“I was once consulted by a very highly placed hetaira on account of supposed articular rheumatism. When I informed her of my diagnosis of lues, she was greatly moved, and said to me that I shouldnot therefore think the worse of her. She was better than her occupation; she had never followed it on account of evil passions; she was quite insensitive; she had done it only in order to provide for her parents freedom from care in the evening of their life, and to secure the future of her small child. She also told me on this occasion that she owed her success to her coldness,for which condition she was extremely thankful. She never gave herself for less than 1,000 marks (£50). At the same time, she made a mock of her colleagues—those stupid and wicked girls who frequently, when their heads were fired by champagne, would give themselves for nothing, and would even run after men.”
“I was once consulted by a very highly placed hetaira on account of supposed articular rheumatism. When I informed her of my diagnosis of lues, she was greatly moved, and said to me that I shouldnot therefore think the worse of her. She was better than her occupation; she had never followed it on account of evil passions; she was quite insensitive; she had done it only in order to provide for her parents freedom from care in the evening of their life, and to secure the future of her small child. She also told me on this occasion that she owed her success to her coldness,for which condition she was extremely thankful. She never gave herself for less than 1,000 marks (£50). At the same time, she made a mock of her colleagues—those stupid and wicked girls who frequently, when their heads were fired by champagne, would give themselves for nothing, and would even run after men.”
Otto Adler describes Madame de Warens, in Rousseau’s “Confessions,” as a type of such afemme de glace. Frigid women marry with comparatively greater frequency than women who are sexually very excitable, because their natural reserve endows them with greater value in the eyes of men, and also offers a certain security for their faithfulness. Such marriages are naturally in almost all cases unhappy, for the man soon grasps the true nature of the case, and since most will say with Ovid,odi concubitus qui non utrimque resolvunt, he seeks outside the house someresponsefor hislove.[436]In some cases, indeed, frigid women make a pretence of experiencing libido and the sexual orgasm, so that the man is deceived. In some cases, also, notwithstanding a manifest frigidity on the part of the wife, the marriage is none the less happy when the husband is partially or wholly impotent, and voluntarily renounces coitus. Such a case I myself recently observed.
“The case was that of a merchant, physically and bodily in excellent health, aged a little under forty years, who, since the eleventh year of his age down to the present time, has continued to masturbate (between the eleventh and eighteenth years of his life, twice daily). He has often had ejaculationwithouterection. When twenty years of age, he frequently attempted coitus, but could not obtain an erection. Generally speaking, he never had an erection when his attention was directed to the matter, but only without his co-operation, on other occasions than those of attempted sexual intercourse. Thus, until his engagement, in the thirtieth year of his age, he had never completed normal coitus, but had only obtained sexual gratification by means of masturbation, and therefore married with considerable hesitation, although during the eleven months of his engagement he had masturbated much less frequently. On the wedding-night, however, and later, itappearedthat his wife had anatural disinclination to coitus, wasextremely frigid, and only had traces of sexual sensation when, by means of onanistic stimulation on the partof her husband, her libido was slightly stimulated. Spontaneously she never felt any desire for sexual gratification, not even in consequence of masturbation. The two have lived for seven years inmost happymarried life, and love one another tenderly,withoutever having completed coitus. This deficient sensibility in the wife, and her failure to respond, have naturally not relieved the impotence of the husband, and he gratifies himself now, as before, by solitary masturbation.”
“The case was that of a merchant, physically and bodily in excellent health, aged a little under forty years, who, since the eleventh year of his age down to the present time, has continued to masturbate (between the eleventh and eighteenth years of his life, twice daily). He has often had ejaculationwithouterection. When twenty years of age, he frequently attempted coitus, but could not obtain an erection. Generally speaking, he never had an erection when his attention was directed to the matter, but only without his co-operation, on other occasions than those of attempted sexual intercourse. Thus, until his engagement, in the thirtieth year of his age, he had never completed normal coitus, but had only obtained sexual gratification by means of masturbation, and therefore married with considerable hesitation, although during the eleven months of his engagement he had masturbated much less frequently. On the wedding-night, however, and later, itappearedthat his wife had anatural disinclination to coitus, wasextremely frigid, and only had traces of sexual sensation when, by means of onanistic stimulation on the partof her husband, her libido was slightly stimulated. Spontaneously she never felt any desire for sexual gratification, not even in consequence of masturbation. The two have lived for seven years inmost happymarried life, and love one another tenderly,withoutever having completed coitus. This deficient sensibility in the wife, and her failure to respond, have naturally not relieved the impotence of the husband, and he gratifies himself now, as before, by solitary masturbation.”
