Under the caption of sexual anaesthesia will be treated here not only the deficiency of sexual emotion or the absence of the sexual feeling, i. e., the impotence of voluptas or the lack of erotic desire, but all other deficiencies, declines or abatements in the realm of sex, such as absence of experiencing satisfaction, impotency of copulation and of propagation.
Etiology of male impotence.—In the etiology of impotence three main causes must be taken into consideration. Impotence is almost always met with in congenital or acquired malformation. Such anomalies lie more in the province of surgery and need not be considered here any further. Impotence is also found as a symptom in certain constitutional diseases. The patients suffering from these troubles, are seeking medical advice more for their causative anomaly than for the symptom of impotence, which in these cases is of secondary importance. Hence the consideration of these cases may also be omitted. The anomaly of impotence par excellence and for which medical advice is mostly sought is nervous impotence. This impotence from nervous collapse is the commonest and complicates all other kinds.
The patients of this class have always been normal in their sex-life. Suddenly, one day, they find themselves impotent. The cause of this kind of impotence is, in the majority of cases, sexual excesses, and four different kinds of excesses may be taken into consideration, excesses in copulation, in masturbation, in mental erethism, or commonly called day-dreaming, and finally excesses in tactile eroticism, or the common sexual dalliance or caresses of young lovers.
Copulation excesses.—During coition all the parts of the genital apparatus are in a state of extreme congestion. If such congestions are too often provoked they have a more or less deleterious effect upon the organs. Especially the colliculus and the prostatic portion of the urethra are affected by such repeated congestions. While the other parts assume their normal state soon after ejaculation and the cessation of erection, the colliculus remains still in a state of turgescence for some time. Now, the prostatic urethra is very rich in sensible nerves, and by its congestion all the generative organs are kept in a state of erethism. The irritation of this area is also capable of deranging the spinal genital centres. It either increases excitability and causes ejaculatio praecox, or it decreases excitability, and erections are no longer evoked.
Besides affecting the special nerves, the repeated orgasm, through the mental vertigo, the muscular convulsion, the cardiac and respiratory excitement, must lead to nervous disorders. As a matter of fact, venereal excesses are followed by malaise, nervousness, mental depression, lassitude, fatigue, satiety, heaviness in the head, disposition to sleep, dulness of intellect, indisposition to exercise, want of decision, regrets and ill humor, and the other symptoms of general neurasthenia.
Masturbatic excesses.—Still excesses in copulation are not so harmful as excesses in masturbation. In the first place excesses in copulation are self-limited. Indulgence in intercourse requires the consent of the partner, and where a second person is needed, there is always a limit put to the will of the first party. Furthermore, excesses in coition require each time a complete erection, and abused nature will finally deny erections. If the young and vigorous individual should in the beginning be able to command quite a number of erections in one night, after a certain time, he will be glad if he could have one complete erection during a night, or even once a week. In this way Nature herself regulates such excesses and takes care that “the trees should not sweep the stars down.”
The case is different with masturbation. No limit is set here to the excesses. Self-abuse does not require cooperation of a second person, and what is of more importance, erection is not requisite. Thus even Nature is here powerless. Hence when there is a propensity to masturbatory excesses, there is nothing to prevent the individual from abusing its favorite pastime.
Besides the harm to the greater frequency, excesses in masturbation offers additional injury through the youth of the individual. Copulation excesses are indulged in by individuals after puberty, i. e., by persons with fully developed generative organs and in full virility. The practice of masturbation, on the other hand, is often begun by mere children, before the genital organs have had time to fully develop, and it is easily seen that excesses will cause greater damage to these undeveloped organs. Hence when young individuals are given to inordinate masturbation, they harm the organs in a higher degree than excesses in copulation.
Furthermore, ejaculation in masturbation is forced through purely local manipulation. There is only a local excitation of the nerves. The help of the psyche and phantasy is missing, and the lumbar centres are tasked to the utmost. When the masturbator tries to supply the psychic means, he relies on the fertility and the extravagance of the lewd images which he presents to his mind to increase the libido. Hence masturbation is more injurious because it is generally effected through the influence of an exalted imagination.
Very soon the masturbator discovers that visions, once sufficient to produce the requisite excitement, have lost their power, and that the images need to be of a more extravagant salacity. In this way, the masturbator accustoms himself to extraordinary means of sexual gratification, so that attempts of normal copulation are no longer successful. When he attempts coition, he finds that reality is so much less than his imagination has led him to believe and that it is incapable of rousing his appetite.
