REFLEX ANOMALIES
We have already mentioned vaginismus, which is often produced in women by the first coitus. Priapism in man is somewhat analogous to vaginismus. It is produced by an exaggerated reflex irritability of the nerve centers for erection, and results in continual and painful erections, which sometimes end in ejaculation without sensation. Another anomaly, more or less reflex and very frequent, produces voluptuous sensations and premature ejaculation after short and incomplete erections. In some nervous women also, the venereal orgasm occurs very rapidly and briefly. These anomalies belong to the domain of medicine and are of little importance for our subject.
PSYCHIC IMPOTENCE
Psychic impotence is a symptom which occurs accidentally in the normal state and very frequently in psychopathological conditions.
A representation or idea of any kind, may suddenly paralyze by suggestive action the normal reflex mechanism of the center for erection. The blood ceases to accumulate in the corpora cavernosa and erection is either arrested or not produced at all. For example, a very excited lover, who has had strong erections at the moment when he prepared to copulate, may be suddenly overcome with the idea that he will fail, or by some other thought which paralyzes erection and renders coitus impossible. The remembrance of such a failure and the distress and shame attached to it, even efforts to produce erection indirectly for another attempt, constitute further causes of inhibition of the cerebro-spinal activity; they temporarily extinguish the sexual appetite, and prevent by their interference the automatic mechanism of erection which they strive to produce. The greater the fear of failure, the more the psychic impotence increases. This phenomenon may be limited to a certain woman, but it is more often general. Sometimes an incomplete erection is produced, which is insufficient.
This condition, which depends on auto-suggestion, is best treated by hypnotic suggestion. The sentiment of impotence powerfully depresses a man, and the depression increases his impotence. This condition often, however, disappears by itself.
A special variety of psychic impotence is that in which erection takes place, but the idea of ejaculation predominates so much that it paralyzes the voluptuous sensations, and causes ejaculation to occur without pleasure, or even erection to cease.
Impotence may occur at the first coitus, or may come on gradually. It is often produced suddenly at the time of marriage in persons who have hitherto been very capable, even in Don Juans. Men may have normal erections and pollutions, but these may be stopped by counter-suggestions at each attempt at coitus. Habitual masturbation may in some cases contribute to produce impotence, but we must not generalize from such cases, nor construct a dogma from them, for continence may also be a cause of impotence.
All these details, which are combined in all kinds of ways with other sexual troubles, but which are also produced alone in men who are otherwise normal, throw much light on the relation of the momentary mental state of man to his sexual appetite and the accomplishment of coitus.
I do not know under what heading the following case should be placed: