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In a calculation of the incidence of overt homosexual activity beginning at puberty and ranging up to age twenty-six, beyond which the increment is small, we find that in four of the six sex-offense types the sexual psychopaths have larger proportions of men with homosexual experience. Among the offenders vs. children, however, the sexual psychopaths display smaller proportions of experienced individuals by any age. The exhibitionists present a mixed picture.

In the light of the previous indications that in the homosexual-offense types the sexual psychopaths were more homosexually oriented than the Other homosexual offenders, it is no surprise that the accumulative incidence measure corroborates this finding. However, what is surprising are the vast differences in the incidence of homosexual experience among the incest offenders vs. children; here the proportion of sexual psychopaths with such experience is often more than double that of the other offenders.

Calculation of the median age at first homosexual activity gave no clear findings, but there is a slight tendency for the sexual psychopaths of three of the six offense types to have had their initial experience earlier in life. Two exceptions are the offenders vs. children and the exhibitionists—both, as one will recall, being the offense types for which the incidence of homosexual experience was not higher for the sexual psychopaths.

If the homosexual experience we have been measuring and discussing was rather pronounced—or at least more than incidental in nature— we could easily hypothesize that the clinicians used homosexual experience as a criterion in judging a person to be a sexual psychopath. However, what we are dealing with runs the gamut from a pronounced form to a trivial one-time event shortly after puberty. Consequently the homosexual history of many of our interviewees was of such an incidental nature as to have easily escaped clinical notice or, if found, to have been considered inconsequential. Another indication that homosexuality was not used as a criterion by the clinicians is the fact that the incidence was lower for the sexual psychopaths among the offenders vs. children. Also, it would be odd indeed had the clinicians so efficiently selected the home-sexually experienced from the incest offenders (leaving only about one fifth to one quarter) yet been unable to do so for other offense types.

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Sex offenses, especially those involving younger children, taking place on or near schoolgrounds, turned out to be so few that they could well have been combined with the miscellaneous cases in the “other places” category. Understandably, they were most often against young girls, but the incidence was only 3 per cent and represents only eight cases. Schoolgrounds were a location in from 1 to 2 per cent of each of the three homosexual-offense groups, there being a total of six cases in the 490 such offenses on which pertinent data are available. School premises were also only a minor factor in cases of exhibition, occurring there 2 per cent of the time. Thus the relative unimportance of schools and schoolgrounds as a place of offense in the present data is clear. It is a fact that California law since 1947 has had very strict penalties for loitering near schools, and the threat of enforcement of its terms (one year to life) may have had a real deterring effect. This would apply at least in the California cases, which represent more than a half of the present sample.

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Questions concerning age preference for males were asked only of persons with more than incidental experience; consequently we shall deal here solely with the three homosexual-offender groups, the only groups where such persons constitute a majority. Even so, we are plagued with large numbers of unknowns—instances where the interviewer failed to ask for or record the desired data.

It appears that the majority of homosexual offenders would prefer sexual contact with adults, and particularly young adults, just as do the heterosexual-offender, control, and prison groups; only the gender of object differs. However, we did find that some homosexual offenders preferred younger males, and that these preferences correlate with their offense behavior.5 More offenders vs. children preferred children (29 per cent), fewer offenders vs. minors (9 per cent), and very few offenders vs. adults (1 per cent). Similarly, more offenders vs. minors preferred minors (47 per cent), and more offenders vs. adults preferred males in their thirties or over.

In addition to questions as to preference, men with more than incidental homosexual experience were usually asked the age of their youngest male sexual partner since they themselves were at least eighteen years old. Again the number of cases where the question was not asked is large enough to make our statements only tentative.

Seventy-three per cent of the homosexual offenders vs. children admitted to homosexual contact with children (though we assume that most had in fact had such contact), but only 38 per cent of the homosexual offenders vs. minors, had contact with a boy aged eleven or younger. Only 9 per cent of the homosexual offenders vs. adults had had contact with children, but a third had had sexual experience with boys aged twelve to fifteen.