Another injury done to the character of the masturbator is the guilty conscience. Almost every masturbator seems to feel that his acts degrade his manhood.AR He seems to know by intuition that his practice is injurious to his health and is morally wrong, because it is not in accord with the general plan of the creative power in the universe. Still in spite of himself, he continues to indulge in it. The will seems to have entirely lost its control. The masturbator is thus engaged in a conflict between moral conviction and sensual indulgence. Herein lies one of the most harmful effects of masturbation. It is undermining the individual’s will-power and destroying his character. Every masturbator resolves again and again, after each exercise, to resist henceforth the inclination and to overcome the temptation,AS each time with the same futile result. A paralyzing sensation arises in him, a feeling of shame and self-contempt overtakes him, because he has again failed to show enough energy, has again been too weak to resist the impulse. Finally these disturbing and paralyzing sensations give rise to the conviction of his being lacking in will-power and to the feeling of being generally deficient in everything else in life. In this way, excesses in masturbation harm the generative organs not only directly but also indirectly by first injuring the individual’s entire nervous system, and the different kinds of impotencies are only symptoms of the general neurasthenia.
Mental erethism.—The other kind of sexual excesses, those of mental erethism and frustrate eroticism, are even more harmful than excesses in copulation and masturbation.
By mental erethism or, as it is generally called, or rather misnamed, mental masturbation, is understood the filling of the phantasy with lascivious pictures. The dreamers give themselves up to sensual thoughts, allowing the mind to dwell constantly on sexual ideas, or erotic subjects of connubial enjoyments, conjuring before the unruly imagination extravagant and voluptuous visions and bawdry portrayals. The mind is fixed on images of individuals of the other sex, all in lustful positions, on pictures of the nude and of their genitals and of couples in actione coeundi.
The voluptuous day-dreamers, not needing material manipulation, may busy themselves with their favorite thoughts while seemingly conversing with their friends or on the most solemn occasions, as when listening to a sermon, etc. These erogenous thoughts, these libidinous images, these constant broodings on sex-matters create a habit which secures such a hold upon the individual that he cannot overcome it. The habit becomes so rooted in some instances that it is impossible for the patients to free their thoughts from fancies and pictures of lustful situations, while alone. Not even with the greatest efforts are they able to rid themselves from imagining erotic scenes of various kinds. Their minds are constantly preoccupied with a single engrossing subject to the exclusion of all other topics and are perpetually turned on sexual subjects, so that they are unable to concentrate their attention upon any other matters.
These perennial broodings on sex subjects keep the genital organs in a permanent state of sexual excitation and erethism. While in masturbation the material congestion of the generative organs is removed with each ejaculation, in mental erethism relief by ejaculation is missing. In the first stage of the vicious habit, the morbid mental lubricity and the lascivious unlicensed thoughts may occasionally provoke an ejaculation. But later on, when the genitals have undergone a certain weakness, ejaculation is not brought on any longer by these images, and the genital organs remain in a continual state of material congestion and nervous tension. In this way not only the colliculus and prostratic urethra, as in excesses of copulation and masturbation, but all the genital organs are in a state of chronic inflammation, which in time becomes the cause of impotence.
Tactile eroticism.—Worse than mental erethism is tactile eroticism. By tactile eroticism is understood, keeping the genital organs constantly irritated by dalliance with individuals of the other sex, stopping short of the act of copulation. On a walk through the city parks, any summer evening, or on a trip on the Sunday excursion boats, young men and women may be observed lying in each other’s arms in a continual caress, kissing, hugging, and fondling each other for hours, scarcely confining themselves within the limit of decency. These couples are actually exercising the sexual act, although they do not obtain sexual congress. These tremors and ecstasies, these amorous ardors and intoxications, these sensual joys which stimulate with rapture the higher centres and infuse the mind with sexual gratification, are all a part of the chain of the sexual act. The interruption of this chain of impulses short of copulation may satisfy the moral conscience of the young people, but it does not make such excesses less injurious. On the contrary, the generative organs are deprived of the relief which ejaculation lends to these organs. The genital tube remains surcharged with blood, and the hyperaemia subsides but slowly. The normal outlet of the sex-activity has been cut off by a special process of repression. If these frustrate stimulations are frequently repeated, they perpetuate the genital congestion, and through the retention of the secretions, a catarrh of the genital organs ensues, just as inflammations often originate in the mammary glands through the accumulation of the milk after weaning the child.
These perennial congestions are the cause of prostatic inflammations not seldom met with in young men who never were infected by gonorrhoea. The ulcerations of the cervix so often found in young girls and young mothers of one child may often be attributed to no other cause than to frustrate eroticism in the young girls and to onanismAT in the young mothers. The cervix is damaged in the same way as the soil, burned by the sun, in the absence of a beneficent rain, cracks and slits.
