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March 27, 2009
In this article I review normal male and female genital anatomy. A complete understanding of this anatomy will help in understanding how sexually transmitted diseases occur and where the symptoms may be noticed.
Both men and women have bladders and lymph nodes, and these parts of the anatomy can be affected by STDs. I begin by describing these structures and then move on to the genital area, where men and women look very different from each other.
The bladder is where urine is stored. Urine is made in the kidneys and travels to the bladder through the ureters. Because in women the opening of the urethra is so close to the openings of the vagina and the anus, bladder infections are not uncommon in women. Men, on the other hand, rarely get bladder infections because there is a large distance between the urethra and the anal area. Symptoms usually associated with a bladder infection, such as burning with urination, may also be caused by sexually transmitted infections such as chlamydia or herpes.
The lymph nodes are part of the immune system and are found throughout the body. The immune system is the body’s defense against foreign invasions of bacteria, viruses, and protozoa, as well as cancer cells, and the lymph nodes are where the cells of the immune system congregate as they flow throughout the body. People have lymph nodes in the neck, under the arms, and in the groin, among other places. The lymph nodes usually cannot be felt with the fingers (in medical language, they are “not palpable”), or else they are palpable but are very small. They can become swollen in response to infection or sometimes from invasion with cancer cells. The lymph nodes that swell with a genital infection are located in the groin. Lymph node swelling in the groin may be the only indication that a person has a genital infection.
*1\213\8*
Our standard practice in this volume is to make explicit the quantity of unknowns, but base all calculations upon the known. In instances where the data for one group contain a large number of unknowns and the data for another group contain few, one is forced to omit the unknowns—otherwise the calculations represent not so much the differences or similarities between the groups but the variations in their proportion of unknowns.
Ordinarily the number of unknowns is small, but there are two situations that lead to very large numbers of unknowns. One results from the fact that a particular question was not included in the earlier interviewing schedule, but was added later. For example, in 1939-1940 we asked only about current masturbation frequency, not about previous frequencies; consequently, nearly every male case history of that early stage of the research will count as an unknown for masturbation frequencies prior to the year of interview.
The second situation arises only in areas of peripheral interest, where we are seeking in our accumulated data an item of information that was not covered in our routine interviews. The best examples concern the circumstances existing at and just prior to the commission of a sex offense. The nature of the place where the offense occurred—at the subject’s residence, at the object’s residence, in an automobile, in a rural area, etc.—is unknown in from one fifth to one third of the cases. The question of who reported the offense to the police has even greater proportions of unknowns.
The exclusion of unknowns is a dangerous procedure only when some bias is involved. In other words, if there is reason to believe that the unknowns differ from the knowns, then drawing inferences from only the knowns is misleading. For example, let us say that the younger the child, the more sensitive and guilt-stricken was the offender, and the less likely he was to admit he knew the child’s age. Thus a high proportion of the unknowns would in actuality represent young children, and a calculation of ages based solely on the knowns would result in an erroneously high average age. It should be added that this illustration actually was no problem to us and, moreover, we had access to the records wherein the age of the object was usually given.
The problem of unknowns has led us to abandon a concept extensively utilized in our earlier publications: the concept of the frequency of total outlet, that is, the frequency of the sum total of all orgasms experienced regardless of source.
*5\161\2*
Few things annoy the scientist and madden the statistician more than Ns (numbers of cases) which vary mysteriously and inexplicably from table to table. Having been guilty of this offense in our 1948 volume and properly taken to task, we have become meticulous about making explicit the quantities upon which our figures are based. Any variations in N will be noted and explained either in the tables or in the text.
Nevertheless, this study presents some unusual opportunities for confusion, which can be avoided only by recognizing which of our three sorts of Ns are being considered.
N of individuals. This is the number of persons interviewed and used in this study: 477 white males of the control group, 888 white males of the prison group, and 1,356 white males convicted of sex offenses.
N of sex offenses. Since a male may commit more than one offense, this number exceeds the number of individuals. There were 2,274 sex offenses in all.
