A twenty-eight-year-old woman: Whenever I go out with a guy, it seems like all he’s interested in is sex. We sleep together once or twice and suddenly he disappears. I think all the men I know are afraid of a really intimate relationship.
A twenty-five-year-old man: It’s sad to hear women condemning men for being unwilling to get into close, loving relationships. Many of my friends value intimacy highly, although admittedly it’s not easy to find.
The two opinions quoted above about sex differences in intimacy highlight a much-debated topic. Currently, there aren’t any reliable data on whether men and women have different levels or types of motivations for intimacy. Thus, the best we can do is review current research evidence on sex differences in particular aspects of intimate behavior, such as self-disclosure.
,A number of studies show that women seem more adept at self-disclosure than men, and that girls and women disclose more intimate information to their friends than boys or men do. In addition, girls tend to have more intimate friendships than boys do, and women show a higher correlation between friendship and intimate disclosures than men do. Furthermore, women have an easier time building deep, loyal, noncompetitive friendships with other women than men do with other men.
However, the research evidence does not uniformly support the view that there are major sex differences in self-disclosure. Rubin and his co-workers, who conducted a study of 231 dating college couples in 1980, found few differences in the levels of self-disclosure that men and women made to each other. Fifty-seven percent of each sex had made full disclosure of their previous sexual experiences to their current partner, 73 percent of the men and 74 percent of the women had fully disclosed their feelings about their sexual relationship together, and 48 percent of the men and 46 percent of the women had given their partner their honest views on the future of the relationship. Although some differences were found (e.g., women revealed more about their greatest fears, their feelings toward their parents, and their feelings about their closest friends, while men revealed more about the things they were proudest of, the things they liked best about their partners, and their political views), the researchers noted that overall, their sample of college students generally adhered to a norm of “full and equal disclosure.” Other studies have also found that men confide more in their girlfriends than in anyone else and that sex differences in self-disclosure are minimal.
Other research indicates that intimacy is somewhat easier for women than men and/or that intimacy is more rewarding to or ingrained in women. For example, lesbians are more likely to pair off in intimate relationships than gay men. Similarly, sex therapists have noted that fear of intimacy is relatively common in men but less frequent in women. Furthermore, men seem to want “instant intimacy” more often than women, an attitude that indicates a fundamental misperception of how intimacy actually develops.
How can we explain such differences? First, we should realize that the existing research focuses on intimacy in only a limited way, particularly emphasizing verbal self-disclosure. This approach necessarily avoids a more comprehensive view of intimacy as an ongoing experience in which time together, physical contact, and shared activities may outweigh the importance of the verbal exchanges that occur. Thus, it is possible that with more sophisticated studies, male-female intimacy differences would prove to be minor or nonexistent. However, it may be that early differences in the socialization of males and females in our society account for later differences in intimacy skills. Generally, females in our culture have been socialized to show their feelings, while males have been taught to keep their feelings hidden and to show no signs of weakness or fear. (As Kate Millett succinctly put it, “Women express, men repress.”) In addition, females tend to be touched more during infancy and early childhood than males, something that might lead to later sex differences in intimacy. Similarly, the competitive, aggressive behaviors that are generally encouraged in males in our society do not, in turn, encourage intimacy, while the nurturance and sensitivity usually encouraged in females do enhance intimate behavior.
Whatever differences in intimacy preparation exist because of childhood socialization, men are certainly fully capable of intimacy; some of them simply seem to need a while to learn how to find it. In fact, the author Gail Sheehy has noted that men seem to become increasingly concerned with intimacy from age forty on, although many men certainly develop a great deal of intimacy at much earlier ages. Perhaps the real dilemma of the sex-differences-in-intimacy problem has been aptly described by Rubenstein and Shaver in their 1982 book, In Search of Intimacy, who point out that although “men and women need intimacy to the same degree . . . fewer women than men get their needs met, despite women’s expertise, because so many men are intimacy-takers rather than givers.”
*115\342\2*

