It is of great practical interest, alike from the gynecological and from the neuropathological standpoint, to determine the consequences in women of ungratifying sexual intercourse. In the present state of our experience it must be assumed that the effect of abnormal sexual intercourse, that is of intercourse which does not culminate in gratification produced by the sensation of ejaculation, is deleterious. This is explained by the fact that, owing to the absence of the muscular contraction of the genital passage, the latter remains engorged with blood; the resultant hyperæmia passes away very slowly, and, when frequently repeated, gives rise to chronic tissue changes, manifesting themselves as diseases of the reproductive organs. Injury to the nervous system ensues, partly in consequence of these organic changes, partly also in consequence of psychical non-gratification in the widest sense of the term. The nervous disorders thus produced are typical forms of (sexual) neurasthenia; and in cases in which the pathogenesis is predominantly psychical (antipathy to the husband, etc.) hysterical types of disorder are especially frequent. Von Krafft-Ebing believes that incomplete coitus, that is, coitus not culminating in the sensation of ejaculation, is a frequent cause of hysterical disorders in women.
When once the clinical picture of neurasthenia sexualis is fully developed, each act of intercourse (like pollutions or coitus in the sexually neurasthenic male) gives rise to renewed troubles, which are easily recognized as symptoms of venous stasis in the reproductive organs (sacrache, sensations of weight and bearing-down in the pelvis, fluor albus): in addition we observe exacerbations of the lumbar spinal disorder, in the form of spinal irritation, irradiating pains in the sacral plexus, etc. In this way general neurasthenia develops. The conditions found in such cases on gynecological examination (chronic endometritis, metritis, oöphoritis, etc.) are produced by the same cause as the nervous symptoms, namely, by an unhygienic mode of sexual intercourse. They are not the cause of the neurosis, but important concomitant disorders; and their effect in rendering the nervous disturbances more severe must be freely admitted.
Among important causes of ungratifying coitus must be enumerated: weak erection and ejaculatio praecox in the male, rendering the stimulation inefficient; in addition, coitus reservatus, coitus interruptus, and coitus condomatus. If the noxious influence is frequently repeated, the occurrence of neurasthenia sexualis and its consequences is greatly to be feared, and in women of neuropathic constitution it is practically inevitable.
Unsympathetic coitus appears to act, not merely in a somatic manner, but mainly upon the psyche, and to originate states of hystero-neurasthenia or pure hysteria. If the influence of such unhygienic conditions of the vita sexualis co-operates with that of inherited or acquired sensuality, further dangers ensue: in cases of ungratifying sexual intercourse, the danger of manustupration; in cases of unsympathetic intercourse, the danger of psychical onanism, or that of marital infidelity.
Although until recently the matter received but little attention, it must now be regarded as a well-established fact, that in the female (as in the male) the climax of voluptuous sensation in sexual intercourse is normally characterized by a process of ejaculation, accompanied by a voluptuous sensation of ejaculation, dependent upon the acme of excitement of a reflex centre in the lumbar enlargement of the spinal cord.
Just as in the male, this centre may be excited to action, not only by local stimulation of the genital organs, but also by (psychical) stimuli proceeding from the brain (pollutions), so also in the female a similar process may occur, and for this reason it is correct to speak of “pollutions in the female.” Rosenthal appears to have been the first writer to speak of pollutions in women. In his clinical study of nervous diseases, Rosenthal described processes of the nature of pollutions, originated in erotically over-stimulated women by lascivious dreams. In one case he detected the outflow of a “mucus-like” fluid from the apparently intact genital organs; he believed this to proceed from the ducts of Bartholin’s glands, and from the mucous glands surrounding the urethral orifice. Féré reports the case of a patient who had an erogenic zone in the region of the upper part of the sternum; pressure on this zone gave rise to a profuse secretion of vulvo-vaginal fluid. In this connection we may also recall the “clitoris-crises” to which tabetic women are subject. Gutceit described the process of pollution in women in the following words: “It is remarkable that in dreams such women experience the sensation of ejaculation.”
The psychical preliminary is invariably constituted by lascivious dream perceptions. It merely remains open to question whether this process, which in the male is indisputably physiological, in the female may be said to occur within physiological limits. The researches published by von Krafft-Ebing more than twenty years ago, under the title “Concerning Processes Analogous to Pollutions Occurring in the Female,” gave negative results as far as healthy individuals were concerned; on the other hand, the phenomenon in question was by no means rare in nervously disordered, and above all in sexually asthenic women. The neurosis was in part found as a result of psychical or manual onanism in virgins with morbidly intensified libido: in part in married women, as a result of ungratifying coitus, as previously described: in part, also, in married women with powerful libido and enforced abstinence from intercourse, owing to acquired impotence or death of the husband.
Just as in the case of the neurasthenic male, these pollutions made the primary neurosis more severe, and relief from the nervous trouble was not obtained until the factor of the “pollutions” had been recognized, and made the object of special treatment. In exceptional cases the “pollutions” appeared to be the starting point of the entire neurosis.
It was further remarkable, again here displaying analogy with what occurs in the male, how much stronger and more deleterious was the shock-effect of an inadequate process of ejaculation occurring in a sexual dream, as compared with the far less deleterious influence of similar incomplete ejaculation when occurring viâ coitus. In very severe degrees of neurasthenia sexualis, just as in the male, the waking imagination may give rise to a “pollution.” In such cases the shock-effect on the nerve centres tends to be excessively severe. A still higher degree of irritability of the genital system appears to exist in cases in which excitement and orgasm of the reproductive organs may culminate in a “pollution” by purely spinal paths, without the intervention of the imagination. The significance of this fact would appear to be considerable for the proper comprehension and for the treatment of certain conditions of neurasthenia (sexualis) in the female. The “pollution” may here be the actual cause of the neurosis. But in any case, in the female, the occurrence of pollutions is an extremely important symptom as regards both diagnosis and therapeutics. It is extremely probable that hallucinations of coitus, and the complaints made by insane women of attempted violation during the night, are really dependent upon such “pollutions.”
Von Krafft-Ebing reports the following characteristic case. Miss X., thirty years of age, belonging to a family predisposed to insanity, and herself neuropathic since early childhood, declared that since she was six years old she had been subject to lascivious imaginations, to which she became continually more liable as she grew older. Ultimately, typical psychical onanism developed, and in recent years her trouble assumed the form of sexual neurasthenia. The patient herself suspected there was a connection between her nervous disorder and her evil habit. The popular work by Bock finally brought her full enlightenment, associated with severe emotional disturbance. This latter was now increased by misfortunes from which the family suffered. The patient then relinquished her bad habit, but her state of health nevertheless became worse. She was nervously extremely irritable; her sleep was insufficient, unrefreshing, and disturbed by lascivious dreams; she suffered from spinal irritation, anæmia, scanty and painful menstruation. Inclination toward the opposite sex and toward marriage, hitherto but slight, now sank to a minimum: on the other hand, the patient, in spite of all efforts to the contrary became more and more subject to a condition analogous to priapism in the male, a genital orgasm by no means voluptuous in character, and often indeed actually painful. Associated therewith, nocturnal pollutions occurred, the patient awaking from lascivious dreams with a voluptuous sensation and moistness of the external genital organs. After such pollutions, throughout the ensuing day, she felt extremely weary and depressed and suffered from severe spinal irritation. After a time, the nocturnal pollutions occurred without being preceded by lascivious dreams, and ultimately analogous states were experienced in the daytime. With much difficulty the patient now made up her mind to seek medical advice. She was anæmic, emaciated, emotional, and moody. The lumbar and cervical regions of the spine were extremely sensitive to pressure. Sleep was scanty and unrefreshing, the patient felt weary and miserable, she complained of dragging sensation and other paralgic sensations, in the regions supplied by the lumbar and sacral plexuses. The deep reflexes were increased. She dreaded the onset of disease of the spinal cord, and believed that the cause of her illness was to be found in the prolonged indulgence in psychical onanism. The perusal of Bock’s book had first made her understand the true nature of her misconduct. She had never practised manual masturbation. Her principal complaint was of an almost unceasing uneasiness and excitement in the genital organs. She compared it to the uneasiness in the stomach produced by hunger. In the genital organs (which on examination appeared quite normal), she had a distressing sense of burning heat, of pulsation, of disquiet as if there were a clockwork mechanism working there. Very rarely now were these sensations associated with voluptuous ideas. This sexual neurosis had an intensely depressing constitutional effect. She had transient relief only when the local sensations culminated in pollution; but this, on the other hand, increased her general neuropathic troubles. She suffered most severely during the menstrual period. She was ordered sitz-baths at a temperature of 23° to 19° R. (84° to 75° F.), suppositories of monobromide of camphor, 0.6 (9 grains), with extr. belladon. 0.04 (⅗ gr.), sodium bromide 3.0 to 4.0 (45 to 60 grains), every evening; also powders containing camphor 0.1 (1½ grains), lupulin 0.05 (¾ grain), extr. secal 0.08 (1¼ grains), twice daily. This treatment gave the patient great relief, and secured complete ease during the daytime. Therewith returned her greatly impaired trust in the future, and her emotional calm was restored.