Weight loss and diet plan for a healthy lifestyle.

Five males (aged seventeen to nineteen) and the eighteen-year-old offender picked up a nineteen-year-old girl who had missed the bus home from an amusement park. After parking near the river two of the males went off to swim and the other three persuaded her to have coitus. She finally agreed and got into the back seat. One male attempted intercourse without success, but the second succeeded. The present offender claimed he only held the door open for her. As she was a virgin, she bled profusely and later charged rape against all five males. Here, while all the males were accessories, only two were apparently directly involved in the sex behavior.

An eighteen-year-old male and three companions en route home from a party all had coitus with a nineteen-year-old girl who was in the car with them. They were chased by the police and apprehended. The final conviction was based on their buying alcohol for another seventeen-year-old girl, but it was a direct result of the earlier event. The nineteen-year-old girl had given evidence, and, hence, was not involved in the charge.

Six army buddies, plus the offender, aged twenty-two, had a drinking party on the beach. It ended in their attacking a dating couple and attempting intercourse with the female. The offender claimed he did not have intercourse but admitted his fly was open, and he was charged with holding the girl’s head down while she was raped by a companion.

A twenty-two-year-old male and four friends picked up an eighteen-year-old girl and her girl friend. The latter was let out and the party continued into the hills, drinking. The girl accused the males of forceful coitus, but since medical examination showed her hymen to be intact, coitus was apparently attempted rather than completed.

*373\161\2*

Every human being is continuously assailed by numerous stimuli, which he must interpret in order of importance, kind, and intensity. Because of our physiological and cultural uniformities we tend to make similar interpretations. Certain stimuli are usually interpreted as sexual in content and sexually arousing in effect. Such stimuli command attention and consequently are much used in the media of mass communication and entertainment.

In the years just after puberty, especially, many stimuli produce sexual arousal and even orgasm in males. The threshold of sexual response is low and selectivity relatively undeveloped. In young mammals one often sees general excitement transmute into sexual excitement, and this same ability is found in many young human males and probably in some females as well. With increasing age and experience the individual responds much more selectively and less readily, partly because of physiological deterioration and partly because of psychological fatigue: the desire becomes the familiar and the familiar becomes the monotonous. Often a novel stimulus of lower intensity than a familiar stimulus will produce a more rapid and intense response.

The interpretation of and response to various stimuli is often so subjective and complex that thus far the Institute for Sex Research has undertaken only limited and quite crude investigations of both contact (which we shall term “physical”) and noncontact (“psychological”) stimuli and resultant response. As far as physical stimuli are concerned, we have generally assumed some degree of sexual arousal and also a high positive correlation between the frequency of, preference for, and intensity of response from certain techniques. Nor have we investigated in any degree the so-called “erogenous zones,” except for a study of female genital sensitivity which is not synonymous with erogeneity. These are matters that will claim some of our attention in subsequent research.

Without becoming entangled in the definition of intelligence, we wish to observe that it is obviously involved in psychosexual arousal, and that we have collected information on the intelligence of the majority of males comprising this study. For the incarcerated males this information was obtained from the official records, which expressed the degree of intelligence either in terms of various psychometric tests or in summary descriptive labels such as “feeble-minded,” “moron,” “dull normal,” “above average,” “superior,” etc. When no official information was available (as was the case for nearly all the control group), we relied upon the brief descriptive notes we append to every case history at the time of the interview.

For practical purposes we condensed the data into four categories: feeble-minded (IQ-70), below-average (IQ 71-89), average (IQ 90-109), and above-average (IQ 110-f-). As might be expected, about half the control group fall in the average category and the others are more or less equally divided into above- and below-average. The prison group and the sex offenders present quite different distributions.

It is difficult to draw meaningful conclusions from these data. One can say, however, that of the tripartite groups the heterosexual offenders are the dullest (from 45 to 49 per cent were below the category of average), while the homosexual offenders were the brightest—roughly one third to two fifths rated as above-average.

The heterosexual offenders were joined by the peepers and by the aggressors vs. children to constitute the five dullest groups, while the five brightest include, besides the homosexual offenders, the incest offenders vs. children and the prison group. There is a strong correlation between intelligence rating and completed education. The five brightest groups also include the three with the largest proportions of college-educated, and four of the five groups with the largest proportions of persons with 11 and 12 years of education. Conversely the five dullest groups contained those with the poorest educations. This is not wholly a cause-and-effect relationship; certain forms of sample bias are also involved. Thus the homosexual offenders contain a large number of better educated because many were interviewed outside prison and came from a more favorable social milieu. On the other hand, the heterosexual offenders were, in comparison, far more rural and financially poorer.

