Sexual abnormality

“ It is only in cases in which the female genital organs are wanting, wholly or to a considerable extent, or in which there are important cerebral disturbances or states of mental degeneration, that the sexual impulse is wanting. ”

“ Continence, while in itself not an abuse, in any manner, of the sexual organs, yet is a fruitful source [23] of disease. The erotic male may contract troublesome disease, both local and general, by too close proximity with a voluptuous female; and why not as much a cause of disease in the female? It is the condition so commonly caused by the affectionate and chaste embraces of parties “engaged to be married.” When this condition exists the marriage ceremony had better be consummated as soon as possible, or injury may come to both parties. ”

“ Their erotic needs, which could not be gratified in normal fashion, led to this sexual perversion—a tendency observable especially in persons with neuropathic predisposition, or with a liability to hysteria or to epilepsy. Sometimes such girls, even before puberty, show an inclination to wear boys’ clothes, to avoid all feminine manual occupations, and to examine and to handle the genital organs of their playmates. ”

“ For the physician himself, sexual anomalies, treated as they are in a distant manner in text-books on psychiatry, are in greater part a terra incognita. Exact knowledge of the causes and conditions of development of sexual aberrations, and of the influence on them of hereditary constitution, education, the impressions of every-day life, and modern refined civilization, is the prerequisite for a rational prophylaxis of sexual aberrations, and for a correct sexual education. ”

“ Maladroit and incomplete attempts at intercourse, and the consequent repeated failure to obtain complete sexual gratification, affect a woman’s nervous system to a varying degree; but apart from this, in women who have long cohabited with men of deficient sexual potency, we often find a remarkable condition of complete relaxation of the genital organs, associated with great hypersecretion of the mucous membrane, flaccidity of the muscles of the pelvic floor, and displacements of the uterus. ”

“ Before entering into a consideration of the venereal diseases proper, we shall consider a sexual disorder which is extremely important on account of its widespread character, but the origin of which is just the opposite to venereal diseases, as it is due not to sexual intemperance, but to sexual continence. ”

“ The married female’s sexual life and acts are often brought to the knowledge of her physician. I have often been asked the question, why so many married women become invalids from uterine and ovarian diseases? Not referring to child-bearing, abortions, and many indirect causes of disease which are numerous, but not enough to furnish an etiology for the long category of nervous ailments with which the medical man has to contend, my answer is, sexual abuse ”

“ By the term precocious menarche we understand the pathological state in which a typical, four-weekly, sanguineous discharge from the female genital organs sets in at an abnormally early age, and is to be regarded as a symptom of a premature sexual development. ”

“ Finally, I have endeavoured to determine the data which may serve to establish a differential diagnosis of the different groups and classes of sexual aberrations. We shall begin by describing the forms of sexual aberrations most frequently encountered. ”

“ Modern culture and the social organization of the present day, in association with the resulting sexual neuropathy of women, have exercised on their sexual life an influence as powerful as it is unfavorable, manifesting itself in the overpowering frequency of the diseases of women. ”

“ In young married couples especially, vaginismus is an extremely distressing condition, and one that entails very serious consequences, inasmuch as the pains and reflex spasms which result from any attempt at coitus, and even from the mere approximation of the penis to the female genital organs, render sexual intercourse absolutely impossible. ”

“ Only when the cerebral cortex, as the place of origin of sensations 188and perceptions, fails to perform its functions in the manner just described, or when the anatomico-physiological processes in the genital organs which normally act as peripheral stimuli fail to occur, or when there is a failure in the conducting tracts, are sexual perceptions and impulses lacking. Such anomalies may be congenital. A milder form is that, likewise congenital, in which a woman has a sexually “cold nature;” ”

“ Not one young person, for example, in twenty, is ever told, that sexual intercourse during the period of a woman’s courses is not unfrequently productive to the woman of a species of fluor albus, and sometimes (as a consequent) to the man of symptoms very similar to those of urethritis or gonorrhœa, but more easily removed. Yet what fact more important to be communicated? And how ridiculous the mischievously prudish refinement that conceals from human beings what it most deeply concerns them to know? ”

“ That total sexual abstinence may have very injurious effects on the nervous system, as mentioned in Chapter IV, and assist in the development of hysteria and neurasthenia, is shown by the fact that when there is an accumulation of semen in the male, or a swelling of the Graafian follicles in the female, then an excitation of the nervous system follows, with sexual desire. ”

“ In other cases we have to do with a psychopathic state, a form of mental degeneration due to very various causes, or in some cases inverted sexual sensibility exists in a person whose mind is in other respects normal. ”

“ More particularly in such circumstances are evil effects on the nervous system likely to ensue, since we have a combination of excessively prolonged and frequent sexual intercourse, and of interference with complete sexual gratification. ”

“ Freund has observed a number of unequivocal instances showing that a first encounter with the sexual problem, a rather sudden unveiling of what has hitherto been concealed, as, for instance, the sight of some sexual act, or something read or heard in conversation, may, in a girl at the time of puberty, give rise to an anxiety-neurosis, which is in a very typical manner combined with hysteria. ”

“ In men the unfavorable suggestions occur particularly as a consequence of affections of the external organs. In women the same suggestions are likely to make themselves felt with regard to the internal genital organs. We all recognize the exaggeration of feeling and even physical reaction that takes place with regard to slight sexual ailments in the male, because it is easy to recognize just exactly what pathological conditions are present and how trivial they may be and yet produce serious depression and all kinds of symptoms, reflexly referred to many other organs. ”