The frequently repeated engorgements of the blood vessels which do not receive the normal physiological relief by ejaculation provoke in both parties an exaggerated sex-sense and produce the emotions, known as satyriasis in men and as nymphomania in women. The exaggeration is followed later on by exhaustion of the libidinous impulses, and the men become hypochondriacs and impotent and women neurotic and shallow.
The continual congestion in the genitals causes also a continued feeling of heaviness and discomfort in the lower abdomen. Urination becomes frequent in both sexes, and in women menstruation is irregular. The patients complain of profuse pains in the back, legs, sides, and of weakness, nervousness and sleeplessness. These troubles cause general debility and a complete breakdown of the nervous system.
The generative centres are particularly damaged by the constant congestion of the genitals. The frequent stimuli keep the lumbar centres in a condition of constant irritation. The nervous system, presiding over the function of erection, thus becomes worn out and exhausted, and the nerves do not respond even to the strongest stimulations, which would otherwise set them in action. In this way, the centres get accustomed, so to say, of not responding any longer with erection to the proper stimuli, or in other words, the consensualism between the genital nerves and their centres is broken.
Hence, besides the harm done to the nerves by the general debility, there is great damage done to the genital nerves and centres by the break in the chain of the reflex mechanism. In no other sex-activity, except in actual copulation, are the generative organs in such a constant and intense excitement as in dalliance with individuals of the other sex, no other erotic stimuli create such libidinous turgescence of the organs and such a high degree of sex-tension, exciting with rapture the higher centres, no other excitations cause such a consumption of nerve power as this gratification of the impulse of contrectation by tactile manoevres. The erections of penis and clitoris are vigorous and violent. The organs are set in a state of expectancy for the final act. If the act is not terminated within a certain limited time, the state of expectancy cannot last for ever. The mode of action is limited in length of time. Except in the abnormal state, known as priapism, the duration of erection is relatively short in the normal individual. Its beginning is synchronous with the onset of the material congestion and nervous tension of the genital parts, and its subsidence should normally be synchronous with ejaculation. If the latter be prevented, erection has to cease sooner or later, even when congestion and tension remain unabated. Hence after long and lasting amorous caresses the erections fail.
If these manœuvres are often repeated, the excitations finally do not effect the proper response, and erection fails from the outset. The strong and continuous stimulations render the nerves and their centres inert in reaction and weak in power. The centres of erection and ejaculation become blunted, the inhibitory centres get very sensitive, and erection cannot be provoked. When the nerve centres presiding over the function of erection get into the habit of not responding to the highest excitations of the tactile stimuli, they do not respond even to the stimulations concarnationis. The cooperating nerve-apparatus has been affected, and a perverted innervation is created. The close interdependence of the mechanism of erection and the centres is removed, and an abnormal reflex-excitability is produced. The consensualism between the corpora cavernosa and the centre of erection is interrupted.
Before the indulgence in frustrate caresses has become a habit, i. e., in the beginning of the practice, erections are vigorous and of considerable duration. But the duration diminishes with each repetition. After a few months or years of these nerve-destroying practices, according to the patient’s nervous constitution, there is no response by erection even to the strongest stimuli. The consentaneous action, which, otherwise, connects the excitement of the organs with erection and completion of the act, does not take place. This lack of consensualism on the part of the several factors which go to make up the orgasm leads finally to complete impotence.
Continence, if long continued, has been claimed to be the cause of impotence. But there is no valid reason for this belief. To prove the harmfulness of continence, an analogue is brought forward between the atrophy of a muscle in enforced idleness and the injury to the sex organs in enforced abstinence. But the proof is somewhat feeble. The essential organs of generation are not muscles but glands, and who has ever heard of a tear gland atrophying for lack of crying. Furthermore, abstinence does not condemn the generative organs to absolute rest. Every individual, especially when abstinent, has frequently nocturnal erections through the entire period of his sexual activity, and there is no reason why such erections should not keep the genitals in the required exercise and should not prevent the alleged atrophy. As far as the exercise to prevent atrophy is concerned, nocturnal erections ought to be of the same service as erections followed by intromissions. The nocturnal erections seem to be even more harmless. The engorgement of the colliculus is less pronounced in these erections. Micturition, on awakening with an erection, is immediately possible, while there is a pronounced inability of micturition after an erection and ejaculation either through initu aut stupro manu.
