There appear to have been but few systematic observations on the persistence of the sexual impulse in women after the menopause. It is regarded as a fairly frequent phenomenon by Kisch, and also by Löwenfeld (Sexualleben und Nervenleiden, p. 29). In America, Bloom (as quoted in Medical Standard, 1896), from an investigation of four hundred cases, found that in some cases the sexual impulse persisted to a very advanced age, and mentions a case of a woman of 70, twenty years past the menopause, who had been long a widow, but had recently married, and who declared that both desire and gratification were as great, if not greater, than before the menopause.
Reference may finally be made to those cases in which the sexual impulse has developed notwithstanding the absence, verified or probable, of any sexual glands at all. In such cases sexual desire and sexual gratification are sometimes even stronger than normal. Colman has reported a case in which neither ovaries nor uterus could be detected, and the vagina was too small for coitus, but pleasurable intercourse took place by the rectum and sexual desire was at times so strong as to amount almost to nymphomania. Clara Barrus has reported the case of a woman in whom there was congenital absence of uterus and ovaries, as proved subsequently by autopsy, but the sexual impulse was very strong and she had had illicit intercourse with a lover. She suffered from recurrent mania, and then masturbated shamelessly; when sane she was attractively feminine. Macnaughton-Jones describes the case of a woman of 32 with normal sexual feelings and fully developed breasts, clitoris, and labia, but no vagina or internal genitalia could be detected even under the most thorough examination. In a case of Bridgman's, again, the womb and ovaries were absent, and the vagina small, but coitus was not painful, and the voluptuous sensations were complete and sexual passion was strong. In a case of Cotterill's, the ovaries and uterus were of minute size and functionless, and the vagina was absent, but the sexual feelings were normal, and the clitoris preserved its usual sensibility. Mundé had recorded two similar cases, of which he presents photographs. In all these cases not only was the sexual impulse present in full degree, but the subjects were feminine in disposition and of normal womanly conformation; in most cases the external sexual organs were properly developed.[[15]]
Féré (L'Instinct sexuel, p. 241) has sought to explain away some of these phenomena, in so far as they may be brought against the theory that the secretions and excretions of the sexual glands are the sole source of the sexual impulse. The persistence of sexual feelings after castration may be due, he argues, to the presence of the nerves in the cicatrices, just as the amputated have the illusion that the missing limb is still there. Exactly the same explanation has since been put forward by Moll, Medizinische Klinik, 1905, Nrs. 12 and 13. In the same way the presence of sexual feelings after the menopause may be due to similar irritation determined by degeneration during involution of the glands. The precocious appearance of the sexual impulse in childhood he would explain as due to an anomaly of development in the sexual organs. Féré makes no attempt to explain the presence of the sexual impulse in the congenital absence of the sexual glands; here, however, Mundé intervenes with the suggestion that it is possible that in most cases "an infinitesimal trace of ovary" may exist, and preserve femininity, though insufficient to produce ovulation or menstruation.
It is proper to mention these ingenious arguments. They are, however, purely hypothetical, obviously invented to support a theory. It can scarcely be said that they carry conviction. We may rather agree with Guinard that so great is the importance of reproduction that nature has multiplied the means by which preparation is made for the conjunction of the sexes and the roads by which sexual excitation may arrive. As Hirschfeld puts it, in a discussion of this subject (Sexual-Probleme, Feb., 1912), "Nature has several irons in the fire."
It will be seen that the conclusions we have reached indirectly involve the assumption that the spinal nervous centers, through which the sexual mechanism operates, are not sufficient to account for the whole of the phenomena of the sexual impulse. The nervous circuit tends to involve a cerebral element, which may sometimes be of dominant importance. Various investigators, from the time of Gall onward, have attempted to localize the sexual instinct centrally. Such attempts, however, cannot be said to have succeeded, although they tend to show that there is a real connection between the brain and the generative organs. Thus Ceni, of Modena, by experiments on chickens, claims to have proved the influence of the cortical centers of procreation on the faculty of generation, for he found that lesions of the cortex led to sterility corresponding in degree to the lesion; but as these results followed even independently of any disturbance of the sexual instinct, their significance is not altogether clear (Carlo Ceni, "L'Influenza dei Centri Corticali sui Fenomeni della Generazione," Revista Sperimentale di Freniatria, 1907, fasc. 2-3). At present, as Obici and Marchesini have well remarked, all that we can do is to assume the existence of cerebral as well as spinal sexual centers; a cerebral sexual center, in the strictest sense, remains purely hypothetical.
Although Gall's attempt to locate the sexual instinct in the cerebellum—well supported as it was by observations—is no longer considered to be tenable, his discussion of the sexual instinct was of great value, far in advance of his time, and accompanied by a mass of facts gathered from many fields. He maintained that the sexual instinct is a function of the brain, not of the sexual organs. He combated the view ruling in his day that the seat of erotic mania must be sought in the sexual organs. He fully dealt with the development of the sexual instinct in many children before maturity of the sexual glands, the prolongation of the instinct into old age, its existence in the castrated and in the congenital absence of the sexual glands; he pointed out that even with an apparently sound and normal sexual apparatus all sorts of psychic pathological deviations may yet occur. In fact, all the lines of argument I have briefly indicated in the foregoing pages—although when they were first written this fact was unknown to me—had been fully discussed by this remarkable man nearly a century ago. (The greater part of the third volume of Gall's Sur les Fonctions du Cerveau, in the edition of 1825, is devoted to this subject. For a good summary, sympathetic, though critical, of Gall's views on this matter, see Möbius, "Ueber Gall's Specielle Organologie," Schmidt's Jahrbücher der Medicin, 1900, vol. cclxvii; also Ausgewahlte Werke, vol. vii.)
It will be seen that the question of the nature of the sexual impulse has been slowly transformed. It is no longer a question of the formation of semen in the male, of the function of menstruation in the female. It has become largely a question of physiological chemistry. The chief parts in the drama of sex, alike on its psychic as on its physical sides, are thus supposed to be played by two mysterious protagonists, the hormones, or internal secretions, of the testes and of the ovary. Even the part played by the brain is now often regarded as chemical, the brain being considered to be a great chemical laboratory. There is a tendency, moreover, to extend the sexual sphere so as to admit the influence of internal secretions from other glands. The thymus, the adrenals, the thyroid, the pituitary, even the kidneys: it is possible that internal secretions from all these glands may combine to fill in the complete picture of sexuality as we know it in men and women.[[16]] The subject is, however, so complex and at present so little known that it would be hazardous, and for the present purpose it is needless, to attempt to set forth any conclusions.
It is sufficiently clear that there is on the surface a striking analogy between sexual desire and the impulse to evacuate an excretion, and that this analogy is not only seen in the frog, but extends also to the highest vertebrates. It is quite another matter, however, to assert that the sexual impulse can be adequately defined as an impulse to evacuate. To show fully the inadequate nature of this conception would require a detailed consideration of the facts of sexual life. That is, however, unnecessary. It is enough to point out certain considerations which alone suffice to invalidate this view. In the first place, it must be remarked that the trifling amount of fluid emitted in sexual intercourse is altogether out of proportion to the emotions aroused by the act and to its after-effect on the organism; the ancient dictum omne animal post coitum triste may not be exact, but it is certain that the effect of coitus on the organism is far more profound than that produced by the far more extensive evacuation of the bladder or bowels. Again, this definition leaves unexplained all those elaborate preliminaries which, both in man and the lower animals, precede the sexual act, preliminaries which in civilized human beings sometimes themselves constitute a partial satisfaction to the sexual impulse. It must also be observed that, unlike the ordinary excretions, this discharge of the sexual glands is not always, or in every person, necessary at all. Moreover, the theory of evacuation at once becomes hopelessly inadequate when we apply it to women; no one will venture to claim that an adequate psychological explanation of the sexual impulse in a woman is to be found in the desire to expel a little bland mucus from the minute glands of the genital tract. We must undoubtedly reject this view of the sexual impulse. It has a certain element of truth and it permits an instructive and helpful analogy; but that is all. The sexual act presents many characters which are absent in an ordinary act of evacuation, and, on the other hand, it lacks the special characteristic of the evacuation proper, the elimination of waste material; the seminal fluid is not a waste material, and its retention is, to some extent perhaps, rather an advantage than a disadvantage to the organism.
