If we confine ourselves to modern times and to fairly precise medical statements, we find in Schurig's Spermatologia (1720, pp. 274 et seq.), not only a discussion of the advantages of moderate sexual intercourse in a number of disorders, as witnessed by famous authorities, but also a list of results—including anorexia, insanity, impotence, epilepsy, even death—which were believed to have been due to sexual abstinence. This extreme view of the possible evils of sexual abstinence seems to have been part of the Renaissance traditions of medicine stiffened by a certain opposition between religion and science. It was still rigorously stated by Lallemand early in the nineteenth century. Subsequently, the medical statements of the evil results of sexual abstinence became more temperate and measured, though still often pronounced. Thus Gyurkovechky believes that these results may be as serious as those of sexual excess. Krafft-Ebing showed that sexual abstinence could produce a state of general nervous excitement (Jahrbuch für Psychiatrie, Bd. viii, Heft 1 and 2). Schrenck-Notzing regards sexual abstinence as a cause of extreme sexual hyperæsthesia and of various perversions (in a chapter on sexual abstinence in his Kriminalpsychologische und Psychopathologische Studien, 1902, pp. 174-178). He records in illustration the case of a man of thirty-six who had masturbated in moderation as a boy, but abandoned the practice entirely, on moral grounds, twenty years ago, and has never had sexual intercourse, feeling proud to enter marriage a chaste man, but now for years has suffered greatly from extreme sexual hyperæsthesia and concentration of thought on sexual subjects, notwithstanding a strong will and the resolve not to masturbate or indulge in illicit intercourse. In another case a vigorous and healthy man, not inverted, and with strong sexual desires, who remained abstinent up to marriage, suffers from psychic impotence, and his wife remains a virgin notwithstanding all her affection and caresses. Ord considered that sexual abstinence might produce many minor evils. "Most of us," he wrote (British Medical Journal, Aug. 2, 1884) "have, no doubt, been consulted by men, chaste in act, who are tormented by sexual excitement. They tell one stories of long-continued local excitement, followed by intense muscular weariness, or by severe aching pain in the back and legs. In some I have had complaints of swelling and stiffness in the legs, and of pains in the joints, particularly in the knees;" he gives the case of a man who suffered after prolonged chastity from inflammatory conditions of knees and was only cured by marriage. Pearce Gould, it may be added, finds that "excessive ungratified sexual desire" is one of the causes of acute orchitis. Remondino ("Some Observations on Continence as a Factor in Health and Disease," Pacific Medical Journal, Jan., 1900) records the case of a gentleman of nearly seventy who, during the prolonged illness of his wife, suffered from frequent and extreme priapism, causing insomnia. He was very certain that his troubles were not due to his continence, but all treatment failed and there were no spontaneous emissions. At last Remondino advised him to, as he expresses it, "imitate Solomon." He did so, and all the symptoms at once disappeared. This case is of special interest, because the symptoms were not accompanied by any conscious sexual desire. It is no longer generally believed that sexual abstinence tends to produce insanity, and the occasional cases in which prolonged and intense sexual desire in young women is followed by insanity will usually be found to occur on a basis of hereditary degeneration. It is held by many authorities, however, that minor mental troubles, of a more or less vague character, as well as neurasthenia and hysteria, are by no means infrequently due to sexual abstinence. Thus Freud, who has carefully studied angstneurosis, the obsession of anxiety, finds that it is a result of sexual abstinence, and may indeed be considered as a vicarious form of such abstinence (Freud, Sammlung Kleiner Schriften zur Neurosenlehre, 1906, pp. 76 et seq.).
