousins, since most states prohibit first-cousin marriages. We have departed from the above definition by considering as incest coitus with a sister-in-law, an act which most individuals regard as close to, if not actually, incest, despite the fact that one can marry an ex-sister-in-law. It is curious that despite Biblical exhortations, marrying a former sister-in-law is often frowned upon—particularly if divorce rather than death made the marriage possible.

Incestuous behavior is commonest with first cousins and least common with mothers. The sequence is: first cousin, sister, aunt, sister-in-law, then (almost equal), niece and daughter, and lastly, mother. Note the commonest four relatives are those apt to be near the subject’s age; an aunt who is one’s peer is not uncommon, particularly in the lower socioeconomic stratum. The frequency of sister incest may be explained by the combination of proximity and very early coitus; brother-sister incest is almost invariably at a young age and seems essentially a carry-over from prepubertal sex play. Incest with grandmother and granddaughter has been omitted from the list above because almost no cases of coitus exist in our sample.

Aside from the obvious statement that coital incest, as defined above, is most prevalent among the incest offenders vs. adults and minors, little can be said. Due primarily to the ages of their daughters or stepdaughters, coital incest is uncommon among the incest offenders vs. children. The reader will recall that coitus is not a requisite in the definition of incest offenders. Except for first-cousin incest, incest is such a minority phenomenon that any generalizations are reduced to the status of near speculation. Nevertheless, it is clear that the prison group and the sex offenders as a whole far exceed the control group in incestuous behavior. Lastly, the heterosexual aggressors appear to be the most incest-prone of any group except for the incest offenders. All three aggressor groups have over one eighth of their members with incestuous coitus, and consequently occupy die upper portion of the rank-order.

*301\161\2*

The question whether the sex play was heterosexual is our next concern. In compiling a rank-order of those who ever took part in heterosexual play, it again becomes obvious that the percentages involved are influenced by the average age at puberty, although not so strongly as was true for prepubertal sex play as a whole. The agreement between incidence of heterosexual play and age at puberty is rather good except that the homosexual offenders show more moderate figures despite their early puberty (their homosexuality seems to compete with heterosexuality), and two aggressor groups have larger incidence figures than their age at puberty would make one anticipate. We see that relatively few of the heterosexual (including incest) offenders against females aged twelve and over had prepubertal heterosexual play: they occupy the lower portion of the rank-order. These groups were relatively late in reaching puberty. The control and prison groups are 52 and 53 per cent, i.e., centrally located in the rank-order. The offenders against female children under twelve, the homosexual offenders, and most of die heterosexual aggressors rank higher than the control group. The first three positions are filled by groups whose members reached puberty early. However, fourth place is occupied by heterosexual aggressors vs. adults who reached puberty rather late; this, plus the fact that the heterosexual aggressors vs. minors head the rank-order, makes one feel that aggressiveness per se may be associated with prepubertal heterosexuality.

In homosexual play the three homosexual-offender groups occupy the first three ranks with percentages of from 60 to 69. Once again the control group is rather central (41 per cent), and the heterosexual offenders (including incest) against females aged twelve and older occupy the lower portion of the rank-order. Two of the heterosexual-aggressor groups are low in homosexual play whereas they were central to high rated by heterosexual play. We shall see that this is probably the result of the aggressors being more strongly oriented toward prepubertal heterosexuality than most of the other groups. The prison group, which was close to the control group in measurements of the presence or absence of prepubertal sex play and in heterosexual play, exceeds the control group in the proportion of members who had homosexual play. This is our first intimation that throughout life, pre- or postpubertal, the prison group is more homo-sexually inclined than the control group, an inclination subsequently reinforced by imprisonment. The correlation between incidence and age at puberty again exists as it did with heterosexual play (see Table 20).

Having examined the simple presence or absence of prepubertal hetero- and homosexual play, it is worthwhile to see how many individuals with sex play were exclusively heterosexual or homosexual in their sexual activity.