This case proves that the capacity for love is to a certain extent independent of the strength of the libido; frigid men and women can be thoroughly “erotic”; that is to say, they can experience the need for tenderness, just as “erotomania”—that is to say, the excessive longing for love—is completely different in its nature from satyriasis and nymphomania (= excessive sexualdesire).[437]
Julius Pagel and other authors have recently drawn attention to the fact that the condition of “erotomania”—excessive amativeness—was fully described by the ancient and medieval physicians, who regarded it as a morbid state. He published (in theDeutsche Medizinal-Zeitung, 1892, p. 841) under the title, “A Historical Contribution to the Chapter of ‘Cures by Disgust,’” the translation of a passage from theLilium Medicinæof Bernhard von Gordon in Montpelier, a well-known and favourite compendium of the beginning of the fourteenth century, in which, following the example of Avicenna, theamor (h)ereoswas numbered among themelancholicæ passiones, and was considered to constitute a particular section of the group of diseases of the brain (see the edition of theLilium Medicinæ, p. 210 (Lyons, 1550)). It is, unfortunately, impossible here to deal at any length with the exceedingly instructive and remarkable contents. One of the methods of treatment was to find an old hag as hideous and repulsive as possible, who was to hold under the nose of the erotomaniac a chemise stained with menstrual blood, saying at the same time,talis est amica tua. We may remark, in passing, that this genuine medieval “cure by disgust” diverges, much to its disadvantage, from the manner in which in antiquity (three centuries before Christ) Erasistratos, the pupil of Aristotle, a celebrated physician of the Alexandrian school, cured the son of King Antiochus, who had fallen in love with his stepmother Stratonica. An account of the ancient therapeutic art is also to be found in another work by J. Pagel, “Introduction to the History of Medicine” (Berlin, 1898). In a comprehensivework, “The History of Love Considered as a Disease,” this topic has recently been considered by Hjalmar Crohns. Here we have a theme the literature of which is very extensive, and which might be suitably dealt with in a special treatise.
In the male, sexual frigidity in the majority of cases is associated with sexual weakness or with impotence—that is to say, with the impossibility of copulating or of procreation. The former variety of sexual incapacity (impotentia cœundi) is, properly speaking, peculiar to the male. The second form—true “sterility” (impotentia generandi)—occurs in women as well as in men.
In the case of male impotence, various symptoms, preliminary disturbances, and associated phenomena, make their appearance, and these we shall have to describe separately, since they often occur as independent disorders.
This is, above all, true of theoutflow of sexual secretions from the urethra,seminal losses(pollutions[438]andspermatorrhœa), and the evacuation of thesecretion of the prostate gland, the so-called “prostatorrhœa.” The literature of these conditions, which are partly physiological (as a proportion of pollutions) and partly morbid, is enormous. Of fundamental importance, notwithstanding the serious exaggerations of the author, is the celebrated work of Dr. M. Lallemand, “Involuntary Losses of Semen.” In recent times this important province of sexual pathology has been more especially advanced by the researches of leading German physicians, above all by those of Curschmann and Fürbringer.
The most important question with regard to seminal losses or pollutions in any case is this: have we to do with physiological processes, lying within the range of health, or have we to do with morbid processes?
As normal, not morbid, seminal losses Lallemand regarded pollutions inhealthy, sexually mature, continentindividuals, occurringspontaneously during sleep, associated witherectionof the penis and voluptuous sensations. He rightly regarded these as physiologically necessary, indicated their purpose to be thedischarge of sexual tension, the prevention of an excessive accumulation of the reproductive products, and compared their effect with that of hæmorrhages from the nose, which are so common in youth, and in most cases are distinctly beneficial. But he drew attention to theindeterminate, fluctuating boundary-linebetween normal and morbid pollutions. This latter point of view is dealt with also by Eulenburg (“Sexual Neurasthenia,” p. 171), in opposition to other authors who regarded all pollutions, even the physiological, as abnormal. In practice, however, it is generally not difficult to distinguish between physiological and morbid seminal losses. The former are characterized, not only by the distinctive signs already mentioned, but also by their occurrenceat longer intervals, and by theabsenceof any disadvantageous effect upon the general state of health. As soon as pollutions have such a deleterious influence they are morbid; and they are generally morbid when they occur abnormallyearly, before puberty, with abnormalfrequency, at abnormaltimes of the day, and in association with abnormalconditions of the genital organs. According to Fürbringer, the normal intervals between pollutions in the case of continent youths vary between ten and thirty days. Löwenfeld considers pollutions occurring once a week, and even the transient occurrence of pollutions on several successive nights, as a result of sexual excitement, as being still within normal bounds. But if these repeated pollutions within a single week, or even within a single day, continuefor a long time, we are always concerned with morbid pollutions. These sometimes occur not only at night, but also—a fact to which the German physician Wichmann, in his dissertationDe Pollutione Diurna(Göttingen, 1782), drew attention—they occurby day(“diurnal pollutions”), in the waking state, without masturbation or coitus, upon slight mechanical or physical stimulation. In such