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The efficient and continuous use of contraception, and the choice of method, is not always an easy matter. The individual is affected by conscious ideas about the methods and about him or herself. Unconscious factors are of equal importance, and are complicated by the projective forces acting to varying degrees between the two members of every couple.

Contraception is about sexual feelings, and such feelings spring from, and are affected by, the deepest layers of the personality. As detailed earlier in this book, the provision of contraceptive care is not always as straightforward as it seems. However, what may appear at first as a heavy burden on the providing doctor or nurse can be viewed in a different light. The contraceptive consultation can provide an opportunity to reveal hidden anxieties and discomforts in the hope that some help will be forthcoming. Because contraception is inextricably connected to sex it can provide a communication pathway for the patient’s deepest feelings. Using this pathway the patient may be able to reach outwards towards a professional person in the hope of finding help with an inner pain.

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Fear of pregnancy may inhibit sexual responsiveness. Patients who feel that a baby would be a disaster, or have had previous failure of their contraceptive method may need frequent reassurance about the method. They may reattend with complaints that the withdrawal bleed is too short or too long, or that they felt sick and were not sure that they had absorbed the Pill, or that the tenderness of the breasts must mean that they are pregnant despite the regular bleeding. The amenorrhoea following use of injectables may require frequent pregnancy tests, or there may be repeated requests for emergency contraception because of anxieties about whether the condom was used correctly. A previous unfortunate experience (a stillbirth, neonatal death, or an eventful pregnancy or delivery) may make the woman fearful of another disaster. Another reason for apprehension may be the fear of disapproval of sexual activity which would become evident to the world outside if the woman becomes pregnant. Attendance for contraception can be hidden; a pregnant abdomen much less so. The responsibility for the sexual activity becomes vested in the doctor: if pregnancy occurs it is the doctor’s failure, not the patient’s sexuality which has caused it.

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Some women enter this phase of life with unresolved feelings of resentment and anger which can affect their contraceptive decisions. Previously the need for contraception had been obvious, and while they were busy with the home and children, the use of contraception was accepted and had become a routine. However, having acknowledged that their child-bearing days are over, they may feel that it is their partner’s turn. When these feelings are suppressed it can lead to deliberate or unconscious pressure on the partner to use a sheath or have a vasectomy. If the doctor is sensitive to such unspoken feelings it may be possible to help the woman to continue to take contraceptive responsibility herself. On the other hand, once the feelings have been explored it may become apparent that the man has a genuine wish to play his part now, and he may be happy to have a vasectomy. The worst outcome is if she stops all contraception, or changes to a less safe method such as the sheath and becomes pregnant. Then the angry feelings that she already has are likely to be exacerbated by the agony of having to decide between an unwanted baby and a termination. Such a decision can be particularly difficult when the couple are older, especially when strong religious views conflict with a realistic appreciation of the dangers and difficulties.

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Vasectomy involves division of both vas deferens, an easy operation which can be undertaken under local anaesthetic. It is therefore often quicker to arrange and there are fewer complications than with female sterilization, although it is not always available on the NHS. In competent hands the failure rate is as low as 0.02 per hundred women years (HWYs). It is not immediately effective and follow-up semen analyses must be arranged. Alternative contraception must be used until the seminal fluid contains no spermatozoa.

Female sterilization involves blockage or removal of the fallopian tubes, and is usually available on the NHS. The most popular methods are by the application of clips or by diathermy. Both these operations can be undertaken at laparoscopy. Salpingectomy and hysterectomy both involve a laparotomy.

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In this situation the doctor acted as an adviser, offering suggestions that the patient could accept or reject. Other simple remedies such as the use of pillows strategically placed to support or hold parts of the body can be very useful, for instance to hold floppy legs in a flexed position. However, it may be that the opportunity for the patient to share the painful and embarrassing feelings is even more important than specific suggestions, for once the patient feels able to discuss the feelings with the partner they can often work out some practical solutions for themselves.

The doctor therefore needs to be able to combine the skill of listening and helping the patient to share his feelings, while at the same time being able to make detailed practical suggestions in such a way as to leave the choice of which advice to follow to the patient. Such steps as the use of penile implants, papaverine injections, vacuum condoms or the use of a sex aid may need to be explored. Such simple measures as adjusting the timing of medication to maximize mobility and the reduction of pain, or the attendance to bowel and bladder by adjustment of diet, or emptying a colostomy bag, may be valuable. It is the doctor’s attitude in being willing to address these problems which is the most enabling factor.

