During a short family planning consultation in general practice or in a clinic it will, of course, be necessary to ask some questions and to give some advice, but the timing of such activity is worth studying. Is it an appropriate moment to move on with the practicalities, or has the doctor escaped into ‘traditional doctoring’ because of some discomfort between doctor and patient? Noticing, thinking about and possibly commenting on that discomfort rather than running away from it can provide a further space for the patient to reveal hidden feelings.

*361/197/1*

He was pleased when she returned and told him that she did not know what to do. He had the bright idea that perhaps she wanted a pregnancy (she was now 34 years old) and wanted a less certain method so that she could become pregnant by accident rather than making a definite decision about a family. She shot him down. There was no question of her wanting a child. Her husband, she reminded him, had three rising teenagers by his previous wife, quite enough to cope with. And for herself, she had never wanted children, and was pleased to find a partner who would not put any pressure on her in that direction. The Pill was so convenient and reliable, all the other methods seemed so hit and miss. What did he think her chances of being sterilized were? Perhaps, she rushed him onwards, she could have it done privately. The doctor struggled to regain the initiative. Why did she want to stop the Pill? She was healthy with no risk factors and could continue on for several years yet if she wanted. He waited and rather wished he had not confronted her, as the silence became very uncomfortable. Just as he was thinking perhaps he should just agree to refer her for sterilization, she seemed to make up her mind to confide in him. She told him that she had never had any satisfaction making love with her husband. Mr S. thought that she did not reach orgasm because she was on the Pill, but, blushing, she was able to tell the doctor that she had been orgasmic with other partners before her husband, and had been on the Pill then. She told him that she had not minded at first, she had thought it was just that he was so ardent and passionate that he came so quickly and could not hold back. She had thought that as their relationship became more mature and less urgent he would slow down, but he always came as soon as he was inside her, and sometimes before.

*322/197/1*

It needs to be realized, too, that patients do not want to use contraceptives at all – nobody looks forward in keen anticipation to using the chosen method – so that a contraceptive method which affects the enjoyment of sexual behaviour may be discontinued. As Robert Snowden said in the foreword ‘Contraception is not normally viewed by users in an objective clinical manner but within the context of an erotic and emotional experience’.

*284/197/1*

Sometimes the forces propelling the patient towards sterilization are to do with the inability of the patient to take control of the situation for herself, and this powerlessness may be a symptom of a deeper problem.

*246/197/1*

There is a need for realistic assessment without prejudice. Sensitive issues surrounding the question of congenital disability need to be addressed and perhaps a genetic opinion obtained.

A person with a disability knows how it is to grow up and live with the disability. Some will feel that there is no way in which they would bring a child into the world with the risk of their disability recurring, but others will feel that they know, understand and are coping with their own disability, and that the risk is reasonable and acceptable, as they could offer true insight and support if their child had a similar disability. Pressure from doctors based on their views of the disability must be avoided at all costs, since it implies a devaluation of the patient’s life, as if their life is useless and perhaps they should not have been born either.

*208/197/1*

The salient fact in Table 152, which shows the source of report or discovery of the offender, is that offenses against children and against minors were reported to the police largely by members of the child’s or minor’s family or by friends. This is most clearly evident in the offenses involving children, occurring in about two thirds to five sixths of the cases. Among the offenses vs. minors, the four groups break into two pairs. In incest and aggression over 70 per cent of the offenses were reported by relatives or friends, while in the remaining two—heterosexual and homosexual offenses vs. minors—the percentage drops to a level in the 40s. In the case of incest vs. minors, the high figure is due to the fact that mothers constitute a large proportion of those who reported the offense. The aggression offenses vs. minors have no comparable explanation, but it is true that when force is involved friends and relatives are less hesitant about getting in touch with the authorities. Apprehension indirectly through the results of police investigation largely take up the slack in the two sets of offenses vs. minors which are low in report by relatives and friends.

It is clear that in general the three incest groups show the highest incidence of offenses reported by friends or relatives. From almost half to five sixths of the offenses in each of the three groups were brought to the attention of the police by a relative or friend, as one would expect. The majority of the complaints in the incest offenses are lodged originally by the wife of the offender, who is, of course, also the mother of the object of the offense.