cases erection of the penis is often completelywanting; ejaculation of the semen takes place with the organ flaccid, and even without any voluptuous sensation. In many cases, indeed, these pollutions are accompanied by actualpainfulsensations in the genital organs, and instead of voluptuous dreams or thoughts, the nocturnal ejaculation is accompanied by anxious dreams, the daylight pollution by an extremely disagreeable sensation. Commonly in these pollutions ordinary semen is at first evacuated—a mixture of the secretions of the testicles, the prostate, the vesiculæ seminales, and Cowper’s glands—containing numerousspermatozoa. After the trouble has lasted a long time thesemen becomes thinner (owing to its containing a smaller proportion of the thick testicular secretion) and more transparent; the spermatozoa are less numerous and mostly undeveloped, and ultimately they may be completely absent. Löwenfeld observed a peculiar form of pollution in which the semen was ejaculated only in drops, or might becompletely wanting—that is to say, there might be a pollutionwithoutejaculation, purely a voluptuousorgasm.[439]
In such cases Löwenfeld was able to prove that it is not the loss of semen which weakens, as Lallemand assumed, but that it is thenervous disturbanceof the lumbar spinal cord which plays the principal part. This irritable weakness of the lumbar spinal cord may have existed for a long time before, or may have developed only as the result of repeated pollutions or of excessive sexual excitement; it may give rise, not only to proper seminal emissions, but, in addition, to “spermatorrhœa”—that is to say, to theoutflow of semen accompanying urination or defecation; and it may also cause the rarer “prostatorrhœa”—the outflow of the secretion of the prostate gland. A long duration of all these morbid discharges has a serious effect on the health, and induces the typical picture of sexual neurasthenia. As acauseof seminal losses we must mention masturbation, excessive sexual intercourse, chronic inflammation of the urethra (especially aftergonorrhœa), stricture of the urethra, rectal affections, alcoholism, diabetes, and tabes dorsalis.
Inwomen, also,processes analogous to pollutionmay be observed, although much more rarely than in men, and generally as a consequence of masturbation practised for several years. According to Adler (op. cit., p. 130), pollutions—that is to say, evacuations of the secretion of the vaginal glands and of the uterine mucous membrane, as well as of the secretion of Bartholin’s glands near the vaginal inlet—never occur in chaste and intact virgins, but only in women who have already learned the enjoyment of sexual intercourse, and who are subsequently compelled to lead a continent life. For this reason pollutions are a “trouble of young widows,” and occur in young girls only when they have learned to know the nature of sexual pleasure by means of masturbation. Eulenburg remarks (“Sexual Neurasthenia,” p. 174):
“In connexion with lascivious dreams there occur spontaneous, more or less abundant, discharges of the clear muco-gelatinous secretion of the glands. These form a striking manifestation of sexualneurasthenia in women, and can be compared with the morbid pollutions occurring in similar circumstances in male neurasthenics. We hear less about them, however, and they are insufficiently known, even by medical men. For this reason especially, when they occur in association with physical virginity and a normal genital condition in other respects, they do not usually receive sufficient attention.”
“In connexion with lascivious dreams there occur spontaneous, more or less abundant, discharges of the clear muco-gelatinous secretion of the glands. These form a striking manifestation of sexualneurasthenia in women, and can be compared with the morbid pollutions occurring in similar circumstances in male neurasthenics. We hear less about them, however, and they are insufficiently known, even by medical men. For this reason especially, when they occur in association with physical virginity and a normal genital condition in other respects, they do not usually receive sufficient attention.”
The older physicians, especially those of the eighteenthcentury,[440]described these pollutions in women very well and thoroughly; in erotic and pornographic literature they have always played a great part. An interesting observation on peculiar processes analogous to pollutions is reported by PaulBernhardt.[441]A hysterical sempstress, twenty-five years of age, as the result of any kind ofannoyance, experienced sexual excitement completely resembling the sensation of sexual intercourse, and ending with a discharge of mucus. This was, however, never accompanied by any trace of voluptuous sensation; on the contrary, it gave rise to lumbar pains. Also, when she dreamed of anythingdisagreeableor hadnightmare, this condition recurred. Erotically the patient is very indifferent, and denies the practice of masturbation.
To the category suggested by P. Bernhardt of sexual excitement induced by anxiety and trouble belongs the case reported to me by Dr. Emil Bock of a boy of fifteen years of age, who, when very anxious about his inability to complete a school task, experienced an ejaculation for the first time. To the literature of impotence belongs the work by Nicolo Barrucco, “Sexual Neurasthenia, and its Relations to the Diseases of the Genital Organs.” Regarding physiological pollutions, and the trifling difference between them and normal seminal discharge during coitus, Schopenhauer makes some apt observations in his “Neue Paralipomena,” pp. 230, 231.
In thetreatmentof pollutions, which always demands the most careful medical observation and examination of the individual case, the most important measures aredietetic and hygienictreatment,change of scenefrom town tocountry, and especially tomountain air, methodicalhydrotherapeutic measures,warm baths,massage,electricity,hyperalimentation, the use ofbromides,local treatment of the urethra, etc., etc.