The histories of patients are cited to prove the deleterious effects of total abstinence. Cases are known of alleged abstinent neurasthenics, on the point of a complete breakdown, who recovered perfect health after marriage. But even this proof cannot stand a closer scrutiny. Who can prove the total abstinence of these patients? The layman is prone to regard the actual intromission only as sexual activity. If he has abstained from this final phase, he considers himself abstinent. But chastity is not continence by any means. Absolute continence is abstinence not only from the gratification of the impulse of detumescence concarnatione, but also from that of contrectation, i. e., from mental and tactile caresses and from all other abnormal practices. We must distinguish between chastity and abstinence. Those who are chaste out of fear of venereal infection or for lack of opportunity are not always abstinent. They are just the individuals who are indulging immoderately in mental erethism or even masturbation.
The mere assertion of the patient that he never indulged in unnatural practices does not count. The patient’s veracity is very questionable. All venereal troubles seem to exert an inhibitory influence upon the truth-centres. The propensity of the masturbator to conceal the truth is notorious. If such a patient claims that he has never masturbated, it is likely that he is still practising it. A special psychical element, associated with this habit, prompts the majority of patients to gross and intemperate prevarication.
But even if such a “rara avis,” who has abstained from actual manusturpation, should exist, still mental erethism cannot entirely be excluded. The elicitation of a history of mental erethism is connected with great difficulty. Masturbation with these patients means only the indulgence in manual practices; the voluptuous day-dreams are considered of no account, and the peculiar type of mendacity prevents them from revealing the truth even to him, upon whom they called to consult.
Hence the loss of sexual power in these patients may not have been effected by continence but, on the contrary, by continual erethism. The examination of such patients really shows, as a rule, the prostatic urethra in a state, which is usually caused by prolonged erethism. After marriage, with its regulated sexual activity and the removal of the inclination to the wild erotic fancies, the neurasthenia is soon cured, not because the patient has given up abstinence, as interpreted by the anti-abstinence advocates, but, on the contrary, because he has now become real abstemious from the excesses of mental erethism. Hence the cure of neurasthenia by marriage is no proof against sexual abstinence. The patients who seek medical advice for their neurasthenic troubles may be those who have only abstained from coition but have freely and immoderately indulged in the unnatural modes of sensualism, whence their troubles originated. The real continent individuals who avoid any kind of erotic practices remain sound and healthy and do not require medical help. Their cases remain hence unknown to the profession.
If total abstainers from every kind of sexual erethism should sometimes become neurasthenic, this fact would not prove yet that the nervous trouble was caused by total abstinence from the gross sexual gratification. Even the man about town may become neurasthenic for lack of the gratification of the impulse of permanent mating. The apologists of promiscuous intercourse forget or are ignorant of the fact that the impulse of permanent mating in normal men and women cannot be satisfied by promiscuity. The craving for a permanent mate, home and family unconsciously demands gratification even from him who leads a promiscuous sexual life. If this impulse is not gratified, as in cranky old bachelors or hysterical old maids, it may lead to severe attacks of neurasthenia. Such cases will not be cured by the association with venal women or by promiscuous sensuality, but they may be cured by a permanent mate, home, and family life. Hence the cure of the total abstainer from his nervousness by marriage is again no proof against total abstinence. The cause of the trouble may have been the unsatisfied impulse of permanent mating which has been now satisfied by marriage. Promiscuous relations would not have cured the neurasthenia, but marriage with its accompanying emotional tones.
There is, therefore, no valid proof of the harmfulness of total abstinence in a healthy individual without a hereditary taint. If total abstinence ever harmed anybody, the patient was either a congenial weakling or has acquired his lack of resistance through indulgence in early eroticism. A perfectly healthy man is never injured by abstinence. At least there is no sufficient proof that it ever did. But there are unmistakable proofs that total abstinence does not harm the individual. The best proof is furnished by many chaste and healthy women. Few women seem to suffer from total abstinence. The rejoinder that woman’s sexual desires are very feeble, that the female sex has no sexual needs, that it is more or less frigid, are mere masculine assertions without objective proofs. Women writers, who ought to know best the feelings of their own sex, claim just the opposite. Johanna Elberskirchen (in Sexualempfindung bei Weib und Mann) has well satirized the masculine impertinence which tries to teach woman what her emotions are or are not. The fact that many a young woman runs the risk, in the present state of sex-morality, of ruining her entire future by the indulgence in extra-marital sexuality, under conditions where pecuniary or other considerations are entirely out of the question, would tend to show that the sexual impulse is by no means so weak in women, as many would lead us to believe. It is simply incomprehensible that the female sexual needs should be less urgent than those of the male sex. Woman has by far the greater part of labor in the sex-performance. With the ejaculation the man’s biological part is at an end. He may leave now the scene of his activity, while the woman’s part just begins and is continued through nine months of pregnancy and about a year of nursing of the new being. Dr. M. Glasgow, as a woman perfectly competent to judge, says (Review of Reviews, 1912, p. 319): “The strong sexuality displayed by a sex whose contribution to the germ of the race is discharged in a brief moment of enjoyment must be greatly less than exhibited by the other party, whose contribution is made through long months of patient endurance.” The prominent part woman takes in the propagation of the race forces to the logical conclusion that her erotic needs are of necessity stronger, although, as Ellen Key puts it, they may be calmer than that of man’s. Woman is able in a quite extraordinary way to produce the impression that she herself is really non-sexual and that her sexuality is only a concession to man. But the seeming reluctance of the female is intended to increase the sexual activity in both mates. The passivity of the female throughout nature is only apparent, it is the passivity of the magnet. As a matter of fact, women experience during the orgasm an ecstasy of feeling greater than in men, involving the whole system in an ecstatic nervous erethism.