There is a curious relationship in the degree to which the reporting of incest by wives lessens as the age of the daughter increases. It starts at 63 per cent for the incest vs. children, drops about ten points in the offenses vs. minors, and ends up at only 37 per cent for the offenses vs. adult daughters. It would be tempting here to theorize that the wife’s reporting decreases in the latter case because she is a willing observer of her sexual displacement, and in fact that she tends to cover up the offense since she is satisfied to see her mature daughter take over her sexual role in the dynamics of the family. As pointed out before, there was no doubt in the record of the extent to which the sexual relationship was complete. This tentative hypothesis is also supported by the fact that these mothers of adult daughters are older women who may have less interest in marital coitus than their husbands wish. On the other hand, the sample is small, a quarter of the cases are unknown, and in addition the supposition is weakened somewhat by the fact that the daughter herself made the complaint in an additional 21 per cent of the offenses.

In the next category—that of the reporting of offenses by onlookers —the peeping offenses rank highest, with over 40 per cent of them so classed. However, this figure may possibly be distorted, since almost half of the peeping cases had no data on this point. Since the person who is being watched by a peeper is usually unaware of what is occurring, it is not surprising that onlookers or passers-by would be the persons to lodge a complaint. In these cases there is little personal commitment or embarrassment involved in making such a report. Ranking second in report by onlooker are the aggression offenses vs. children, with 32 per cent of them so categorized. At first thought it would appear unlikely that such conspicuous offenses would be attempted in the presence of witnesses, but actually in many of the cases what was observed was the preliminary behavior, which aroused suspicion of the aggressor’s ultimate intentions. It is easily understandable why anyone might readily take it upon himself to notify the authorities in such circumstances. The remaining offense types range from none of the cases reported by onlookers, to 24 per cent (exhibition offenses). Typically the range is from about 5 to 10 per cent.

Turning now to offenses reported by the person who is the object or victim of the offense, one finds not unexpectedly that adults are in general more likely to report directly to the police than are minors, and minors report the offense directly more often than do children. This progression is consistent except in the case of the adult homosexual partners, where there is little change. A second point to notice is that in the heterosexual offenses the adult is clearly most willing to report the offense herself either when force has been used against her or when the offense does not specifically involve her person. Thus in aggression vs. adults over three fourths of the offenses were reported directly by the female, and in exhibition about half of the cases were turned in to the police by the offended female. The reason for the high figure here is that when there is little or no sexual involvement on the part of the female she is less embarrassed to report the offense.

Next to consider is the discovery of the sex offense by the police in the course of their routine duties as law-enforcement officers. In the present sample the homosexual offenses were clearly the most vulnerable to this type of detection. A total of almost three fourths of the homosexual offenses vs. adults were so classified, over a quarter of the homosexual offenses vs. minors, and more than a sixth of the homosexual offenses vs. children. The more specific question of police entrapment in these homosexual cases has been discussed previously, but it can be summarized here by the observation that while it was true of only one case among the offenses vs. minors, it did account for the origin and of course detection of the offense in a sizable proportion (20 per cent) of the homosexual charges involving an adult. In many of these instances the original homosexual approach was actually made by a plainclothes police officer. Other types of offenses which showed high levels of police work as the basis for apprehension were peeping (30 per cent), and the heterosexual offenses vs. minors (27 per cent) and vs. adults (22 per cent). The arrests for peeping were the result of routine patrolling and direct observation by the police. On the other hand, a large proportion of the heterosexual offenses vs. minors and adults came to light indirectly as a result of police investigation of family situations or reported general delinquency of some sort other than sexual behavior. In the remaining eight types of offenses, police work was not one of the major factors in the pinpointing of the offense, although it was not negligible in the incest offenses and aggressions vs. minors.

In short, police do not frequently just happen upon sex offenses in general, and must count heavily on information from other sources to make their arrests in this area of crime. These complaints come primarily from friends and relatives of the prison against whom the offense is committed, and secondarily from witnesses or from the person concerned.

The final category of «other» includes a wide variety of sources. Typical of them would be welfare reports, health officer or other medical investigations, teachers, and ministers.

The evidence from the present analysis is that channels of report are extremely varied in sex offenses. This is a result of both the wide range in age of the objects involved and the hesitation that many have about presenting the facts to the authorities.

*384\161\2*

Crimes against property. These include larceny, burglary, fraud, theft, damaging property, and similar crimes. None involve bodily harm or threat of bodily harm.

Crimes against person. Here we class all nonsexual offenses involving violence or harm (or threat of harm) to humans—e.g., homicide, manslaughter, assault, battery, and armed robbery.

Crimes of vagrancy and disorderly conduct. Loosely defined and hence convenient to the police, this category includes a wide variety of trivial but undesirable behavior. Examples are drunkenness, loud and boisterous behavior, minor fighting, begging, loitering, profanity, and similar products of poverty and/or alcohol. An unknown number of these offenses were simply police «pickups» for purposes of identification or investigation, and the term «vagrancy» or «disorderly conduct» provided a convenient label for the legal charge necessary to hold these persons.