N of type offenders. This category is the only one hard to grasp. Since a man who commits two or more different types of sex offenses is counted as a member of each sex-offender category, the number of such “type offenders” (to coin a term) exceeds the number of actual individuals. For instance, a man is counted both as an exhibitionist and a rapist if he has been convicted on both charges. However, a man is counted only once within each offender type category: a peeper convicted a score of times for peeping still counts as one peeper. Adding up all the individuals represented in each category, one comes out with a total of 1,685. Within each offender type no confusion exists—the N of type offenders and the N of actual individuals are synonymous. For instance, the offenders vs. children category consists of 199 men, all of whom were convicted one or more times of an offense against a child; the fact that some of these men also committed other sorts of sex offenses is another matter and one that is dealt with separately. The confusion and apparent discrepancy arises only when one tries to add the Ns of the individual categories. For example, while there are 96 homosexual offenders vs. children, 136 homosexual offenders vs. minors, and 199 homosexual offenders vs. adults, there are not 431 homosexual offenders in all because some men have been counted in two or more categories. Fortunately this N of “type offenders” is seldom employed.
The discussion of Ns naturally should include our attitude toward the size of the groups with which we deal. While validity decreases with decrease in sample size, we have been surprised at how even tiny samples exhibit value in special situations. If a tiny sample is in line with a trend established by large samples, that tiny sample is meaningful, and suitably qualified inferences may be drawn from it. In other instances small samples may be said to support one another. For example, both the aggressors vs. children and the aggressors vs. minors are groups with relatively few members (25 and 27 respectively), and if only one group ranked high in some particular respect, little significance could be attributed to this; however, if both ranked high, and especially if the two groups were contiguous in the rank-order, the joint evidence is great that, regardless of the small number of people involved, high ranking in this particular item is a trait of aggressors. To have two groups of a tripartite larger group contiguous in a seriation is not likely to be the result of chance even with a small number of individuals involved.
Another consideration is the known or assumed incidence of the behavior in question. Five cases of some common type of sex offense such as statutory rape would not warrant publication, but five cases of a rare type constitute an important body of data, publication on which is obligatory. In many respects, this small N problem boils down to one’s philosophy, and we feel that some information is better than none. Only the most impractical purist would maintain that a deliberately preserved ignorance is preferable to running the risk of being misled by a small sample.
Note regarding tables and figures. In tables, calculations based on Ns of ten to 19 are in italics, and in charts they are indicated by one asterisk. Calculations based on Ns of nine or less are italicized in tables and enclosed within parentheses; in charts they are indicated by two asterisks.
When data have not been calculated a blank space appears in the tables; three dots indicate that there are no applicable data. In addition, when calculations of means and medians would have been based on nine or fewer cases no figure has been expressed,
*4\161\2*
The control, prison, and sex-offender groups were compared with respect to a large number of items. Since these represent only a portion of the information we possess for each individual, we should explain why these particular items were selected and others ignored. The majority require no discussion, since they are basic to the whole study: incidence and frequency of sexual activity, marital status, age, education, etc. Our concern is not with these matters of obvious importance, but with those where selection was necessary.
The selection was made on the basis of what we thought would prove more meaningful. For example, from our body of data about the recreational activities of each person we selected three items: use of alcohol, use of drugs, and social dancing. The first two we chose because there is great interest in their role in criminal behavior, and the third was selected as one measure of heterosexual socialization. We ignored all other recreational data: reading, fishing, athletics, music, theater attendance, etc., as having less significance. Similarly, from our long list of psychologic sexual stimuli we selected only a few and passed over such minutiae as whether or not strip-tease shows caused sexual arousal. Some categories of data were wholly omitted—contraceptive data is one example. In still other instances we merely made broad categories out of detailed information. The best example of this concerns the information on the various positions of coitus; rather than punch all of the relevant information on cards and sort for all possibilities, we simply made two categories: those in which (1) only the standard male-prone female-supine position was used, and (2) other positions had been used as well. We felt that this would suffice to show the presence or absence of any marked degree of rigidity and inhibition regarding coital techniques.
