In the atonic form of impotence conditions of absolute impotency are quite rare. Absolute impotence is mostly found in the paralytic form which is caused by cerebrospinal and nervous diseases. In the atonic anomaly the vast majority of cases are of partial impotence.
The impotence due to weakness is distinguished by premature ejaculation and the subsequent immediate subsidence of erection. Sometimes a vigorous erection ceases suddenly before emission has occurred, and the penis becomes completely flaccid and shrivels to half its normal size before the entrance into the vagina. When ejaculation does later occur it takes place without erection or pleasurable sensations. Not seldom the entrance into the vagina is effected with good erection, but when about to begin the act, the penis suddenly wilts, the wilting either followed by ejaculation or not. The following case illustrates the ordinary symptoms:
Mr. L., 45 years of age, happily married, and father of several children, was always healthy and strong and had never had gonorrhoea or syphilis, but had freely masturbated when he was young. He always considered himself a powerful man. He is given to athletics, horseback riding, ball playing, swimming, rowing, etc. For the last year the patient noticed a certain weakness in his potency. As soon as he enters the vagina, ejaculation takes place at once and is followed by immediate flaccidity of the penis. Sometimes, while trying intromission, the erection ceases like a shot ante portas. When he does not try congressus the erection lasts much longer. The patient’s wife has been of a rather frigid nature, never asking or caring for concarnatio. But recently she seems at times to have rather a certain longing for the embrace. This fact makes the patient feel doubly miserable, not to succeed, when the partner seems to desire and enjoy the initus.
This case is one of those where objectively there is very little to discover. In some cases of atonic impotence the patients show neurasthenic or cerebrasthenic symptoms. The underlying cause of the impotence, as a rule, determines the symptom-complex of the case. If the cause of the impotence is excess in masturbation, the case will show all the symptoms of the typical masturbator. The latter is generally small, emaciated, hollow-chested, thin-necked and weak-kneed. He shows deep-set eyes and pale hollow cheeks. The penis and testicles are small. The penis is cold and shriveled. The patient has a bad taste in his mouth, and suffers from winds in his stomach. He also suffers from obstinate constipation and colicky pains in the bowels. He complains of palpitation of the heart, shortness of breath and of a burning sensation in his arms. He suffers from loss of memory and from tinnitus aurium. The patient also shows a certain moral abasement, incontrollable restlessness, carelessness in dress and person and shambling in gait. The history of the following case is that of a typical masturbator:
Mr. C. is 31 years of age and unmarried. At the time of puberty, when he was 14 years old, he began to practise stuprum manu. Se stuprabat manu three to four times daily. When twenty years of age he began to associate cum meretricibus. But the natural initus did not seem to satisfy him. Post omnem initum manu se stuprabat, in addition, as soon as he reached his residence. Three years ago he contracted gonorrhoea, from which he suffered a whole year. Since a year he noticed a certain weakness in his potency. He is able to effect intromission, but before he can begin the act, ejaculation without the least trace of libido takes place, followed by immediate flaccidity of the penis. He has some erections in the morning but they are not complete as in former times.
When the cause of the atonic impotence was venereal excesses or gonorrhoeal prostatitis, the long-kept-up congestion of the prostatic urethra and of the colliculus leads to general reflex excitability, to a high degree of nervousness, cerebrasthenia, and neurasthenia. The colliculus being an organ which finds its analogue in the female uterus, its constant irritation will show phenomena in men, usually found in intensely hysterical women only.
The impotent men generally change their entire psychic nature. They become timid, morose, solitary, melancholic, hypochondrical and despondent. They are discontented, peevish, ill-humored, and evince either blunted or inordinate sexual desires. They show profound agitation at the slightest excitement. The patients are troubled with insomnia or unrefreshed sleep and with a feeling of heaviness on rising. The mind is enfeebled and the memory impaired. The mental debility and dulness cause inability to collect their thoughts and thus enfeebles the mind in its power of concentration. The patients suffer from vertigo, singing in the ears, from a feeling of fulness in the head, from asthenopia, depression, anxiety and irritability. They often suffer from palpitation of the heart, sick headaches, coldness of the hands and feet, dull heavy feelings, a sense of fatigue and a loss of flesh. They also complain of creeping sensations in the loins, of pricking in the back, of twitching and jerking of the muscles, of muscular weakness, of lumbar pain and asthma. The intestinal canal shows a general derangement, as coated tongue, poor appetite, sense of weight in the epigastrium after eating, flatulence, sluggishness of the bowels and constipation. The general health of the patient is broken, the countenance is vacant and the gait feeble.
Besides the general symptoms, the genito-urinary organs are especially affected in atonic impotence. The external genitals show a certain flaccidity, shrinkage, paleness of the mucous membranes and a diminution of the sensibility and electrical irritability. The skin of the penis is cold, shriveled and somewhat insensible to electrical stimulation. The electrical irritability of the skin of the two halves of the scrotum is of a different degree, the right half being sometimes more sensitive than the left.
The testicles are often very painful and tightly drawn up against the external abdominal rings. The spermatic cord often shows an enlargement of the veins (varicocele). The vas deferens and the ampulla are in a state of inflammation.
The seminal vesicles are plainly felt indurated, nodular and distended with fluid. In a large proportion of cases the repeated congestion causes a veritable seminal vesiculitis. This inflammation is not seldom extended to the ejaculatory ducts and occludes the same. Through this occlusion spermatic colic, i. e., a severe pain in the region of the vesicles, often seizes the patient, especially after some sexual excitement, as dancing, caressing, and even flirting. After such excitement a dull pain in the region of the prostate and in the perineum as well as in the testicles, spermatic cords and in the rectum is very annoying to the patient. Ejaculation often removes these pains. For that reason the patient tries to relieve himself from the painful sensations by masturbation. Ejaculation also removes the irritations of the thighs, hips, anus, hypogastric region and in the smalls of the back.