Long before Pat had the hysterectomy that she believes ruined her sex life, and long before Ed lost all sexual desire for her because she no longer turned heads, their marriage had plenty of conflict in it. From the outset, Ed, whose narcissistic personality traits included needing to have his self-worth constantly confirmed by other people’s respect, admiration, and praise, was capable only of taking from Pat, who periodically got tired of doing all the giving when she was getting very little in return. “Oh, we had a great house,” she said, “nice cars. He would buy me clothes and jewelry and he did take me out a lot, to dinner, to social functions for his company, things like that. He treated me well in that way, but I always felt like a ‘Stepford wife,’ you know, a little robot replica of a wife who did everything her husband wanted but wasn’t supposed to have needs or a mind of her own.”
For instance, Ed was very “particular” and demanding about everything from Pat’s housekeeping to her hairstyle. “I don’t think he means to be cruel or unreasonable,” she commented. “He’s just very appearance-conscious. He has certain ideas about how his children and his wife are supposed to look and act, especially in public. He wants everything to appear perfect, including me. We all try to please him, but sometimes he just goes too far.”
According to Pat, asking Ed to change his behavior or lower his expectations was pointless. Consequently, from the start, whenever Ed became overly demanding, cruel, or insensitive, Pat, who knew that having sex with her “boosted Ed’s ego,” started withholding sex. “I just said no,” she recalled. “And-1 kept on saying no until he started showing me a litde more respect and affection.”
In this way, Pat not only punished Ed for behavior she found unacceptable, but also made an attempt to balance the give/get tally sheet in a relationship where she did most of the giving. Since Ed was basically incapable of giving, the only way Pat could achieve a balance was to not give Ed something that he wanted—sex.
Withholding sex is one way less “powerful” partners, like Pat, can exercise some power in their relationships. Through actions rather than words, they say, “Well, maybe you do make decisions without consulting me. Maybe you do constantly put me down and pay more attention to your career than you do to me and expect me to drop everything to meet your needs, but you do not have all of the power in this relationship. When you want to have sex, it’s my turn to call the shots. In the bedroom, I have something you want, but you can’t have it until I’m ready to give it to you.”
What’s more, even if you do periodically give in to your higher-desire partner’s pressure and have sex, if you haVe ISD, you still have an ace up your sleeve. As Pat put it, “Sometimes, Ed can get me to have sex, but he can’t make me want it or like it.”
Higher-drive partners can also use sex as a weapon or means of expressing anger, such as when they initiate sex even though they know their partners aren’t interested. In doing so they may be disappointed, but also feel somewhat self-righteous. Meanwhile, because the higher-drive partner is using sexual advances as a weapon of humiliation, the other partner may feel sexually inadequate.
Unfortunately, while sexual withdrawal and sexual humiliation are powerful weapons and a way of evening the score, using them does not resolve the underlying problem. In fact, it usually only makes the problem worse.
*116\261\8*

The good news is that treatment with antibiotics is usually successful, and relief is as dramatic as the symtoms were. Important: Antibiotics must be taken for six weeks even after the symptoms have disappeared. The reason is that, if it’s not obliterated right away, acute bacterial prostatitis becomes much more difficult to cure. Eradicating acute bacterial prostatitis the first time around, by relentless treatment with antibiotics, is the best way to avoid developing chronic bacterial prostatitis.

Chronic bacterial prostatitis is also caused by bacteria, and also treated by antibiotics. It can be a recurring illness, coming back periodically for years after an initial episode of acute bacterial prostatitis. Its symptoms are usually milder versions of those in the acute form. Here, too, treatment with antibiotics should continue for six weeks.

Nonbacterial prostatitis is the most common form of prostatitis, and it’s a mystery. Nobody knows what causes it, and antibiotics don’t make it go away. Men with this form of prostatitis may have many of the same symptoms as in chronic bacterial prostatitis, and white blood cells may be present in fluid made by the prostate—but as far as we know, it doesn’t involve bacteria.

Prostatodynia has basically the same symptoms as nonbacterial prostatitis; the difference is made in diagnosis. Prostatodynia can be caused by many things, particularly muscle spasms in the bladder neck, urethra, perineum, or pelvis.

Treatment for nonbacterial prostatitis and prostatodynia is largely sy/mptomatic. Muscle relaxants and other drugs have been helpful in easing the muscle tension in the prostate and making urination easier. Some doctors recommend anti-inflammatory drugs and sitz baths, and many men have found that diet has an effect on nonbacterial prostatitis, and that some foods—particularly, spicy dishes, red wine and caffeine—seem to aggravate their symptoms.

Even if prostatitis is not always curable, it is treatable. Most men can get medical relief from their symptoms. It is not contagious; men can continue a normal sex life without worrying about giving the disease to someone else. And, having prostatitis does not mean you’re at a greater risk of getting BPH or prostate cancer.