The chief value of these intelligence data in this study lies in their explicating our findings concerning fantasy and psychosexual response.

Of the various noncontact stimuli—olfactory, gustatory, auditory, visual, and fantasy—we have concerned ourselves almost exclusively with the latter two. Our questions regarding visual stimuli were simple: we asked whether or not and to what degree the person was sexually aroused by seeing adults of the same and opposite sex, either in the flesh or in pictures, in various conditions of nudity and sexual activity. Naturally the questions and responses were highly interrelated; for example, a male who reported sexual arousal from seeing females also reported arousal from seeing nude female art, strip-tease, and representations of heterosexual activity. Because of this uniformity we decided to use in this present study only a few of the questions regarding visual stimuli. First, there is a general basic question: was the individual aroused, and to what degree, by the sight of other adult humans under ordinary conditions, as on the street or at a social gathering? It must be noted that even this seemingly simple question, “Does it arouse you sexually to see women (or men)?” is fraught with all manner of assumptions and qualifications about time, place, dress, physique, etc., and, to make matters worse, we considered frequency and intensity as equivalent. Despite these numerous and serious qualifications, and pending more sophisticated investigation, this question does afford worthwhile gross data. Second is the more specific question whether the individual was sexually aroused by pornographic photographs or drawings. The usefulness of this question is limited by psychologic conflict: the person may reply that he is not aroused, but is upset or disgusted—emotions which stem from a conscious or unconscious erotic response to the pornography. Nevertheless, such a reply was recorded as a negative. Because of the suggested connection between sex offenses and pornography we also inquired whether the person had owned pornography or had merely been briefly exposed to it. The third question is “visual” only in part: was the individual aroused by sadomasochistic pictures or stories?

The other area of psychological stimuli, fantasy, we have already treated in questions concerning sexual dreams and masturbation fantasy. In addition, we asked everyone we interviewed a more general question: “Are you aroused by thinking of the opposite (or same) sex?” This is the equivalent of asking, “Do you have sexual daydreams of the opposite (or same) sex?”

Before going on to describe our findings, one more complication needs to be discussed. While it is no surprise to find individuals who do not respond to specialized stimuli such as sadomasochism, or individuals whose inhibitions produce a negative rather than a positive response to blatant sexual stimuli, it is surprising to find substantial percentages of heterosexually active individuals who report no arousal from seeing or thinking of members of the opposite sex.2 Were these reports actually true, one would have to believe there were equivalent percentages of people who responded only to physical stimuli, who were never aroused by recalling past sexual experiences, and who never initiated sexual activity unless previously aroused by physical contact. Fortunately, we are not required to believe this. The truth of the matter is our questions were so phrased that only moderate to strong responses were counted as affirmative, and a mild response was almost certain to be recorded as negative. For people in the more educated upper socioeconomic level we used the phrase, “Does it arouse you sexually to . . . ?” while for the lower socioeconomic level we not infrequently used the phrase, “Does it make you (or get you) hot to . . . ?” This phraseology implies a considerable degree of sexual arousal to most persons. Indeed, if a person, when queried, asked for a clearer definition of arousal, we mentioned increased pulse, increased respiration, cutaneous warmth, etc., all of which are symptomatic of a rather intense or prolonged arousal:

Consequently, we cannot at present say how many heterosexually active individuals do not respond sexually to seeing or thinking about members of the opposite sex, and this statement also applies to the response of the homosexually active to the same sex. However, we can say definitely how many respond strongly and/or frequently, moderately and/or occasionally, and formerly (degree unspecified) but not currently; we can then provide a residual category for those who respond little or not at all. In this category of “little or none” we recognize that the “nones” are extremely rare in youth, but increase with age so that by perhaps the fifth decade of life the term “rare” is no longer appropriate, at least for males. A “none” report may be safely accepted when one notes that the person also no longer has sexual dreams or fantasy and has little or no overt sexual activity.

