Sexual dysfunction

“ Inability to perform the sexual act while suffering from any mental derangement, or misunderstanding one’s own mental elaborations, is not impotence; but there must be impairment of the integrity of the nerve-substance that evolves the force that sustains the sexual organ in its erect attitude, and also supplies the so-called physiological irritation. If we attempt to name this peculiar disease from other stand-points, we shall become confused; as it would only demonstrate a function-disease, which is an impossibility and leads to confusion. ”

“ 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. ”

“ From the time of puberty up to the time of marriage the growing woman is under the influence of the now awakened sexual impulse, which experiences ever-renewed stimulation. A sedentary mode of life, unsuitable nutriment, and the early enjoyment of alcoholic beverages, exhibit their inevitable result in the frequency with which, in this epoch of the sexual life, chlorotic blood-changes, neurasthenic conditions, and diverse symptoms of irritation of the genital organs, make their appearance. ”

“ 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 ”

“ I believe that the problem of sexual frigidity in women is one of the gravest problems of our times. Over 40 per cent of married women suffer from it in one or another of its degrees or forms. And their suffering, emotionally and physically, is very real indeed. ”

“ 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) . ”

“ Fere has recorded the interesting case of a man who, having all his life after puberty been subject to monthly attacks of sexual excitement, after the age of 45 completely lost the liability to these manifestations, but found himself subject, in place of them, to monthly attacks of frequent and copious urination, accompanied by sexual day-dreams, but by no genital excitement. ”

“ 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. ”

“ 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. ”

“ Neurologists have observed women on whom continence was forced either during marriage or after its dissolution, who thereupon fell into a state of severe nervous exhaustion or nervous excitement, or suffered from threatening or even actually developed psychoses. That sexual abstinence is “absolutely harmless,” as moralists and many physicians would so gladly believe, appears to Erb a quite unwarrantable assumption.
“In the processes of reproduction,” continues Erb in his discussion of this subject, “woman is the principal sufferer. ”

“ 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. ”

“ Of dyspareunia we shall speak more at length later, in connection with the pathology of copulation. As regards the entire lack of the sexual impulse, however, in women whose genital organs are normally developed and normal in the performance of their functions, and whose cerebral condition is also normal, we must consider such lack an extremely rare condition, if indeed it ever occurs. ”

“ 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. ”

“ A word in the beginning as to the harm produced by abuse of the sexual function. The injury thus received is purposely magnified tenfold for reasons of gain by quacks who work upon the fears of their victims for their own selfish purposes. The voluntary exercise of the sexual function—unlike that of any other important organs—is not necessary to health until maturity has been reached ”

“ As a sequel, continually recurrent menstrual insomnia, accompanied by an impulse to embrace boys under ten years of age, to kiss them, and to handle their genital organs. Impulse toward coitus, to close sexual contact with a grown man, non-existent at this time. The patient often speaks openly of her morbid impulse, and begs that she may be supervised, as she feels unable to answer for her own conduct. In the intervals, however, she carefully avoids all reference to the matter, is strictly decent in her conduct, and in no way sexually ardent. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ Young women who find they have problems in the sexual sphere may be spared years of misery if they are given a real understanding of the matter in the beginning. Many of my patients, had they been given an insight into the nature of 19 their difficulties at the start, might have avoided the inevitable and innumerable poor choices and often disastrous decisions which are so characteristic of the woman suffering from a sexual problem. ”

“ Not, indeed, that it is an infallible means, but none the less the effects are often striking, as I have frequently had occasion to observe, both in young women so affected entering upon marriage for the first time, and also in young widows who have remarried. Especially is this true of women in whom the sexual impulse is exceedingly powerful, and even pathologically increased to the extent of marked sexual hyperæsthesia; likewise also in women whose social circumstances and manner of life induce increased sexual appetite. ”

“ This then, is how, biology can represent destiny, with a helping hand from psychology. In a very real sense this dual potentiality of woman’s anatomy contains the seeds of sexual and hence personal tragedy.
Remember that the woman whose orgasm is confined to the clitoris is definitely frigid. Statistics on the prevalence of this kind of sexual problem are not available, but most psychiatrists and psychoanalysts agree that it is very widespread, may even be the dominant form of frigidity in our society. ”

“ 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. ”

“ Although it cannot be denied that the changes in the entire organism which attend the extinction of sexual activity, bring numerous dangerous influences into play, yet I feel bound to maintain that these dangers are by no means so great as those which are involved by the sexual life in its ripest period of development—the dangers of pregnancy, parturition, and the puerperium. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ Of course, I do not propose that ideal sexual conditions in marriage may justify pre-marital incontinence, but I make this sharp contrast simply to emphasize the belief that sexual intemperance and selfishness of men in marriage causes more mental and physical suffering of women than does sexual incontinence of men before marriage, and I am not forgetting the vast problem of social diseases and prostitution. ”

“ 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. ”

“ You will remember that in the female genitalia both the clitoris and the vagina are capable of experiencing orgasm. This fact is of decisive importance to the problem of frigidity in women.
Why? It means, in effect, that women have two distinct sexual organs, both capable of bringing her release from sexual tension. In the unconscious sense many women can “choose” one type of sexual satisfaction in preference to another. This ability to choose often spells disaster, for one of these methods of gratification represents immaturity and is allied to neurosis.
A man has only one organ: his penis. ”

“ Owing to the fact that to the cultivated woman sexual gratification is possible only in the married state, whilst social conditions render marriage impossible to many women greatly in need of such gratification; in consequence, also, of the modern and ever more widely diffused practice by husbands of coitus interruptus altogether regardless of the woman’s need for complete sexual gratification—there arise in women numerous 282local disorders and nervous disturbances, hysteria and even insanity being results by no means infrequent. ”

“ The latter cause is in operation when there are diseases of the female reproductive organs preventing the physiological completion of intercourse; but especially in consequence of the modern practice of coitus interruptus, in which the man breaks off the act of intercourse the moment he feels that ejaculation is imminent, without troubling himself regarding the natural course of sexual excitement in the woman. ”

“ 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. ”