Members learn to make allowances for their own private biases within the privacy of their own personal lives. A few who find that the group experience stirs up personal difficulties will seek personal help outside the group.

*369/197/1*

One of the ways of helping doctors and other health care workers to provide better contraceptive services is to study what happens in the consultation. Such study can help the doctor to acquire the skill of becoming entangled with the patient’s problem and then stepping back and thinking about what is happening. In this chapter mainly the process of the consultation is considered; outcomes of consultations are less well researched and hopefully more can be included in future editions of this book.

*331/197/1*

*292/197/1*

Some people have great difficulty in allowing themselves to be fully sexual when there is no chance of becoming pregnant. There was clearly an element of such a problem in the case described above, where the patient found sex more exciting when there was a risk of pregnancy. Although her anger at her husband’s infidelity was important, it is interesting that she herself wanted to see if she could respond with a fertile man.

*254/197/1*

This information does not match the prevailing view that it is predominantly ignorance and cultural taboos that prevent couples having access to family planning methods. As with most things in poor countries, it is as much a question of resources as of education.

*216/197/1*

The only petting technique for which a comparison was made was mouth-genital contact. More of the patterned than of the incidental offenders had been fellated by females, in every instance by a margin of from three to 28 percentage points; some half to four fifths reported this activity.

More of the patterned offenders in four of the six groups had been fellated by female companions before marriage than had the incidental offenders. In fellation by prostitutes the patterned again led in five out of six groups. In marriage the patterned offenders always exceed the incidental, often by large margins, with from one third to about two thirds of them having been fellated by their wives.

When one studies cunnilingus (male mouth on female genitalia), the differences we observed in fellation are even more apparent. In all six groups more patterned than incidental offenders had performed cunnilingus, and the differences are often wide: from about one third to three quarters of the patterned offenders as against from one twelfth to three fifths of the incidental offenders. Similarly the patterned offenders substantially exceed the incidental in the proportion of males who had cunnilingus with premarital companions, post-marital, and extramarital companions, and with wives. The differences dwindle or are even reversed with respect to cunnilingus with prostitutes, but never more than 8 per cent of any group were involved.

It would appear that mouth-genital contact—fellation and cunnilingus—is an important variable in differentiating between males who have histories of extensive sex-offense experience as opposed to those with only a single offense. Why this should be true is a matter for conjecture. It may indicate an aggressive orality, from a psychiatric viewpoint; it may indicate a preoccupation with sexual esoterica; or it may be simply a healthy lack of inhibition.

*392\161\2*

Abstinence from alcohol is a characteristic of only 16 per cent of the control group and a similar proportion (14 per cent) of the prison group. A plus or minus of about five percentage points from these two groups would include most of the sex-offender groups. No clusterings or trends are observed in the percentages of teetotalers among the various groups. Abstinence, as we employ the term here, does not mean that an alcoholic beverage has never passed the person’s lips. We include persons who drink a small amount once or twice per year. An example would be the man who has one drink at a wedding or the man who will allow a drink to be pressed upon him by friends rather than risk being impolite by adamant refusal.

Our next category is that of slight to moderate use of alcohol. By this we mean anything from a few drinks a year up to a drink every two days. Infrequent drunkenness, such as an annual intoxication at a New Year’s party, would not exclude a man from this category. Except for two, all the sex-offender groups have from two to three fifths of their members in this category of moderate drinkers. Our nonsex offenders come close to marking the extremes of the range, the control group having the three-fifths figures and the prison group the two-fifths. The only observable clustering is that the homosexual offenders have rather large proportions (52 to 63 per cent) of moderate drinkers, the proportion being larger among those with older partners. This situation may reflect the fact that they frequent bars for sexual purposes.

The next category we employ is that of frequent use of alcohol, by which we mean the range from a minimum of one drink per day up to but not including alcoholism. We would include a man who regularly got drunk once every month even though his drinks, if prorated, might not attain a daily average. We are trying to include in this group those who use alcohol habitually, and those to whom alcohol has some importance, but who are not alcoholics. The groups with the fewest frequent users are the control group and the homosexual offenders vs. adults, both with 18 per cent, while the aggressors vs. children have the most, nearly one third. In general, the various groups cluster around proportions of one fifth to one quarter. The only trends noted were that the homosexual offenders tend to have rather few frequent users and the aggressors tend to have many.

Alcoholics, our ultimate category, we define as those who habitually use alcohol to such a degree as to interfere seriously with their social relationships and employment, or those who drink on the average of one fifth of whiskey (or equivalent liquor) a day even though they may be able to maintain their social and economic status.

There is a great variation among the comparative groups in incidence of alcoholism, the proportions ranging from the 6 per cent of the control group and the offenders vs. adults up to the 40 per cent of the aggressors vs. children. In all the tripartite groups those whose objects were children have larger proportions of alcoholics than those whose sex-offense objects were aged twelve or older. In two of the four tripartite groups these differences are quite large. There is also a tendency for those whose sexual objects were minors (age-period 12—15) to have more alcoholics among their members than those involved with adults.7

An additional and anticipated finding was that never less than half, and generally two thirds to all, of the offenses committed while drunk were committed by frequent drinkers or alcoholics. Moreover, of the drunken offenses (including aggression) against children, from half to four fifths were committed by just the alcoholics. Only about one fifth to two fifths of the drunken offenses against adults were by alcoholics. Conversely very few (0 to 5 per cent) of the offenses committed while sober were committed by alcoholics and not many more (0 to 17 per cent) by frequent drinkers.

