Trichomoniasis
Unlike many of the other STIs, trichomoniasis is caused by a protozoan. Although as many as half of the men and women in the United States may have this organism present, most remain free of symptoms until their bodily defenses are weakened. Both men and women may transmit the infection, but women are the more likely candidates for infection. The “trich” infection may cause a foamy, yellowish discharge with an unpleasant odor that may be accompanied by a burning sensation, itching, and painful urination. These symptoms are most likely to occur during or shortly after menstruation, but they can appear at any time or be absent altogether in an infected woman. Although usually transmitted by sexual contact, the “trich” organism may be easily spread by toilet seats, wet towels, or other items that have discharged fluids on them. You can also contract trichomoniasis by sitting naked on the bench of the dressing room of your local health spa or locker room. Treatment includes oral metronidazole, usually given to both sexual partners to avoid the possible “ping-pong” effect of repeated cross-infection so typical of the STIs.
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The “Rollerball” Variation. In a brand new approach to TUR, surgeons use an electrocautery “rollerball” instead of the cutting loop. Overgrown tissue is vaporized, not chiseled away, so there are no leftover chips. The technique is highly promising: It appears to have minimal complications, litde bleeding, and shorter catheterization and hospital stays. And, while it offers many advantages of laser prostatectomy and other high-tech procedures, it’s far less expensive. There are many good reasons to believe the rollerball may soon become the technology of choice.

TUR Syndrome. This, too, occurs very rarely—in about 2 percent of patients. It’s caused when the body absorbs excessive amounts of the irrigating fluid used during the TUR procedure. Its symptoms are nausea, confusion, vomiting, high blood pressure, a falling heart rate, and visual problems. TUR syndrome is temporary and is quickly reversible with diuretics or a saline solution, which help restore the body’s normal fluid and mineral balance.

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It usually takes less than five minutes for one of these drugs to work, and the erection can last as long as a couple of hours. It will be important for your doctor to determine the lowest possible doseyoxi need to achieve an erection; this will help reduce the risk of side effects. Other ways to help lessen side effects include limiting injections to no more than once a day, and using an insulin syringe (which has a smaller needle than many syringes) to minimize pain and bleeding from the injection. Also, men should compress the site where the needle went in for three minutes after the injection; this also helps reduce bleeding and tissue damage.

Penile injection is not for everybody. These erection-producing agents won’t help men with vascular problems. However, they do work in most patients. Because of the nature of this therapy—giving the penis a shot—it obviously is not ideal for men who can’t see well, men with poor hand-eye coordination, or men who are very overweight. Also, because many erection-producing drugs reduce blood pressure, this can cause problems for some men with heart disease.

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These drugs don’t care how much LHRH, LH, FSH, testosterone, or DHT you make; it doesn’t matter to them. (Actually, antiandrogens cause testosterone levels to go up because of an increase in LH.) All they do is make sure testosterone and DHT don’t reach their targets—the receptors. In other words, antiandrogens act as dummy keys in the “locks,” or receptors. When testosterone and DHT reach the receptors, there’s already a key sitting in the lock—so they can’t enter the lock and activate the receptors. Therefore, the tumor doesn’t get the hormones it needs to nourish its androgen-dependent cells.

Flutamide is the most widely used anti-androgen. Casodex, a new, not-yet-approved drug, is another; so is cyproterone acetate, an antiandrogen that’s used in Europe but is not yet approved in this country.

Their potential advantage is that, because testosterone is not suppressed, they preserve potency. In men taking flutamide, for example, 87 percent remain potent. (This is not true, however, for cyproterone acetate. This drug, like estrogen, also suppresses the hypothalamus-pituitary connection—so it lowers LH, which affects testosterone production. Thus, it does produce impotence.)

But do antiandrogens work? The answer, for now, is probably not enough when they’re used by themselves. They also produce breast enlargement in 74 percent of the men who take them.

In total androgen blockade (see below), flutamide is given along with an LHRH agonist. In new research, scientists are looking into combining flutamide with something else—perhaps finasteride (discussed later in this chapter) to increase its effectiveness.

Side effects: Flutamide’s major side effect is diarrhea. Also, it can cause significant liver damage in some men; therefore, it’s a good idea for men taking flutamide to have their liver function checked after the first few months of treatment.

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The concept is not new. Pierre Curie thought of it nearly a century ago— even before external-beam radiation treatment came on the scene—and doctors in New York tried it several years later; they inserted thin glass tubes with a radioactive substance called radon directly into tumors. The treatment killed tissue, all right, but the results were uneven; some of the targeted tissue was devastated while other tissue remained unscathed. In the next decades, scientists improved the technique, but its popularity waned as hormonal treatment developed and as external-beam radiation therapy got better (see above). In the 1950s and 1960s, however, improvements in dosages and radioactive materials helped foster a comeback for interstitial therapy: Doctors implanted radioactive gold “seeds,” or tiny chunks of radioactive material, in men with prostate cancer; this was combined with external-beam radiation therapy. A few years later, doctors began using radioactive iodine seeds to fight prostate cancer.

