for the sake of matrimonial peace, simulation of libido and orgasm is a justifiable fraud. Even to resort to some lubricant to simulate the secretion from the Bartholinian and cervical glands is permissible. The man is easily deceived in this respect. He does not in any way feel the ejaculation of the woman. He only surmises her orgasm by her bearing during the culmination of the libido.AY The woman also does not feel immediately the male ejaculation, but she perceives it soon by the increase of moisture. Then the effect naturally increases the excitement, as the following case shows:

A young woman of twenty-two, who has practised stuprum manu from her early childhood, confided to the author that she derived more libidinem de stupro manu quam de initu. Yet, she added, after some abstinence from regular initus, although she is fully indulging in her favorite pastime, she has a veritable sitim seminis.

Patients afflicted with congenital impotence of libido are very seldom seen by the physician. They are not aware of their anomaly, and being otherwise normal and in full possession of the power of procreation, they never ask for treatment. The physician learns of such cases only by chance. It is different in acquired impotence of libido. Here the patient knows what she has lost, and the physician is often asked for advice and for a remedy. Hence the study of this anomaly is very important for the physician, although this impotence has not the same importance in women as it has in men, where it causes impotence of copulation and destroys the marriage relations of the couple.

Orgasmus retardatus.—The other grade in the impotence of libido is partial anaesthesia, in which the patient is able to experience the ant-orgastic pleasure, but cannot induce real orgasm. The intensity of the pleasurable feeling does not reach the sudden climax and does not diminish abruptly. The climax is never reached, and the ant-orgastic libido decreases gradually and slowly, it dies away. In idiopathic partial anaesthesia, where the anomaly is congenital, the patient has never experienced an orgasm, and hence is not aware of her anomaly.

It is different in the acquired form of partial anaesthesia or in the so-called orgasmus retardatus. The sexual excitement of the woman suffering from orgasmus retardatus is never abated, her libido is unimpeded, but the potency of experiencing orgasm is diminished or entirely absent. The following extracts of a letter from a patient suffering from a certain degree of orgasmus retardatus well illustrates the complaints of this class of patients:

I have been married over a year now, and have never experienced any satisfaction in initu. The glands seem to secrete the fluids, and the cupido congressus is there, but no satisfaction. I am always sleepless and nervous afterwards and sometimes suffer from headaches the following morning. I am at times bothered with leukorrhoea. When a child faciebam stuprum manu, but not since my sixteenth year of age, and I am at present twenty-five years old. I have never been pregnant.

The following case is extremely interesting, because the patient is able to induce orgasm only in one certain position. In all other positions she is impotent of experiencing libido. In March, 1908, the patient consulted the author about her anomaly. Being a highly educated woman (she was a school teacher before she married) she was asked to write in a letter the history of her case, and the following are the contents of her letter:

I am forty-one years of age, eleven years married, have two children, one ten, the other eight years old. I began to menstruate at the age of thirteen and was always regular, the menstruation lasting three to four days. The flow was always scanty.

As a child I was sad and dreamy. I can recall times when I would weep, I scarcely knew for what. When I was nearing puberty coepi me stuprare manu. No one taught me. I could not help it; I did not know what I did it for (I was reared on a farm). The method was sitting on a chair and moving to and fro. I must have continued till I was eighteen or nineteen years old. I stopped it long before I knew it was wrong, long before I have ever read it in books. No one told me it was wrong. I was a good girl in the eyes of every one.

At the age of twenty I went to college. I think the reason I stopped stuprum manu was that my mind was greatly engrossed in my studies. True, I often had the desire, but the association with the opposite sex would lessen it. I was fond of men in a silent way. I never, even though in their company, was familiar with them.

When twenty-three years of age I met one towards whom I was changed. I could not keep away from his presence. I remained a virgin till we married, when I was thirty years of age. I had known him seven years, but only saw him often, say three or four times a week, for the last two years. We spent only one or two evenings each week together. I allowed and deeply enjoyed all caresses, but they were not of the lewd fashion. I must have been excited sexually, for I would experience excessive humorem ut in initu.

At the age of forty-one, libidinem capio ex initu, yet experience no orgasm save in the position “vir infra,” and in this position very, very little sensation till the orgasm comes. I am fond of the concarnatio, but aside from the position just mentioned, I have not the least libido inter initum. It is a pleasure, you know, to give, but my own libido is wanting in any of these positions. My husband prefers alios positus to the one in which I have orgasm; præbente majorem libidinem.

Multum humesco in initu. Quamquam comisceor quot noctibus præferrem longum quam parvum temporis spatium concarnationi.