*313\201\8*

Early randomized trials comparing laser prostatectomy to TUR demonstrate that urinary flow rates and symptom improvement are better in patients who have TUR. In these early laser studies, about 10 percent of men needed to be retreated in the first year. Laser treatment of BPH is too new for anyone to make predictions about its long-term effectiveness.

So, the jury’s still out; the final verdict on laser prostatectomy won’t be given until we know what the true retreatment rates will be. Currently, the results for laser prostatectomy aren’t as immediate or as long-lasting—and improvement is not as dramatic—as in TUR. However, unlike TUR, laser prostatectomy doesn’t involve hospitalization, and it can be done under local anesthesia. Currently, many men would rather have two TURs in ten years than one open prostatectomy. It may be that, in the future, men will prefer to have two or three treatments with a laser than one TUR Another point to keep in mind, as a Stanford urologist noted in a recent journal article, is that “all laser devices available today represent first-generation products … All will most likely become obsolete in the foreseeable future,” as the design of these devices, and the knowledge it takes to use them, continues to improve that surgeons can use them, continuous to improve.

*275\201\8*

Your doctor will probably begin with the outside first, checking your abdomen for swelling (to see whether the bladder is emptying completely), and to make sure the kidneys feel normal—and that they’re not palpable. (Normally, kidneys cannot be felt in a physical exam through the abdomen.) Also, your doctor will probably examine your testicles, to make certain that both are present and that they’re normal in size.

Because of the prostate’s location—below the bladder, and just in front of the rectum—it can’t be seen or examined from the outside. So the first step in examining it is usually the digital rectal examination, in which a doctor’s gloved, lubricated finger is inserted into the rectum to feel for lumps, enlargement, or areas of hardness that might indicate the presence of cancer. Because BPH affects only the innermost core of the prostate, your doctor may find nothing out of the ordinary here. It’s important to keep in mind that the size of the prostate often has nothing to do with the degree of symptoms. Some men with major prostate enlargement have no urinary tract trouble, while other men with seemingly minor enlargement suffer many symptoms of obstruction. Again, it depends on the site of enlargement in the prostate (see above). Some men, for example, may have middle lobe growth, but hardly any lateral lobe enlargement. Because the middle lobe can’t be felt by a doctor’s finger, a man may have what feels like a very small prostate, yet have big trouble with urinary retention.

*236\201\8*

Drugs for Milder Pain

Listed here are some nonsteroidal anti-inflammatory drugs (NSAIDs) and some of their brand names. (Just because we don’t mention the brand name here doesn’t mean it isn’t a good drug.) Over-the-counter drugs include aspirin; acetaminophen (brand names include Tylenol and Datril); and ibuprofen (brand names include Motrin, Advil and Nuprin). Prescription drugs include diflunisal (Dolobid); choline magnesium trisalicylate (Trisilate); salsalate (Disalcid); naproxen (Naprosyn); naproxen sodium (Anaprox); indo-methacin (Indocin); sulindac (Clinoril); and ketorolac (Toradol).

Drugs for Moderate to Severe Pain

Here are prescription drugs, and some of their brand names. (Again, not all brand names are mentioned here.) They include fenatyl (Duragesic); propoxyphene (Darvon, Darvocet); codeine (Tylenol with codeine); oxycodone (Tylox, Percocet, Percodan); meperidine (Demerol); methadone (Dol-ophine); hydromorphone (Dilaudid); and morphine (Roxanol).

*197\201\8*

How does an X-ray machine work? The simplest way to think of it is to imagine yourself getting a suntan. The difference here is that you can’t feel or see the X-ray energy hitting your body, and the “tan” occurs internally, as the radiation particles destroy DNA, causing targeted cells to die. The best way to get a good, even tan is in increments, not all at once. Therefore, radiation doses are spread out over several weeks’, with each treatment lasting only minutes at a time. The goal here, besides killing the cancer, is to do as little harm as possible to the surrounding tissue—the rectum, bowel, bladder, bone and skin.

External-beam radiation therapy’s effects may not be as durable in the long run as those of radical prostatectomy; it is often associated with positive biopsies and, over time, with increases in PSA. This is why external-beam radiation therapy is an ideal option for older patients. However, within the last few years, an exciting new technique called 3-D conformal radiation therapy has come on the scene. It increases external-beam therapy’s potential by maximizing the dose of radiation to the prostate tumor, while keeping the risk of damaging nearby tissue to a minimum—and it may improve long-term results.