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The offenses involving the youngest groups not only show the highest incidence of petting as offense behavior, but also the widest use of mouth-genital contacts. Table 148 shows this type; of sexual behavior in 16, 19, and 39 per cent of the heterosexual offenses, aggressions, and incest offenses involving children. In contrast to this, the incidence of this particular technique among the offenses committed with minor and adult females is much lower, and ranges from none among the cases of incest with adult daughters to a high of only about 7 per cent in the aggression offenses against minor girls. It is clear that the high degree of oral contact in incest vs. children shows it to be one of the preferred behaviors. In the two other pedophilic-offense groups it is resorted to as an alternative but is not one of the favored sexual techniques.

Although anal coitus occurred, it was of very little importance in the heterosexual-offense groups. It was reported as the basic offense behavior in only one case having to do with minor females. A complete tabulation revealed three other cases in which it was reported as concomitant behavior but did not furnish the basis of the final charges. Two of these were aggression offenses and one a non-force offense against an adult female.

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Erotica is a general term covering all graphic, literary, and auditory materials that induce, at least occasionally, some degree of conscious sexual response in most adults, chiefly male adults. This definition must be statistical, since all manner of things have been sources of sexual arousal to a few persons. Just because a few hundred or possibly a few thousand individuals respond sexually to rubber garments, these garments cannot be classed as erotica. Similarly-there is little to be gained by labeling the Bible erotica because certain passages sexually excite; a small number of readers.

Within the general class of erotica there is the smaller and more specific subclass of pornography. Pornography is material deliberately designed to produce strong sexual arousal rather than titillation and which usually achieves its primary goal. Intent, as a lawyer would say, is an essential criterion of pronography, but the intention must meet with some success. A man who writes what he believes to be a pornographic poem which is received with laughter rather than sexual excitement has not, despite his intention, produced pornography. Conversely, the Hindu sculptor who with some religious symbolism in mind depicts coitus has not produced pornography, even though his work may inflame the imaginations of most Occidental viewers. While some erotica can be most indirect and subtle, pornography is almost always direct and obtrusive. Nevertheless, there is no reason why in skilled hands pornography could not be an aesthetically legitimate art form. At this juncture the authors would like to express their regret that the adjective “obscene” has taken on, in the United States, an almost wholly sexual meaning. This restriction of a previously more widely useful word is unfortunate, for “obscenity” is not synonymous with “pornography.”

In the following pages we will analyze our data concerning response to and ownership of pornography. Since our definition of pornography, above, is not comprehensive (an article could easily be written on the subject), it should be noted that when we interviewed we were very specific, our question usually being, “Does it arouse you sexually to see photographs or drawings of people engaged in sexual activity?” If the interviewee seemed uncertain, we would add concrete examples in language suitable to the individual.

Even greater than the concern over the graphic or literary depiction of violence has been the concern over erotica and especially over pornography. Indeed many of those concerned are so emotional that they fail to differentiate between the two, assuming that any degree of sexual response to various materials makes them somehow equivalent. Thus “vile and obscene” material often turns out, upon objective inspection, to be rather simple erotica, giving most adults a mild pleasurable response, partly aesthetic and partly sexually titillating, and evoking strong sexual response in only those adolescent males who have not become blas? through repeated exposure to the material. With great assurance many persons state that exposure to erotica and pornography leads to moral decay and sex offenses. The axiomatic character of these statements would lead one to the conclusion that incontrovertible scientific evidence had been adduced, either of an experimental or survey character, for their support. The present state of confusion in the courts and legislatures is ample evidence that these purported causal relationships have not been subjected to any scientific test. What we shall present here, while modest in scope, are quantified data and not the customary clinical impressions or unsupported estimations.

First of all, it is striking how few of the males in this study have failed to see pornography. Only two males in the control group, three in the prison group, and nine sex offenders reported never having been exposed to any—a total of only 14 males out of our sample of 2,721. Obviously the prevalence of pornography among the social classes with which this study is chiefly concerned is such that exposure is almost inevitable.

The common presumption is that depiction of sexual activity is a strong stimulus of sexual arousal, and one which not infrequently engenders sexual activity of one sort or another. This presumption is shaken by the discovery that rather large proportions of the men reported little or no sexual arousal from pornography. The groups reporting the largest proportions of males essentially unmoved by such stimulus are the incest offenders vs. adults (63 per cent), the offenders vs. adults (61 per cent), the offenders vs. minors (53 per cent), and the incest offenders vs. minors (53 per cent). These four groups obviously have in common an interest in females twelve and over, but this is not significant. What is significant is the fact that two of these four groups (the heterosexual offenders) have relatively low intelligence rankings, while the other two have some special characteristics relevant here. The incest offenders vs. adults appear to owe their position to a number of factors: they are the most devout (and inhibited), the oldest, the most married (at report), and the most poorly educated. All these things militate against conscious sexual response to pornography.