The last and most important of the phenomena connected with sexual neurasthenia issexual weaknessorimpotencein its variousforms.[442]
We distinguish in the maletwo principal formsof impotence: (1) “Impotentia coeundi”—that is, incapacity for erection of the penis and the completion of coitus; (2) “impotentia generandi”—that is, the impossibility of fertilization (owing to want of semen or to the lack of fertilizing quality in this fluid).
Congenital malformations of the genital organs giving rise to impotence are extremely rare. Gyurkovechky, amongst 6,000 men fit for military service, found three such men only. More frequently areacquireddefects met with as causes of impotence, such as complete or partial loss of the penis and testicles, as in eunuchs and castrated persons. It is well known that, notwithstanding the removal of the external genital organs, sexual desire may persist; and when the penis is retained, though the testicles have been removed, erection and copulation are possible, providing the castration was effected after puberty. But it is obvious that in most cases potency is very markedly interfered with, and ultimately it may entirely disappear. More light is thrown on the question by the occurrence of impotence afterunilateralcastration. A tragical case of this latter kind is reported by von Gyurkovechky (op. cit., p. 71):
“A former colleague of mine at the University of Vienna had to have one of his testicles removed in consequence of obstinate inflammation resulting from gonorrhœa; thereafter the second testicle underwent complete atrophy. The much-to-be-pitied, handsome, elegant, and amiable young man remained for some years capable of performing coitus, was greatly pleased with himself for this reason, and paid ostentatious court to ladies. Still, he was seldom in a position to perform coitus, and after three years he completely withdrew himself from the society of ladies, and became gradually moroseand reserved, until one day he disappeared from Vienna, discontinued his studies, and never let any of us hear from him again. This case has remained very vividly in my memory, and it illustrates most clearly the influence of virile potency upon the entire being of the individual.”
“A former colleague of mine at the University of Vienna had to have one of his testicles removed in consequence of obstinate inflammation resulting from gonorrhœa; thereafter the second testicle underwent complete atrophy. The much-to-be-pitied, handsome, elegant, and amiable young man remained for some years capable of performing coitus, was greatly pleased with himself for this reason, and paid ostentatious court to ladies. Still, he was seldom in a position to perform coitus, and after three years he completely withdrew himself from the society of ladies, and became gradually moroseand reserved, until one day he disappeared from Vienna, discontinued his studies, and never let any of us hear from him again. This case has remained very vividly in my memory, and it illustrates most clearly the influence of virile potency upon the entire being of the individual.”
If the second testicle remains intact, the capacity for sexual intercourse is not interfered with; and reproductive capacity also persists, although it may be diminished in degree.
An important source of sterility in the male, in which the capacity for sexual intercourse remains unimpaired, isbilateral epididymitis, consequent upongonorrhœa. This represents more than 50 % of all the cases of incapacity for procreation in the male. Finger found in 85 % of cases of epididymitis that thespermatozoa were absent from the semen(the so-called “azoospermia”); and Fürbringer is led by his own experience to believe that 80 % of men who have had double epididymitis are incapable of procreation. Thus we may really speak of “gonorrhœal sterility in the male.” In many sterile marriages the fault lies with the husband, as was first clearly proved by F. Kehrer’s fundamental investigations. And the no less momentous gonorrhœal sterility in women is also, in the majority of cases, ultimately dependent upon the husband, who has presented his wife with “gonorrhœal infection as a weddinggift.”[443]
An extremelysmall sizeof the penis, also arelatively small sizeof this organ in cases of obesity and tumours,malformationsof the penis, also the by no means rare mechanical hindrances to erections due to injuries and indurations in the corpora cavernosa (especially as a result of gonorrhœal inflammation)—all these may make coitus impossible. Fürbringer and Finger have also seen peculiar chronic shrinking processes of the corpora cavernosa occur independently of gonorrhœa and tumours. All these conditions give rise toincompleteerection, in which the penis is bent at an angle at some point or other, or is curved, so that it cannot be introduced into the vagina (chordee).
All the hitherto described forms of impotentia coeundi are less frequent than thosein which the external genital organs are completely intact, and in which we have to do simply withimperfectionorcomplete failure of erectionin consequence of variousgeneral disorders.
Erection of the penis is induced bothcentrallyfrom the brain (by voluptuous ideas), and from the spinal cord (by directstimulation), and alsoperipherallyfrom the genital organs (by friction of the glans penis), by stimuli proceeding from the urethra, bladder, prostate, seminal vesicles, rectum, and the neighbourhood of the genital organs (as, for example, the buttocks), and may be either of a morbid or of a physiological character. When there are inflammatory conditions of the genital organs, especially gonorrhœa of the anterior and posterior urethra, erections occur very readily. From the full bladder there also proceed stimuli giving rise to erection, thus inducing the well-known “morning erection,” utilized by many who would otherwise be completely impotent. Blows on the buttocks also give rise to erections—a subject to which we shall return when we come to discuss flagellation.
Thenatureof erection can be very briefly described as consisting in a stiffening of the penis by the profusestreaming of bloodinto thereticular spacesof thecorpora cavernosa, enlarged bystimulationof theerection nerves. The consequent erection of the penis is dependent upon the action of a particular muscle—the ischio-cavernosus muscle.