*335\161\2*

Among those who had premarital coitus with companions, the heterosexual offenders vs. adults usually lead in the tables showing median frequency, followed by the prison group and offenders vs. minors. The aggressors vs. adults also tend to rank somewhat high. A considerable frequency gap usually separates the offenders vs. adults from the second ranking group; aside from this, the order reveals a reasonably gradated sequence with the control group in the middle. At or near the bottom are the homosexual offenders. However, the peepers, who were low in incidence of premarital coitus, are not low in terms of frequency. This is because we are dealing with “active” frequency, much of which consists of the coital frequencies of the sexually active subgroup of peepers. The same appears true of the incest offenders vs. adults in the one age-period for which we have data. In brief, the incest offenders vs. adults and the peepers who had premarital coitus had it with moderate frequency.

In mean frequency of premarital coitus with companions, a similar situation prevails. The offenders vs. adults generally lead, with the prison group and offenders vs. minors following, and the aggressors vs. adults sometimes close behind. Unlike the median frequency, in the mean-frequency calculations the control group moves from a low rank up to second rank between ages twenty-six to thirty, when the offenders vs. adults inexplicably pause in their coital activity (resuming their usual frequency later) and the offenders vs. minors and aggressors vs. adults also curtail their activity.

As usual one sees the homosexual offenders low in mean frequency of premarital coitus with Companions—particularly later in life when, so to speak, the sexual die has been cast—but they are joined by two unexpected groups. The frequencies of the aggressors vs. children can be calculated only for age-periods 16-20 and 21-25, and in both this group occupies the lowest rank; their incidence figures gave no warning of this. The incest offenders vs. minors also are at, or second from, the bottom in the rank-orders wherever data for them exist.

At this juncture it is necessary to make explicit one of our assumptions. We have felt that a positive correlation should exist between incidence and frequency. Thus if the incidence figure of a group is high for a certain sexual activity, we feel that this probably indicates a high interest in die activity, and logically a high interest should result in high frequencies. In a rough way this assumption can be justified by our data. For example, the homosexual offenders vs. adults have both low incidences and low frequencies of premarital coitus with companions whereas the heterosexual offenders vs. adults and the prison group have high figures. However, in particular groups and at particular ages this correlation between incidence and frequency is weak or absent.

The frequencies of premarital coitus with prostitutes are less than the frequencies of premarital coitus with companions. The frequency data concerning premarital coitus with prostitutes often do not agree with the incidence data. The highest median frequencies are displayed by the homosexual offenders vs. children, and the heterosexual offenders vs. adults and minors. The highest mean frequencies are those of the heterosexual offenders vs. adults. By and large there are no cohesive tendencies or outstanding trends; the tripartite groups are usually scattered through the rank-orders, and the age-of-object (child, minor, adult) categories are similarly distributed. One gains the impression that the frequency of coitus with prostitutes often depends upon paradoxical and sometimes fortuitous factors. It can be on one hand a sort of “spillover” on the part of a very active heterosexual group, representing a psychologically and numerically unimportant part of life; on the other hand, for another group, it may represent a substantial or major part of their heterosexual activity and be of extreme importance. One means of telling which of the two possibilities is applicable is to consider simultaneously the ratio between the proportion of total outlet derived from premarital coitus with companions and that derived from prostitutes, and die median frequency of total premarital coitus. Taking age-period 21-25, one finds that the four groups with the highest frequencies of premarital coitus have total outlet ratios wherein coitus with companions outweighs that with prostitutes by 5 to 1, 7 to 1 (two groups), and 8 to 1. For these groups, prostitution may be assumed to represent a “spillover.” The four groups with the lowest frequencies of premarital coitus have total outlet ratios of 4 to 1, 2 to 1 (two groups), and one group derived more outlet from prostitutes than from companions. These groups would exemplify those wherein prostitution was an important part of sexual life.

