Unfortunately in our country, with its innumerable castes, customs and rituals, we have developed an allergy to touching and being touched. A male greeting a female or even a male does so with folded hands. In a namaskar even hand-contact is absent.Caste distinction abounds, despite our Constitution forbidding it. We do not touch individuals of certain castes. This unwillingness to touch has led to sensory deprivation and affected our sexuality. The male, owing to ignorance and upbringing, does not touch or feel the need of touching the female partner, except during sex.This is unfortunate, as true touch is the most powerful means of sexually exciting and gratifying the female. Dr. Masters calls it ‘sexual touching pleasuring’. It is the common grouse of many women that their partners do not touch them for touch’s sake. Many males are surprised when I tell them about the importance of touching their partners.*107\262\8*

SEX GLANDS
The glands of sex serve a double function: they provide the necessary materials for reproduction of the human being, the male sex cell uniting with the female sex cell; they also provide material which goes directly from the glands into the blood, and which determines the nature of the growth of the body. If the amount of the material secreted by the gland into the blood is insufficient, definite changes will take place in the body inclining towards the female side if the male sex tissue is insufficient, and to the masculine side in the woman if the female sex tissue is insufficient.
A deficiency of the male sex material may result from absence or destruction of the gland or from failure to function, in cases where the pituitary gland does not produce the trophic hormone that stimulates the male sex gland. Again, there may be disturbance of the function of the cells within the gland, without actual destruction of the tissue.
A deficiency of male glandular material varies in its effects according to the age at which it occurred. If the material is completely absent, the condition called “eunuchism” is developed; this usually refers to a complete loss. When the loss of sexual gland function takes place before the time of maturation into an adolescent, a deficiency is shown in growth. The skin is delicate; the hair that ordinarily covers the surface of the body of the male is absent; there also may be exaggerated length of the arms and legs with broad hips and a tendency towards the development of a “pot belly”; sometimes also the breast of the male will enlarge.
*1/318/5*

Weak or Missing Sperm
Only one healthy, active sperm is needed for fertilization to take place. For insurance, however, nature creates at least 100 million sperm in every ejaculation in the normal male. If the man makes too few sperm or only weak, slow-moving sperm, the chances of fertilization drop dramatically.

Causes and Treatments
Hormonal imbalances and blocked tubes can destroy, weaken, or otherwise damage sperm. Microsurgery can repair a man’s damaged sperm ducts. Hormone therapy works only when a specific hormone deficiency has been diagnosed. Treatment with hormones that stimulate testosterone – the male hormone responsible for sperm production -increases sperm count. But treatment with actual testosterone does not. Other hormone treatments are still in the experimental stages.
Most frequently, the quality of a man’s sperm declines because one testicle has a varicose vein, called a varicocele. Like most veins, the ones in the testicle have little valves that prevent backflow of blood. If that valve cannot close or is absent, blood flows backward and the vein swells. This heats up both testicles. Heat interferes with sperm production.
Dr. Richard D. Amelar, of the New York University Medical Center, blames 40 percent of male infertility on varicoceles. With a simple half-hour operation, he and Dr. Lawrence Dubin blocked off the damaged delicate veins in almost 1,000 men whose sperm was otherwise normal. Sperm quality improved in three of four men. For more than half, the wives became pregnant.
A non-surgical treatment for overheated testicles was developed by Dr. Adrian Zorgniotti of the New York University School of Medicine. He fashioned a water-cooled jockstrap that the man wears for several months. Of 26 patients, Dr. Zorgniotti reports, 10 became fathers.
*1/266/5*

When he was 66 years old, Bill realized he had a problem that wasn’t going away—urinary trouble. For more than a year, he’d noticed a big change in the way he was urinating; his stream was weak, no matter how hard he tried to force the urine out. He couldn’t cut off his stream, he couldn’t keep it going— it started and stopped—and there was a problem with dribbling. “I was never totally blocked,” he says, “but it was bothering me.” Particularly annoying were the frequent nighttime trips to the bathroom. “I realized something had to be done.”

So he went to a urologist. “Bill had significant oudet obstructive symptoms,” his urologist recalls. “His prostate weighed forty-one grams (more than an ounce); he had a urinary flow rate of five milliliters per second, and his symptom score was 14.” (His BPH symptoms were scored from a minimum of 1 to a maximum of 4 for four symptoms: Hesitancy, decreased stream, dribbling, and intermittency. On this test, the best possible score is 4; the worst is 16.)

