In enuresis nocturna, often found in masturbating children, there is an imperfect innervation of the sphincter, while the innervation of the detrusor of the bladder is perfect.
In all these anomalies the urethra is very sensitive. The passage of an instrument causes unbearable anguish. The patient acts as mad when the sound is introduced. There is often found a troublesome burning in the urethra, especially in the fossa navicularis, during or after micturition.
Besides the frequent urgency to urination, in all these troubles, there is not seldom an actual polyuria present. The urine is pale, clear, watery, with low specific gravity, often as low as 1002. The urine is not seldom loaded with phosphates. Sometimes oxaluria, with high specific gravities up to 1050, is discovered. Transient glycosuria as high as two to three per cent. is also found. At times vesical tenesmus is met with. Sometimes anuria is observed, although the kidneys are in perfect order.
The pathology of female impotence.—The same four kinds of impotencies found in men are also met with in women, with the only difference that the frequency of one or the other of the impotencies is different in the different sexes. They are: 1) impotence of voluptas, 2) impotence of copulation, 3) impotence of reproduction, and 4) impotence of libido.
Impotence of voluptas.—The entire absence of the sense of sex, or impotence of voluptas, where the individual has absolutely no sexual inclination to any individual of the other sex, is more frequently met with in women than in men. Still even in women this idiopathic frigidity, this insensibility where the woman is completely frigid by temperament, is much rarer than is generally believed. In fact, it is extremely difficult to find a woman who is without aptitude of sexual emotion.
Physiological frigidity exists in infants and in very old age. After a regular and satisfactory orgasm the woman is physiologically more or less anaesthetic for some time. The ablation of both ovaries before puberty causes total anaesthesia, while the operation after puberty produces, for a certain time, at least, only an impairment of libido, or orgasmus retardatus. Congenital degeneration of the ovarian glands will be accompanied by total absence of the sense of sex. As in men, the total absence of sexual desire is found in severe cases of neurasthenia, where the entire nervous system is in a low state of efficiency. Idiopathic impotence of voluptas is further found in low idiots and in dementia, where there is lack of understanding of the opposite sex. The sexual perversity of homosexuality, as a rule, causes total impotence of sexual desire for the opposite sex. Sometimes the cause for the anaesthesia lies in the centre, otherwise the patient is perfectly normal, as in the following case:
The patient, forty years of age, twenty years married, is a highly cultured lady. She never had a child or was pregnant while living with her two first husbands. A prominent gynaecologist, who had examined her several years previously, attributed the cause of her sterility to an infantile uterus. She has never, in her life, experienced any sexual desire and seems to be proud of it. She attributes this lack of passion to her great mental activity. An examination revealed a pregnancy of about four months.
Impotence of copulation, except in the anomaly known as vaginism, is very rarely found in women. Conjugation is, of course, impossible in the rare cases of total absence of the vagina. In hypospadia, where the vaginal orifice is situated within the rectum, vaginal conjugation is well-nigh impossible. Adhesions of the labia majora or minora, a rigid imperforated hymen, an extreme vaginal atresia near the orifice and elephantiasis of the vulva will cause impotence of conjugation. All acute inflammations of the vulva, vagina, rectum, uterus tubes, or ovaries may render approach painful and impossible. Urethral caruncles, urethritis, fissures at the neck of the bladder, rectal fissures or hemorrhoids may also render conjugation difficult. The tetanic contraction of the sphincter cunni and the tetanic spasm of the perineal muscles, constrictor cunni, transversus perinei, sphincter and levator ani which close tightly the orifices of the vagina and the entire vaginal canal will also be the cause of impotentia coeundi. The solitary tetanic contraction of the sphincter cunni, known under the name of vaginism, will make conjugation impossible until the hymen is removed. The following case operated by the author illustrates this anomaly:
Mrs. X., twenty-two years of age, for three months married to a physician, was unable to be approached by her husband. As soon as the penis touched the labia, the sphincter cunni contracted so tightly that there was an utter impossibility to transverse the virginal portals. During the examination, at the least touch of the nymphae, the sphincter could be observed contracting, just as seen in animals after defecation when the sphincter ani contracts. The ablation of the hymen cured the anomaly. This fact shows that it was only a reflex-irritation, started at the highly sensitive hymen. The sphincter itself was perfectly normal.
Impotence of reproduction.—More frequent than impotence of copulation is female impotence of reproduction. This anomaly is naturally found in all those cases where there is impotence of copulation. It is sometimes met with in excessive acid reaction of the vaginal contents, where the spermatozoa are killed before they reach the uterus.