The whole subject of sexual abstinence has been discussed at length by Nyström, of Stockholm, in Das Geschlechtsleben und seine Gesetze, Ch. III. He concludes that it is desirable that continence should be preserved as long as possible in order to strengthen the physical health and to develop the intelligence and character. The doctrine of permanent sexual abstinence, however, he regards as entirely false, except in the case of a small number of religious or philosophic persons. "Complete abstinence during a long period of years cannot be borne without producing serious results both on the body and the mind.... Certainly, a young man should repress his sexual impulses as long as possible and avoid everything that may artificially act as a sexual stimulant. If, however, he has done so, and still suffers from unsatisfied normal sexual desires, and if he sees no possibility of marriage within a reasonable time, no one should dare to say that he is committing a sin if, with mutual understanding, he enters into sexual relations with a woman friend, or forms temporary sexual relationships, provided, that is, that he takes the honorable precaution of begetting no children, unless his partner is entirely willing to become a mother, and he is prepared to accept all the responsibilities of fatherhood." In an article of later date ("Die Einwirkung der Sexuellen Abstinenz auf die Gesundheit," Sexual-Probleme, July, 1908) Nyström vigorously sums up his views. He includes among the results of sexual abstinence orchitis, frequent involuntary seminal emissions, impotence, neurasthenia, depression, and a great variety of nervous disturbances of vaguer character, involving diminished power of work, limited enjoyment of life, sleeplessness, nervousness, and pre-occupation with sexual desires and imaginations. More especially there is heightened sexual irritability with erections, or even seminal emissions on the slightest occasion, as on gazing at an attractive woman or in social intercourse with her, or in the presence of works of art representing naked figures. Nyström has had the opportunity of investigating and recording ninety cases of persons who have presented these and similar symptoms as the result, he believes, of sexual abstinence. He has published some of these cases (Zeitschrift für Sexualwissenschaft, Oct., 1908), but it may be added that Rohleder ("Die Abstinentia Sexualis," ib., Nov., 1908) has criticized these cases, and doubts whether any of them are conclusive. Rohleder believes that the bad results of sexual abstinence are never permanent, and also that no anatomically pathological states (such as orchitis) can be thereby produced. But he considers, nevertheless, that even incomplete and temporary sexual abstinence may produce fairly serious results, and especially neurasthenic disturbances of various kinds, such as nervous irritability, anxiety, depression, disinclination for work; also diurnal emissions, premature ejaculations, and even a state approaching satyriasis; and in women hysteria, hystero-epilepsy, and nymphomaniacal manifestations; all these symptoms may, however, he believes, be cured when the abstinence ceases.
Many advocates of sexual abstinence have attached importance to the fact that men of great genius have apparently been completely continent throughout life. This is certainly true (see ante, p. 173). But this fact can scarcely be invoked as an argument in favor of the advantages of sexual abstinence among the ordinary population. J. F. Scott selects Jesus, Newton, Beethoven, and Kant as "men of vigor and mental acumen who have lived chastely as bachelors." It cannot, however, be said that Dr. Scott has been happy in the four figures whom he has been able to select from the whole history of human genius as examples of life-long sexual abstinence. We know little with absolute certainty of Jesus, and even if we reject the diagnosis which Professor Binet-Sanglé (in his Folie de Jesus) has built up from a minute study of the Gospels, there are many reasons why we should refrain from emphasizing the example of his sexual abstinence; Newton, apart from his stupendous genius in a special field, was an incomplete and unsatisfactory human being who ultimately reached a condition very like insanity; Beethoven was a thoroughly morbid and diseased man, who led an intensely unhappy existence; Kant, from first to last, was a feeble valetudinarian. It would probably be difficult to find a healthy normal man who would voluntarily accept the life led by any of these four, even as the price of their fame. J. A. Godfrey (Science of Sex, pp. 139-147) discusses at length the question whether sexual abstinence is favorable to ordinary intellectual vigor, deciding that it is not, and that we cannot argue from the occasional sexual abstinence of men of genius, who are often abnormally constituted, and physically below the average, to the normally developed man. Sexual abstinence, it may be added, is by no means always a favorable sign, even in men who stand intellectually above the average. "I have not obtained the impression," remarks Freud (Sexual-Probleme, March, 1908), "that sexual abstinence is helpful to energetic and independent men of action or original thinkers, to courageous liberators or reformers. The sexual conduct of a man is often symbolic of his whole method of reaction in the world. The man who energetically grasps the object of his sexual desire may be trusted to show a similarly relentless energy in the pursuit of other aims."
