Chronic bacterial prostatitis is one of the most common causes of a repeated urinary tract infection in men, as the same bacteria tend to be involved in both problems. The disease is linked so intrinsically with urinary tract infections that many doctors believe that if you don’t have a urinary tract infection, and if you’ve never had one, you probably don’t have chronic bacterial prostatitis. One reason the situation remains chronic is that, even though the urine becomes free of bacteria and the symptoms of a urinary tract infection go away after treatment, the bacteria persist in the prostate because many antibiotics are not as effective there; these drugs do not diffuse well in the prostatic tissue.

*303\201\8*

This “dry” ejaculation is the most common sexual side effect, and it has nothing to do with a man’s ability to have an erection or to reach a sexual climax. If you are not planning to father children, this is nothing to worry about.

Some 10 to 15 percent of men who have BPH surgery report problems with impotence, or difficulty with erections. Even this does not have to be a permanent problem. There are many options to help men with impotence (see Chapter 8), now more than ever before.

*264\201\8*

BPH involves different kinds of cells, and their growth seems to be stimulated by many factors. (This is frustrating for researchers seeking treatment for BPH, because what works on one group of cells may have little effect on another.)

BPH is not merely a matter of prostate cells on the rampage; the problem involves two kinds of tissue. One is glandular tissue, made up of epithelial cells, which secrete fluid that becomes part of the semen. The other is smooth muscle tissue, made up of stromal cells, which contract automatically to launch these secretions out of the prostate and into the urethra. This is the same kind of tissue found in the walls of the intestines and in blood vessels; the actions of this tissue are involuntary responses to signals from the nervous system. Because this dynamic, nerve-rich tissue is easily stimulated, it seems to be set off by the glandular cell build-up in BPH, and it responds with varying degrees of tension. So, together, these prostate cells act as a “double whammy” on the urethra: As the glandular tissue enlarges and begins to clog the urethra, the smooth muscle tissue tightens, and clamps the urethra.

*226\201\8*

At the writing of this book, there is not any form of treatment that will eliminate all the cancerous cells once the cancer has reached the lymph nodes.

And so, again, the big, tough question: What should you do? Although all these forms of treatment may be necessary someday, we believe that taking any of these steps now will not prolong your life. (And conversely, not taking them now will not shorten your life.) All that will happen, if you begin these forms of treatment now, is that your quality of life will be disrupted.

For these reasons, we believe that men in this situation should opt for watchful waiting now. This decision of watchful waiting may be one of the hardest you’ll ever have to make, but remember: Watchful waiting doesn’t mean being passive. It means treating specific symptoms if and when they arise. In this case, watchful waiting should also mean that your doctor will monitor your health very carefully and that you will have a physical examination, including a digital rectal exam, PSA, and serum creatinine tests, every three to six months, as well as a bone scan every six to twelve months.

*187\201\8*

One long-term study predicted a local relapse rate (where cancer returns to the prostate or surrounding tissue) of 52 percent at fifteen years, with a failure rate during this time of about 11 percent a year. The average time it took for local recurrence to be diagnosed was nine years.

With external-beam radiation treatment, the five-year mark after treatment is a big milestone; in most cases, if cancer’s going to come back, it happens before then. But with interstitial brachytherapy, in a significant number of men cancer comes back after five years. In one study, for instance, only 57 percent of the men who ultimately would have a relapse were diagnosed within five years. In another study, it took at least six to eight years before half of the men experienced local relapse.

*149\201\8*

In age-specific incidence these offenders usually rank high. Between puberty and fifteen they are in second place with 14 per cent; after falling to intermediate status between ages sixteen to twenty, they rise to third rank in age-period 21—25 with 5 per cent, and to second rank in the next age-period (26-30) with 4 per cent. In this last age-period it is noteworthy that the three homosexual-offender groups rank first, third, and fourth.

As with the other homosexual offenders, we are inclined to view the relatively high incidence of animal contact among the homosexual offenders vs. minors as chiefly a by-product of their typical emphasis upon self-masturbation.

While the offenders vs. minors rank high in terms of incidence, the actual frequency of their activity is not particularly high. Of those who had contact with animals, for the average (median) offender it was a matter of 4.5 times a year between puberty and age fifteen, a frequency shared by the heterosexual offenders vs. minors and children, and very similar to that of the control and prison groups. Actually, we cannot expect too much from frequency data concerning an activity that we know to be sporadic, rather rare, and heavily dependent upon factors that are largely fortuitous.