*3\161\2*
More important assumptions underlie our taxonomic method—the division of our data into units for study and comparison. Some of our decisions were forced by the nature of our data. For instance, we sometimes could not make units based on the presence or absence of a given sort of sexual behavior because we had not routinely asked the relevant questions. Until 1958 our routine interviews did not include questions about peeping, exhibition, fetishism, pedophilia, and force. The interview was such that had any of these things been of importance in an individual’s life they would have come to the interviewer’s attention, but minor or sporadic manifestations would have remained concealed. In consequence, while we can set apart a group of men convicted for a certain kind of sexual activity (and extensively questioned by us concerning it), we have for comparison no group whose members are known to lack that activity. Because of this unfortunate hiatus in our knowledge, we have sometimes had to settle for the next best—comparison of a group all of whose members had and were convicted for a certain sexual behavior with a group whose members we presume have had little or no behavior of that sort—e.g., our control group. This presumption is justified when the behavior, such as public genital exhibition, is considered by others as well as ourselves to be rare, but totally unjustified when it is probably commonplace. Thus, a comparison between convicted exhibitionists and the control-group individuals is tantamount to a comparison between persons who have exhibited and those who have not, but the same does not hold true for peeping.
To return to the subject, the assumptions basic to our taxonomy, it is first necessary to reiterate the purpose of the study: to determine if and how persons convicted of sex offenses differ from those who have not been so convicted. For the purpose of our study we subdivided sex offenders into a number of types, on the assumption that most of these would prove to be fairly discrete clusters of individuals linked by common demographic and behavioral traits. This seeming optimistic error of manufacturing types with die hope that they will prove to coincide with some natural inherent typology in the data is not as erroneous as it at first appears. This is because we chose as our criteria items of basic psychological and sociological importance: whether or not the behavior constituting the offense was directed at a person of the same or opposite sex; whether that person was a child, minor, or adult; whether he or she was genetically or socially closely related to the offender; whether the relationship was by consent or forced; and whether or not physical contact was involved. All these differentiations are integral parts of our whole social system wherein we modify our behavior according to the age and sex of the person or persons with whom we are dealing, and wherein the distinction between voluntary action and duress is fundamental to our laws and political system. Consequently, we need only describe, not further justify, our use of these criteria to establish the types of sex offenders; these are the same criteria that society used in convicting the men as sex offenders.
Having set up various sex offense and offender types, we did not look upon them as immortal or immutable. Certain types (e.g., pedophiles as a whole) were discarded and others were changed during the study. Also we recognize that certain types are more discrete than others. For purposes of analysis we made a separate category of offenses against persons aged twelve to fifteen inclusive (whom we call “minors”) in order more sharply to separate offenses against children aged eleven and less from offenses against persons aged sixteen and more (“adults” in our terminology). We found that beyond having a sort of negative value as insulation, the men in this category (with objects aged twelve to fifteen) frequently were distinctive in various respects. Though our original assumption that they were a mixture of pedophiles who raised their age ceiling, and “adultophiles” (no better term exists) who lowered their age floor, was proven essentially correct, we also discovered that these men were often unlike their brothers who set for themselves less elastic age limits. Our taxonomy does not prevent intratype analysis, and we have attempted it as far as sample size permits and sometimes, it might be confessed, further.
To achieve the purpose of this study, we needed not only different types of sex offenders but a group of individuals never convicted of a sex offense. We had thousands of such case histories, but two assumptions markedly reduced the number of those eligible for our present use. The first assumption was that persons who had been convicted for offenses other than sex offenses probably differed in outlook and behavior from those who had never been convicted of any offense; this led to the formation of our “prison group.” It was clear that the sex offenders and members of the prison group were both primarily from the lower to lower-middle socioeconomic stratum, and that very few had gone beyond high school in education and many not so far as high school. This knowledge is a part of the second assumption: that money and education are powerful factors in determining whether or not a person goes to prison. To have our groups comparable, this axiom disguised as an assumption necessitated our excluding from the group never convicted of any offense everyone educated beyond high school. Since socioeconomic status and education are closely correlated, this process excluded virtually all wealthy persons. Those left in the sieve constitute our control group, and the educational ceiling we imposed upon them makes them roughly equivalent to the sex offenders and prison group in terms of education and socioeconomic status.
Lastly, we have confined this study to individuals considered as “white” in our social system. Individuals who can be identified on the basis of inherited physical characteristics as belonging to a cultural minority group based on “race” were excluded for several reasons. First, we know that their sexual behavior and attitudes differ to some degree from those of “whites” of comparable socioeconomic status and that therefore they should be separately considered. Second, separate consideration would additionally complicate this already overly complex study and could better be presented in another book or series of articles. Third, we know that the police and courts tend to treat the members of ethnic minority groups differently than they treat the “white” majority, and this fact makes separate analysis and presentation even more necessary.
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