In summary, while the use of alcohol is more important among the sex offenders than among the control group, it is more important still to the prison group. Alcohol as a group phenomenon does not seem to be any greater a factor in the predisposition to sex-offense behavior than in predisposition to nonsexual criminality. Intoxication inclines persons to legally punishable behavior, but it does not determine the form that behavior will take.

*354\161\2*

In our earlier volume on males, one of the most interesting findings was that the incidence and frequency of extramarital coitus decreased with age among men in the lower socioeconomic brackets and increased among those in the upper brackets. Knowing, then, that extramarital coitus could be a rather sensitive indicator of social and behavioral differences we hoped that it would also prove useful in differentiating sex-offender and control groups.

*316\161\2*

In this present study, then, we use the term “masturbation” only for self-stimulation resulting in orgasm in the absence of a sexual partner, unless we specify otherwise.

Like most forms of sexual behavior, masturbation can be many things. In one person it may be a temporary substitute for coitus or for a homosexual contact that is not readily available. In another, it may be a chosen form of sexual outlet that represents a major portion of the person’s total sexual behavior. In a third case it may be a component of compulsive behavior, which provides apparently little satisfaction or relief from sexual tensions.

Within the twentieth century masturbation has been divested of its reputation of being physically damaging, although it has retained in the eyes of some religious groups its quality of sin and self-pollution. Setting aside theology, one may say that masturbation has now been accepted as a normal activity for the young. Perhaps the word “tolerated” should be substituted for “accepted,” since efforts are still made to prevent or minimize masturbation; the current popular attitude seems to be not to punish or admonish a child for masturbating, but to prevent the activity by distracting him or substituting some other interesting activity. What to do with a masturbating teenager is a question that most authors writing on the subject avoid, and those who do treat the matter give the impression that they wish the activity could be kept minimal through “other interests” or by means of the standard “wholesome” activities that we elders are always urging upon teenagers. This stigma in regard to frequency grew from the logic that since there were no limiting factors in masturbation except privacy, one’s desire, and physical strength, it would tend to lead to “undesirable excesses.” Thus, while it could be tolerated as a substitute for heterosexual outlets, it was considered dangerous if condoned without restrictions. Since masturbation is so important in early life (it precedes and outweighs sociosexual behavior in many young individuals) it has come to be associated with youth, and, consequently, is often regarded as an infantile or juvenile activity which should not be perpetuated in adult life. Moreover, because of the purposive reproductive bias with which adult sexuality is regarded in our society, masturbation in grown men and women is looked upon as inappropriate behavior. The psychiatrists, and more particularly those with a psychoanalytic background, have been prone to label it regressive or immature behavior when it occurs in an adult.

At this point we should like to make clear our attitude toward masturbation. We contend that there is nothing intrinsically desirable or undesirable about it; like most phenomena it derives its significance from its context. At worst it may be, if quantitatively important in a person’s life, symptomatic of an inability to make the social and emotional adjustments required for most sociosexual activity. At best it may be a needed neurophysiological release which may also facilitate subsequent sociosexual behavior. In many instances it is essentially neutral: a transitory moment of pleasure without emotional content or consequence. In any case it is a source of pleasure, and as such deserves to be regarded as a potential asset in life. We must also reiterate that we have never seen a case where masturbation in and of itself had any deleterious consequences, physical or emotional.

In our study of sexual behavior in the male we discussed the significance of masturbation at some length, pointing out that while for most men coitus is the primary sexual outlet of a lifetime, masturbation is typically secondary. In our present sample, since the men are chiefly of high school education and below, the role played by masturbation is de-emphasized. It is generally true, however, that masturbation provides from a third to a half of the orgasms of a noncollege group prior to marriage. Marital and postmarital levels are typically lower, but still represent from 5 to 10 per cent of the total sexual outlet. Thus, in any analysis of the patterns of sexual activity of various types of sex offenders, particularly in their single years, the masturbation factor must be examined.

For our purposes here an analysis can perform several services. Since we in general consider masturbation to be typical male sexual behavior, engaged in to a varying extent at different ages, we clearly do not expect to use it as a gross tool for singling out abnormalities. Sex offenders, like other males, use masturbation as one of their important sexual outlets. However, when different types of offender groups show varying patterns of masturbation, there are inferences to be drawn about their basic differences in personality and types of behavior. The degree of early sexuality, the extent to which they repressed their overt sexual activity, the balance of solitary and sociosexual outlets, the amount of worry over masturbation, and a glimpse into the offenders’ dream world of masturbation fantasy—all these can be used as tools in gaining an understanding of the differing psychosexual patterns of various types of sex offenders

*278\161\2*