Setting clear training boundaries that exclude personal sexual revelations and that tie all discussion to a specific case, allows for a study of those difficult moments in the consultation when a feeling of sexiness develops in the room. For the woman doctor faced with a man who produces an erection, the embarrassment can be great for both parties. It may be possible to see such moments as uncon-sicous defences on the part of the patient (Skrine, 1987). Certainly the doctor is usually de-skilled and has to retreat to the safety of the prescription pad, the ordering of tests or a referral to another doctor. During training the doctor can learn to cope with such moments with some degree of equanimity.

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A couple came for advice about their infertility. They were in their early 40s, the man dressed in a neat business suit, and his wife also formally dressed. She was so distressed that the overwhelming impression was of a woman with a mass of wild auburn hair and barely restrained emotion. They had married at 18 and had three adult children. After the birth of the third child, the husband, aged 22, had undergone a vasectomy in the puerperium. There appeared to have been no encouragement for him to discuss his decision with his wife. Initially the situation seemed acceptable, but as the years went on and the children grew up, the couple became increasingly distraught. They found adoption was impossible and fostering did not meet their emotional needs. They both regretted the operation and reversal was undertaken but pregnancy did not follow.

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After some years on injectable progestogens she dreads the thought of periods again and she is currently discussing the possibility of sterilization and endometrial ablation. Further long-term use of the injections has to be considered carefully in view of the possible risk of osteoporosis, which is already a risk factor for her due to her immobility. It is important that Ann and John feel comfortable with the decision made.

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In some cases offenders commit specifically one type of offense against persons in one age group. In others they stick to the general type, e.g., homosexual offenses, but the ages of the objects may vary. In another case the offender group may commit many different types of offenses with persons of varying ages. These differences are worth exploring for the light they cast upon the sex offender.

First we must define our terms, and the simplest way to do so is by example. For a homosexual offender vs. adults, the specific offense would be a homosexual offense with an adult; homosexual offenses with minors or children would be within his general-offense category, but would be nonspecific; all nonhomosexual offenses would be nonspecific and also outside his general category.

The groups displaying the greatest specificity are the homosexual offenders vs. adults and all three incest groups. Only 17 per cent of the offenses of the former were nonspecific. For the incest offenders the percentage ranges from 19 to 22. At the opposite extreme, the least specific groups are the aggressors vs. children and minors (with 46 and 51 per cent of their offenses nonspecific) and the homosexual offenders vs. children and minors (41 and 38 per cent). These homosexual offenders tend to cross over into other homosexual categories; the aggressors seem simply more polysexual in their offenses. The only other noteworthy finding is a tendency for the offenders or aggressors vs. children and minors of either sex to be less specific in their offenses than those who offend or aggress against adults.

Let us now examine the percentages of offenses that are not only nonspecific but outside the general category—for example, the non-homosexual offenses of the three homosexual-offender groups, and the offenses of the aggressors that lacked the element of threat or force. The least specific groups are the aggressors, next are the three heterosexual-offender groups, and following them is a mixture of homosexual and incest offenders. Those whose objects were adults were the most specific in their behavior. In fact, no incest offender vs. adults had any sex-offense conviction other than incest, and only 4 per cent of the convictions of the homosexual offenders vs. adults were for nonhomosexual offenses.

All of this sums up to the fact that homosexual and incest offenders are rather rigidly departmentalized in their sex-offense behavior (as measured by convictions) while the aggressors are quite prone to commit a variety of offenses. The greater specificity of the homosexual offenders is further illustrated by the fact that among all other offenders (except for the incest offenders vs. adults) the percentages of nonspecific offenses outside the general-offense category always strongly exceed the percentages of nonspecific offenses within the general-offense category. Among the homosexual offenders this situation is reversed: nonspecific homosexual offenses outnumber the nonhomosexual offenses.