*159\201\8*

That the homosexual offenders vs. adults were the most homosexually oriented of any sex offenders is borne out by an examination of their heterosexual petting. While nearly 92 per cent petted, this is the next to the smallest percentage manifested by any of our groups numerically large enough to afford statistical comparison. By age twelve they had die smallest proportion (24 per cent) of individuals with petting experience, which is not unexpected. It is, on the other hand, ominous that their excellent socialization with females reported for ages ten to eleven did not result in their being high in rank-order of those with petting experience by age twelve. Relatively few began to pet between the end of the twelfth year and the end of the fourteenth year; indeed at age fourteen they retain die lowest place (40 per cent) in the rank-order of those with petting experience. They rise a bit by sixteen but by eighteen have dropped back to the bottom of the rank-order with only three quarters of their members having ever petted.

Despite the fact that the homosexual offenders vs. adults reached puberty at an earlier age than other sex offenders, the median individual had his first postpubertal petting experience at 15.7 years of age, which is rather late.

In terms of age-specific incidence, the percentage with petting experience within given age-periods, the homosexual offenders vs. adults display the smallest percentages of any group from age sixteen on. Note that in age-period 16-20 all three homosexual groups occupy the lower three ranks in the rank-order. From puberty to fifteen, when the other homosexual offenders occupy middle ranks, the homosexual offenders vs. adults are near the bottom, 11 percentage points less than the homosexual offenders vs. children.

As one would expect, they also had relatively few partners. Ten per cent (the largest proportion of any group) had had no partners and nearly 15 per cent had but one. The average (median) individual had petted with 9.5 partners, the smallest number recorded and half as many as reported by the control group.

This comparative paucity of petting partners is interesting in view of the fact that before puberty the homosexual offenders vs. adults had the largest number and proportion of female playmates of any group, and had a substantial amount of sex play with them. Moreover, at ages sixteen to seventeen they were still reasonably well off as far as female friends and companions were concerned—more so than the other homosexual offenders. One is left with the general impression that here is a group of individuals who always got along well with females but who, because of their homosexual interests, did not take advantage of their ability.

The proportions of homosexual offenders vs. adults who reached orgasm in heterosexual petting are small in all age-periods, never more than 19 per cent, and the accumulative incidence figures are also low (23 per cent by age thirty).

The ambivalent position of the homosexual offender vs. adults in getting along well with females but not having much to do with them sexually is again illustrated in the frequency with which they reached orgasm while petting. As we have seen, relatively few petted at any time, and, of course, still fewer had an orgasm; nevertheless, those who did reach orgasm did so with considerable frequency. For the average (median) individual it was a matter of about 3 to 4 times a year, which ranks him with most other sex offenders from puberty to age thirty. The average (mean) frequency was also stable for some time: between puberty and twenty-five it amounted to about once a month, a frequency similar to that of the control group. In the following age-period this frequency was more than halved. To put it briefly, our sample of homosexual offenders vs. adults contains a small number of men who, while they had very little coitus, did reach orgasm in heterosexual petting with frequencies similar to those of other groups, including the controls.

At this juncture it is worth mentioning that some predominantly or exclusively homosexual males exert a singular attraction for certain females. These are women who become tired of continually fending off sexual advances and are pleased to find a man with whom they do not have to be perpetually on the defensive. Often they become intrigued by his lack of sexual response and, after a time, make sexual overtures toward him. This has not infrequently resulted in the homosexual male’s having heterosexual activity that he did not particularly desire. In other cases the relationship remains mutually agreeable but platonic.

In their premarital lives only 76 per cent experienced genital manipulation on or by a female; this is the next smallest percentage recorded. Seventy-nine per cent, a figure exceeded by only three groups, had never at any time placed their mouths on female genitalia. For the one quarter of these offenders who married, the percentages with marital, extramarital, and postmarital cunnilingus are moderate. In terms of cunnilingus with premarital partners (17 per cent) and with prostitutes (4 per cent) the homosexual offenders vs. adults maintain middle positions in the rank-orders.

