In paralytic impotence the genitals are more or less withered. The skin of penis and scrotum is almost anaesthetic. The entire urethra is insensible, the sound passes into the bladder with the greatest ease. The skin of the thigh in the vicinity of the genitals is more sensitive to electric currents than that of penis and scrotum. The following history well illustrates a typical case of paralytic symptomatic impotence:
Mr. H., 45 years of age, a widower with one child, contracted lues fifteen years previously and was apparently cured after two years’ treatment. For the last two to three years he began to suffer from shooting pains around the abdomen (Gürtelschmerz) and in his legs. Micturition is frequently urging, and the stream is slow. The knee-jerks are greatly exaggerated. The patient’s gait is still normal, and he does not show any other sign of tabes dorsalis. About the time when the pains first appeared, he also noticed a certain weakness in erection and premature ejaculation. He began then to associate with meretricious women who practised on him fellatricia, or insertio fascini in os. From this time the impotence increased and is now complete. For the last two years he never had even nocturnal erections. The penis is in a state of atrophy, and is now of the size of a boy’s, fourteen to fifteen years of age. The skin of the penis is shriveled and cold. The glans is pale. The entire skin of the penis and scrotum is quite anaesthetic to the galvanic current. An application of about fifteen milliamperes in strength, which produced an ulceration by burning, was scarcely felt by the patient. The faradic reaction is normal.
Psychic impotence.—The mode of impotence known as psychic is a very frequent anomaly. It is the disease of the cultured classes. The action of the nervi erigentes is incomplete in psychic impotence, and the complete relaxation of the corpora cavernosa does not take place. Hence a sufficient quantity of blood can not enter the erectile tissue to exert pressure on the outgoing veins. The corpora cavernosa become smaller and harder at the critical moment and do not admit the entrance of the blood. The diameter of the penis becomes less than that of the glans. The penis feels cartilaginous, and the skin is found in transverse folds through the contraction of the corpora cavernosa. Hence erections are feeble or entirely wanting at the critical moment. When the patient is lying in bed alone he has, in distinction from atonic impotence, quite vigorous erections.
Psychic impotence is transitorily found also in healthy individuals when they are in a state of agitation. The more agitated the patient is, the more the penis shrinks. In psychic impotence, if the wife is of an exceedingly passionate disposition, she will make advances and may often evoke powerful erections, whereas the wife’s indifference would cause impotence.
In this way this form of impotence is often only relative. With one woman the inability injungendi is complete, while the virile power is exuberant in concarnatione with another. As a rule, the patient who has reached the critical age of fifty to sixty, does not succeed in his conjugal duties but is able commisceri meretricis auxilio. The indifference of the wife who, as a rule, is about forty to fifty years of age and has either passed or is very near the climacterium, accounts for the husband’s impotence in her company. Such men are able to perform the act only when the woman actively or at least cheerfully and willingly yields herself. The sullen, supine position of the frigid wife is not enough to hold a man’s love forever.
Temporary psychic impotence of short duration is sometimes met with in newly married men through lack of confidence. When about to be married, the broodings over things to come overstimulate the inhibitory centres in the brain. As a result, at the critical moment, the penis gradually shrinks, grows smaller and moves in a worm-like manner in the course of its diminution.
The following case may serve as an illustration for such cases:
Mr. S., 23 years of age, had suffered from gonorrhoea a few years previously. He has practised stuprum manu moderately at the time of puberty. Later on he associated cum meretricibus. He always considered himself healthy. The seminal discharge was somewhat precipitated, but the patient attributed this phenomenon to his extraordinary strength and was rather proud of it. When he became engaged to his present wife he abstained henceforth from illicit relations. Two days before the consultation the patient married and, upon approaching his young bride, found that the erection was too weak to transgress the virginal portals. After his first failure, every repeated attempt caused the penis to shrink almost half the normal size of the flaccid condition. The wife’s genitals were perfectly normal. She did not suffer from vaginism. Therapeutic suggestion and a medicinal tonic (ut aliquid fiat) removed the anomaly in a few days.
In this case the anaphrodisiac of fear after the first failure was the cause of the impotence.
Psychic impotence is sometimes present for a short time after long continued abstinence in men who for some reason have interrupted their regular sexual relations. Young men who have never had yet any sex relations are never affected by mere abstinence. Psychic impotence is not seldom found in men with a certain vocation requiring great mental strain, as literary men, bookworms, mathematicians, engineers, etc.