*193\161\2*

All the elements that served as real or fancied mitigating factors in the case of incest offenders vs. minors are intensified in the incest offenders vs. adults. The females were all physically mature and would be considered appropriate sexual partners by most men. The “child molesting” element of the other incest offenders no longer exists. Bluntly speaking, society tells the father or stepfather of a female aged sixteen or over, “You must live on rather intimate terms with a female who is old enough for sex and who is sexually attractive, but you must not allow yourself to take advantage of this situation.” To the average person this dictate seems a reasonable law and one easy to obey. However, in certain circumstances even the most conservative person must admit that obedience to the law requires an iron will. For example, there are cases where a man marries a woman who has a full-grown daughter perhaps far more attractive than her mother; here the man may find himself sharing a home with a female with whom he could have a socially acceptable sexual relationship were it not for the fact that he married her mother. To view this female, whom he can scarcely look upon as a true daughter, in provocative dishabille without any thought of sex entering his mind is a virtual impossibility. The daughter, looking upon him not as a father but merely as her mother’s husband, may make the situation more acute by applying to him the semisexual behaviorisms that have proved useful in obtaining her way with other males.

Many a father who would rather commit suicide than have sexual contact with his daughter has guiltily repressed incestuous thoughts that come unbidden to his mind. It is hard to recognize sexual attractiveness without being sexually attracted.

At the other extreme one sometimes finds cases that bring to mind the primate families or European peasant families of the past, where the wife and nubile daughters were regarded as the personal property of the male to do with as he pleased. Even today in some nations incest is looked upon as a family problem rather than a matter calling for legal action by society. In these cases the male’s basic attitude is a simple and not illogical one: “I’ve reared them, fed them, and protected them for years; by rights I should have sexual access to them in recompense.” Vestiges of this old pattern remain in some of our culturally “backward” communities and urban slums. These vestiges are not only recognized but expected by the persons involved—”Pop’s drinking again tonight, Sis; you’d better go over and stay with Aunt Jennie.” Such a situation, accepted as one of life’s hazards by the participants, is enough to send the college-educated social worker running for the nearest policeman.

*151\161\2*

On the whole, the aggressors vs. adults showed a definite tendency to marry more than once, although not to the same extent as the aggressors vs. minors. Roughly one third of them had married twice, a proportion exceeded by only two other groups, one of which is the aggressors vs. minors. Also, a relatively large number of them had had brief marriages (two years’ duration or less) that ended in divorce or separation.

The aggressors vs. adults had known their wives for a little over five months, on the average, before marriage. This seems a brief courtship, and, in fact, falls in the shortest third of a rank-order of brevity. However, the aggressors vs. adults cannot be called impetuous when compared with the other aggressors, for a hasty marriage is typical of the group as a whole.

Within this admittedly limited period of acquaintance some 65 per cent had premarital coitus with their future wives—a figure exceeded by only two groups, one being the aggressors vs. minors. Aggressiveness is a decidedly effective factor in obtaining coitus, as the success of these two groups attest; this is particularly true outside of wedlock.

Since a relatively large number of aggressors vs. adults had premarital coitus with their future wives, and presumably rather often (the total premarital coital frequency with companions is rather high), a proportionately large number (24 per cent, the second largest number) of brides were pregnant when they married.

There is nothing remarkable about the subsequent fertility of these aggressors.

Like the aggressors vs. minors, the aggressors vs. adults devoted an unusually large amount of time to petting preliminary to coitus. Thirty-seven per cent, the largest proportion recorded, ordinarily spent 30 or more minutes in this way. Again like the aggressors vs. minors, a large percentage of aggressors vs. adults included mouth-genital contact in their precoital play—an activity that, as we have observed, was also evident in their premarital lives. Only one other group had more members experienced in marital mouth-genital contact. It is noteworthy that in those cases where mutuality (i.e., both fellation and cunnilingus) was not obtained, the desire was such that the aggressors vs. adults rank second among those with only fellation and those with only cunnilingus. The aggressors vs. minors also rank high in this respect.