Impotence when the external organs are intact is in most cases due to central causes, and ultimately to psychical causes, even though severe bodily affections or local morbid states play a predisposing part (the so-called “functional impotence”).
This impotence is sometimes one of theearliestsymptoms ofdiabetes mellitusand ofchronic Bright’s disease with contracted kidney, also ofsevere conditions of exhaustion—to which consumption offers a significant exception, signalized already by the old saying,phthisicus salax—ofobesity, and oftabes dorsalis, in which the sexual potency gradually disappears, but libido outlasts the capacity for erection. Certainpoisonsalso particularly damage potency. This is especially the case withalcohol, the deleterious influence of which on potency has already been described (pp. 293,294). Georg Hirth goes so far as to recognize a special “impotentia alcoholica.”
“Above all, no alcohol,” says he, “especially not as a means for producing erection. In youth a man needs no such stimulus, and in age he will be apt to find, with the porter in Shakespeare’s ‘Macbeth’ (Act ii., Scene 3), that ‘drink may be said to be an equivocator with lechery,’ for, as he says, ‘it provokes the desire, but it takes away the performance; it makes lechery, and it mars him; it sets him on and takes him off; it persuades him and disheartens him; makes him stand to and not stand to: in conclusion, equivocates him into sleep, and, giving him the lie, leaveshim.’”[444]
“Above all, no alcohol,” says he, “especially not as a means for producing erection. In youth a man needs no such stimulus, and in age he will be apt to find, with the porter in Shakespeare’s ‘Macbeth’ (Act ii., Scene 3), that ‘drink may be said to be an equivocator with lechery,’ for, as he says, ‘it provokes the desire, but it takes away the performance; it makes lechery, and it mars him; it sets him on and takes him off; it persuades him and disheartens him; makes him stand to and not stand to: in conclusion, equivocates him into sleep, and, giving him the lie, leaveshim.’”[444]
Fürbringer’s view, that alcohol, taken up to the degree of slight intoxication, rather increases potency, in connexion with which he refers to sexual invalids who are only able to perform sexual intercourse in a state of moderate intoxication, cannot be regarded as generally true. It is possible that in these admitted sexual invalids alcoholic intoxication overcomesstronger psychical inhibitions, which in the state of sobriety had hindered erection. For the normal individual alcohol is not a means for the increase of sexual potency, but the reverse.
The free use of tobaccocertainly also impairs sexualpotency.[445]Nicotine and love are as little compatible as alcohol and love. Fürbringer, Hirth, and Eulenburg, ascribe to the excessive use of tobacco a diminution in sexual potency. The following interesting passage is from the Diary of the De Goncourts (op. cit., p. 89):
“There is an antagonism between tobacco and women. The taste for one diminishes the taste for the other. So true is this, that passionate Lotharios usually give up smoking,because they feel or believe that tobacco diminishes their sexual appetite and their powers of love.”
“There is an antagonism between tobacco and women. The taste for one diminishes the taste for the other. So true is this, that passionate Lotharios usually give up smoking,because they feel or believe that tobacco diminishes their sexual appetite and their powers of love.”
Coffeeandtea, taken in excess, and, above all,morphine, are also antagonistic to potency. Dupuy has observed the frequent occurrence of impotence in men who were in the habit of drinking large quantities of strong coffee (five or six breakfast-cups every day). Sexual potency returned as soon as the use of coffee was discontinued; whilst when the use of the beverage was resumed the impotence again appeared (Comptes Rendus de la Société de Biologie, 1886, No. 27).
The majority of cases of functional disturbances of potency depend upon nervous impotence. It is the form which at the present day the physician most frequently encounters. It is intimately connected with the state of “irritable nervous weakness,” or sexual neurasthenia, the most important symptom of which is represented by “psychical” impotence. There exist, also—and this justifies the independent consideration of psychical impotence—numerous cases of impotencewithoutneurasthenia (Fürbringer). This remarkable form occurs especially in perfectlyhealthyyounghusbands, who often before were completely potent, and had previously effected coitus in a perfectly normalmanner, or had lived a quiet, continent life, without having injured themselves in any way by masturbation. Such individuals, in consequence of the excitement, shame, and embarrassment of the wedding-night, often suffer from psychical impotence.Réti[446]speaks of “impotence due to compassion,” arising from “the sympathy felt with the pains suffered by the still virgin wife” when the attempt at coitus is made.
“The young married pair kiss one another and vie with one another in tenderness, but when the matter becomes serious—when the husband wants to enjoy his rights as a husband—the wife experiences incredible anxiety; she trembles in all her limbs, writhes, screams, and weeps. The man becomes exhausted, and at length, when the wife is resigned, and willing to surrender herself to her fate, he has become unfitted for his share in intercourse.”
“The young married pair kiss one another and vie with one another in tenderness, but when the matter becomes serious—when the husband wants to enjoy his rights as a husband—the wife experiences incredible anxiety; she trembles in all her limbs, writhes, screams, and weeps. The man becomes exhausted, and at length, when the wife is resigned, and willing to surrender herself to her fate, he has become unfitted for his share in intercourse.”
