“The young married pair kiss one another and vie with one another in tenderness, but when the matter becomes serious—when the husband wants to enjoy his rights as a husband—the wife experiences incredible anxiety; she trembles in all her limbs, writhes, screams, and weeps. The man becomes exhausted, and at length, when the wife is resigned, and willing to surrender herself to her fate, he has become unfitted for his share in intercourse.”
It is clear that these forms of psychical impotence, which appear in very various shades, are mostly transient phenomena, and exhibit a good prospect of complete cure.
Much more difficult is the matter when we have to do with cases, becoming commoner every day, of psychical impotence in consequence of sexual perversions. Sadistic, masochistic, fetichistic, and homosexual inclinations may, in certain individuals, predominate to such an extent that either copulation cannot be effected without the preliminary gratification of these perverse instincts, or else the latter entirely usurp the place of normal coitus, which has become, generally speaking, quite impossible (relative and absolute psychical impotence in consequence of sexual perversions). To the former category belong, for example, those cases, which are by no means rarely seen, in which homosexual persons are only able to have intercourse with their wives after preliminary caresses by their male friends; or masochists must be subjected to a preparatory flagellation in order to become potent. In the second category copulation has become quite impossible; the orgasm takes place only in connexion with the activity of the perverse impulse, and there often exists an actual repugnance to normal coitus.
Well known also is that rare relative psychical impotence in which the man can perform coitus only with prostitutes, whereas he is impotent as regards decent women. This, however, may often be associated with the existence of sexual perversions, which are gratified only during intercourse with prostitutes.
Another form of relative psychical impotence is temporary impotence, in which the potency is entirely subject to custom, and a change in the custom induces impotence. Thus, Frenzel reports the case of a man who had always had intercourse with his wife immediately on going to bed, and proved completely impotent when this habit was interrupted, and he now wished to perform the act early in the morning. Only gradually did he recover his lost potency and become able to adapt himself to the changed conditions.[447]
Another form of impotence by no means rare, and occurring in otherwise healthy men, is that produced by powerful mental activity or artistic production, the impotence of literary men and of artists. It is usually of a transient nature,[448] manifesting itself only during the periods of intellectual activity, and it is explicable in accordance with the law of sexual equivalents, according to which the sexual potency appears in the latent form of spiritual productive activity. A remarkable case of this impotence of literary men is reported by the just quoted Frenzel.[449] Allied with this variety of impotence is the form due to transient mental distraction, to instantaneous ideas, which suddenly act as psychical inhibitions. These sudden ideas can be of a very varied content—joyful, sad, anxious, annoying; in every case they are capable of annulling the already existing potency, and of making the further erection of the penis impossible. Such conditions occur alike in healthy persons and in those who are readily excitable and neurasthenic. A classical instance of this nature is J. J. Rousseau’s adventure with the Venetian courtesan Giulietta, which he describes very vividly in his “Confession.” He went to see her full of passionate desire for sexual enjoyment, but Nature “had put into his head a poison against this unspeakable happiness” for which his heart yearned. Hardly had he glanced at the beautiful girl than an idea came to him which moved him to tears, and completely diverted him from his purpose. He became more deeply absorbed in this idea, the sexual desires completely disappeared, and he was no longer in a position to prove his manhood. To this tragi-comic episode we owe the exclamation of the disappointed girl, which has passed into a proverb: “Lascia le donne e studia la matematica” (“Leave women alone, and go and study mathematics”). In the reflective love of Kierkegaard, Grillparzer, Alfred de Musset, and other men of remarkable genius, there is also recognizable an element of impotence.
The majority of all cases of impotence belong to the class of true nervous, neurasthenic impotence, and these are diffused especially among the circles who supply the greatest contingent to the ranks of neurasthenics in general—that is, among officers, merchants, physicians, and other classes of the cultured part of our population whose professional duties are arduous. Among the causes of neurasthenic impotence, excessive masturbation and chronic gonorrhœa, with its consequences, play the principal part. Neurasthenic impotence manifests itself, above all, by abnormal conditions of erection and ejaculation, either of which may by itself be diminished or completely prevented; or, again, both may exhibit abnormalities, whilst in some cases even erection may be very frequent, unusually powerful, and long-lasting (the so-called “priapism”), whilst ejaculation and voluptuous sensation are completely wanting, and these erections are in most cases accompanied by very painful sensations. An extremely characteristic symptom of nervous impotence is a premature discharge of the semen, not merely ante portas, but often even at the first signs of activity of the libido sexualis, at which time erection may be very well developed. In other cases, again, erection occurs, but no ejaculation of the semen. Finally, both may be completely wanting (the so-called “paralytic impotence”).
The following cases, which came under my own observation, show some of the above-mentioned types of impotence:
1. A man, twenty-nine years of age, married for ten months, complains, after obviously excessively frequent enjoyment of his conjugal rights, of a sense of weakness and weariness after intercourse, such as he has never previously experienced, as well as of a continually earlier ejaculation, latterly even on simple contact of his penis with the vulva. Erection is always present and is powerful. On further inquiry he admitted that in his four-weeks’ honeymoon he had connexion once daily, and thenceforward two or three times a week.
2. A man, twenty-one years of age, states that a year and a half ago for the first time he endeavoured to have sexual intercourse; he has never yet succeeded in completing coitus. Since the age of fourteen years he has suffered from frequent pollutions and from marked sexual excitability. He has often tried to effect coitus, but there has always resulted precipitate ejaculation, with his penis in a flaccid condition. He has, properly speaking, only morning erections, dependent upon a full bladder. It is possible that a marked varicocele on the left side has something to do with the genesis of this impotence.