It is clear despite the limitations of our data that there is a tendency among homosexual offenders, even among the offenders vs. adults, to have some sexual contact with very young males.

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Petting, by our definition, consists of physical contact, not involving insertion of the penis into the vagina or anus, between a male and female, designed (by at least one member of the couple) to produce sexual arousal. Consequently, it may range from a simple embrace or kiss to more extensive techniques such as mouth-genital contact. In our society, at least, premarital petting has become a rather stereotyped procedure wherein die techniques follow a relatively unvarying sequence: hugging and kissing, thence to breast manipulation, thence to the leg and up the leg by degrees to- the genitalia. Needless to add, petting is usually initiated by the male; the female either encourages, permits, delays, or stops his activity at some one of the transitional points in the sequence. Ordinarily the female does not touch the male’s genitalia until after he has stimulated hers. A sexually sophisticated couple, especially if they have had prior contact, may speed up the sequence of activity or omit the earlier stages.

There seem to be three types of petting, the differences being those of intent. There is petting that is undertaken for its own sake with no intention of consequent coitus; this is common among teenagers and young adults, and also among married adults in special situations such as cocktail parties. One might term this social petting. Secondly, there is petting as a mode of seduction. One member of the couple, generally the male, intends that it should arouse the other to a point where she (or he) will permit coitus. Not infrequently this results in sexual competition that is recognized as such by both parties, with coitus symbolizing victory for the male and defeat for the female. There is a great deal of such seduction-petting, and only a portion of it ends in coitus. Lastly, there is petting as acknowledged coital foreplay: this is the petting used by couples -who intend to have subsequent coitus.

While there are no inflexible criteria differentiaing these three types, generalities can be made. For example, complete nudity and mouth-genital contact are more common in foreplay petting and less common in social and seduction petting (although they may occur in the terminal phase of the latter if coitus results). Differences in sequence and duration also exist. Foreplay petting tends to involve genital stimulation soon, and the duration of the petting is relatively brief. Seduction petting tends to be very protracted, and genital stimulation is delayed. Social petting may be lengthy; for example, it may occupy the whole afternoon and evening of a collegiate picnic, or it may be extremely brief, as a fleeting contact at a party when a couple is momentarily out of the sight of others.

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We have in our sample of sex offenders only five cases of individuals legally punished for sexual behavior with animals. While this number is too small to permit meaningful generalizations, we cannot simply ignore these cases any more than a zoologist could ignore a new species because only five specimens were known.

In our society an amazing amount of shame surrounds sexual activity with animals. Despite its frequency among country boys, it is one of the most taboo of all sexual acts, one toward which society reacts with both condemnation and ridicule. A more potent combination can scarcely be imagined. An outcast or rebel may endure or even enjoy social condemnation, but no one can long tolerate ridicule. Even in circles where statistically unusual sexual practices are regarded as interesting eccentricities, bestiality is a matter for contempt. A man might not conceal his homosexuality, he might enjoy a notoriety because of his fetishism or sadism, but he would shrink from letting his animal contacts be known.

It is not too surprising (although disappointing) that all five of our cases not only denied the offense to us, but denied any other animal contact. Moreover, they did not report any fantasies or dreams of sexual behavior with animals and denied any sexual arousal from watching animals in coitus.

The animals involved in the five cases include dogs, cows, chickens, and a mare. The ages of the males at the time of offense were sixteen, sixteen, “in youth,” twenty-six, and about thirty-eight.

The sociosexual fives of the five men are not unusual. Their hetero-sexuality falls within ordinary limits. Of the four full-fledged adults (one of the five cases was a sixteen-year-old when interviewed), all had had coitus with prostitutes, but only two had relied heavily upon them. Two had married. Three of the five had had sexual activity with other males, but only one had a strong homosexual history.

Four of the males came from broken homes—a high percentage. One had always lived in cities, two had always been rural, and two had been temporarily rural in their teens before their animal contact offenses. It is possible that this background predisposed them to animal contact.