It is clear that these forms of psychical impotence, which appear in very various shades, are mostly transient phenomena, and exhibit a good prospect of complete cure.
Much more difficult is the matter when we have to do with cases, becoming commoner every day, of psychical impotence in consequence ofsexual perversions. Sadistic, masochistic, fetichistic, and homosexual inclinations may, in certain individuals, predominate to such an extent that either copulation cannot be effected without thepreliminarygratification of these perverse instincts, or else the latterentirely usurp the placeof normal coitus, which has become, generally speaking, quite impossible (relative and absolute psychical impotence in consequence of sexual perversions). To the former category belong, for example, those cases, which are by no means rarely seen, in which homosexual persons are only able to have intercourse with their wives after preliminary caresses by their male friends; or masochists must be subjected to a preparatory flagellation in order to become potent. In the second category copulation has become quite impossible; the orgasm takes place only in connexion with the activity of the perverse impulse, and there often exists an actual repugnance to normal coitus.
Well known also is that rare relative psychical impotence in which the man can perform coitus only withprostitutes, whereas he is impotent as regards decent women. This, however, may often be associated with the existence of sexual perversions, which are gratified only during intercourse with prostitutes.
Another form of relative psychical impotence istemporaryimpotence, in which the potency is entirely subject tocustom,and a change in the custom induces impotence. Thus, Frenzel reports the case of a man who had always had intercourse with his wife immediately on going to bed, and proved completely impotent when this habit was interrupted, and he now wished to perform the act early in the morning. Only gradually did he recover his lost potency and become able to adapt himself to the changedconditions.[447]
Another form of impotence by no means rare, and occurring in otherwise healthy men, is that produced by powerfulmentalactivity orartisticproduction, the impotence of literary men and of artists. It is usually of a transientnature,[448]manifesting itself only during the periods of intellectual activity, and it is explicable in accordance with the law of sexual equivalents, according to which the sexual potency appears in the latent form of spiritual productive activity. A remarkable case of this impotence of literary men is reported by the just quotedFrenzel.[449]Allied with this variety of impotence is the form due to transientmental distraction, toinstantaneous ideas, which suddenly act as psychical inhibitions. These sudden ideas can be of a very varied content—joyful, sad, anxious, annoying; in every case they are capable of annulling thealready existing potency, and of making the further erection of the penis impossible. Such conditions occur alike in healthy persons and in those who are readily excitable and neurasthenic. A classical instance of this nature is J. J. Rousseau’s adventure with the Venetian courtesan Giulietta, which he describes very vividly in his “Confession.” He went to see her full of passionate desire for sexual enjoyment, but Nature “had put into his head a poison against this unspeakable happiness” for which his heart yearned. Hardly had he glanced at the beautiful girl than an idea came to him which moved him to tears, and completely diverted him from his purpose. He became more deeply absorbed in this idea, the sexual desires completely disappeared, and he was no longer in a position to prove his manhood. To this tragi-comic episode we owe the exclamation of the disappointed girl, which has passed into a proverb: “Lascia le donne e studia la matematica” (“Leave women alone, and go and study mathematics”). In thereflective loveof Kierkegaard, Grillparzer, Alfred de Musset, and other men of remarkable genius, there is also recognizable an element of impotence.
The majority of all cases of impotence belong to the class of truenervous, neurasthenicimpotence, and these are diffused especially among the circles who supply the greatest contingent to the ranks of neurasthenics in general—that is, among officers, merchants, physicians, and other classes of the cultured part of our population whose professional duties are arduous. Among the causes of neurasthenic impotence, excessive masturbation and chronic gonorrhœa, with its consequences, play the principal part. Neurasthenic impotence manifests itself, above all, by abnormal conditions of erection and ejaculation, either of which may by itself be diminished or completely prevented; or, again, both may exhibit abnormalities, whilst in some cases even erection may bevery frequent,unusually powerful, andlong-lasting(the so-called “priapism”), whilst ejaculation and voluptuous sensation are completely wanting, and these erections are in most cases accompanied by verypainfulsensations. An extremely characteristic symptom of nervous impotence is apremature discharge of the semen, not merelyante portas, but often even at the first signs of activity of the libido sexualis, at which time erection may be very well developed. In other cases, again, erection occurs, but no ejaculation of the semen. Finally, both may be completely wanting (the so-called “paralytic impotence”).