Still the normal woman can stand absolute continued continence without any injury to her body and mind (e. g. nuns). Hence there is no reason why the human male, if left to himself, and nothing comes to disturb the natural course of his sexual development, should be harmed by abstinence. Until the impulse of permanent mating enters into play, and this comes relatively late in life, abstinence will harm neither men nor women, if they live in an atmosphere free from the influence of artificial stimulation.
If the animal kingdom could be taken as proof for or against total abstinence in man, we find that pet animals, as canary birds or dogs, who rarely have the opportunity to exercise their sexual powers, are generally as healthy and live as long as those living in freedom.
Hence the claim that abstinence is the cause of impotence has absolutely no ground to stand upon. If the young man kept his thoughts pure and avoided exciting amusements which create emotional disturbances, impotence would be an unusual occurrence. If the young woman would avoid puttering over her genitalia, pelvic obsession with its accompanied hysterical conditions of hyperesthetic or paresthetic erethism would be rarely met with.
The only cause for impotence remains sexual excesses. They are very seldom the immediate cause of the impotence. But they leave such weakness in the genital organs and in the nervous system that it requires only the least disturbance to provoke total impotence. Such disturbances, as remorse over the formerly committed irregularities, or distrust in one’s powers, or the mental attitude of the woman to whom sexual approaches are a matter of real or assumed indifference, are sufficient to render the weakened neurotic man total impotent.
Next to excesses, gonorrhoea, in a great many cases, leaves the genitals in a similar weakened condition. Gonorrhoea often causes acute inflammation of the prostatic urethra, and the mucous membrane not seldom undergoes the changes characteristic of chronic catarrh. The sensory nerves reflexly keep the centres for erection and ejaculation in a condition of hyperesthesia. This condition finally leads to the paralysis of the centres and nerves, and reflex-erection cannot be produced.
Psychic causes of impotence are mental fatigue, overwork, preoccupation with mathematical or financial problems, fear,AU anger, grief, and disgusting sights or odors. Prolonged excitement before attempting coition may also lead to temporary impotence.
The other causes of impotence are the symptomatic ones. Impotence is met with in tabes dorsalis, diabetes, nephritis, obesitas, oxalic diathesis, haemorrhoids, fissures of the anus, seat worms, etc. Excesses in the consumption of certain drugs may also lead to impotence. Such drugs are alcohol,AV morphine, cocaine, tobacco and the bromides.
Etiology of impotence in women.—The same causes, at work in producing impotence in men, are also affecting impotence in women. The only modification lies in the fact that impotence of copulation, which is the impotence par excellence in men, is of a negligible quantity in women. The main mode of impotence found in women is that of experiencing libido. This impotence may be either idiopathic or also caused by excesses as the impotence of copulation in men. Idiopathic impotence of libido is oftener met with in women than in men. Still even in women this insensibility is much rarer than is generally believed. The explanation for the greater frequency of impotence of libido in women than in men has first been given by Freud (Sig. Drei Abhandlungen über Sexualtheorie).
The autoerotic activity of the erogenous zones in children is the same in both sexes. It may be asserted, says Freud, that the sexuality of the little girl has entirely a male character. The chief erogenous zone in the female child is the clitoris which is homologous to the male penis. The frequent spontaneous discharges of sexual excitement in little girls manifest themselves in twitching and erections of the clitoris. But while in the male the erogenous zone remains the same after puberty as before, namely in the penis, puberty is distinguished in the girl by a wave of repression of the clitoris-sexuality and in the change of the erogenous zones. The rôle of the clitoris is henceforth to conduct the excitation to the adjacent parts. It often takes some time to affect this transference. During this time the young woman remains anaesthetic to stimulations of the internal organs as vagina or cervix. This anaesthesia may become permanent if the clitoris zone refuses to transfer its excitability. This anaesthesia in women is often only apparent and local. They are anaesthetic at the vagina and cervix, but not at all unexcitable through the clitoris or even through other erogenous zones, such as the lips or the nipples. The women are impotent of experiencing libido in coition but potent when the clitoris is excited by any other stimuli.