With regard to exclusive heterosexuality, all of those whose sex offenses were against female children are in the upper portion of the rank-order with percentages of from 25 to 36. Similarly, the heterosexual aggressors rank rather high, occupying second, third, and fourth ranks. The control group is once more centrally located with 23 per cent. The homosexual offenders occupy the bottom ranks.

Exclusively homosexual play is somewhat less common. First through third ranks are occupied by the homosexual-offender groups (20-24 per cent), the prison group is more or less central, and die control group is a bit low. Again revealing their prepubertal heterosexual orientation, two of the three heterosexual-aggressor groups occupy the lowest two ranks.

Since one lone experience suffices to place a person in a category such as “exclusively heterosexual play,” we had to get an idea of the quantity and intensity of the sex play in some other way. We therefore calculated the duration of sex play and the techniques involved.

*263\161\2*

Examination of the ages of the first coital companions of the peepers results in something of a problem. Peepers had relatively few young (fifteen years or under) coital companions, which one would anticipate since they tended to start having coitus later in life than most. But in the age-category of companions who were sixteen to seventeen they suddenly appear in first rank with an astonishing 50 per cent who had their initial coitus with girls of that age. This is in keeping with what we have seen in the accumulative incidence of premarital coitus: a sudden rise from a low rank-order position by age sixteen to an intermediate position by age eighteen. The problem arises in the next age-category of females aged eighteen to twenty, where the peepers fall to a low position in the rank-order with only 10 per cent, the same percentage they exhibited in age-category 14-15. Later, in the age-category 21+, they again achieve intermediate status.

All in all, the picture is one that we have seen before: a relatively inhibited, or at least inactive, group blossoming out in later life. This phenomenon is almost automatically insured; since the vast majority of all groups were coitally experienced, if the number of experienced persons is small earlier in life, it must of necessity radically increase later in life.

There is nothing significant in the reported age preferences of the peepers. While we did not routinely ask them the ages of the women they hoped to see, we do have the impression that they were primarily interested in females in the age-range regarded by our society as most physically attractive. Not infrequently the peepers spoke of having left their vantage points because the females were too young or too old. Pedophilia and gerontophilia are not attributes of the ordinary peepers.

*224\161\2*

Toxoplasmosis. Toxoplasmosis is an infection caused by the parasite Toxoplasma gondii. Approximately 80 percent of all adults have been infected with T. gonda at some point in their lives, and most healthy people experience no symptoms or problems from this infection. However, in people with AIDS this infection can reactivate and cause problems in the central nervous system, such as encephalitis and pockets of infection in the brain. A blood test can tell whether or not someone has been infected and therefore whether he or she is at risk of the T. gondii infection reactivating as the HIV infection progresses.

Trimethoprim/sulfamethoxazole is the medication of choice; alternatives are pyrimethamine and dapsone.

Tuberculosis. Skin testing for tuberculosis will tell if a person has been exposed to the disease in the past. This is a particularly good idea for HIV patients, because a reactivation of the tuberculosis can occur as the immune system declines. If a skin test is positive, the medication isoniazid is recommended to kill the bacterium and prevent the disease from occurring.

Mycobacterium avium Complex Infection. When the T-helper-cell count falls below 50, about 30 percent of people with AIDS will develop infection with this organism. Symptoms include fever, night sweats, weight loss, and stomach pain. Three medications that have proven effective in treating this infection are clarithromycin, azithromycin, and rifabutin.

Fungal Infections. Fungal infections are very common among persons with AIDS, and they include cryptococcal meningitis and fungal infections of the esophagus and mouth. Fluconazole has been shown to prevent these infections; however, because it interacts with other medications that are commonly used to treat HIV infection, it is recommended that fluconazole be used only to treat active infections and not to prevent potential infection.

*334\213\8*

The hepatitis C virus is the most common cause of what used to be called “non-A, non-B” hepatitis, a term formerly used to describe viral hepatitis that was not caused by hepatitis A or B. Hepatitis C is a major health concern in the United States and around the world, and it is the most common cause of chronic liver disease in the United States.