*297\161\2*

The average (median) persons of the control and prison groups reached puberty at 13.8 and 13.6 years of age respectively. Puberty is here identified with the development of pubic hair and the ability to ejaculate; a more detailed definition is to be found on pages 182-189 of our earlier volume, Sexual Behavior in the Human Male. Puberty is, of course, one of the major turning points of life, and as such has been publicly noted and celebrated in some fashion by most human societies. At this time the boy acquires not only physical secondary sexual characteristics, but also a whole new set of obligations and privileges. However, societies often define puberty on a social rather than a purely physical basis, and of a group of boys undergoing tribal puberty rites a number may still be prepubertal and others may have reached puberty several years previously. Similarly, while our own society treats puberty as an important dividing line, we too tend to define puberty rather arbitrarily. The boy who reached puberty at ten gets into the theater at age twelve on a child’s ticket, whereas the prepubescent thirteen-year-old must pay an adult admission fee. The wearing of certain sorts of clothing and cosmetics is an age-graded affair with chronological age (socially defined puberty) being as important a factor as physiological status. This use of social rather than physiological puberty raises a number of problems for the unfortunate children who attain puberty far in advance of or long after the socially determined age, which in our society roughly coincides with the average age of physiological puberty, i.e., around thirteen to fourteen in boys and a year earlier in girls. Society has made no provision for the boy who reaches puberty at nine or ten; his intensified sexual needs are ignored or looked upon as problems verging upon the pathological. The boy with belated puberty suffers from the gibes of his peers and is often thrust by social pressures into unwanted dating and dancing.

The group with the most delayed puberty—the median person attaining it at age 14.5 years—is the incest offenders vs. adults. Following in order are the heterosexual offenders vs. minors, the heterosexual aggressors vs. children, and the heterosexual offenders vs. adults. The most precocious group is the homosexual offenders vs. adults (13.1); in fact, the average individual of all homosexual-offender groups reached puberty relatively early, between 13.1 and 13.6 years of age.

Whereas only 24 and 31 per cent of the control- and prison-group members reached puberty before age thirteen, no less than 47 per cent of the homosexual offenders vs. adults did so, and a relatively large proportion of the other homosexual offenders. At the other extreme, those who reached puberty at or after age fifteen, we find the incest offenders vs. adults leading with 39 per cent, trailed by the aggressors vs. children and offenders vs. minors.

This phenomenon of early puberty in the homosexual offenders suggests that if the sexual drive develops at an age before society sanctions heterosexual activity, the drive, blocked from heterosexuality, may turn toward homosexuality. In this connection it is noteworthy that the heterosexual aggressors vs. minors, whose median individual reached puberty at the second youngest age, are also second only to the homosexual offenders in the percentage with both prepubertal and postpubertal homosexual experience.

*259\161\2*

Singularly few of the peepers had sex dreams. Of all groups, they had the smallest number (73 per cent) who had experienced nocturnal emissions. In age-specific incidence they also are very low. For example, during age-period 16-20 when nocturnal emissions are at their peak and when from 55 to 79 per cent of the single members of other groups were having them, only 52 per cent of the peepers experienced these “wet dreams.” Too few peepers married to permit age-specific calculations for that portion of the sample.

Even when one examines only those peepers who did experience nocturnal emissions, it is evident that the frequency was low. This is most clearly seen in the calculation of average (mean) frequency in various age-periods from puberty up to age thirty: the peepers are in the lowest or next to lowest position in the frequency rank-orders with rates of only 5 to 10 nocturnal orgasms per year. In terms of median frequency, they are like other sex offenders.

As one could surmise from the above, the proportion of total sexual, outlet the peepers derived from nocturnal emissions is extremely small. The unmarried peepers have either the smallest or nearly the smallest proportions (1-5 per cent) recorded from puberty on to age thirty, after which we have no further data.

In dream content this same deficiency is evident. Nearly one fifth, the largest proportion on record, reported that their emissions were unaccompanied by dreams. Similarly, in the percentages who had homosexual and animal contact dreams the peepers are low in the rank-orders. None had sadomasochistic dreams despite the fact that 8 per cent had sadomasochistic masturbatory fantasies. In short, the tendency displayed by peepers for exotic fantasy is not reflected in their dreams.

*220\161\2*

In general, treatment with only one of the agents [monotherapy] has been found to be inferior to treatment with two or more of the drugs [combination therapy). Most providers have now abandoned monotherapy because the data so clearly demonstrate that combination therapy works significantly better. However, combination therapy raises the possibility of more potential side effects and involves greater cost. Thus, once again, any treatment plan must be individualized.

The goal of treatment is to decrease the viral load to undetectable levels. If the viral load is greater than 30,000 to 50,000, then medication should be considered even if the T-helper-cell count is stable and a person is feeling well physically. If the T-helper-cell count is decreasing, or a person is experiencing progression of the infection with various opportunistic infections, then medications should be considered even if the viral load is low and stable.