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The age-specific incidence of petting after age fifteen is low: within age-period 16-20 the percentage is next to the lowest (82 per cent). It is significant that during these years the homosexual offenders occupy the three lowest positions in the rank-order of percentages. In age-period 21-25 the homosexual offenders vs. minors again have the next to lowest percentage of individuals involved in petting (80 per cent).

The accumulative incidence—the proportion with petting experience by a given age—shows a rather similar picture. By age twelve the homosexual offenders vs. minors fall in the lower part of the rank-order; by age fourteen and thereafter they occupy intermediate to low-intermediate positions.

A moderate proportion (ultimately nearly a third) of homosexual offenders vs. minors reached orgasm in premarital petting, but they did so with only moderate to low frequencies, ranging from about 6 to 10 times per year (mean frequency). One may recall that the homosexual offenders vs. children displayed even lower frequencies, but it should not be assumed that petting to orgasm is rare among homosexual offenders until the homosexual offenders vs. adults have been examined.

The age-specific incidence of petting to orgasm was moderate in all age-periods, reaching its maximum of 27 per cent in age-period 16-20 and declining to 16 per cent in age-period 31-35.

Nine per cent had no female petting partners, a figure exceeded only by two groups, the homosexual offenders vs. adults and the peepers. Examination of the percentages with various numbers of partners (one, two to five, six to ten, etc., up to 101 plus), shows that the homosexual offenders vs. minors tend to occupy middle positions in the rank-orders. The largest percentage (18 per cent) had from 11 to 20 partners, the highest modal category of any of the homosexual offenders. By and large the percentages of the homosexual offenders vs. minors are similar to those of the control group in the categories beyond two to five partners.

The heterosexual adjustment of the homosexual offenders vs. minors is something of a puzzle. We have seen that in preadolescence, at ages ten to eleven, they had an excellent socialization with girls and a relatively abundant amount of sex play with them. This auspicious beginning seems to have deteriorated subsequently, for at ages sixteen and seventeen they reported having had comparatively few female friends and companions—fewer even than the other homosexual offenders. This lack of interest in or unpopularity with females is reflected in the relatively large number who had never petted. However, those who did pet had a moderate number of partners.

The conflict of homosexuality and heterosexuality is also apparent in a study of their petting techniques. Of those who had petted, 80 per cent had never placed their mouths on female genitalia, the third largest “never” percentage recorded. This is partly because so few-only about a third—of the homosexual offenders vs. minors married. Nevertheless, only a small number of the married males had cunnilingus with their wives (20 per cent) or with extramarital and postmarital partners (7 per cent). In terms of cunnilingus with premarital partners, the homosexual offenders vs. minors have a middle status (15 per cent), as do the other homosexual offenders.

However, with reference to fellation the homosexual offenders vs. minors occupy middle positions in the rank-orders, half having had the experience.

Some people have considered heterosexual mouth-genital contact a form of behavior indicative of homosexuality, but it is clear that this belief is erroneous.

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When asked how old they preferred their coital partners to be not one of the incest offenders vs. minors (or incest offenders vs. adults, either) gave an age lower than sixteen. While this omission may to some extent represent deception, it may also simply be because we asked for their current age preference and, as we have noted, our sample of incest offenders vs. minors is our second oldest sample, the oldest being the incest offenders vs. adults. Large proportions of both groups expressed a preference for women of twenty-five or older. One must also recall that we asked for age preference, not an age range of acceptability; a male may prefer a woman of thirty but be willing to accept for coitus a girl of fifteen. A moderate number, 11 per cent, of the incest offenders vs. minors said they preferred girls of sixteen or seventeen.

Aside from their offenses with their daughters or stepdaughters, the incest offenders vs. minors display no salient features in other forms of incest, though they do exceed the prison- and control-group individuals in incest with sisters and sisters-in-law.

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The aggressors vs. minors may be characterized as irresponsible, aggressive, and amoral young men seeking the gratifications of today with little concern for the future. They were quite active sexually, beginning at an early age, and seem to have sought variation and novelty in both techniques and partners, which led them into a considerable amount of sexual experience with other males and with animals.

Their drive, impulsiveness, and inability to defer gratification seem also to have produced hasty and brief marriages, many of which soon became unhappy.

One can see that individuals with this kind of personality or life philosophy would repeatedly run afoul of the rules of society. However, some of them were not simply thoughtless, hot-blooded young men but were plainly antisocial and criminal. In consequence the aggressors vs. minors have an unenviable record of serious offenses, violence, and recidivism. Separating the dangerous and criminal men from what one might call the overactive extrovert troublemakers is a difficult task, but one that therapists and parole boards must attempt.

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