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*

Although as a group the heterosexual aggressors vs. children reached puberty late, the median age at which postpubertal masturbation began is not significantly different from the medians of other groups. A large proportion (92 to 96 per cent) of the single males among these particular sex offenders masturbated in their teens, and a moderate proportion (75 per cent) later.

With regard to the frequency of masturbation before marriage, we cannot give trustworthy data beyond age twenty for the aggressors vs. children, since they number so few. The masturbatory frequency of the average (median) aggressor vs. children can be termed intermediate both at puberty to fifteen, when it was once a week, and from sixteen to twenty when it was once every two weeks—both frequencies being less than those of the control group.

Sample size also precludes effective computation of masturbatory frequencies of married aggressors vs. children, which in turn prevents our determining the percentage of total outlet (total number of orgasms) derived from masturbation.

Among the never married the percentage of total outlet constituted by masturbation varies erratically from age-period to age-period up to age twenty-five, beyond which calculations cannot be made. The aggressors vs. children rank first during the years from puberty to fifteen, when 90 per cent of their orgasms were self-induced; from sixteen to twenty the percentage is moderate (49 per cent); and from twenty-one to twenty-five they again rank first with two thirds of their outlet coming from masturbation. The influence of one atypical individual is only too clearly seen. Nevertheless, the generally large proportions of total outlet derived in early premarital life from masturbation suggest heterosexual difficulties, which we shall later see again reflected in the small proportion of total outlet derived from premarital coitus. A second aspect concerns masturbation fantasy: a larger proportion of aggressors vs. children had fantasied than in any other group except the other aggressor groups. This tendency toward fantasy characterizes all the aggressors. In connection with this it is noteworthy that these aggressors were rather responsive to psychic and visual stimuli—some 88 per cent reported sexual arousal from thinking of or seeing females, a proportion exceeded by only three groups, one of which is the aggressors vs. minors. Yet, on the other hand, these men were curiously immune to pornography: half said it did not sexually arouse them. Strangely enough, no aggressor vs. children reported having any sadistic or masochistic fantasies, whereas the other aggressors rated first and second, as one would anticipate. This absence is all the more striking since, like all aggressors, a relatively large percentage (12 per cent) of the aggressors vs. children reported that sadomasochistic stories or pictures aroused them sexually. As a whole, they are a deteriorated alcoholic group, and it may be that, unlike the other aggressors, their behavior is simply disorganized, rather than motivated by aggressive sadistic impulses. The aggressors vs. children show nothing distinctive in other classes of fantasy except that none reported bizarre fantasies.

The aggressors vs. children worried more than an average amount over masturbation, reporting that in nearly half of the years during which they masturbated there was accompanying anxiety. This percentage, which is the fourth largest, is shared by the aggressors vs. minors. The aggressors vs. adults reported a percentage of 44, and hence one can generalize that all aggressors have above-average concern about masturbation. It is interesting that in spite of (or because of?) their concern, they tend to have masturbated more often in any one week then other offenders.

A study of how the aggressors vs. children first learned of masturbation reveals that no less than 48 per cent, the second highest percentage recorded, learned by observing others, talking, or reading. A very few learned through being masturbated by another person. The importance of observation and talk as a. source of information fits well with the fact that these aggressors reached puberty rather late and also had a good relationship with their peers. Thus they would see or hear about the activity before they were physiologically motivated to attempt it.

*77\161\2*

The juvenile criminal records of the offenders vs. children reveal nothing noteworthy. Indeed, these offenders are not an especially criminal group and not until age twenty-six had even half of them ever been convicted for any sort of offense, whereas half of the prison group had been convicted by age twenty. The average age at the first conviction was a late twenty-seven, which is exceeded only by the incest offenders, and the average age at their first offense vs. children was a late thirty-four.

In addition to a rather belated criminality, these men tend to be predominantly sex offenders to a greater degree than most: about two thirds of all their convictions were for sex offenses, and nearly three fifths of the men had no convictions other than for sex offenses. Consequently, while other offenders were being given light sentences for minor offenses, a larger number of offenders vs. children were being dealt with more severely because their offenses were sexual.

There were not quite two sex offenses per offender; if these men committed an offense other than one against a female child, it was usually against a female minor, or it was exhibition. The offenders were moderately recidivistic: one fourth had two such convictions, 16 per cent three, one fifth had four to six, and 8 per cent had seven or more.

*34\161\2*