“ At the menacme, the beauty and energy of women attain their fullest evolution, her sexual characteristics their strongest development. It is this period of life, however, that entails the greatest dangers to beauty and health in connection with the functions of the genital organs. Copulation, the first act of sexual intercourse with the male, often produces in the female injuries from which she never completely recovers. ”

“ Nothing could be more mistaken than such an approach to the solution of a sexual problem in a woman. In the first place, surgery performed on the genitalia of a woman who is already sexually disturbed can cause profound shock to her psychologically, deepen her disturbance immeasurably—such was the case with this woman, my colleague told me. Second, the fact that the clitoris and not the vagina is responsive is a form of frigidity in itself. ”

“ While the terminal forms of sexual aberrations end in asylums for the insane, the doubtful cases, in which incompleteness of development or apparent viciousness render correct diagnosis difficult, make up the majority. ”

“ In consequence of long-continued masturbation, other pathological changes may take place in the female genital organs, such as hypertrophy of the nymphæ, proliferation or glandular hypertrophy of the uterine mucous membrane, ovarian irritation, pains in the ovarian region which, in severe attacks, may radiate to the thighs. ”

“ In hysteria, according to this author, the sexual life is especially often abnormal; in cases with neuropathic inheritance, one may say always: “All possible anomalies of the sexual functions occur in such cases, with the utmost variety and the strangest commingling, based upon hereditary degenerative processes, and accompanied by moral imbecility in its most perverse manifestations. * * *. Frequently, in hysterical subjects, the sexual life is morbidly excitable. ”

“ Shameless prostitution may result, even in married women. In cases of a milder type, the sexual impulse is exhibited in the form of onanism, nude perambulations about the room, wearing of male attire, etc. In cases of hysterical mental disorder, the morbidly excited sexual life may manifest itself in the form of maniacal jealousy, baseless complaints against men of indecent assault, hallucinations of coitus, etc. Sometimes there may be frigidity, with lack of sexual pleasure, commonly due to genital anæsthesia. ”

“ A decline in the intensity of the sexual impulse in consequence of degeneration of the conducting tracts, is found, according to von Krafft-Ebing, in diseases of the brain and the spinal cord. Central affection of the sexual impulse may be due to organic disease of the cerebral cortex (dementia paralytica, general paralysis of the insane, in the later stages) , or it may be due to functional disorder, such as hysteria, or to mental diseases (melancholia or hypochondriasis) . ”

“ In many cases, however, we observe in women suffering from sexual neurasthenia, that sexual intercourse, even when practiced at long intervals, gives rise to nervous prostration with deep emotional depression and long-lasting aggravation of the existing nervous disorder. This statement applies with especial force to very hysterical epileptic girls with hereditary predisposition to mental disorder. ”

“ The neuroses that appear as the sequelae of injuries are especially common in the male sex, because the occupations of men expose them more than women to injuries of all kinds. Of such cases, of course, we do not speak here. But there are some unquestionably hereditary morbid tendencies which manifest themselves by preference in one sex or the other, and such sexual predisposition shows itself even in childhood. ”

“ He maintains, further, “that such women, in consequence of the stimulation of the genital organs in the absence of sexual gratification, become affected with all kinds of menstrual irregularities, with fluor albus, prolapse of the uterus, and chronic metritis; they suffer from digestive disturbances and constipation, leading to emaciation; and they are prone to hysterical manifestations.” ”

“ First, the sexual organs, like any other part of the body, can be the seat of different inflammations, tumors, accidental injuries, etc., and in the case of any grave general sickness the sexual system is naturally involved and suffers to a greater or smaller degree. Second, the sexual organs present very often congenital (inborn) defects of development, varying to an enormous degree in individual cases. ”

“ This is all I have to say concerning the relationships of the sexual life of the child to the occurrence of nervous diseases. The sexual life has, of course, important bearings on health in other ways. The venereal diseases, in most cases, result from sexual intercourse; and it will readily be understood that since early sexual intercourse is rendered more likely by a premature awakening of the sexual life, an increased danger of venereal infection will thus arise. ”

“ The morbid manifestations of sexual activity separate first of all into two great groups, according as they develop in such subjects as are from their birth disposed to such aberrations and to nervous disorders of all sorts, or on the other hand, show themselves in persons, relatively healthy, and who are not under the influence of hereditary infirmity. ”

“ It is of great practical interest, alike from the gynecological and from the neuropathological standpoint, to determine the consequences in women of ungratifying sexual intercourse. In the present state of our experience it must be assumed that the effect of abnormal sexual intercourse, that is of intercourse which does not culminate in gratification produced by the sensation of ejaculation, is deleterious. ”

“ I might enumerate scores of similar cases, in which it is impossible to see any cause but abuse of the sexual function, in which spermatorrhœa and impotence blend in a very obscure manner, but combined with other phenomena prove, beyond a doubt, the existence of a sexual neurosis, peculiar to itself, which needs study as to pathological anatomy; when it will be discovered that more than mere cause for general neurosis is found in the sexual abuse so lightly spoken of by authors in treatises on diseases of the nervous system. ”

“ But one must from the first be prepared for similar frequent occurrences of sexual irregularities under the stress of the social relations of our society, and one could therefore remain in doubt as to what part of the deviation from the normal sexual function is to be considered as a morbid cause. ”

“ Unfortunately there are a variety of morbid conditions to which the female is liable, so that sexual desires arise in spite of every effort to keep aloof from them—even though there is not the slightest guilt in mental or bodily transgression. These are owing to disordered conditions of the sexual system, just as other disorderly desires arise, and are often inherited—remember this all parents!—or they may be caused by some morbific influences, as are other diseased conditions of the body. ”