Many, though not all, who deny that prolonged sexual abstinence is harmless, include women in this statement. There are some authorities indeed who believe that, whether or not any conscious sexual desire is present, sexual abstinence is less easily tolerated by women than by men.[[94]]
Cabanis, in his famous and pioneering work, Rapports du Physique et du Moral, said in 1802, that women not only bear sexual excess more easily than men, but sexual privations with more difficulty, and a cautious and experienced observer of to-day, Löwenfeld (Sexualleben und Nervenleiden, 1899, p. 53), while not considering that normal women bear sexual abstinence less easily than men, adds that this is not the case with women of neuropathic disposition, who suffer much more from this cause, and either masturbate when sexual intercourse is impossible or fall into hystero-neurasthenic states. Busch stated (Das Geschlechtsleben des Weibes, 1839, vol. i, pp. 69, 71) that not only is the working of the sexual functions in the organism stronger in women than in men, but that the bad results of sexual abstinence are more marked in women. Sir Benjamin Brodie said long ago that the evils of continence to women are perhaps greater than those of incontinence, and to-day Hammer (Die Gesundheitlichen Gefahren der Geschlechtlichen Enthaltsamkeit, 1904) states that, so far as reasons of health are concerned, sexual abstinence is no more to be recommended to women than to men. Nyström is of the same opinion, though he thinks that women bear sexual abstinence better than men, and has discussed this special question at length in a section of his Geschlechtsleben und seine Gesetze. He agrees with the experienced Erb that a large number of completely chaste women of high character, and possessing distinguished qualities of mind and heart, are more or less disordered through their sexual abstinence; this is specially often the case with women married to impotent men, though it is frequently not until they approach the age of thirty, Nyström remarks, that women definitely realize their sexual needs.
A great many women who are healthy, chaste, and modest, feel at times such powerful sexual desire that they can scarcely resist the temptation to go into the street and solicit the first man they meet. Not a few such women, often of good breeding, do actually offer themselves to men with whom they may have perhaps only the slightest acquaintance. Routh records such cases (British Gynæcological Journal, Feb., 1887), and most men have met with them at some time. When a woman of high moral character and strong passions is subjected for a very long period to the perpetual strain of such sexual craving, especially if combined with love for a definite individual, a chain of evil results, physical and moral, may be set up, and numerous distinguished physicians have recorded such cases, which terminated at once in complete recovery as soon as the passion was gratified. Lauvergne long since described a case. A fairly typical case of this kind was reported in detail by Brachet (De l'Hypochondrie, p. 69) and embodied by Griesinger in his classic work on "Mental Pathology." It concerned a healthy married lady, twenty-six years old, having three children. A visiting acquaintance completely gained her affections, but she strenuously resisted the seducing influence, and concealed the violent passion that he had aroused in her. Various serious symptoms, physical and mental, slowly began to appear, and she developed what seemed to be signs of consumption. Six months' stay in the south of France produced no improvement, either in the bodily or mental symptoms. On returning home she became still worse. Then she again met the object of her passion, succumbed, abandoned her husband and children, and fled with him. Six months later she was scarcely recognizable; beauty, freshness and plumpness had taken the place of emaciation; while the symptoms of consumption and all other troubles had entirely disappeared. A somewhat similar case is recorded by Camill Lederer, of Vienna (Monatsschrift für Harnkrankheiten und Sexuelle Hygiene, 1906, Heft 3). A widow, a few months after her husband's death, began to cough, with symptoms of bronchial catarrh, but no definite signs of lung disease. Treatment and change of climate proved entirely unavailing to effect a cure. Two years later, as no signs of disease had appeared in the lungs, though the symptoms continued, she married again. Within a very few weeks all symptoms had disappeared, and she was entirely fresh and well.
Numerous distinguished gynæcologists have recorded their belief that sexual excitement is a remedy for various disorders of the sexual system in women, and that abstinence is a cause of such disorders. Matthews Duncan said that sexual excitement is the only remedy for amenorrhœa; "the only emmenagogue medicine that I know of," he wrote (Medical Times, Feb. 2, 1884), "is not to be found in the Pharmacopœia: it is erotic excitement. Of the value of erotic excitement there is no doubt." Anstie, in his work on Neuralgia, refers to the beneficial effect of sexual intercourse on dysmenorrhœa, remarking that the necessity of the full natural exercise of the sexual function is shown by the great improvement in such cases after marriage, and especially after childbirth. (It may be remarked that not all authorities find dysmenorrhœa benefited by marriage, and some consider that the disease is often thereby aggravated; see, e.g., Wythe Cook, American Journal Obstetrics, Dec., 1893.) The distinguished gynæcologist, Tilt, at a somewhat earlier date (On Uterine and Ovarian Inflammation, 1862, p. 309), insisted on the evil results of sexual abstinence in producing ovarian irritation, and perhaps subacute ovaritis, remarking that this was specially pronounced in young widows, and in prostitutes placed in penitentiaries. Intense desire, he pointed out, determines organic movements resembling those required for the gratification of the desire. These burning desires, which can only be quenched by their legitimate satisfaction, are still further heightened by the erotic influence of thoughts, books, pictures, music, which are often even more sexually stimulating than social intercourse with men, but the excitement thus produced is not relieved by that natural collapse which should follow a state of vital turgescence. After referring to the biological facts which show the effect of psychic influences on the formative powers of the ovario-uterine organs in animals, Tilt continues: "I may fairly infer that similar incitements on the mind of females may have a stimulating effect on the organs of ovulation. I have frequently known menstruation to be irregular, profuse, or abnormal in type during courtship in women in whom nothing similar had previously occurred, and that this protracted the treatment of chronic ovaritis and of uterine inflammation." Bonnifield, of Cincinnati (Medical Standard, Dec., 1896), considers that unsatisfied sexual desire is an important cause of catarrhal endometritis. It is well known that uterine fibroids bear a definite relation to organic sexual activity, and that sexual abstinence, more especially the long-continued deprivation of pregnancy, is a very important cause of the disease. This is well shown by an analysis by A. E. Giles (Lancet, March 2, 1907) of one hundred and fifty cases. As many as fifty-six of these cases, more than a third, were unmarried women, though nearly all were over thirty years of age. Of the ninety-four married women, thirty-four had never been pregnant; of those who had been pregnant, thirty-six had not been so for at least ten years. Thus eighty-four per cent, had either not been pregnant at all, or had had no pregnancy for at least ten years. It is, therefore, evident that deprivation of sexual function, whether or not involving abstinence from sexual intercourse, is an important cause of uterine fibroid tumors. Balls-Headley, of Victoria (Evolution of the Diseases of Women, 1894, and "Etiology of Diseases of Female Genital Organs," Allbutt and Playfair, System of Gynæcology,) believes that unsatisfied sexual desire is a factor in very many disorders of the sexual organs in women. "My views," he writes in a private letter, "are founded on a really special gynæcological practice of twenty years, during which I have myself taken about seven thousand most careful records. The normal woman is sexually well-formed and her sexual feelings require satisfaction in the direction of the production of the next generation, but under the restrictive and now especially abnormal conditions of civilization some women undergo hereditary atrophy, and the uterus and sexual feelings are feeble; in others of good average local development the feeling is in restraint; in others the feelings, as well as the organs, are strong, and if normal use be withheld evils ensue. Bearing in mind these varieties of congenital development in relation to the respective condition of virginity, or sterile or parous married life, the mode of occurrence and of progress of disease grows on the physician's mind, and there is no more occasion for bewilderment than to the mathematician studying conic sections, when his knowledge has grown from the basis of the science. The problem is suggested: Has a crowd of unassociated diseases fallen as through a sieve on woman, or have these affections almost necessarily ensued from the circumstances of her unnatural environment?" It may be added that Kisch (Sexual Life of Woman), while protesting against any exaggerated estimate of the effects of sexual abstinence, considers that in women it may result, not only in numerous local disorders, but also in nervous disturbance, hysteria, and even insanity, while in neurasthenic women "regulated sexual intercourse has an actively beneficial effect which is often striking."