The following cases, which came under my own observation, show some of the above-mentioned types of impotence:
1. A man, twenty-nine years of age, married for ten months, complains, after obviously excessively frequent enjoyment of his conjugal rights, of a sense of weakness and weariness after intercourse, such as he has never previously experienced, as well as of a continually earlier ejaculation, latterly even on simple contact of his penis with the vulva. Erection is always present and is powerful. On further inquiry he admitted that in his four-weeks’ honeymoon he had connexion once daily, and thenceforward two or three times a week.2. A man, twenty-one years of age, states that a year and a half ago for the first time he endeavoured to have sexual intercourse; he has never yet succeeded in completing coitus. Since the age of fourteen years he has suffered from frequent pollutions and from marked sexual excitability. He has often tried to effect coitus, but there has always resulted precipitate ejaculation, with his penis in a flaccid condition. He has, properly speaking, only morning erections, dependent upon a full bladder. It is possible that a marked varicocele on the left side has something to do with the genesis of this impotence.3. A man, forty-eight years of age, has noticed for some years a distinct decline in sexual potency. Ejaculation always occurs shortly beforeimmissio membri, when the penis is flaccid or only semi-erect. If erection is complete, on the other hand, then ejaculation fails to occur.
1. A man, twenty-nine years of age, married for ten months, complains, after obviously excessively frequent enjoyment of his conjugal rights, of a sense of weakness and weariness after intercourse, such as he has never previously experienced, as well as of a continually earlier ejaculation, latterly even on simple contact of his penis with the vulva. Erection is always present and is powerful. On further inquiry he admitted that in his four-weeks’ honeymoon he had connexion once daily, and thenceforward two or three times a week.
2. A man, twenty-one years of age, states that a year and a half ago for the first time he endeavoured to have sexual intercourse; he has never yet succeeded in completing coitus. Since the age of fourteen years he has suffered from frequent pollutions and from marked sexual excitability. He has often tried to effect coitus, but there has always resulted precipitate ejaculation, with his penis in a flaccid condition. He has, properly speaking, only morning erections, dependent upon a full bladder. It is possible that a marked varicocele on the left side has something to do with the genesis of this impotence.
3. A man, forty-eight years of age, has noticed for some years a distinct decline in sexual potency. Ejaculation always occurs shortly beforeimmissio membri, when the penis is flaccid or only semi-erect. If erection is complete, on the other hand, then ejaculation fails to occur.
Very peculiar, and offering a kind of analogy to vaginismus in women, is impotence consequent uponexcessively painful sensibility of the glans penis, as a result of sexual neurasthenia or of local inflammatory processes (balanitis, etc.). The pains during coitus in these cases are often so severe that those thus affected completely abandon any attempt at intercourse.
The questionwhether impotence can result from sexual abstinenceis still disputed. Fürbringer does not know of any certain cases. According toVirey,[450]by “complete and continuous abstinence from intercourse” in the male the organs by which the semen is prepared—the testicles, the seminal vesicles, and the vasa deferentia—and also the penis, become smaller, “unsightly, wrinkled, and inactive.” Galen reports the same of the athletes of the Roman Empire, men who had to live a life of strict continence. Virey alludes to an “extremely chaste saint, in whom after death no trace of genital organs could be discovered” (!). That absolute abstinence must ultimately limit potency, if only by psychical means, isa prioriprobable.
Recent observations confirm the view that long-continued absolute sexual abstinence exercises a harmful influence upon potency, and especially upon potentia coeundi. As a proof of this, I may more especially mention two cases of University professors, not yet thirty years of age, both of whom until a little while ago had had no experience of sexual intercourse, one having remained continent during two years of married life! Quite recently both of them repeatedly attempted normal coitus, but with complete failurequoad erectionem. VonSchrenck-Notzing[451]also reported a case of this character not long ago, in which, notwithstanding the strong desire for normal sexual intercourse, in the case of a literary man thirty-five years of age, who prior to marriage had lived a life ofcomplete abstinence, and had never practised masturbation, every attempt at coitus proved a failure.
Finally, we have to consider the more or less physiologicalpresenile and senile impotencewhich accompanies the commencement of old age, but naturally occurs at very different times in different individuals, for some men are already old at the age of forty years, and others are not yet old at the age of seventy years. Von Gyurkovechky dates the first decline in the sexual powers from the fortieth year of life, and considers that normally these powers are completely extinguished at aboutsixty-five years. But there are numerous exceptions. Complete potency in respect of libido, erection, and ejaculation has been observed in men of seventy and eighty years; and isolated cases have even been recorded in which men of ninety and one hundred years have procreatedchildren.[452]In the sense of Metchnikoff and Hirth, who in their writings proclaim the prevention of senility as a hygienic ideal, this physiologicalpotentia senilisis no Utopia, and a future scientific macrobiotic will defer the onset of old age by from ten to twenty years.
“I do not ask,” says Georg Hirth, “that the man in advanced age should play with his sexual powers; but that he should possessthe consciousness of being able to use them—that I do demand” (“Ways to Love,” p. 462).
“I do not ask,” says Georg Hirth, “that the man in advanced age should play with his sexual powers; but that he should possessthe consciousness of being able to use them—that I do demand” (“Ways to Love,” p. 462).
