The moment of physical examination can be a time when deep feelings are shared. Such feelings include anger and grief, and it is surprising how much bereavement work goes on in the family planning consultation. The losses of miscarriage and termination might be expected, but it is not unusual for a patient to share such anguishes as the death of a parent. The moment of physical examination may trigger renewed grieving, as has been described previously (Montford, 1992).

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The other aspect of time and the consultation is that it may take place over long periods as a succession of brief contacts. Analysis of one particular contact might reveal the absence of several critical phases. For example, negotiating a plan might well be omitted in subsequent contacts, once it has been agreed, if a contact is following up that particular problem only.

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Despite her 20 years, Miss A. looked like a schoolgirl with her white ankle socks and Alice-banded hair. She sat nervously on the edge of her chair, her big eyes gazing trustingly at the doctor. She had just seen the nurse, who had put her through to see the doctor again because she had a problem. ‘The nurse said you could sort out this problem I’ve got,’ she confided. The doctor felt wary. What was this problem that had to be handed over to the doctor to be sorted out? ‘Tell me about it,’ she responded. Miss A. said that she never enjoyed intercourse and her boyfriend was complaining. She stopped. The doctor went, ‘Urn,’ and nodded. ‘That’s it really.’ Miss A. sat back in her chair, problem handed over, ready for instruction. For an instant the doctor was tempted to launch into a lecture or question and answer session on ‘How to enjoy intercourse’ but recognized the teacher/pupil relationship and restrained herself. ‘Tell me a bit more about you and your boyfriend,’ she said. ‘What do you want to know?’ Miss A. countered. The doctor suppressed her irritation, recognizing the ‘adolescent child’ defiance. She tried to defuse the defence with a smile and said gently, ‘It is difficult to know where to begin, isn’t it?’ and waited. After a moment of bewilderment Miss A. began again. As she progressed through her account she constantly looked for approval that what she was saying was what the doctor wanted. ‘Do you want to hear about that?’ and ‘Perhaps this doesn’t matter’. As she told the story it emerged that she lived at home and they had intercourse only occasionally in either her or his parents’ house. She was able to discover how nervous she felt about either set of parents knowing what they were doing. She felt like a child in both environments and too young to be sexually active. She felt they should just be cuddling not going ‘all the way’. There was a short silence at the end of her account. Then she said, almost as if the doctor was not in the room, ‘We’re going away on holiday together next month; I think I’ll see what it’s like then. It might be better away from home.’ She came back to the present and said, ‘Well, I’d better have some more Pills hadn’t I?’ excluding the doctor from the previous problems and taking back into privacy her doubts about her sexuality.

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A woman was brought to a contraceptive clinic from a longstay hospital. She was preparing to live in sheltered accommodation after a long hospital admission recovering from a road accident in which she had suffered brain damage. She was severely disabled and unable to walk or speak properly. The doctor communicated with her through her partner who was steady and caring. The couple communicated in a unique fashion and had an active sex life. Contraception was felt to be important by the woman, her partner and her advisers, but she could not accept sterilization. It took considerable time and effort to arrive at a situation which met the needs of both partners. This consisted of using a cap, sheath and chemicals all placed by the partner after he had been taught the details at the clinic.

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The response to thinking of or seeing males does not seem a criterion in differentiating patterned from incidental offenders; there were no consistent differences. As far as sexual arousal from sadomasochistic stories is concerned, the findings are weakened by the very substantial proportion of cases where data were lacking, but there does appear to be a tendency for more of the patterned offenders to respond sexually to such stories, even though the percentages are small.

By and large it would appear that patterned offenders are more responsive than incidental offenders to sexual stimuli not involving bodily contact.

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From the percentages of offenses which were first sex offenses it is apparent that certain types of offenses tend to be preceded by other sex offenses of any type.4 This shows up most strongly in exhibition, homosexual offenses vs. minors, peeping, and in the aggression and homosexual offenses vs. children. From half to two thirds of the offenses in these five groups are not first sex offenses. In contrast, toward the lower end of the rank-order are clustered the three incest groups and the nonforce heterosexual offenses vs. minors and adults. The incest offenses are undoubtedly low in prior convictions in part because of the two factors mentioned earlier: older offenders and longer terms of imprisonment. As for the two offense types that rank twelfth and thirteenth, heterosexual offenses vs. minors and adults, these are generally considered to be the least criminal and the most “normal” of the offenses in our 14-typc category, and hence might well be expected to be found low in prior sex-offense convictions. This does not imply that the behavior involved may not be repeated many times subsequently, but rather that the circumstances that led to complaint, arrest, and conviction were avoided successfully. Only 10 per cent of the more “normal” offenses—those vs. adult females—were committed by offenders who had a previous conviction for a sex offense, This is in contrast to double the proportion (still low) for those who committed offenses against minor females.