*330\213\8*

If a person who has not been immunized has been exposed to one who is infectious with hepatitis B, the exposed person should receive the vaccination series as well as a dose of immune globulin specifically directed against hepatitis B. The vaccination itself, if given after exposure, offers some protection against acquiring the infection. Adding a shot of immune globulin improves the outcome. Immune globulin is a collection of antibodies that help to protect against infection on an acute basis; it provides a “boost” for the immune system, but only for a short time, so the vaccination series is given at the same time to offer long-term immunity as well.

Vaccination plus immune globulin is a good idea after sustaining a needle-stick injury, receiving a bite from someone who is a carrier of hepatitis B or newly infected with hepatitis B, or sexual exposure to a person who is either a carrier or newly infected. If a person has sex with an infected partner, this combination can be given within fourteen days after the contact, but it offers the most protection if given within forty-eight hours of exposure. If there is a significant exposure from a needle-stick injury or from an exposure on a mucosal surface (such as the eyes or mouth), then this combination should be given within twenty-four to forty-eight hours after the exposure. In both of these scenarios, the follow-up vaccinations must be given at one- and six-month intervals.

*237\213\8*

incidence: very common

cause: bacterium (Chlamydia trachomatis)

symptoms: burning with urination, discharge (but often none)

treatment: antibiotics

WHAT IS IT?

Recognized since 1970, chlamydia infections are among the most common genital infections. They are caused by the bacterium Chlamydia trachomatis. In addition to genital infections, chlamydia can also cause eye infection in newborns.

Some types of Chlamydia trachomatis can cause lymphogranuloma venereum (LGV), another sexually transmitted infection (see the entry for this disease). Other species of Chlamydia cause different infections. Chlamydia pneumoniae, for example, causes respiratory infection, and Chlamydia psittaci, which is transmitted from birds to humans, also causes a respiratory illness. Here the discussion will be limited to sexually transmitted Chlamydia trachomatis infections.

*146\213\8*

If you are diagnosed with an infection, your health care provider may recommend that your partner be screened or treated for that infection. If this presents problems—because of any number of issues that can arise in our relationships with other people—you can ask your provider for suggestions about the best way to handle the situation. Sometimes role playing, with the health care provider acting as your partner, can help you find an effective way to communicate this news. You may want your provider to call your partner for you, or you may want to come to the office or clinic together so that everything can be explained. As discussed earlier, in some instances the local or state health department will help you notify your partner or partners. It may or may not be possible to determine who had the infection first, and in any case that’s not the most important thing: the most important thing is for both partners to receive treatment. It is a sign of respect and concern for your partner to let him or her know what is going on with you. Lack of symptoms doesn’t always mean lack of infection: even without symptoms, he or she could have the infection. This is the time to ask any questions, no matter how silly they may seem. The provider is there not only to diagnose and treat your infections, but also to educate you about STDs and help prevent you from putting yourself or anyone else at risk in the future. Abstinence and safe sex practices will usually be discussed Health care providers expect to receive phone calls from patients, so if you have questions about what was discussed during the examination, do not hesitate to contact your health care provider.

Regular sexual health care check-ups are as important a part of maintaining your health and well-being as a blood pressure check or a cholesterol screen. If you are currently sexually active, or are thinking about becoming active, find a health care provider in your community with whom you feel comfortable discussing these issues. Your health is worth it.

*63\213\8*

Contrary to common misperceptions, not all itching in the female genital area is caused by yeast infections. Because of the availability of over-the-counter yeast treatments, however, many women self-treat for genital itching with these medications and never receive professional evaluation of their symptoms. For this reason, some women never receive an accurate diagnosis of what’s really causing their symptoms. For instance, a herpes outbreak may cause genital itching, which a woman may think is caused by a yeast infection; she may start treating herself with an over-the-counter cream. Her symptoms resolve, and she believes she has successfully treated the yeast infection, when in fact the herpes outbreak merely resolved on its own, which it will do without treatment. So even if you think your symptoms are “typical yeast” symptoms, it is a good idea to be evaluated by a health care provider while you are having symptoms (especially the first time you have these symptoms), or if the symptoms recur frequently.

*17\213\8*