The hepatitis C virus has only recently been recognized as a cause of viral hepatitis, and a test to screen blood for it has been available only since 1990. Because it has been identified only recently, hepatitis C is not clearly understood in the way that hepatitis A and B are. Much research is currently under way, however, and new information is emerging rapidly.

Several types of hepatitis C virus have been recognized so far, each with a slightly different genetic makeup. A person may have infection with one or several types. Although the symptoms the viruses cause are similar, their response to treatment with medication (alpha-interferon) differs, and their degree of infectiousness may also differ. The most common types in the United States are hepatitis C types 1 (a and b), 2, and 3. Type 4 is more common in northern and central Africa and the Middle East, whereas type 5 is seen in South Africa and types 7, 8, and 9 in Vietnam.

*241\213\8*

Chlamydia infection of the eye usually produces redness, itching, and pain in the lining of the eyelids, this infection is called conjunctivitis.

A man or woman who becomes infected with chlamydia in the anal area after receiving anal intercourse from someone who is infected may develop a mucous rectal discharge, rectal bleeding, diarrhea, and pain with bowel movement. Or there may be no symptoms.

Finally, the throat can also be a site of infection with chlamydia, usually in someone who performs oral sex on a man who is infected. Men who perform oral sex on women are usually not at high risk, since there is no direct contact with the cervix, which is the usual site of infection in women. Kissing is not a risk factor for chlamydia. Although throat irritation can occur with chlamydia throat infection, when someone has a chlamydia infection of the throat.

*150\213\8*

Talking about sex can be very difficult, so many people—regardless of their gender, age, or sexual orientation—avoid the subject altogether. For example, a recent American Social Health Association survey of women attending college showed that although 81 percent, on entering into a sexual relationship, asked their partner how many partners he had had in the past, only slightly more than half asked if he had ever had a sexually transmitted infection or had ever had unprotected sex. Fewer than a third asked whether their partner had ever had a same-sex partner or had ever used intra- venous drugs. And these are the findings on how women behaved when they knew their partner. fairly well before entering into the sexual relationship. When women were entering into a new sexual relationship with a casual partner, even fewer of them asked these important questions. Finally, although about 85 percent of the women in this study were sexually active, fewer than half of them used any method to protect against sexually transmitted infections, and about a quarter had never had a pelvic examination.

*65\213\8*

Lice. Pubic lice, also known as “crabs,” are tiny bugs that infect the pubic hair and sometimes the hair under the armpits and the eyelashes. They can but do not always cause itching. A person with lice may also notice tiny blood spots on their underwear, resulting from the openings in the skin where the lice have bitten.

Scabies. Scabies causes itchy bumps and small lines (which are the burrows of the mites that cause the infection) on the body in a characteristic pattern. Most often, these are seen in the genital area, around the beltline, in the armpits, and in the webs between the fingers. The itching is usually worse at night and after a shower.

Trichomoniasis. The itching resulting from a trichomonas infection can range from mild to severe. The discharge is usually thin and yellow-green in color. There may also be a strong, fishy odor.

Warts. Warts are usually small, hard, flesh-colored bumps that can occur anywhere in the genital or anal area. They may also be cauliflower-like in appearance. Although warts usually don’t produce any accompanying symptoms, about 20 percent of people with warts experience itching, which is usually mild.

Yeast. Yeast infections—usually caused by the fungus Candida albicans—can occur at any time of the year, but they occur more often in the warmer months. Often there is itching, which can range from mild to severe, as well as a thick, white, clumpy discharge. If the inflammation is severe or if a woman scratches in the genital area, there may be breaks in the skin as well. A woman who has recently taken an antibiotic is more likely to develop a yeast infection, since the antibiotics temporarily diminish the quantity of the normal vaginal bacteria and allow yeast to overgrow.

*19\213\8*