Not anxious to rush into surgery, Bill agreed to take part in a short-term study of an LHRH agonist to see if the drug could make a difference in his symptoms. After six months, his prostate had shrunk to thirty grams, or one ounce; his urinary flow rate had increased to fifteen milliliters per second, and his symptom score had dropped to 9.

Although his symptoms were better, the LHRH agonist “was a pain in the neck,” Bill says. “It was not a very pleasant experience. I’m one of the few men who had hot flashes, like a woman has during menopause—now when women say they have hot flashes, I know what they mean!” The hot flashes diminished after a few weeks, but the drug also produced other undesirable hormonal effects; one was some mild swelling of the breasts. The other was worse: “My potency was pretty much knocked out.”

Bill stopped taking the drug after six months when the study was over, and a year later he was back in the doctor’s office. His prostate had grown again and now was at forty-three grams; his urinary flow rate had dropped back down to five milliliters per second. His symptom score, however, was only 10, so he decided to wait a while before taking the next step—his doctor recommended a TUR. It took just over a year for Bill’s symptoms to worsen until he was ready for surgery.

During the TUR, his urologist removed eleven grams of tissue—the same amount by which Bill’s prostate had been reduced on the drug therapy. “The important thing is that this was a strategic strike,” his doctor notes; “the tissue was removed just in the area that was obstructing the urethra.” A year later, Bill’s urinary flow rate was 17.5 milliliters per second and his symptom score was 5.

“If I had the whole thing to do again, I wouldn’t take the LHRH agonist,” Bill says. “I’d have the TUR again in a minute. I feel fine. My urination is okay. It’s not as strong a stream—not like it was when I was 20—but it’s a heck of a lot better than it was; I may have to get up once during the night, but only occasionally.”

Bill’s recovery from surgery was uneventful, with only mild discomfort for a couple of days after the operation, and he’s had no problems with potency or incontinence. He does have dry ejaculation, but he says, “It’s not a problem— not when you’re my age and you’ve had six kids!”

*296\201\8*

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Perforation of the Prostate or Bladder. Another rare complication, this also occurs in 2 percent of patients. Its symptoms are nausea, restlessness, vomiting, and pain in the lower abdomen or back that can be felt despite the anesthesia. This is generally taken care of by stopping the operation and draining the bladder with a catheter. The injury can be allowed to heal on its own, or in severe cases it can be repaired surgically

Inability to Urinate. The most common problem right after surgery— experienced by 6.5 percent of men in one study—is the inability to urinate. Sometimes this goes away in a few hours. If it doesn’t, your doctor may want to investigate to make sure no excess tissue is remaining in your prostate. You might also need to have cystometry to check bladder function. Sometimes the trauma of surgery causes the bladder to become slack; the temporary placement of a catheter, giving the bladder a few days’ respite, seems to help bring the bladder tone—and, with it, the ability to urinate— back to normal.

Urinary Tract Infection. The presence of bacteria in the urine, sometimes associated with fever, may develop in as many as 10 percent of men who have a TUR, and is easily treated with antibiotics. Men over age 80 are more likely to have problems with urinary retention and urinary tract infection than younger men.

Bladder Neck Contracture. Rarely—in fewer than 3 percent of men who have a TUR—scar tissue develops at the neck of the bladder, just above where it empties into the prostatic urethra. This generally happens within the first four to six weeks after surgery. After experiencing a good urinary stream for several weeks, some men notice a sharp change—the stream is poor again, like it was before surgery. What’s happened is that scar tissue is blocking the urethra, just as the tissue in BPH did, except the dam in the river has moved upstream. This can be diagnosed with a cystoscope in an outpatient procedure. By making a few tiny incisions, your urologist can open the scarred tissue and restore urine flow.

Urethral Stricture. Another rare complication, occurring in fewer than 3 percent of men after a TUR, this is caused by trauma to the urethra— sometimes from a catheter, and sometimes from the resectoscope.

*257\201\8*

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One side effect is that if the injection is too strong, it can produce a prolonged erection that may require some medical therapy to relieve it. Some doctors ask patients who opt for penile injections to sign a consent form because of some other side effects—some of them long-term—associated with the injections. These can include tiny blood clots, burning pain after injection, damage to the urethra, or minor infection. But the worst is that in some men, over time, painless, fibrous knots of tissue build up in the corpora cavernosa, and this can cause the penis to become curved. Doctors aren’t entirely sure why this happens; it may be related to the frequency of injection, strength or dosage of the drug used, and the amount of bleeding resulting from the shots. Some doctors believe compressing the site at the time of injection may be critical to minimizing this risk; also, keeping the dosage to a minimum, or using a blend of several drugs may help.