As usual, more had been fellated by a female (38 per cent) than had performed cunnilingus on a female (21 per cent). Even so, the 38 per cent who had been fellated is a somewhat small percentage and near that of the control group. Moderate proportions of these offenders had been fellated by their wives or by extramarital or postmarital partners (33 and 16 per cent). Of those who had patronized female prostitutes, nearly half (a moderate proportion) had been fellated.

One other form of oral activity merits a brief note—the nibbling or biting of the sexual partner. The homosexual offenders vs. adults were more given to this time-honored mammalian technique than were die members of any other group. Nearly one half had done so, and nearly one quarter had done so frequently, but unfortunately we did not differentiate in our question covering biting whether the recipient was male or female. In the absence of any predisposition among the homosexual offenders vs. adults toward sadistic dreams or masturbatory fantasies, this predilection for biting cannot be, as it was in the case of the heterosexual aggressors, construed as evidence of sadism or aggressiveness.

*203\161\2*

One might anticipate a relatively high incidence and frequency of sexual activity with animals among the incest” offenders vs. adults, since they are by far the most rural of our comparative groups and the most restrained in their sexual activity with humans. Such expectation is shaken when one learns that a rather small proportion, about one eighth, had sexual contact with animals. However, the age-specific incidence of animal contact among single males is somewhat high: these offenders rank third between puberty and age fifteen with 13 per cent, fourth in age-period 16-20 with 8 per cent, and second in age-period 21-25 with 7 per cent.

Those unmarried males who had such activity had it with relatively high frequencies; in consequence these offenders rank first in proportion of total outlet derived from animal contact. Indeed, in age-periods puberty-15 when 8.1 per cent of all orgasms came from this source, 16-20 when the figure is 5.2, and 21-25 (1.8 per cent) the quantitative importance of contact with animals far outweighs the contact with human males. In the youngest age-period the orgasms from animals even numerically exceed the orgasms in sleep. None reported dreams about animal contact.

*161\161\2*

The next variety of aggressor vs. adult, and one accounting for perhaps as much as 10 per cent of the group, is the double-standard variety. The males so classified divide females into good females whom one treats with some respect and bad females who are not entitled to consideration if they become obstinate. While one would not ordinarily think of maltreating a good girl, any girl one can pick up easily has in essence agreed to coitus and can legitimately be forced to keep her promise. These double-standard aggressors are somewhat like the amoral delinquents in attitude, but differ from them in being less criminal, in resorting to force only after persuasion fails, and in not being so generally asocial. In brief, the double-standard variety may be described as rather average males of lower socioeconomic background who feel that with provocation the use of moderate threat or force is justifiable when applied to females judged to be sexually lax or promiscuous. There are strong philosophical parallels with the Latin American “machismo” phenomenon. These double-standard males share with the amoral delinquents a penchant for group activity, the logical result when several males cruise about looking for female pickups. This trend may include a sort of man-to-man generosity, the female being shared much as men would share food or liquor, and with about the same emotional affect. Indeed, we have one case in which the man left a pickup girl and his friend in his car to go to a nearby parked car containing three other men and suggested sharing the girl in exchange for a gallon of wine. Yet this man strongly desired to marry a virgin and had refrained from coitus with his fianc?e.

Another man of limited intellect and education who had a clear record, save for juvenile car theft (not uncommon behavior in his social milieu), helped a woman get her stalled auto started, mistook her appreciation and offer of a lift for an indication of sexual willingness and then threatened and struck her when she refused coitus. The prison report is illuminating: “[The subject has] habitually a naive expression … anxious to have everyone understand that he was neither brutal nor violent with his victim . . . admits that when he could not persuade her in friendly fashion he uttered threats. . . . Frank to admit he sees nothing wrong with what he did for the victim was not harmed in any way and it was nothing more than what he has done on many occasions in the past to other girls. . . .”

The rationalization of a double-standard aggressor might often be in the following vein, to quote one of them: “Man, these dumb broads don’t know what they want. They get you worked up and then they try to chicken out. You let ‘em get away with stuff like that and the next thing you know they’ll be walking all over you.” If a large segment of the population of any socioeconomic class subscribed to this view, we might regard this variety as a “subculture” variety like the offenders vs. minors. However, no large social segment approves of force although it is easily forgiven.

After subtracting the above varieties, nearly one third of the aggressors vs. adults remain. A few of them may be recognized as clear cases of mental defectives and a few others as unquestionable psychotics, but the others strike one as being mixtures of the varieties described.

*119\161\2*