Erection of the penis is induced both centrally from the brain (by voluptuous ideas), and from the spinal cord (by direct stimulation), and also peripherally from the genital organs (by friction of the glans penis), by stimuli proceeding from the urethra, bladder, prostate, seminal vesicles, rectum, and the neighbourhood of the genital organs (as, for example, the buttocks), and may be either of a morbid or of a physiological character. When there are inflammatory conditions of the genital organs, especially gonorrhœa of the anterior and posterior urethra, erections occur very readily. From the full bladder there also proceed stimuli giving rise to erection, thus inducing the well-known “morning erection,” utilized by many who would otherwise be completely impotent. Blows on the buttocks also give rise to erections—a subject to which we shall return when we come to discuss flagellation.
The nature of erection can be very briefly described as consisting in a stiffening of the penis by the profuse streaming of blood into the reticular spaces of the corpora cavernosa, enlarged by stimulation of the erection nerves. The consequent erection of the penis is dependent upon the action of a particular muscle—the ischio-cavernosus muscle.
Impotence when the external organs are intact is in most cases due to central causes, and ultimately to psychical causes, even though severe bodily affections or local morbid states play a predisposing part (the so-called “functional impotence”).
This impotence is sometimes one of the earliest symptoms of diabetes mellitus and of chronic Bright’s disease with contracted kidney, also of severe conditions of exhaustion—to which consumption offers a significant exception, signalized already by the old saying, phthisicus salax—of obesity, and of tabes dorsalis, in which the sexual potency gradually disappears, but libido outlasts the capacity for erection. Certain poisons also particularly damage potency. This is especially the case with alcohol, the deleterious influence of which on potency has already been described ([pp. 293], [294]). Georg Hirth goes so far as to recognize a special “impotentia alcoholica.”
“Above all, no alcohol,” says he, “especially not as a means for producing erection. In youth a man needs no such stimulus, and in age he will be apt to find, with the porter in Shakespeare’s ‘Macbeth’ (Act ii., Scene 3), that ‘drink may be said to be an equivocator with lechery,’ for, as he says, ‘it provokes the desire, but it takes away the performance; it makes lechery, and it mars him; it sets him on and takes him off; it persuades him and disheartens him; makes him stand to and not stand to: in conclusion, equivocates him into sleep, and, giving him the lie, leaves him.’”[444]
Fürbringer’s view, that alcohol, taken up to the degree of slight intoxication, rather increases potency, in connexion with which he refers to sexual invalids who are only able to perform sexual intercourse in a state of moderate intoxication, cannot be regarded as generally true. It is possible that in these admitted sexual invalids alcoholic intoxication overcomes stronger psychical inhibitions, which in the state of sobriety had hindered erection. For the normal individual alcohol is not a means for the increase of sexual potency, but the reverse.
The free use of tobacco certainly also impairs sexual potency.[445] Nicotine and love are as little compatible as alcohol and love. Fürbringer, Hirth, and Eulenburg, ascribe to the excessive use of tobacco a diminution in sexual potency. The following interesting passage is from the Diary of the De Goncourts (op. cit., p. 89):
“There is an antagonism between tobacco and women. The taste for one diminishes the taste for the other. So true is this, that passionate Lotharios usually give up smoking, because they feel or believe that tobacco diminishes their sexual appetite and their powers of love.”
Coffee and tea, taken in excess, and, above all, morphine, are also antagonistic to potency. Dupuy has observed the frequent occurrence of impotence in men who were in the habit of drinking large quantities of strong coffee (five or six breakfast-cups every day). Sexual potency returned as soon as the use of coffee was discontinued; whilst when the use of the beverage was resumed the impotence again appeared (Comptes Rendus de la Société de Biologie, 1886, No. 27).
The majority of cases of functional disturbances of potency depend upon nervous impotence. It is the form which at the present day the physician most frequently encounters. It is intimately connected with the state of “irritable nervous weakness,” or sexual neurasthenia, the most important symptom of which is represented by “psychical” impotence. There exist, also—and this justifies the independent consideration of psychical impotence—numerous cases of impotence without neurasthenia (Fürbringer). This remarkable form occurs especially in perfectly healthy young husbands, who often before were completely potent, and had previously effected coitus in a perfectly normal manner, or had lived a quiet, continent life, without having injured themselves in any way by masturbation. Such individuals, in consequence of the excitement, shame, and embarrassment of the wedding-night, often suffer from psychical impotence. Réti[446] speaks of “impotence due to compassion,” arising from “the sympathy felt with the pains suffered by the still virgin wife” when the attempt at coitus is made.