Two were heavy drinkers and a third had been truly alcoholic-totaling three of the four adults. Drugs seem not to have been involved. Two (one of them the sixteen-year-old) were mentally dull, but the others were average.

Excepting the sixteen-year-old, all the men had antisocial tendencies, essentially offenses against property—thefts. Two had, in addition, some sex offenses. One man who had twice been convicted of molesting young girls was an authentic sex offender; the other was at worst only technically an offender, having been convicted at age eighteen for coitus with a willing girl three years his junior.

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The treatment of choice for PID is antibiotics that treat all the potential bacterial causes of the disease. Health care providers would rather treat a woman for PID if there is any chance that she has it, even if the disease cannot be conclusively diagnosed, because the potential consequences of missing the diagnosis are so severe.

Sometimes the bacteria causing PID are not identified, but the treatment is the same whether or not they are identified.

The treatment of PID is the same whether or not it is thought to be sexually transmitted. Most women with PID are treated as outpatients, but about 20 percent of them must be hospitalized. A woman who has severe pain, or who cannot take oral antibiotics because she is nauseated and vomiting, is often admitted to the hospital to allow antibiotics to be administered intravenously. Younger women are often hospitalized to make sure they receive their full course of treatment.

If there is suspicion of a localized area of infection (an abscess) or if there is any question about the diagnosis, a woman is usually admitted to the hospital. Women who are HIV positive and have been diagnosed with PID must receive aggressive treatment for the disease, and this too requires a hospital stay. Women who are pregnant and have PID are also usually hospitalized for aggressive treatment of the disease. Irrespective of the circumstances, any decision regarding hospitalization must be discussed with one’s health care provider.

Some of the medications used to treat PID are ceftriaxone (given as an injection) and doxycycline, or ofloxacin and metronidazole. These medicines are usually administered for two weeks.

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Since it is likely that everyone with herpes infections, whether oral or genital, type 1 or type 2, sheds when they are symptom free at some time or another, one might think “Since practically everyone has herpes, and it’s not clear when it’s safe to have sex, it’s inevitable that I’ll get it if I have a partner who has herpes!” or “I’m going to get herpes anyway, so I might as well give up trying not to get it.” Some people want to do everything they can to prevent transmission of herpes.

Some couples who have been together a while and are planning to remain together may not be as worried about transmitting the virus. In my opinion, it is always a good idea to discuss the question of herpes early in a relationship, before becoming sexually active, so that you can decide together how you want to approach this issue.

Everyone, and every couple, approaches the issue differently. It is best to make decisions based on accurate, current information, not on myths. Likewise it is very important that decisions be made together, as a team. Sometimes the person with herpes thinks it is entirely his or her responsibility, but this is not the case. Facing the question of herpes is often the first difficult decision that a couple makes, and working through this issue can be the first step toward real closeness. Remember: being in a relationship involves confronting thousands of issues over time. Herpes is just one of them.

This section will provide some tools for couples who want to take steps to prevent the transmission of herpes. What can you do to prevent yourself from getting herpes, or how can you keep from transmitting herpes to your partner? The first thing is to know your herpes status. Getting a blood test will tell you your status for both type 1 and type 2 herpes (see the discussion of testing later in this section); you don’t need to be experiencing symptoms to be tested. A couple who know their individual statuses for herpes infections can then make informed decisions about what type of sexual contact is safe and what type is risky. If you or your partner have not had this test performed and thus don’t know whether one of you has herpes, then use a condom to help protect against transmission until you can be tested. As noted earlier, if both partners have the same kind of genital herpes (both have type 1 or both have type 2), then they will not reinfect one another, nor will they trigger outbreaks in one another.

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Any person, male or female, whether sexually active or not, can develop a genital yeast infection. There are no reliable statistics on how many people contract such infections because many people self-treat and never see a doctor about a yeast infection. Men probably have yeast infections less often than women, even though they are very common in men.