Up to the age of thirty-five, which is as far as our data will let us go, the aggressors vs. adults have the greatest frequency of marital coitus. The average (median) aggressor vs. adults is also unusual in twice defying the frequency-depressing effects of age: he had intercourse more often at twenty-one to twenty-five than at sixteen to twenty, and still more often between thirty-one and thirty-five than between twenty-six and thirty. Indeed, his 3.75 per week frequency between thirty-one and thirty-five is the highest recorded in any age-period. He also ranks first in age-periods 21-25 and 26-30. The tendency of aggressors vs. adults toward high coital frequencies in premarital life—despite the complaint of a large proportion that lack of opportunity seriously impeded their efforts to obtain still more coitus—is seen in retrospect as an omen of their marital coital performance.

The mean frequencies are both relatively and absolutely erratic. However, here again the frequency in age-period 21-25 exceeds that of 16-20, and 31-35 exceeds that of 26-30. Also once more the aggressors vs. adults rank first by a big margin in age-period 31-35.

We may seem to be placing too much emphasis on the coital peak of the married aggressor vs. adults during the 31-35 age-period, since only 17 individuals constitute the sample by that age. However, the coital frequencies of these 17 are so smoothly distributed that we are inclined to believe that their behavior is more typical than we would if the average frequency were high only because of one or two extreme individuals.

The proportion of total outlet derived from marital coitus was generally moderate, ranging from 82 to 88 per cent.

One quarter of the aggressors vs. adults, the second largest percentage recorded, had had anal coitus with their wives, and an additional 8 per cent had attempted it. This is not unexpected in a group which, as we have seen, had an unusual amount of heterosexual activity, was little troubled by moral restraints, and had a strong proclivity toward taboo sexual techniques (e.g., mouth-genital contact). Since anal coitus is initially almost always painful, and since many females feel humiliated by it, there is probably a sadistic component here that is in keeping with aggression.

Whereas the wives of the aggressors vs. minors reportedly reached orgasm in coitus with unusual frequency, the wives of the aggressors vs. adults were not so fortunate; in fact, if one accepts their husbands’ estimates, they made a rather mediocre showing. A moderate number reached orgasm regularly, but nearly one fifth of their married years were marred by low (less than 10 per cent) orgasm rates.

As for how they evaluated the happiness of their marriages, the aggressors are in no way unusual; their marriages were not especially happy or unhappy in comparison to those of the other groups.

*109\161\2*

In general, moderate proportions of these offenders have extramarital coitus with companions during the various five-year age-periods. Up to age thirty between 38 and 44 per cent were so involved; after age thirty the proportions decline to 20 to 30 per cent. The age-specific incidence figures for extramarital coitus with prostitutes are similarly moderate in most instances, generally being 10 to 16 per cent. However, among those who did have extramarital coitus (from one third to nearly half in various age-periods), the average (median) individual exhibits the highest frequencies from age thirty on, and fairly high frequencies prior to that, being at or near a 0.3 per week level until age thirty-six when an increase to 0.4 occurs. In brief, the premarital pattern of high coital frequency carried over into extramarital activity. The great majority of the coitus was with nonprostitutes.

From 1 to 12 per cent of the total sexual outlet of these married offenders came from extramarital coitus with companions, and never more than 3 per cent from prostitutes. However, this latter figure (actually 2.8 per cent in age-period 46-50) is the highest recorded by any group; when we couple this with the fact that they ranked third in the two preceding age-periods we see dimly reflected in these married males the increasing importance of prostitution among the single men in this offender group.

*67\161\2*

We asked everyone we interviewed how he got along with his parents between the ages of fourteen and seventeen, the years when rebellion and emancipation generally begin. The adjustment of the offenders vs. children to their fathers was inferior to that of the control group, but not remarkably so. However, when they are compared with other offenders, an interesting trend is seen: the offenders vs. adults (whose female partners were aged sixteen or over) had an excellent adjustment with their fathers; the offenders vs. minors (whose female partners were aged twelve to fifteen) got along somewhat less well, though they were still in this respect superior to the control individuals; but the offenders vs. children had, relatively, a distinctly poorer adjustment.

A similar situation is seen when one examines the adjustment with the mother—the offenders vs. adults and minors had a good adjustment while the offenders vs. children had a poorer (but generally average) adjustment.

