In England, a survey by the Home Office Research Unit -- based on an analysis of the offenses of all persons convicted for indictable sex offenses in a given year -- concluded that 43 percent of all the offenders had been involved with victims or participants who consented to the sexual contact. This did not include any victims under 10 years old nor any victims who appeared to cooperate out of fear or obedience to authority. Moreover, of the nonconsensual sexual incidents, many involved minor sexual contact or touching. In England, rapes constitute only about 5 percent of recorded sex offenses, and a recent survey of all reported rapes over a 5-year period in six English police jurisdictions indicated that less than 6 percent of the attacks resulted in an injury requiring medical treatment. The dangerously violent sexual offenders constitute a small proportion of sex offenders. These offenders are exceptional in the excessive violence of their assaults, their selection of strangers as victims, and their repetition of attacks. Clinicians have identified five dominant themes in the personalities of such offenders: exaggerated machoism, psychopathic ruthlessness, misogyny based upon wounded masculinity, sexual sadism, and hatred of sexuality. Case studies of such offenders in both the United States and England are used to demonstrate these five characteristics.