Crimes against public order, other than vagrancy and disorderly conduct, include a number of unrelated offenses. All narcotics violations and gambling offenses are placed in this category. We have also included all military offenses which would not be offenses if committed by civilians: absence without leave, insubordination, etc.

Sex-connected crimes. These are offenses wherein sex is clearly an element, but which cannot be classed as sex offenses because the element of immediate sexual gratification of the offender is absent. Examples are bastardy, bigamy, prostitution, pimping, and sale or possession of pornography.

Crimes against property represent the bulk of the offenses of the prison group; nearly half of their offenses were of this type; this finding is similar to that of other studies of criminals. No sex-offender group equals this proportion, but four approach it. The range for the sex offenders is from 18 to 45 per cent with the bulk falling between 29 and 42 per cent. No clear trends or clusterings are evident, although some tripartite groups are more prone to commit property offenses than are others.

The per capita number of crimes against property gives a somewhat different picture: the prison group have by far the most (1.7 per man), and the per capita crimes against property of the sex offenders are, with but one exception, less than half of this (see Table 124). In other words, the sex offenders include far fewer thieves than the prison group. The only generalization to be drawn from the figures is that the aggressors are more inclined toward crimes against property than other groups, an inclination in keeping with the philosophy of taking what one wants, be it property or sex.

Crimes vs. person account for one tenth of the prison group’s convictions. Five sex-offender groups, including all three aggressors, exceed this figure, the maximum being 18 per cent. The homosexual offenders, as a group, have the smallest proportion of crimes against person: about 4 to 6 per cent. An examination of the per capita numbers shows the prison group and the aggressors as being quite comparable (the aggressors’ figures being 0.27 to 0.48 and the prison’s 0.37), but the other sex offenders have no more than 0.16 crimes against person. If the aggressors are excluded, one can say that sex offenders are nonassaultive and that the homosexual offenders are the least physically dangerous of all.

Crimes of vagrancy and disorderly conduct are the commonest nonsexual offenses: even the group with the smallest proportion of such offenses, the prison group, had one fifth of its convictions stemming from these charges. All groups had from one fifth to one half of their convictions in this category. The homosexual offenders are especially liable to arrest and conviction, since they loiter about schools, theaters, bars, and other suitable places; indeed, from 40 to nearly 50 per cent of their convictions derive from vagrancy and disorderly conduct. Oddly enough, the groups with the most persons rated as frequent drinkers and alcoholics do not appear to have unduly large proportions of their convictions based on vagrancy or disorderly conduct. Obviously the effects of alcohol are being overridden by other factors, as in the case of the homosexual offenders, who were our soberest group. Nevertheless, the drunkenness of our most alcoholic group, the aggressors vs. children, could not be wholly masked for they display the highest per capita number of vagrancy and disorderly conduct convictions (1.1). The range per capita is from 0.27 to 1.08, with most sex offenders falling between 0.33 and 0.62. The prison group ranks third with 0.72. As one would anticipate from our earlier statements, the homosexual offenders, as a group, have large per capita figures (0.58 to 0.92).

Crimes vs. public order represent in some ways a wastebasket category and hence one would not expect the figures to mean much. A plus or minus of five percentage points around the prison group’s 16 per cent embraces nine of the sex-offender groups. The only generalization that can be made is that the incest offenders have relatively large proportions of their convictions for crimes vs. order (23 to 36 per cent), and the aggressors have relatively small proportions (10-12 per cent). The low figures for the aggressors, we must hastily add, are the result of their promiscuity in other types of crime rather than of any respect for order. Actually their per capita convictions for crimes vs. order are not small. The highest per capita figure, 0.56, was that of the prison group; the lowest was 0.18. Eleven of our 14 comparative sex-offender groups fall within the ten percentage points from 0.18 to 0.28. Once again the incest offenders rank high in crimes vs. order, having per capita rates of 0.27, 0.36, and 0.40.

Sex-connected crimes constitute a very small proportion, never over 4 per cent, of the crimes that led to conviction. Only four groups have figures of 3 per cent or more. Three of the four, the homosexual offenders vs. minors and adults, and the exhibitionists, owe most of their convictions to masquerading and/or transvestism. Since we decided, after making these calculations, that there was sufficient sexual gratification involved in such cross-dressing to warrant a small sex-offender category for masqueraders, these convictions should be subtracted from the percentages of sex-connected convictions. The subtraction reduces the sex-connected convictions for these three groups to between 1 and 2 per cent. The number of convictions per capita for sex-connected offenses is always quite small, the largest being 0.06.