The future looks much more promising, however: On the horizon are better drug-delivery systems that may render the syringe—and its worst side effects—obsolete. New approaches include a salve to rub on the penis and erection-producing suppositories to place inside the urethra.

*220\201\8*

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The theory here is that even low levels of testosterone and DHT— produced by the adrenal androgens—can stimulate cancer in the prostate, and that they must be stopped. This can be accomplished by combining whatever achieves a castrate level of testosterone—surgical castration, estrogen or an LHRH agonist—with flutamide.

Total androgen blockade became a hot concept in the medical community about a decade ago, due largely to the work of one scientist. This scientist reported that combining an LHRH agonist with an anti-androgen was far more successful than using either approach alone. But there are a few things you should know about this research: One is that no other scientist has ever reproduced this man’s spectacular results. In his study, 97 percent of men with advanced cancers who were treated with an LHRH agonist plus flutamide were still alive eighteen months later.

The sad truth is that in nearly every other doctor’s experience, only half of patients diagnosed with metastatic prostate cancer are alive two or three years later, and no treatment, so far, has made a real difference in those numbers. The survival rates for men with advanced prostate cancer in 1995 are not much different from the rates in 1965.

Most studies since then have shown either no difference in survival or an overall survival time lengthened by only a few months. One study, however, has produced results that suggest that patients with only minimally advanced disease—men with just a few metastases—have the most potential to benefit from the combined therapy of castration or an LHRH agonist plus flutamide. For men with minimal disease, total androgen blockade might be a reasonable option; it might prolong life. (This currently is being tested in a large study in the United States. In the next few years, we should know much more about the true benefits of this form of treatment.) However, for most men, and particularly for men with widely metastasized disease, it probably will not be of great benefit.

*181\201\8*

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Over the years, several other radioactive materials, including palladium, have been tested, and the means of implanting them have evolved from a subjective, free-hand technique (which requires surgery to give the doctor access to the prostate) to state-of-the-art, ultrasound- and CT-guided systems involving templates. (Some of these techniques mean open surgery is not necessary, although laparoscopic surgery may still be used to see whether cancer is in the pelvic lymph nodes.

So, doctors have become highly sophisticated in targeting and placing these radioactive seeds. But do they work? The bottom line is: Not as well as radical prostatectomy or external-beam radiation therapy. And who should get this treatment? It’s not ideally suited for men with a large, bulky tumor, a high-grade (Gleason score 7 or above) tumor, or lymph node metastases. Most implantation regimens don’t include the seminal vesicles or tissue outside the prostate—so if there’s the slightest risk that cancer has spread to these areas, implanting radiation seeds within the prostate won’t do anything to fight the cancer outside it. And implanting foreign particles—no matter how tiny—into the body may cause infection-over time as the body moves to fight these invaders. (To avoid this risk, some implants are removed after several days.)

*143\201\8*

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The homosexual offenders vs. minors occupy intermediate or low-intermediate positions in the various rank-orders of premarital coitus. By age fourteen somewhat more than one quarter were no longer virgin; by age sixteen the same can be said of half of them, and by twenty-three of three quarters of them. At the time we interviewed them, some 82 per cent had had premarital coitus, a percentage that half of our comparative groups had equaled or surpassed by age twenty, but still a percentage exceeding that of the controls. Their relative lack of heterosexual coitus is in keeping with the poor socialization with females that existed when they were aged sixteen to seventeen, and accords with the relatively small number who petted during their late teens and early twenties.

The age-specific incidence figures are also rather low, and in age-period 26-30 and again at 31-35 these offenders have next to the smallest proportions of individuals who engaged in premarital coitus.

Typically, the age-specific incidence of premarital coitus with prostitutes is small; among the unmarried males it is usually next to the lowest in any age-period. After age fifteen only about one third of these single males were involved with female prostitutes in any five-year age-period.

The homosexual offenders vs. minors had quite low frequencies of premarital coitus with companions. The average (median) individual with coital experience ranked low not only between puberty and fifteen, with a frequency of but 5 a year, but in every age-period thereafter. The figures are usually much lower than those for the control group. He also had intermediate to low frequencies of premarital coitus with prostitutes—again less than those of the control group.

In view of the data already given, it is no surprise to find that the homosexual offender vs. minors with coital experience had had premarital coitus with nine companions (a few more than the control group) and ten prostitutes in the course of his life prior to interview, both figures being low-intermediate in rank-order.