I am never ill, no aches or pains. The only premonition I have of the approach of the menses is a fulness and tenderness of the breasts. I menstruate very regularly.

Believe me when I say that once only in the seven years I knew the one I eventually married—I must have been twenty-three and a half years old, when I had spent hours in his company, with no more familiarity than a kiss at parting—I was so excited ut pulvillum premerem usque ad orgasmum. I could not have helped it, no matter what had occurred. Often I have been excited thus, but I never before or since did the same.

I never yielded to desire, though gently pressed to do so. Had I been urged beyond my power of endurance I cannot tell what I would have done. Yet I trust my virtue was due to a predominance of will-power and not a lack of passion.

I cannot say the lapse of years has changed my desires or lessened what I call my passions. I am affectionate by nature, but I trust my emotions are more than affection.

The patient makes these last remarks because she is unable to bring in accord her own feelings with the diagnosis frigidity,AZ received from several physicians whom she had consulted. She herself knows well that she is passionate enough to exclude any possibility of frigidity. Hers is a typical case of orgasmus retardatus of a slight degree (for, in the position “vir infra” orgasm is possible, for in this position coition lasts considerable longer), due probably to masturbation but mostly to the tactile eroticism, practised during the seven years of her engagement.

In pronounced orgasmus retardatus the sexual impulse is very vivid, but the patient can never find the acme of gratification in coition. It may often require hours concarnationis continuæ before the orgasm is induced, and sometimes it may never be experienced. While there is a strong desire and a theoretical ability to induce the orgasm,—the patients are able to experience the orgasm in all its intensity by masturbation—in practice it is seldom or never attained, because the male will always reach the acme of coition before the woman has arrived at this point. Her nervous system remains, therefore, excited to the highest pitch and brought to a state of expectancy which is not realized.

This lack of orgasm may also happen in normal women. The woman is generally slower to reach the height of the venereal paroxysm than the man. Ab initio commixtionis, she experiences a certain degree of libido that is of greater intensity than that of the man, i. e., the ant-orgastic libido is of higher value in women than in men. But this libido is not developed to its utmost extent, the orgasm, as rapidly as it is with the man. Still in the normal woman normal conditions will finally ensue after some experience—it is known that in women lustful feelings are not always brought about by the first contact,—while the conditions are entirely different in the partially impotent woman. No one man, except he be a eunuch, is ever able to satisfy her in a natural way. Her nervous system remains in a constant state of excitement to the highest degree, analogous to satyriasis in men. Her active potency appears to the superficial observer to be increased, it is almost inexhaustible. The following case will illustrate this point:

A young lady, twenty-one years of age, for six months pregnant with her first child, showed at the examination normal internal genital organs, but small nymphae and an undeveloped clitoris. The patient coepit stuprum manu facere, tres annos nata, femora commissa fricando ultro citroque aut pulvillum aut aliam rem inter ea. As far as she can remember she always felt humorem in genitalibus suis after such manipulations. She practised stuprum manu several times daily until her marriage. Her husband left her in the first months of her pregnancy and she began to indulge in her favorite practices. “In coitione usitata frictiones continuas poscit”, and can endure them for hours. She claims to have the feeling of becoming wet several times during the “copulatione longa et continua,” but the libido does not materially increase cum humorem sentiat. The intensity of the libido remains always the same. She is continually uttering endearing words to her mate and is begging him, ne patiatur ejaculationem cito venire. She remains excited “postquam frictiones cessaverunt” and is always showing her disappointment when the penis “retractus est.” After a little while, her excitement gradually subsides, and the patient falls asleep. When she awakes she immediately “coitionem iterum poscit.”

Here we have a case of a partially impotent woman whose anaesthesia and slight development of the clitoris was in all probability the result of her early practice of masturbation. The orgasm cannot be induced, but the ant-orgastic state is accompanied by libido of a considerable degree. The glands furnish enough secretion to give the feeling of moisture; there is no real ejaculation as in normal congressus.