The role of education merits a few more words. In general, the better educated tend to be more imaginative and more able to project and empathize, all of which makes them more sensitive to psychological stimuli. The poorly educated are apt to be much more pragmatic and require something more concrete in order to respond. Thus an uneducated male from the lower socioeconomic stratum may say, “Why get worked up about a picture? You can’t do nothing with a picture.” Response to the sight of a living female would “make more sense” to him, since the female represents an attainable goal in the immediate environment. The heterosexual offenders vs. adults are the second least responsive to pornography for some of the same reasons: they had the second poorest education, and a high proportion were currently married. However, rather than being inhibited by religion, they are the least devout of any group, and singularly uninhibited insofar as coitus is concerned. A good part of their unresponsiveness is the result of satiation. The person, especially at this social level, whose sexual needs have been met does not readily respond to pornography, and in comparison to other groups the offenders vs. adults satisfied at least their physical needs quite thoroughly. The position of the next two groups, the offenders vs. minors and the incest offenders vs. minors, can be accounted for in the same way.

At the opposite end of the scale the most responsive to pornography are the homosexual offenders vs. adults, the aggressors vs. minors, and the control group. Education is undoubtedly an important factor for the homosexual offenders and the control group. Of the aggressors one can only say that they seem in general a group of uninhibited young men who respond unthinkingly and violently to various stimuli. Then-reaction to pornography is merely a part of their exaggerated reaction to almost everything.

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We asked all our interviewees who did not have premarital coitus what factors restrained them, and we asked those with premarital coitus what prevented them from having more. Some of the restraints derive from religious morality, some from secular morality (public opinion), and others from concern over possible physical sequelae (pregnancy, venereal disease). These are all restraints of choice, so to speak; the person makes the decision to have or not have coitus. Sometimes no decision is involved—it is simply lack of opportunity that determines that coitus will not occur. Lastly, the absence or reduction of coitus may be due to lack of motivation caused by satiation, homosexuality, or by some abnormality or pathology of neurophysiology.

Since almost every man with reasonable memory and prudence can recall being influenced to some degree by all the restraints mentioned above, we have chosen in the following discussion to confine our attention to the instances where a given restraint was reported as being a powerful factor in preventing coitus.

First is moral restraint, which correlates highly with religious devoutness, a deterrent based on the concept of premarital coitus as sinful. Some individuals stated this explicitly; others rationalized or were ambiguous: “Oh, there is nothing wrong about it, but we just thought we would wait until we were married,” or “I have no religious or moral objections; I just don’t think it’s the thing to do.” Such moral restraint was a strong deterrent to no more than 36 per cent of any group. The incest offenders vs. adults had the most individuals who reported strong moral scruples, followed by die control group, the heterosexual offenders vs. children, and the homosexual offenders. Those least influenced include the heterosexual aggressors vs. minors and adults (4 and 12 per cent), the heterosexual offenders vs. adults, and the prison group—the groups whom we have seen had the largest numbers of their members beginning coitus in their early and middle teens. The coital morality of the homosexual offenders in their premarital lives is an interesting phenomenon: in part it is a cause of their homosexuality and in part it is a result of their homosexuality.

Second is lack of opportunity. This category is complicated by the fact that many who gave it as a reason were, in actuality, rationalizing. Very few males have lacked the opportunity to have premarital coitus —willing females or prostitutes exist in or near virtually every community. When an individual reports he did not have premarital coitus because of lack of opportunity, he is usually in essence saying that moral or aesthetic considerations prevented him from accepting the opportunities that existed. If he says that he did not have more coitus because of lack of opportunity, his report is more in keeping with reality. Limitations imposed by time, money, and female availability do obviously exist and constitute the most common deterrent in all groups save the homosexual offenders. Between one third and four fifths of the members of the comparative groups reported lack of opportunity as a major factor in their premarital sexual activity. The aggressors, despite their relatively adequate incidence and frequency figures, found lack of opportunity a more important factor than did others. A sense of being deprived of opportunity or even cheated of what they construed as rightful opportunities may have contributed to the aggressive nature of their offenses.

Third is lack of interest. Unfortunately this category is also spoiled to some degree by the fact that lack of interest can be the product either of a general disinterest in females or of temporary satiation. Thus a male with a low sex drive or with strong homosexual orientation will report lack of interest in having more coitus because he was already having all he wanted. Consequently, about all that can be salvaged from this category is the not unexpected finding that the three homosexual-offender groups had the largest proportions (49 to 77 per cent in order of the strength of their homosexual orientation) of individuals who found lack of interest a major reason for abstention from coitus. Next in the rank-order come some “sated groups”—the offenders vs. minors and adults and the prison groups—all notable for high frequencies of premarital coitus, and with 43 vs. 48 per cent reporting lack of interest in having more. The equivalent figure for the control group is 26 per cent.

