To the category suggested by P. Bernhardt of sexual excitement induced by anxiety and trouble belongs the case reported to me by Dr. Emil Bock of a boy of fifteen years of age, who, when very anxious about his inability to complete a school task, experienced an ejaculation for the first time. To the literature of impotence belongs the work by Nicolo Barrucco, “Sexual Neurasthenia, and its Relations to the Diseases of the Genital Organs.” Regarding physiological pollutions, and the trifling difference between them and normal seminal discharge during coitus, Schopenhauer makes some apt observations in his “Neue Paralipomena,” pp. 230, 231.
In the treatment of pollutions, which always demands the most careful medical observation and examination of the individual case, the most important measures are dietetic and hygienic treatment, change of scene from town to country, and especially to mountain air, methodical hydrotherapeutic measures, warm baths, massage, electricity, hyperalimentation, the use of bromides, local treatment of the urethra, etc., etc.
The last and most important of the phenomena connected with sexual neurasthenia is sexual weakness or impotence in its various forms.[442]
We distinguish in the male two principal forms of impotence: (1) “Impotentia coeundi”—that is, incapacity for erection of the penis and the completion of coitus; (2) “impotentia generandi”—that is, the impossibility of fertilization (owing to want of semen or to the lack of fertilizing quality in this fluid).
Congenital malformations of the genital organs giving rise to impotence are extremely rare. Gyurkovechky, amongst 6,000 men fit for military service, found three such men only. More frequently are acquired defects met with as causes of impotence, such as complete or partial loss of the penis and testicles, as in eunuchs and castrated persons. It is well known that, notwithstanding the removal of the external genital organs, sexual desire may persist; and when the penis is retained, though the testicles have been removed, erection and copulation are possible, providing the castration was effected after puberty. But it is obvious that in most cases potency is very markedly interfered with, and ultimately it may entirely disappear. More light is thrown on the question by the occurrence of impotence after unilateral castration. A tragical case of this latter kind is reported by von Gyurkovechky (op. cit., p. 71):
“A former colleague of mine at the University of Vienna had to have one of his testicles removed in consequence of obstinate inflammation resulting from gonorrhœa; thereafter the second testicle underwent complete atrophy. The much-to-be-pitied, handsome, elegant, and amiable young man remained for some years capable of performing coitus, was greatly pleased with himself for this reason, and paid ostentatious court to ladies. Still, he was seldom in a position to perform coitus, and after three years he completely withdrew himself from the society of ladies, and became gradually morose and reserved, until one day he disappeared from Vienna, discontinued his studies, and never let any of us hear from him again. This case has remained very vividly in my memory, and it illustrates most clearly the influence of virile potency upon the entire being of the individual.”
If the second testicle remains intact, the capacity for sexual intercourse is not interfered with; and reproductive capacity also persists, although it may be diminished in degree.
An important source of sterility in the male, in which the capacity for sexual intercourse remains unimpaired, is bilateral epididymitis, consequent upon gonorrhœa. This represents more than 50 % of all the cases of incapacity for procreation in the male. Finger found in 85 % of cases of epididymitis that the spermatozoa were absent from the semen (the so-called “azoospermia”); and Fürbringer is led by his own experience to believe that 80 % of men who have had double epididymitis are incapable of procreation. Thus we may really speak of “gonorrhœal sterility in the male.” In many sterile marriages the fault lies with the husband, as was first clearly proved by F. Kehrer’s fundamental investigations. And the no less momentous gonorrhœal sterility in women is also, in the majority of cases, ultimately dependent upon the husband, who has presented his wife with “gonorrhœal infection as a wedding gift.”[443]
An extremely small size of the penis, also a relatively small size of this organ in cases of obesity and tumours, malformations of the penis, also the by no means rare mechanical hindrances to erections due to injuries and indurations in the corpora cavernosa (especially as a result of gonorrhœal inflammation)—all these may make coitus impossible. Fürbringer and Finger have also seen peculiar chronic shrinking processes of the corpora cavernosa occur independently of gonorrhœa and tumours. All these conditions give rise to incomplete erection, in which the penis is bent at an angle at some point or other, or is curved, so that it cannot be introduced into the vagina (chordee).
All the hitherto described forms of impotentia coeundi are less frequent than those in which the external genital organs are completely intact, and in which we have to do simply with imperfection or complete failure of erection in consequence of various general disorders.