It is important to remark that the evil results of sexual abstinence in women, in the opinion of many of those who insist upon their importance, are by no means merely due to unsatisfied sexual desire. They may be pronounced even when the woman herself has not the slightest consciousness of sexual needs. This was clearly pointed out forty years ago by the sagacious Anstie (op. cit.) In women, especially, he remarks, "a certain restless hyperactivity of mind, and perhaps of body also, seems to be the expression of Nature's unconscious resentment of the neglect of sexual functions." Such women, he adds, have kept themselves free from masturbation "at the expense of a perpetual and almost fierce activity of mind and muscle." Anstie had found that some of the worst cases of the form of nervosity and neurasthenia which he termed "spinal irritation," often accompanied by irritable stomach and anæmia, get well on marriage. "There can be no question," he continues, "that a very large proportion of these cases in single women (who form by far the greater number of subjects of spinal irritation) are due to this conscious or unconscious irritation kept up by an unsatisfied sexual want. It is certain that very many young persons (women more especially) are tormented by the irritability of the sexual organs without having the least consciousness of sexual desire, and present the sad spectacle of a vie manquée without ever knowing the true source of the misery which incapacitates them for all the active duties of life. It is a singular fact that in occasional instances one may even see two sisters, inheriting the same kind of nervous organization, both tormented with the symptoms of spinal irritation and both probably suffering from repressed sexual functions, but of whom one shall be pure-minded and entirely unconscious of the real source of her troubles, while the other is a victim to conscious and fruitless sexual irritation." In this matter Anstie may be regarded as a forerunner of Freud, who has developed with great subtlety and analytic power the doctrine of the transformation of repressed sexual instinct in women into morbid forms. He considers that the nervosity of to-day is largely due to the injurious action on the sexual life of that repression of natural instincts on which our civilization is built up. (Perhaps the clearest brief statement of Freud's views on the matter is to be found in a very suggestive article, "Die 'Kulturelle' Sexualmoral und die Moderne Nervosität," in Sexual-Probleme, March, 1908, reprinted in the second series of Freud's Sammlung Kleiner Schriften zur Neurosenlehre, 1909). We possess the aptitude, he says, of sublimating and transforming our sexual activities into other activities of a psychically related character, but non-sexual. This process cannot, however, be carried out to an unlimited extent any more than can the conversion of heat into mechanical work in our machines. A certain amount of direct sexual satisfaction is for most organizations indispensable, and the renunciation of this individually varying amount is punished by manifestations which we are compelled to regard as morbid. The process of sublimation, under the influence of civilization, leads both to sexual perversions and to psycho-neuroses. These two conditions are closely related, as Freud views the process of their development; they stand to each other as positive and negative, sexual perversions being the positive pole and psycho-neuroses the negative. It often happens, he remarks, that a brother may be sexually perverse, while his sister, with a weaker sexual temperament, is a neurotic whose symptoms are a transformation of her brother's perversion; while in many families the men are immoral, the women pure and refined but highly nervous. In the case of women who have no defect of sexual impulse there is yet the same pressure of civilized morality pushing them into neurotic states. It is a terribly serious injustice, Freud remarks, that the civilized standard of sexual life is the same for all persons, because though some, by their organization, may easily accept it, for others it involves the most difficult psychic sacrifices. The unmarried girl, who has become nervously weak, cannot be advised to seek relief in marriage, for she must be strong in order to "bear" marriage, while we urge a man on no account to marry a girl who is not strong. The married woman who has experienced the deceptions of marriage has usually no way of relief left but by abandoning her virtue. "The more strenuously she has been educated, and the more completely she has been subjected to the demands of civilization, the more she fears this way of escape, and in the conflict between her desires and her sense of duty, she also seeks refuge—in neurosis. Nothing protects her virtue so surely as disease." Taking a still wider view of the influence of the narrow "civilized" conception of sexual morality on women, Freud finds that it is not limited to the production of neurotic conditions; it affects the whole intellectual aptitude of women. Their education denies them any occupation with sexual problems, although such problems are so full of interest to them, for it inculcates the ancient prejudice that any curiosity in such matters is unwomanly and a proof of wicked inclinations. They are thus terrified from thinking, and knowledge is deprived of worth. The prohibition to think extends, automatically and inevitably, far beyond the sexual sphere. "I do not believe," Freud concludes, "that there is any opposition between intellectual work and sexual activity such as was supposed by Möbius. I am of opinion that the unquestionable fact of the intellectual inferiority of so many women is due to the inhibition of thought imposed upon them for the purpose of sexual repression."
It is only of recent years that this problem has been realized and faced, though solitary thinkers, like Hinton, have been keenly conscious of its existence; for "sorrowing virtue," as Mrs. Ella Wheeler Wilcox puts it, "is more ashamed of its woes than unhappy sin, because the world has tears for the latter and only ridicule for the former." "It is an almost cynical trait of our age," Hellpach wrote a few years ago, "that it is constantly discussing the theme of prostitution, of police control, of the age of consent, of the 'white slavery,' and passes over the moral struggle of woman's soul without an attempt to answer her burning questions."
On the other hand we find medical writers not only asserting with much moral fervor that sexual intercourse outside marriage is always and altogether unnecessary, but declaring, moreover, the harmlessness or even the advantages of sexual abstinence.