Fourth is fear of pregnancy. This was a strong deterrent for from 7 to 21 per cent of the individuals comprising the various groups. A rank-order reveals little except that the heterosexual aggressors were indifferent to this possible misfortune. The control group ranks third.

Fifth is fear of venereal disease, an apprehension that strongly afflicted from 4 to 22 per cent of the persons of the various groups. The control-group individuals and the peepers (22—20 per cent) were influenced most, the heterosexual aggressors least. This is the reverse of the actual incidence of venereal disease where one finds aggressors heading the rank-orders for syphilis and gonorrhea and the control group having very few infected men. The morality-through-fear method, so frequent in books and lectures aimed at young males, does not appear to be particularly effective. One might say that it stops few but worries more. A considerable number of males were quite blas? about the possibility of contracting venereal disease, looking upon it as a man in a factory would look upon the possibility of an industrial accident, an unavoidable occupational hazard. Others felt that they could adequately detect the presence or absence of disease in a potential partner.

Such layman’s diagnosis ranged from superficial visual impression (“she looked like a nice clean girl”) to more elaborate folkloristic techniques (“you put some lemon juice in and if it hurts her, she’s got the clap”). Still others felt that postcoital measures such as urinating, washing the penis, or using a prepared prophylactic was safeguard enough, and hence were not particularly worried about venereal infection. The reader should recall that most of the premarital life spans under discussion here are of the preantibiotic era. A relaxed attitude toward venereal disease cannot be attributed wholly to “miracle drugs.”

Sixth is fear of adverse opinion by other persons who might learn of the sexual activity. Those who were most prone to abstain from premarital coitus for moral reasons were also those who most feared public opinion: the incest offenders vs. adults, the heterosexual offenders vs. children, and the homosexual offenders vs. children and minors. The incest offenders vs. adults were the most apprehensive; nearly one quarter reported that fear of public opinion had been a major restraint. Once more, the heterosexual aggressors expressed the least fear: two of the three aggressor groups occupy the last two positions in the rank-order (0—4 per cent).

This fear of public opinion was not a fear of legal involvement or of retaliation by the outraged parents of the girl—it was a fear of losing social status and respect; the individual would never think of confessing his virginity to his peers and thereby losing status with them, yet simultaneously he abstained from coitus lest “people find out.” Evidently the desideratum is to be regarded as a Casanova by one’s male friends and as a paragon of virtue by one’s neighbors and relatives. It is interesting that the men who even mentioned concern over the legal sanctions against premarital coitus may be counted on die fingers of both hands. Statutes against fornication seem useless as deterrents.

Lastly, the desire to marry a virgin sometimes prevents a male from having coitus with a female he expects to marry. This particular restraint often represents the old dichotomy of “good girls” (the kind one marries) and “bad girls” (the kind with whom one has coitus), and is seen among males who have premarital coitus, but not with their fianc?es. In other cases this reason for abstention is simply another guise of moral objection to any premarital coitus. It is seen most clearly among males who say they would not have coitus with a girl unless they liked her enough to marry her, and once a girl fulfills this requisite she becomes a potential wife and the male then “thinks too much of her” to have coitus with her. As one might anticipate, the incest offenders vs. adults and the control-group individuals, who rank first and second in moral restraint, have the largest proportion of persons (29 and 24 per cent) reporting that desire for a virgin wife deterred them from premarital coitus with prospective marital partners. However, the rank-order of desire to marry a virgin and the rank-order of moral restraint are by no means identical—for example, the heterosexual offenders vs. adults rank low in the latter, but high in the former. Such discrepancy is possible because the moral restraint category applies to all premarital coitus (and is a single standard binding upon both sexes) whereas the other applies only to coitus with an intended spouse, and is not incompatible with the double standard of sexual morality.

In the final analysis the chief restraint upon the incidence of premarital coitus is a moral one and closely associated with religious devoutness, while the chief restraint on frequency of coitus is probably opportunity. Lack of interest is a factor of consequence only among the homosexual offenders and among a few sated groups with high coital frequencies. Thus we see that moral considerations inhibited the premarital coital activity of our more religiously devout groups such as the incest offenders vs. adults (44 per cent devout) and the control group (28 per cent devout), but played a lesser role among the less devout groups such as the heterosexual aggressors (4 to 15 per cent devout). The aggressors also display a relative disregard for possible sequelae involving pregnancy, disease, and adverse social reaction. Aside from religious morality, the rather marked concern of the control group about possible social and physical sequelae suggests prudence, foresight, and a sense of social responsibility—all attributes that tend to keep their possessors out of prison.