All persons interviewed were also asked with which parent they got along better. The majority of the control group (51 per cent) replied that they got along equally well with both, some got along better with their mothers (39 per cent), and very few (10 per cent) got along better with their fathers. This order, as will subsequently be shown, seems to be the “normal” one. About the same number of offenders vs. children, on the other hand, reported getting along better with the mother (43 per cent) as reported getting along equally well with both parents (44 per cent). This relative maternal preference is seen among all heterosexual offenders whose partners were under twelve years of age.

Half of the heterosexual offenders vs. children came from broken homes; among sex offenders this is a common percentage, but far greater than the percentage in the control group (30 per cent). The breakup by separation, death, or divorce occurred when the average offender was around eight years old—a relatively late date—and about the same age as the average control-group individual from a broken home.

In answer to the question how the parents (or parent surrogates) of the offender vs. children got along with one another when the future offender was between fourteen and seventeen, we find them in a middle position in a rank-order: about half of the various types of sex offenders had parents who got along with one another better than did the parents of the offender vs. children, and about half, worse. Evidently interparental friction is no factor in predisposing one toward becoming an offender vs. children, although it is characteristic of sex offenders in general.

Despite the incidence of broken homes, nearly two thirds of the offenders vs. children had spent 15 or more years of life, out of their first 18 years, in a home with a husband and wife present. The couple were not necessarily the genetic parents of the offender but were, at least, surrogate parents. This is somewhat more years than most other types of offenders spend in an intact home and far more than the prison group. In comparison to the control group, however, for whom the figure is about three quarters, the offenders vs. children do not make so good a showing.

Eight per cent of the offenders vs. children spent ten or more years (before age eighteen) in a household in which the adults were all women. This is a relatively high percentage for a rare phenomenon, being exceeded by only four other sex-offender groups; however, the differences in percentage points are not great, the control group having nearly the same (5 per cent).

It is of interest to see how the heterosexual offenders vs. children adjusted to people outside the family circle. In terms of the number of companions at ages ten to eleven and the ratio between male and female companions, they occupy an intermediate position among the other groups, and are often within a few percentage points of the control group. Like all offenders against children, they tend to have had more female companions than those who offended against older persons, although again the percentage differences are small.

Turning to the more specifically sexual aspects of prepubertal life, we find that roughly 70 per cent of the heterosexual offenders vs. children had prepubertal sex play with other children—a percentage which is in no way unusual, and one not far removed from that of the control and prison groups. Similarly, the percentages with heterosexual and homosexual play are moderate and near those of the control group. This same “middle of the road” trait is evident when one examines the techniques employed and the number of years the play continued. It is evident that there is nothing we have measured in the prepubertal sex play with other children that is diagnostic of the heterosexual offender vs. children.

One might, however, anticipate some significant findings when one studies their prepubertal sexual experiences with adults, but the fact is that as far as their experiences involved women the figures for offenders vs. children are not unlike those for a number of other sex-offender groups. However, the percentage (nearly 10 per cent) is much higher than that for the control group (about 3 per cent). For nearly half of that 10 per cent, the sexual experience included coitus. This is rather high relative to other sex-offender groups and much higher compared to the control group, of whom only 1 per cent had had such prepubertal coitus.

A more pronounced tendency toward contact with adults is seen in the homosexual area: 18 per cent of the future offenders vs. children had had sexual contact with adult males, a figure essentially equal to that of the prison group and exceeded only by the homosexual offenders. Eighteen per cent represents nearly three quarters of those who had ever been sexually approached by adult males: a large proportion compared to other groups. But while their subsequent adult offense was heterosexual, the important thing is that the early experience may have impressed them with the realization that adult males do sexually approach children. Nevertheless, this prepubescent experience did not apparently result in an undue incidence of homosexuality in later life.

The majority of heterosexual offenders vs. children (72 per cent) enjoyed good health in their childhood, a figure below that of the control-group individuals; another 12 per cent (a relatively large percentage) had poor health, so that compared to the other groups the offenders vs. children rate as having had rather poor health.

Some 44 per cent of the heterosexual offenders vs. children had masturbated before puberty, a percentage comparatively neither high nor low. Since the term “masturbation” has been used rather loosely, especially in describing childhood activity, it is appropriate to define our sense of the word. Masturbation is deliberate self-stimulation producing sexual arousal. In the case of prepubescent males, such stimulation is almost always specific manipulation of the genitalia resulting in penile erection and, occasionally, in orgasm. The heterosexual offenders vs. children who engaged in prepubertal masturbation began relatively early, slightly over half before age ten.

*24\161\2*