It is estimated that 75 percent of women will develop a symptomatic yeast infection at some point in their lives and that possibly 75 percent of those women will experience another symptomatic infection later. Some women have very frequent recurrent symptoms, with multiple yeast infections each year. It is believed that about 20 percent of women are colonized with yeast in the vagina. This means that even though the yeast is there, it is not causing infection or symptoms, such as itching and discharge. These women may remain symptom free or may develop symptoms later.

The following circumstances make a woman more likely to be a yeast carrier and to develop yeast infections: pregnancy, using oral contraceptive pills (particularly the higher-dose pills), using oral antibiotics (because they eliminate the normal bacteria from the vagina and allow the yeast to overgrow), and having diabetes that is poorly controlled. Douching disrupts the normal environment of the vagina and may make a woman more likely to get a yeast infection. Warm weather, too, makes yeast infection more likely. Yeast likes warm, moist areas of the body, such as the genitals, and wearing clothing that is tight and restrictive tends to make a person more likely to develop a yeast infection. Other vaginal irritation, for example from an allergic reaction to spermicide, may also allow yeast to overgrow.

Suppression of the immune system (through such medications as steroids or such infections as human immunodeficiency virus [HIV]) can also make a woman more susceptible to frequent symptomatic yeast infections. However, just because a woman develops a yeast infection does not mean she has a serious medical problem: as noted previously, some women are simply subject to recurrent symptomatic yeast infections.

Men who are not circumcised tend to have more frequent penile yeast infections than men who are, probably because the area under the foreskin provides a warm, moist area in which yeast can grow. (A fungal infection under the foreskin is called balanitis.)

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The challenge of discussing a chronic infection with a new partner can seem overwhelming. Some people decide that they don’t want to discuss the topic—ever—but there are two good reasons for bringing the topic up before becoming intimate. First, most potential partners respond favorably and are glad you cared enough about them to be honest. Few people decide not to pursue a relationship because of this one issue. Second, if partners are not told and later find out, or are told after becoming intimate, they may feel betrayed. Trust can be lost. Telling before you become intimate also allows you both to deal with the issue as a couple, rather than putting all the responsibility for preventing transmission on the person who has the infection. Honest discussion often allows people to develop a more intimate relationship. You may encounter a partner who does not respond favorably, and this can be painful. Consider in advance how you will take care of yourself if you get a negative response.

Before you discuss issues of sexual health and become intimate with a new partner—whether or not part of the discussion involves sharing information about a chronic STD—it is a good idea to establish the groundwork for a relationship first. As you get to know the person better, you may find that you don’t want to pursue the relationship any further, and you don’t want to have sex with that person. In that case, you may have discussed these issues unnecessarily If you get to know a person before becoming sexually intimate, it will be easier to tell the person about your STD. Don’t put off discussing this until the heat of the moment, however, because your partner will need time to process the information. Telling him or her as you are about to become intimate can be very awkward.

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The more you read about prostate cancer, the more it seems that one factor is consistendy underplayed—its lack of early symptoms. This is just one way in which prostate cancer differs from other diseases, many of which have early warning signs. To put it bluntly, by the time a man has symptoms of prostate cancer, it’s probably too late to cure it. Unfortunately, when prostate cancer is in its earliest, most curable stages—before it has spread beyond the wall of the prostate—it is silent; it produces no symptoms.

That’s why so much effort is being poured into screening and early diagnosis. To be sure, our understanding of prostate cancer is expanding every day, and the battle is being waged encouragingly on all fronts: prevention, early diagnosis, effective treatment of curable disease, better management of advanced disease. But despite many advances—at least for the immediate future—it’s not likely that a breakthrough in gene therapy will enable doctors to keep prostate cancer from developing, or that scientists will make major strides in curing advanced disease. Right now, the sad truth is that there is no cure for advanced prostate cancer. Until there is, our best hope of reducing the number of deaths from prostate cancer lies in two tactics—early diagnosis and effective treatment of curable disease.

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