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A study of the duration of heterosexual play, based only upon those with such play, reveals relatively little. If it occurred at all, it usually occurred over a span of about three years. In ten of the 15 groups where calculation is feasible the percentages of those whose heterosexual play was spread over three or more years exceeds the percentages of those whose play was of lesser duration.

Medians were also calculated but again no particular trends or clusterings are evident, except that the three heterosexual-offender groups have unusually large proportions of individuals with five or more years of heterosexual play.

Duration of homosexual play could be calculated for 14 groups. Here too it more often than not occurred over a span of three or more years; in fact, for seven groups this is true of over half of their members. Calculation of medians shows two of the three heterosexual-offender groups, the prison group, and the three homosexual-offender groups with longer average durations than the others. The control group, while not the lowest in a rank-order of duration of homosexual play, is near the bottom (2.4 years). Lastly, the average (median) aggressor and incest offender seem to have had a relatively brief period of homosexual play: none are found in the upper half of a rank-order of duration.

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The peepers usually rank rather high (fifth to seventh) in the various measurements of homosexuality. Fifty-five per cent had had a homosexual experience that resulted in orgasm, which places them in seventh rank. Fifty-five per cent is an impressive figure when one recalls that they are our second youngest group, and that their subsequent years of life in and out of prison will increase the proportion correspondingly. By age fourteen close to one third were thus experienced and by age twenty-six, one half. The average (median) peeper had his first postpubertal homosexual activity at 15.2 years of age. Compared to the other groups this is neither young nor old.

Nearly one third of them, which is a fairly high percentage, had more than incidental homosexual experience.

The fact that homosexuality was more than a mere situational phenomenon in their lives is again made clear by the finding that half of them had had homosexual experience outside institutions—a proportion exceeded only by the prison group and the homosexual offenders themselves.

The importance of homosexuality for the peepers is not in accord with other data; only a moderate number reported being sexually aroused by thinking of or seeing males, and a mere 1.8 per cent (the second smallest percentage), reported strong arousal. Overt behavior and psychologic response ordinarily go hand in hand, but not necessarily where homosexuality or animal contact are concerned.

As far as the percentage of members who participated in homosexual activity during specified periods of time is concerned, die single peepers are ordinarily in fourth or fifth rank—i.e., only one or two places below the homosexual offenders. For instance, between puberty and age twenty nearly one third were involved. These percentages, while relatively substantial, have only a moderate social and psychological significance: incidental homosexual activity is common in the teens; even about one fifth of the control group were experimenting at this age. However, the next age-period, 21-25, is the critical one; by this age homosexuality is no longer regarded as a schoolboy peccadillo or adolescent experimentation. For most groups the percentage of those having homosexual activity drops markedly in this age-period, but the reverse appears to be true for the peepers, whose percentage increases slightly. Aside from the homosexual offenders, the aggressors vs. adults, and the exhibitionists, no group other than the peepers were more active homosexually during age-period 21—25 than in age-period 16-20. Our data do not permit us to investigate with any confidence the peepers over twenty-five, but they seem to maintain at least moderate age-specific incidences. Too few married peepers exist in our sample to allow calculations for them.

During their lives spent outside institutions after puberty, the peepers had an average of 5 homosexual experiences a year. For the unmarried peepers with homosexual activity, the figures work out to a mean average of about 3 orgasms a month between puberty and age fifteen and 2 a month between ages sixteen and twenty—moderate frequencies shared by the control group. Between twenty-one and twenty-live, however, the frequency is relatively low: once a month. A rather similar decline is seen in the median frequencies, which fall from once or twice a month to about 5 a year. This drop is in contrast to, but does not necessarily contradict, the age-specific incidence data.

The average (median) peeper had five partners—a moderate number, and in the proportion of total sexual outlet constituted by homosexual activity, they display moderate and steadily decreasing percentages.

All in all, it appears that peepers are relatively prone to have homosexual relationships throughout at least the first three decades of life, but these relationships are infrequent, sporadic, and with few partners.

In short, they were no more successful in homosexual activity than in heterosexual activity.

While both relatively and absolutely few peepers approved of male homosexuality, the numbers who strongly disapproved (29 per cent), mildly disapproved (31 per cent), and were neutral (33 per cent) are nearly equal. No other group is so evenly divided between disapproval and neutrality.

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