The refusal to transfer the clitoris sexuality is, as a rule, caused by an excessive irritation of the clitoris by manusturpation during childhood. The excesses which cause impotence of libido in women are the same which cause impotence of copulation in men, namely excesses in copulation, masturbation, mental erethism, and tactile eroticism. In women the excesses in copulation are more harmful than in men. While in men these excesses are self-limited by the impossibility of provoking any erections, after a certain time of continuous indulgence; in women there is no limitation to the practice. Playing the passive rôle, she can stand congressum continuum for a considerable length of time and tire out a number of men in succession. The vaginal pavement-epithelial lining is very strong.
sings Ovid in his “Ars Amandi.” Hence when a woman has any proclivity for excesses in initu, there is no natural limit to her indulgence. Through the influence of the frequent irritation in copulative excesses, the vaginal mucous membrane undergoes considerable changes. It becomes a veritable skin, a stiff parchment, and thus loses sensitiveness.
The other cause for impotence of libido are excesses in masturbation. The evil results of these practices in women are fully as great as in men, although with women it is the orgasm alone that does the damage, since there is no seminal discharge or loss of vital fluids. Through the frequent application of friction to the parts, they become first hypersensitive and later hyposensitive and non-responsive to normal excitations. Accustomed to excite the genitals by manual stimuli, which may be kept up for a considerable length of time, the masturbator is, later on, impotent to reach the acme through the normal, relatively short excitations, as they take place through the internal organic events in the genitals in normal sex-activity.
In women, the same as in men, the greater damage through excesses in masturbation is done by the greater frequency, because it requires no help, from an outsider, because it is not bound by time and locality, and may be practised by the undeveloped child, and last but not least, because of the constant conflict and struggle of the masturbator between the sensual impulse and the inability to desist and the feeling of womanly unworthiness, dissatisfaction and shame.
Excesses in mental erethism and excessive dalliance with members of the other sex have no less injurious effects in women than in men. In the long run these excesses cause in the woman a number of nervous troubles which take the form of hysteria or assume the character of neurasthenia. These excessive practices of erethism or tactile eroticism are, also in women, worse than excesses in copulation and masturbation, because the former do not lead to the orgasm and to the relief of the nervous tension and material congestion.
Another cause of impotence of libido in women is onanism or the practice of withdrawal. This coitus interruptus which rarely leads to orgasm in the woman, has the same effect upon her as excessive mental erethism or tactile eroticism, because it does not lead to relief from the nervous tension and the congestion. Excesses in onanism are, therefore, very harmful in women, while they are of lesser consequence in men. The repeated congestions of the parts in all these practices lead first to chronic hyperaemia and stasis, and in its further progress to chronic inflammations of the tissues, known under the respective names of metritis, perimetritis, parametritis, endometritis, salpingitis, and ovaritis. The inflammations constantly irritate the nerves and their centres and in this way blunt their normal sensibility. Besides the dulling of the nervous elements, these conditions give rise to great pain in commixtione, and pain and fear are the greatest enemies of libido.
Other causes of impotence of libido in women are excesses in alcohol, bromides, cocaine, morphine and other narcotics and stimulants. Sometimes impotence of libido is the result of a hard confinement. During such confinements extensive lesions in the erectile tissues of the bulbs and in the sphincter cunni muscles are apt to occur. Now, the integrity of the vaginal bulbs, of the sphincter cunni, of the intermediary net of vessels, and of the clitoris is necessary for the normal experiencing of libido. If a serious lesion occurs, the blood current is interrupted, and the blood is prevented from leaving the bulbs and from entering the corpora cavernosa of the clitoris. The following case will serve as an illustration:
The patient, twenty years of age, married twenty months, has a baby ten months old. She states that since her confinement she has no libido during coition. Before this event she always found perfect gratification. The examination shows a first-degree laceration of the perineum.
Absence or smallness of the clitoris and an adherent prepuce may also often diminish the feeling of libido.
Pathology of male impotence.—The minute penetration into the different causes of sexual anaesthesia in the preceding pages was of particular importance, in order to fully understand the pathology of the different kinds of impotence.
The accomplishment of the physiological act of copulation and impregnation requires from the man the possession, first of the desire to associate with the other sex, or of the instinct of voluptas,AW secondly the power of effecting intromission or the potency of erection, thirdly the potency of ejaculating a healthy sperma for impregnation, and finally it requires that libido or pleasure accompanies the emission to assure the repetition of the act.