Some comments about general-offense categories can be profitably made. Offenses against willing or acquiescent females constitute a large proportion—from 27 to 39 per cent—of what one can call the “outside-the-general-category offenses” of all sex offenders except the homosexual and incest offenders (who committed few or none), whereas offenses involving the use of force or threat represent a small proportion of this category. Aside from the incest and homosexual offenders, who committed very few or no such aggressions, from 11 to 28 per cent of the outside-the-general-category sex offenses were heterosexual aggressions.

Incest offenses were rare. A range of 0 to 6 per cent includes all but the offenders vs. adults (12 per cent of whose offenses were incest) and the aggressors vs. adults (8 per cent).

Homosexual offenses were uncommon; no group other than the homosexual offenders had more than 17 per cent of its offenses of this sort.

Peeping was, in general, rare. Seven groups had no peeping offenses; among the remaining groups peeping accounted for 1 to 19 per cent of the outside-the-general-category offenses. Of these groups only three (the offenders and aggressors vs. adults and the exhibitionists) had percentages exceeding 6 per cent.

Exhibition was variable but often constituted a substantial proportion of outside-the-general-category offenses—from 0 to 43 per cent. Aside from this 43 per cent figure for the peepers, exhibition ranged up to 34 per cent. The homosexual offenders, as one might expect, and the incest offenders were low in exhibition offenses.

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Last in a discussion of techniques is the matter of anal coitus. Here again we find that two groups typified by varied and protracted foreplay head the rank-order: the incest offenders vs. children and the aggressors vs. adults. About one quarter of each group had used this form of coitus. The aggressors vs. minors are not far behind, occupying fifth (prison is fourth). We feel that anal coitus, even more than mouth-genital contact, is likely to be used as a sadistic technique since initially it involves pain. To exploit all of a sexual partner’s large body apertures enhances the exploiter’s dominance and aggressive masculinity. This hypothesis fits well with the high incidence of anal coitus among the aggressors and prison group. Near the bottom of the rank-order, with less than 6 per cent involved, are the aggressors vs. children (as expected), two of the homosexual-offender groups, the control group, and the offenders vs. minors. The low ranking of these homosexual offenders is interesting in that it shows there is no carry-over of homosexual anal coitus into heterosexual life.

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Turning to the other extreme, and examining a rank-order of those who had never seen postpubertal female genitalia, one finds that the three homosexual-offender groups lead with from 8 to 11 per cent. One may speculate as to whether this represents disinterest or the repression of memory. The peepers occupy fourth rank with 7 per cent; these must be the unsuccessful peepers.

In a ranking of those who first saw adult female genitalia at a late date, at age nineteen or later, the top four ranks are occupied by incest offenders and homosexual offenders—i.e., the inhibited and the disinterested.

The age-period during which the initial sight of postpubertal female genitalia occurs most commonly is 15-18 inclusive: the ages when heterosexual activity is blossoming into more advanced petting techniques and coitus.

In addition to the matter of age, the question of how these males gained their first sight is of interest. Again we are plagued with many instances where the data were not gathered, but nevertheless certain trends may be seen.

The major situation, which held true in from 32 to 65 per cent of the cases, is that of nonmarital coitus. A study of rank-order provides little meaningful information. The two highest ranking groups, heterosexual offenders vs. minors and adults, one will recall, also ranked very high in incidence of premarital coitus; the lowest ranking groups, peepers and homosexual offenders vs. adults, had low incidence of premarital coitus.

The next most common source of first sight of genitalia is a situation involving accidental circumstances—the source for from 0 to 23 per cent of the males. Again a comparison of percentages yields little.

Other sources are of minor importance, and only two phenomena merit attention. First, marital coitus as a source of first sight of postpubertal female genitalia is significant only for our most restrained group, the incest offenders vs. adults (17 per cent). Second, peeping was a substantial source (29 per cent) only among peepers; no other group exceeds 11 per cent.

The female seen was usually not a relative of the male. From 3 to 19 per cent reported their first sight was of their mothers, up to 11 per cent (excluding one group because of the small sample size) mentioned their sisters, and up to 13 per cent other female relatives. No particular trends or clusterings are evident except for a definite tendency for the peepers, and a lesser tendency for the aggressors, to have seen the genitalia of related females: mothers, sisters, and other relatives.

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