The dependence on prostitutes in premarital life, so striking in the homosexual offenders vs. children, is not seen among the homosexual offenders vs. minors, but it is worth noting that the number of premarital prostitutes is almost equal to the number of premarital companions.

Except for the homosexual offenders vs. adults, the homosexual offenders vs. minors derived the smallest proportion of their total sexual outlet from premarital coitus with companions. They usually have the second smallest percentage in any rank-order, the range being from 3 to 12 per cent. In fact, after age thirty-one nocturnal emissions are quantitatively more important to the unmarried individuals than premarital coitus. Again, except for the homosexual offenders vs. adults, the homosexual offenders vs. minors derived the smallest proportions of total outlet from premarital coitus with prostitutes, the proportions never exceeding 4 per cent.

The restraining factors on premarital coitus reported by the homosexual offenders vs. minors are: moral considerations (29 per cent, fifth in rank), lack of interest (50 per cent, second in rank-order), and fear of public opinion (12 per cent, fourth in rank). They are similar to the homosexual offenders vs. children in the number who said that lack of opportunity was a major deterrent (45 per cent vs. 48 per cent). The truly significant figure is the 50 per cent who claimed disinterest; their concern over morality and public opinion may be largely a by-product of their lack of interest. It is easy for a weakly motivated person to be deterred by moral considerations and the opinions of others. On the other hand, we also know that strong moral scruples against premarital coitus and the related great fear that “people will find out” sometimes predispose a young person toward homosexuality.

While those who rate high in moral restraint and fear of public opinion, such as the control group and the incest offenders vs. adults, express a desire for virginal brides, the homosexual offenders vs. minors are rather unconcerned about virginity. This does not mean that they subscribe to a reverse version of the double standard or morality. It more likely reflects either a general indifference toward females as sexual partners, legal or otherwise, or a tolerance based on a realization that they are in no position to criticize another’s sexual behavior.

*187\161\2*

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The incest offenders vs. minors are, except for the incest offenders vs. adults, the least homosexually oriented of all of the groups. None found any sexual arousal in thinking of or seeing other males. Only 18 per cent had ever had sexual contact with another male since puberty either in or out of a penal institution, and only 17 per cent outside prison. A scant 3 per cent had had more than incidental homosexual experience. Only the incest offenders vs. adults have smaller figures. In this connection it is worth recalling that the incest offenders vs. minors and incest offenders vs. adults also had little homosexual play in their prepubertal lives.

Consequently, it is no surprise to find these two groups of incest offenders with the smallest percentages in the accumulative incidence table. By age fourteen only 8 per cent of the incest offenders vs. minors were experienced; by age eighteen the proportion had increased to 12 per cent and finally, by age twenty-six, to the ultimate 17 per cent.

The first homosexual contact of the average (median) incest offender vs. minors occurred at eighteen—far later than for any group other than the aggressors vs. children whose initial experience was later still. They also show the smallest percentages who had homosexual activity within a given age-period. Among the single between puberty and fifteen only 7 per cent were involved; between ages sixteen to twenty, 9 per cent; and after that homosexual physical contacts ceased. This early cessation is unique among our comparative groups. Among the married men, homosexual activity was confined to the years from twenty-one to twenty-five and was minimal. Too few cases exist to permit the calculation of meaningful frequencies of homosexual activity by married individuals.

Like all incest offenders, the unmarried incest offenders vs. minors had extremely low frequencies of homosexual activity. They averaged only 1 homosexual contact every ten years—the second lowest frequency recorded (the incest offenders vs. adults were the lowest). In consequence, the proportion of total sexual outlet derived by the unmarried offender from homosexual activity is extremely small—1 per cent at most—a distinction shared with the unmarried incest offenders vs. adult daughters. Actually, sexual contact with animals is quantitatively more important to these offenders than sexual contact with other human males.

The average (median) individual had only two male partners, and of those with homosexual experience, more (55 per cent) had only one partner than the members of any other group. Among those with two to five partners, they rank second and none had more than five—in this respect they are unique. They are also unique in that they never reported homosexual activity with a male under eighteen.

With this minimal history of homosexuality it is not surprising to find the incest offenders vs. minors strongly disapproving of male homosexuality (a trait shared by incest offenders vs. adults). Some 76 per cent disapproved against only 8 per cent who approved, making them second only to the heterosexual offenders vs. adults in the degree of disapproval expressed.

*145\161\2*

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