The treatment of impotence in the male in its various forms is indeed a difficult matter in individual cases, more especially in view of the great number of existing methods of treatment; but treatment promises good results when it is based upon an exact, critical, individual analysis of the separate causes and symptoms. It is partlylocaland partlygeneral. In the case of impotence resulting from excessive masturbation, or in the case of the well-known “gonorrhœal” impotence, good results will be obtained fromslight cauterization of the urethraandmassage of the prostate,local carbonic-acid douchesor carbonic-acid baths,warm or cold sitz-baths, or electrical treatment, with which, however, great care must be exercised. In some cases imperfect erection will be benefited by the application of a 10 %ethereal solution of camphor, in the form of friction or a spray, to the entire genital region. Mechanical apparatus have also been employed to favour erection, as, for example, the so-called “schlitten,” consisting of a conducting instrument for an insufficiently erect penis, made up of two thin, suitably shaped laminæ of metal, or the “erector” of Gassen, which works in a similar manner. Apparatus of this nature are useful only to this extent, that they give the penis a certain purchase. We cannot allow that they possess any other effect, any more than Gassen’s other apparatus, the “compressor,” the “cumulator,” and the “ultimo” (Löwenfeld, Fürbringer). Any local changes that can be detected as having some connexion with the occurrence of impotence must receive attention. This is obvious; andno less obvious is the treatment of any general disorders which may give rise to the impotence. As regards the general treatment of impotence,psychicalinfluence must first be considered.In most casesthis must take the form of temporary withdrawal of the thoughts from the sexual sphere in general, for which the strict prohibition of sexual activity (masturbation, etc.) forms the foundation; in addition,willandself-confidencemust be strengthened. In these matters an intelligent wife can do much to supplement the work of the physician. Sometimes a merechangein the mode of life or in the relations between husband and wife, above all, a change in the mode of performing sexual intercourse (a change in posture, greater responsiveness on the part of the wife, etc.), may have a manifest curative influence. The treatment of the neurasthenia which may have caused the impotence will also have a favourable effect. Alcohol and tobacco are best entirely forbidden. Innumerabledrugshave been recommended for the treatment of impotence. The belief in the beneficial effect of cantharides is as much a superstition as the belief in the aphrodisiac action of celery, asparagus, caviare, and truffles. Certainly all these may cause excitement of the genital organs, but this is merely due to an increased flow of blood to these organs, which is of a very fugitive nature, and when the effect is often repeated (especially when cantharides is used for this purpose), it may have serious consequences. The influence of these substances may be compared with the purely stimulating effect of flagellation. More confidence may be placed inphosphorus,strychnine, and, above all, inyohimbin, a drug prepared from the bark of a West Africantree,[453]which is warmly recommended in cases of neurasthenic impotence by Mendel and Eulenburg. Having myself seen good results from the use of Yohimbin Riedel in two cases of pre-senile gonorrhœal impotence, I can confirm the favourable judgment of Eulenburg. In the case of pre-senile impotence in a man nearly sixty years of age yohimbin was the only means which, after several years’ intermission, enabled him once more to have erections, and repeatedly to perform coitus. Eulenburg reports the case of a man, which is probably unique, in whom,after a few days’ use, yohimbin restored sexual potency after he had been impotent for twelve years! This interesting drug is certainly a valuable enrichment of our aphrodisiac armamentarium, and the first drug of thisnature to which the name of a specific against impotence can justly be given.
Quite recently Eulenburg, Posner, Nevinny, and others, have warmly recommended as a true specific in cases of functional impotence a combination of lecithin with the active principle of the Brazilian plantMuira Puama. This new drug is by Eulenburg termed “muiracithin.”
From the above-described individual troubles (masturbation, sexual hyperæsthesia, sexual anæsthesia, pollutions, and impotence) is composed the clinical picture ofsexual neurasthenia, which, however, is manifested also by other symptoms, among which we must mention certainperceptions of anxietyand certaincoercive ideas, such as the condition, known also to the laity, ofagoraphobia, which is very frequently met with in sexual neurasthenia; also the fear of travelling alone by railway, or sudden anxiety in the theatre or concert-hall, in the form of the fear of fire, with the accompanying irresistible impulse to rush out into the open; further,lumbar painsandneuralgia of the genital organs, andanomaliesandpains connected with the evacuation of urine;an inclination to sexual perversions;gastricaffections,[454]such as nervous retching and vomiting, painful cramps of the stomach, loss of appetite, also excessive hunger, nervous dyspepsia, etc.;migraineandheart troublesof manifold kinds. It is not to be wondered at that when sexual neurasthenia is markedly developed, and when several of the above-described manifestations occur, the disease may pass on into a condition of completemental exhaustion, associated withmorbid irritabilityandhypochondriacalandmelancholyideas. We then ultimately see the development of typicalsexual hypochondria.
The treatment of sexual neurasthenia—which in the last-described general symptom-complex occurs also in women, associated in their case withamenorrhœa,dysmenorrhœa, ormenorrhagia[455]—consists for the most part in the already described treatment of the individual symptoms. In addition, we have to make use of hyperalimentation,hydro-therapeutic methods,gymnastictreatment, generalmassage, andclimaticcures.