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General trends are difficult to discern and it is apparent that various groups responded differently to different factors. For instance, the prison group seems to carry over into marriage some premarital promiscuity and then gradually “settle down” to marital fidelity. On the other hand, the control-group individuals—rather restrained sexually before marriage—seem gradually to depend more and more upon extramarital coitus, the proportion of total outlet rising from 1 per cent in youth to 7 per cent in their fifties. Still others, such as the exhibitionists and the homosexual offenders vs. minors, maintain essentially uniform proportions throughout life. Some fluctuate inexplicably in response to what are probably fortuitous circumstances. Lastly, the incest offenders vs. minors and adults display increased proportions of extramarital orgasm as they reach the years (36-40 and 41-45) when their daughters attain the age required by our definitions.

The proportion of total outlet of married males derived from extramarital coitus with prostitutes is usually trivial; few groups exceed 1 per cent, and none exceed 3 prior to age fifty. Such coitus was quantitatively more important to the prison group and to the exhibitionists than to others. Since we know that exhibitionists prefer to exhibit to strange women rather than to their wives or female friends, this preference may account for a mild predilection for prostitutes (i.e., strangers). Concerning the prison group, one feels that their emphasis on prostitution is simply a by-product of their social milieu and style of life rather than any evidence of social adjustment or emotional status.

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Among single males one would therefore expect to find the proportion of total outlet from masturbation large near puberty, then decreasing rather rapidly as sociosexual proficiency developed, finally stabilizing in the late third decade of life (age-period 26-30). In general this is the pattern seen in the control, prison, and most sex-offender groups. However, within this general aging pattern certain temporal and quantitative differences seem important. In terms of the temporal element, note the tendency for those groups which were sexually most active before marriage to achieve an early stable masturbatory proportion of total outlet in age-period 21-25. For example, the figure for the heterosexual offenders vs. minors in this age-period is 26 per cent and remains within a percentage point of that for as far as our calculations carry us (to age thirty-five). The heterosexual offenders vs. adults vary only three points in the same period. The prison group also tends to stabilize, masturbation being quantitatively about the same in age-periods 21-25, 31-35, and 41—45. On the other hand, certain groups characterized by difficulties in sociosexual adjustment show a different picture: the unmarried exhibitionists and peepers have as large a proportion of total outlet from masturbation at ages twenty-one to twenty-five as they had at sixteen to twenty. This suggests a delay in sociosexual adaptation.

The quantitative differences are, of course, of extreme importance. The larger the proportion of total outlet derived from masturbation, the greater one may assume were the difficulties (external or self-imposed) in obtaining sociosexual outlet. Among the single males there is a general tendency for both the control and prison groups and the offenders vs. postpubertal unrelated females to draw comparatively little of their outlet from masturbation—and these groups have the fewest sociosexual problems. Those whose fives are complicated by a desire for contact with children or persons of the same sex usually get a large proportion of their orgasms from masturbation. While the exhibitionists and peepers ordinarily directed their interest toward persons of socially suitable gender and age, they suffered in their younger years from sociosexual maladjustments, which were reflected in the large proportion of total outlet derived from masturbation.

One cannot dismiss these quantitative and chronological phenomena without noticing that the decrease in masturbation with increasing age is sometimes halted and temporarily reversed. Such reversals are seen among the single, married, and previously married.

Among the single, such resurgences of masturbation are not large in either absolute or relative terms, but they cannot be ignored since they occur at roughly the same time (in the thirties) in perhaps as many as six groups (control, prison, offenders vs. children, exhibitionists, and the homosexual offenders vs. children and minors). Among the first four of these groups the increase in the masturbation is coupled with a decrease in the proportion of outlet derived from premarital coitus. This “coital depression,” so to speak, is only temporary but is as yet inexplicable. The homosexual offenders vs. minors suffer a “homosexual depression” simultaneously with their “coital depression.” The subsequent revival of sociosexuality and the return of masturbation to its position of lesser importance is probably the result of a continued dwindling of the sex drive: when the need for orgasm is no longer imperative one can wait for sociosexual expression.

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