While the totally anaesthetic woman has no natural desire for coition, and in this respect resembles the woman who is suffering from idiopathic frigidity or impotence of voluptas, the woman with the power of experiencing libido, but afflicted with the anomaly of orgasmus retardatus, has an intense desire for conjugation. She seeks it oftener than the normal woman, for the reason that her desire is seldom satisfied. She demands, therefore, commixtionem continuam per horas et pæne quot noctibus. Such a Messalina is able commisceri centies in una nocte and yet be unsatisfied. Even if she had it in her power, like Katherine of Russia, to order cubili suo a whole regiment of soldiers quot noctibus, she would still remain unsatisfied. This anomaly, for these reasons, may often be confounded with the perversion of nymphomania, where a normal orgasm is induced with every copulation, but where an immediate reawakening of desires, after normal satisfaction, takes place. Through the similarity of the symptoms of orgasmus retardatus and nymphomania great mistakes in treatment have often been committed. The wisdom of amputating the clitoris in a case of nymphomania is very questionable, but the advice to amputate it in a case of impossible or retarded orgasm and permanently damage the already weakened nerves is a mistake that borders almost to malpractice. For the amputation of the clitoris will impede the inducement of the orgasm even to a greater extent than before. The genital apparatus, which was weakened by excesses in venere or in narcotics, is now irreparably destroyed for all time.

The case of Barrus shows what clitoridectomy may sometimes do. The patient, a young woman, stuprum faciebat manu more or less, all her life, and finally after suffering from several attacks of nymphomania decided to have the clitoris amputated. The result was not only failure to relieve the alleged nymphomania, but even an increase in its severity, causing a shameless and, almost literally, continuous indulgence in the habit.

The cause of orgasmus retardatus is almost always self-abuse, either in form of masturbation, mental erethism, or tactile eroticism. The excitability of the clitoris is so increased through these practices that it refuses to transfer its excitability upon the internal genital organs for the inducement of orgasm by coition. The ant-orgastic pleasure is hence intact or even increased, but the orgasm is seldom or never provoked.

The unsatisfied intercourse will in the long run cause a number of nervous troubles which take the form of hysteria or assume the character of neurasthenia. The unsatisfied initus repeatedly practised, in not leading to the acme of libido and to the relief from the congestion by the ejaculation, is the cause of chronic hyperaemia and stasis. This leads, in its farther progress, to chronic inflammations of the tissues, which are known under the respective names of metritis, perimetritis, parametritis, endometritis, salpingitis and ovaritis. The labia are tumefied and dry, the meatus urinarius inflamed and the urethra pouted out. The clitoris is elongated, inflamed and often abraded. The external genitals are in a state of burning heat. The vaginal mucous membrane is hard and excoriated, the cervix is congested and the external orifice inflamed.

Apart from these pathological changes caused by the failure or the retarding of the orgasm, the anomaly is of grave social importance. The woman with whom orgasm is impossible generally repels her husband. Her nerves never being exhausted, as in the normal woman (it is little known that a woman is more affected and fatigued by a real orgasm than a man), spatium congressus may last as long as the vaginal epithelia can endure it, which means a considerable length of time. This is mistaken by the husband for increased potency. He believes her to be more potent than he is, and, in the long run, a man dislikes a lascivious woman. What he wishes is a modest woman who never asks for conjugal embrace when he is not disposed to it, and at times even knows gently and tactfully to refuse her favors when they are asked. Orgasmus retardatus is hence not simply a question for the physician; it is a matter of serious social importance.

The correct treatment for this anomaly is, in the first place, total abstinence from sexual excitement in any form, and then strengthening of the nerves by tonics, hydrotherapeutics and electricity by Apostoli’s method.

Orgasmus praecox.—The exact opposite to orgasmus retardatus is the anomaly of orgasmus praecox. In men, suffering from this anomaly where ejaculation occurs before the penis has time to enter the vagina, the precipitated orgasm has the same effect as the real impotence of concubitus. In women suffering from orgasmus praecox, the orgasmus is induced as soon as the mentula reaches the vestibule.

In some women the excitability of the genital nerves reaches such a degree that the mere touch of the gynaecologist’s finger during an examination will immediately induce orgasm. Since erection ceases in both sexes after the orgasm, this anomaly is of great importance in men, because the conjugal embrace cannot be consummated. In women, on the other hand, with their passive rôle during concarnatio, and with whom erection of the clitoris is not requisite for sexual congress, the act may be continued as in the normal woman. The anomaly is hence of less importance in women. Still it has some bearing upon the woman’s fecundity. In the ideal commixtione the female orgasm ought to take place immediately after that of the male, so that aspiration of some amounts of sperma could be effected. In the anomaly of orgasmus praecox the spermatozoa have to rely upon their own power of motion to reach the interior of the uterus. The anomaly may, therefore, sometimes lead to sterility. Otherwise medical aid is never sought for. The pathological condition is extremely rare, anyway.

In the same way the anomaly of a diminished frequency is of no importance to the physician when occurring in women. He may be asked for advice when it is met in men, for it may lead to some incongruities in the matrimonial life of the couple, especially when the wife is of a sensual nature. But a woman who is able even very rarely to experience orgasm will never seek the advice of her physician.