Eduard von Hartmann long since remarked that the satisfaction of what we call the sexual instinct through an act carried out with a person of the opposite sex is a very wonderful phenomenon. It cannot be said, however, that the conception of the sexual act as a simple process of evacuation does anything to explain the wonder. We are, at most, in the same position as regards the stilling of normal sexual desire as we should be as regards the emptying of the bladder, supposing it were very difficult for either sex to effect this satisfactorily without the aid of a portion of the body of a person of the other sex acting as a catheter. In such a case our thoughts and ideals would center around persons of opposite sex, and we should court their attention and help precisely as we do now in the case of our sexual needs. Some such relationship does actually exist in the case of the suckling mother and her infant. The mother is indebted to the child for the pleasurable relief of her distended breasts; and, while in civilization more subtle pleasures and intelligent reflection render this massive physical satisfaction comparatively unessential to the act of suckling, in more primitive conditions and among animals the need of this pleasurable physical satisfaction is a real bond between the mother and her offspring. The analogy is indeed very close: the erectile nipple corresponds to the erectile penis, the eager watery mouth of the infant to the moist and throbbing vagina, the vitally albuminous milk to the vitally albuminous semen.[[17]] The complete mutual satisfaction, physical and psychic, of mother and child, in the transfer from one to the other of a precious organized fluid, is the one true physiological analogy to the relationship of a man and a woman at the climax of the sexual act. Even this close analogy, however, fails to cover all the facts of the sexual life.
A very different view is presented to us in the definition of the sexual instinct as a reproductive impulse, a desire for offspring. Hegar, Eulenburg, Näcke, and Löwenfeld have accepted this as, at all events, a partial definition.[[18]] No one, indeed, would argue that it is a complete definition, although a few writers appear to have asserted that it is so sometimes as regards the sexual impulse in women. There is, however, considerable mental confusion in the attempt to set up such a definition. If we define an instinct as an action adapted to an end which is not present to consciousness, then it is quite true that the sexual instinct is an instinct of reproduction. But we do not adequately define the sexual instinct by merely stating its ultimate object. We might as well say that the impulse by which young animals seize food is "an instinct of nutrition." The object of reproduction certainly constitutes no part of the sexual impulse whatever in any animal apart from man, and it reveals a lack of the most elementary sense of biological continuity to assert that in man so fundamental and involuntary a process can suddenly be revolutionized. That the sexual impulse is very often associated with a strong desire for offspring there can be no doubt, and in women the longing for a child—that is to say, the longing to fulfill those functions for which their bodies are constituted—may become so urgent and imperative that we may regard it as scarcely less imperative than the sexual impulse. But it is not the sexual impulse, though intimately associated with it, and though it explains it. A reproductive instinct might be found in parthenogenetic animals, but would be meaningless, because useless, in organisms propagating by sexual union. A woman may not want a lover, but may yet want a child. This merely means that her maternal instincts have been aroused, while her sexual instincts are still latent. A desire for reproduction, as soon as that desire becomes instinctive, necessarily takes on the form of the sexual impulse, for there is no other instinctive mechanism by which it can possibly express itself. A "reproductive instinct," apart from the sexual instinct and apart from the maternal instinct, cannot be admitted; it would be an absurdity. Even in women in whom the maternal instincts are strong, it may generally be observed that, although before a woman is in love, and also during the later stages of her love, the conscious desire for a child may be strong, during the time when sexual passion is at its highest the thought of offspring, under normally happy conditions, tends to recede into the background. Reproduction is the natural end and object of the sexual instinct, but the statement that it is part of the contents of the sexual impulse, or can in any way be used to define that impulse, must be dismissed as altogether inacceptable. Indeed, although the term "reproductive instinct" is frequently used, it is seldom used in a sense that we need take seriously; it is vaguely employed as a euphemism by those who wish to veil the facts of the sexual life; it is more precisely employed mainly by those who are unconsciously dominated by a superstitious repugnance to sex.