From these requirements it follows that the individual must command over four potencies, the potency of voluptas, which compels the individual to seek the society of the other sex, the potentia coeundi, which depends upon strong normal erections, the potentia generandi, depending upon normal secreting testicles, and upon the perviousness of the entire seminal canal, from the testicle to the meatus of the urethra, and finally over the potency of libido, which depends upon the intact centripetal nerves and normal centres of generation in the brain. If any of these potencies are missing, the individual will be impotent. Hence four kinds of impotencies may be distinguished in both sexes:
(1) The impotence of voluptas, or the absence of sexual desire.
(2) The impotence of immission, or absence of the power of erection in men and the anomalies at the entrance into the vagina in women.
(3) The impotence of impregnation, or the absence of spermatozoa in men and of ova in women.
(4) The impotence of libido, or absence of the ability to experience pleasure at the moment of emission.
Impotence of voluptas.—The impotence of voluptas, or male frigidity, unassociated with the two other impotencies of copulation and impregnation, is very rare in men.
Physiological impotence of voluptas exists in childhood and in old age. In the latter period the desires disappear pari passu with the power. Although the feeling of desire is of purely mental origin, the generative organs playing only a secondary part, still when these organs are powerless or absent, the desire is generally also absent.
Impotence of voluptas is found in eunuchs and in castrates,AX who have been operated upon before puberty. Such castrates, even if the penis has not been removed, show not only impotentia coeundi, but also complete frigidity. Their habitus and feelings differ entirely from those of normal men. Castrates, who have been operated upon later in life, retain the habitus of normal men and also the impulse of contrectation. The potency of immission is even greatly enhanced, at least for the first few years after the operation. In normal men erection subsides immediately after the ejaculation. In eunuchs ejaculation does not take place. Hence the erections may last for hours or even days. In the course of time the potentia coeundi even of these castrates begins also to decrease and later on becomes entirely extinct.
Impotence of voluptas is also found in severe cases of neurasthenia, where the entire nervous system is in a low state of efficiency. The history of the following case may serve to illustrate the symptoms of the neurasthenic impotence of voluptas.
Mr. B., 35 years of age, unmarried, had gonorrhoea several times, never lues. Since puberty until about two years ago he was a typical rounder and had an abundance of femininity at his disposal. He is now suffering from general debility and shows all the symptoms of severe neurasthenia, as headaches, pains in the back and abdomen, dyspepsia, constipation, anorexia, insomnia, etc. In addition he has lost all desire for sexual gratification. While in the days of unimpaired vigor his sensual activities were of great frequency, several initus almost every day, at present the necessity for concarnatio is entirely lacking. When he does associate cum muliere, erection and ejaculation are perfectly normal, but the sense of libido is greatly diminished. Sese injungit nowadays only once every three to four months, out of curiosity to try his potency, but not because he feels any necessity for the same.
The case is thus one of pure male frigidity combined with a certain diminution of libido.
Male frigidity or impotence of voluptas is also found among psychopathics, as low idiots and cretins. These patients lack the understanding of the opposite sex. No mental excitations will, therefore, have any effect upon them.
Sexual perversion is another psychosis connected with impotency of voluptas to the opposite sex.
Impotence of voluptas is also often found in dementia. Sometimes impotence of voluptas is congenital with an individual otherwise normal. The impotence is then analogous to colorblindness. Such cases are exceedingly rare.
Impotence of libido.—Similar to impotence of voluptas is the impotence of libido. Here the desire is powerful, the erections are vigorous, yet ejaculation takes place without the usual accompanied libido. It is analogous to the loss or impairment of the sense of taste. Idiopathic impotence of libido in men is very rare. It is mostly found as a symptom of some other anomaly.
Impotence of libido exists in cases of loss of testicles, as in castrates and eunuchs.
As a rule, impotence of libido is met with in men who have severely over-taxed their brains and hence are less impressionable than when in a normal state of health. The impotency is an indication of an exhausted brain where the centres for experiencing libido reside.
Sometimes the centripetal nerves which serve for transmission of the pleasurable sensations to the centres have their impressionability obtunded by excesses in venere. When the nerves are deranged, the desire is strong, the erectile power is sufficient, the mind is in concurrence, emission occurs at the right moment, yet scarcely a vestige of pleasurable sensation is experienced during emission. The following case may serve as a proper illustration of the nature of this anomaly.
