Sometimes the centripetal nerves which serve for transmission of the pleasurable sensations to the centres have their impressionability obtunded by excesses in venere. When the nerves are deranged, the desire is strong, the erectile power is sufficient, the mind is in concurrence, emission occurs at the right moment, yet scarcely a vestige of pleasurable sensation is experienced during emission. The following case may serve as a proper illustration of the nature of this anomaly.
Mr. X., fifty years of age, was seduced to the practice of manusturpation when about thirteen years old. The exercises were carried out daily. After puberty, from about sixteen to nineteen years of age, he was given less to these practices, still once a week he could not resist of indulging in his favorite pastime. At this time he began to associate with meretricious women. This activity alternated with manusturpation until he was forty years old. There were periods of months or even years, while living in localities where the opportunity for normal sex activity was entirely lacking, when he took refuge to weekly practices of manusturpation. At the same time he indulged in excesses of mental erethism. His day-dreams on his long walks and in sleepless nights were filled with images, all taken from the realm of sex. Sometimes he also indulged in excesses of tactile eroticism (manibus ludere cum genitalibus mulierum). At the age of forty he married a very attractive young woman, and although he is greatly in love with his wife and two children, who arrived in the course of time, and is leading a regular sex-life, still the pleasure experienced at the ejaculation is practically nil. What induces him to still keep up his sexual activity is to please his young wife.
Here is a case where the three potencies of voluptas, copulation and procreation are perfectly intact, and where the patient is only suffering from the impotency of experiencing pleasure or libido during his sex-activity. In another case the impotency of libido is complete every time the patient practises coition, but is less pronounced when the act is repeated within an hour after the first exercise.
Mr. N., thirty-five years of age, a prominent lawyer, is suffering from a severe attack of neurasthenia for the last three years, the greater part of which he spent in sanitaria. As a boy he practised masturbation to some extent, but quite moderately. The symptoms are greatly pronounced in the morning, and are manifested by a general malaise, pressure in the head, bulging of the eyes, tremor of the hands, pressure in the rectum, in the prostatic region, and burning at the tip of the penis after urinating. The pressure in the rectum is relieved the day following coition, but returns in aggravated form on the second day. At the same time a mucus-like sediment appears in the urine which, on repeated examinations, showed to consist of oxalate of lime.
For the last few years, ejaculation, in concarnatione, takes place without any trace of libido. But if the act is repeated within an hour, the patient experiences some pleasure. For this reason the patient always exercebat concubitum bis in hora which served to aggravate his neurosis.
In some patients the libido is only diminished. In extreme narrowness of the prepuce the pleasure incident to sexual relation is slight. The author had only recently performed on a man, thirty-two years old, circumcision to cure this anomaly, although, it is said, that in persons who have been circumcized for ritual considerations, the libido is much slighter than in those not circumcized. In the latter, the covering of the glans is almost a mucous membrane and is very sensitive, while in circumcized people the covering of the glans is almost a veritable skin and has lost its finer sensibilities.
Impotence of procreation.—The type of impotence, most frequently met with but rarely complained of by men, is the impotence of propagation. Almost fifty per cent. of all cases of absolute sterility in married couples are caused by this anomaly in men.
Congenital and acquired deformities of the genitals may often cause impotence of procreation. All castrates, even those operated later in life, as the Skoptzies in Russia, are, of course, impotent for procreation, although if the penis has been left intact, they are very vigorous sexually, for a certain time, and are very salacious. Anorchismus, cryptorchismus, atrophy of the testicles, tumors of the testicles, compression by hydrocele, inflammation, ossification, tuberculosis, and cancer of the prostate may cause impotence of procreation without impairing the power of copulation.
Some epispadias and hypospadias may cause impotence of procreation. When the opening is very far back, the emission will take place outside of the vagina.
Aspermia, whether idiopathic or acquired, will always cause impotence of procreation. In the congenital form of aspermia all the genital organs seem to functionate normally, still no ejaculation takes place.
In the acquired form of aspermia both ejaculatory ducts are obliterated, as a rule, through suppurative prostatitis or tuberculosis of the prostatic gland. In both diseases the glandular tissue is frequently destroyed.