*346\161\2*

The remaining groups of sex offenders and the prison group all have even lower levels of fertility. The homosexual offenders vs. adults and minors are the most infertile, averaging less than one child per marriage. While this is in part due to the brevity of the marriage and in part to contraception, one cannot use coital inactivity as an explanation, for these homosexual offenders had quite adequate coital frequencies. Indeed, there seems little relation between coital frequency and fertility; duration of marriage seems a more important factor. Note that the three incest-offender groups and the control group spent more of their postpubertal lives (46 to 58 per cent) as married men than any other group.

*308\161\2*

The vast majority (84 to 94 per cent) reported that most of their early knowledge of sexual behavior and reproduction came from their contemporaries, their friends, and acquaintances. Such verbal enlightenment seems to have been somewhat less important to the homosexual offenders due to their educational and socioeconomic status. The homosexual offenders, especially the homosexual offenders vs. adults, include a disproportionately large number of persons from upper or upper-middle socioeconomic backgrounds (some 23 per cent of all homosexual offenders attended college; no other group exceeds 10 per cent). Parents in such upper- or upper- middle-class environment stress reading as a source of knowledge; hence the importance of companions as a source of information is correspondingly decreased.

The father was listed as the major source of sex information by few, no more than 7 per cent at most. In only five groups did over 4 per cent list the father. The importance of the mother as a major source was equally trivial, 5 per cent (the control group) having the largest percentage who mentioned her.

With two exceptions there seems no positive correlation between the father and the mother as the major source. The exceptions are the control and prison groups, both of which rank high among those listing either parent as a main source.

Reading as the major source was reported by 13 per cent of the; homosexual offenders vs. adults (the largest percentage recorded) and by about 4 per cent of the other homosexual offenders (who rank fourth and fifth in respect to reading). The control group ranks second with 6 per cent. The high rank of the homosexual offenders with respect to learning about sex from books has been explained by their higher educational and socioeconomic background. The same explanation holds for the control group whose members, compared to most of the sex offenders and the prison group, were better educated and hence may be assumed to have come from homes with a better socioeconomic background.

Few individuals reported a relative other than the parents as the major source of sex information, and this tabulation does not reveal any clusterings or trends. A small number of persons reported other sources as major: school instruction, physicians, observation, etc.

*270\161\2*

Theoretically there are homosexual exhibitionists, but we have excluded these from our exhibitionist category. Genital exhibition is a common method of homosexual solicitation in toilets, public baths, and other places where genital exposure is socially appropriate. Moreover, while a homosexually inclined male may derive some gratification from exhibiting his penis to another male, the gratification is only a byproduct of the solicitation, and he should no more be counted a true exhibitionist than a male who derives some pleasure when his female coital partner displays an appreciative interest in his genitalia.

Our concept of the exhibitionist is a male for whom the exhibition is a desired end in itself. True, some exhibitionists hope that their display will sexually arouse the female and result in some mutual sexual activity, but this is only a subsidiary motivation. The exhibitionist himself recognizes that it is a hope rather than an expectation, and would continue his activity for its own sake even if he knew (as most do) drat the odds against any mutual sexual activity were a thousand to one.

Just as with voyeurism, there is a bit of the exhibitionist in nearly all males and in many females as well. All adult humans want to be physically sexually attractive; it is psychologically important to them. Society expects and encourages a certain display of physical charms. Except that they do not expose their genitalia, many a male and female on a public beach could be called exhibitionists: they receive some sexual gratification from displaying their anatomy. In numerous instances the display is not a form of solicitation—they are not seeking sexual activity, but wish to enjoy die knowledge that they are sexually desirable.

There is, however, aside from the question of genital exposure, a subtle but important difference between such socially sanctioned exhibitionists and the exhibitionist in our restricted sense of the term. In the former there is a strong narcissistic element: they are the men who make muscles before their mirrors and the females who also preen and admire themselves; they are the people who have (or fancy they have) some unusually attractive physical attribute. We have no data to indicate that the genital exhibitionist is similarly narcissistic, or that he feels his genitalia are especially worthy of admiration. Indeed, the average exhibitionist’s estimate of the length of his penis was in no way unusual.

Since genital exhibition is neither an expression of vanity nor basically a sexual solicitation, what is the motivation? The answer, or rather we possible answers, to this question are better saved until after presentation of data that gives one a picture of exhibitionists.

*231\161\2*