Mr. X., fifty years of age, was seduced to the practice of manusturpation when about thirteen years old. The exercises were carried out daily. After puberty, from about sixteen to nineteen years of age, he was given less to these practices, still once a week he could not resist of indulging in his favorite pastime. At this time he began to associate with meretricious women. This activity alternated with manusturpation until he was forty years old. There were periods of months or even years, while living in localities where the opportunity for normal sex activity was entirely lacking, when he took refuge to weekly practices of manusturpation. At the same time he indulged in excesses of mental erethism. His day-dreams on his long walks and in sleepless nights were filled with images, all taken from the realm of sex. Sometimes he also indulged in excesses of tactile eroticism (manibus ludere cum genitalibus mulierum). At the age of forty he married a very attractive young woman, and although he is greatly in love with his wife and two children, who arrived in the course of time, and is leading a regular sex-life, still the pleasure experienced at the ejaculation is practically nil. What induces him to still keep up his sexual activity is to please his young wife.
Here is a case where the three potencies of voluptas, copulation and procreation are perfectly intact, and where the patient is only suffering from the impotency of experiencing pleasure or libido during his sex-activity. In another case the impotency of libido is complete every time the patient practises coition, but is less pronounced when the act is repeated within an hour after the first exercise.
Mr. N., thirty-five years of age, a prominent lawyer, is suffering from a severe attack of neurasthenia for the last three years, the greater part of which he spent in sanitaria. As a boy he practised masturbation to some extent, but quite moderately. The symptoms are greatly pronounced in the morning, and are manifested by a general malaise, pressure in the head, bulging of the eyes, tremor of the hands, pressure in the rectum, in the prostatic region, and burning at the tip of the penis after urinating. The pressure in the rectum is relieved the day following coition, but returns in aggravated form on the second day. At the same time a mucus-like sediment appears in the urine which, on repeated examinations, showed to consist of oxalate of lime.
For the last few years, ejaculation, in concarnatione, takes place without any trace of libido. But if the act is repeated within an hour, the patient experiences some pleasure. For this reason the patient always exercebat concubitum bis in hora which served to aggravate his neurosis.
In some patients the libido is only diminished. In extreme narrowness of the prepuce the pleasure incident to sexual relation is slight. The author had only recently performed on a man, thirty-two years old, circumcision to cure this anomaly, although, it is said, that in persons who have been circumcized for ritual considerations, the libido is much slighter than in those not circumcized. In the latter, the covering of the glans is almost a mucous membrane and is very sensitive, while in circumcized people the covering of the glans is almost a veritable skin and has lost its finer sensibilities.
Impotence of procreation.—The type of impotence, most frequently met with but rarely complained of by men, is the impotence of propagation. Almost fifty per cent. of all cases of absolute sterility in married couples are caused by this anomaly in men.
Congenital and acquired deformities of the genitals may often cause impotence of procreation. All castrates, even those operated later in life, as the Skoptzies in Russia, are, of course, impotent for procreation, although if the penis has been left intact, they are very vigorous sexually, for a certain time, and are very salacious. Anorchismus, cryptorchismus, atrophy of the testicles, tumors of the testicles, compression by hydrocele, inflammation, ossification, tuberculosis, and cancer of the prostate may cause impotence of procreation without impairing the power of copulation.
Some epispadias and hypospadias may cause impotence of procreation. When the opening is very far back, the emission will take place outside of the vagina.
Aspermia, whether idiopathic or acquired, will always cause impotence of procreation. In the congenital form of aspermia all the genital organs seem to functionate normally, still no ejaculation takes place.
In the acquired form of aspermia both ejaculatory ducts are obliterated, as a rule, through suppurative prostatitis or tuberculosis of the prostatic gland. In both diseases the glandular tissue is frequently destroyed.
Aspermia may also be due to neurasthenia as the following case may show:
Mr. S., twenty-four years of age, has been treated about two years previously for nocturnal pollutions. They happened every night once or twice and weakened the patient in such a degree that he was unable to perform any kind of work. Electric treatment, hydrotherapeutics, and some medicinal tonics restored him to health. The pollutions happened once in three to four weeks only. A year later the patient called again, this time complaining of weakness in sexual power. After a few weeks’ treatment the improvement was such that the patient was lost sight of.
Six months later the patient returned with the complaint of suffering from aspermia and lack of orgasm. He is erotic, and he has strong vigorous erections, but no matter how long he remains in initu, ejaculation does not take place. The patient falls back from sheer exhaustion, sometimes mentulato membro, without being able to bring it to an ejaculation and orgasm.
In this case the aspermia is due to a certain nervous weakness of a neurasthenic nature. The patient has no strictures, and his testicles are intact.
Aspermia is sometimes found in strictures of the urethra.
In such cases the semen flows backward into the bladder.
In comparison with azoospermia, as a cause of impotence of procreation, all the other described anomalies are of a great rarity.
In azoospermia ejaculation and orgasm are perfectly normal, but the semen shows, under the microscope, the absence of spermatozoa. Azoospermia is sometimes temporarily found after excesses in initu aut stupro manu.