3. A man, forty-eight years of age, has noticed for some years a distinct decline in sexual potency. Ejaculation always occurs shortly before immissio membri, when the penis is flaccid or only semi-erect. If erection is complete, on the other hand, then ejaculation fails to occur.
Very peculiar, and offering a kind of analogy to vaginismus in women, is impotence consequent upon excessively painful sensibility of the glans penis, as a result of sexual neurasthenia or of local inflammatory processes (balanitis, etc.). The pains during coitus in these cases are often so severe that those thus affected completely abandon any attempt at intercourse.
The question whether impotence can result from sexual abstinence is still disputed. Fürbringer does not know of any certain cases. According to Virey,[450] by “complete and continuous abstinence from intercourse” in the male the organs by which the semen is prepared—the testicles, the seminal vesicles, and the vasa deferentia—and also the penis, become smaller, “unsightly, wrinkled, and inactive.” Galen reports the same of the athletes of the Roman Empire, men who had to live a life of strict continence. Virey alludes to an “extremely chaste saint, in whom after death no trace of genital organs could be discovered” (!). That absolute abstinence must ultimately limit potency, if only by psychical means, is a priori probable.
Recent observations confirm the view that long-continued absolute sexual abstinence exercises a harmful influence upon potency, and especially upon potentia coeundi. As a proof of this, I may more especially mention two cases of University professors, not yet thirty years of age, both of whom until a little while ago had had no experience of sexual intercourse, one having remained continent during two years of married life! Quite recently both of them repeatedly attempted normal coitus, but with complete failure quoad erectionem. Von Schrenck-Notzing[451] also reported a case of this character not long ago, in which, notwithstanding the strong desire for normal sexual intercourse, in the case of a literary man thirty-five years of age, who prior to marriage had lived a life of complete abstinence, and had never practised masturbation, every attempt at coitus proved a failure.
Finally, we have to consider the more or less physiological presenile and senile impotence which accompanies the commencement of old age, but naturally occurs at very different times in different individuals, for some men are already old at the age of forty years, and others are not yet old at the age of seventy years. Von Gyurkovechky dates the first decline in the sexual powers from the fortieth year of life, and considers that normally these powers are completely extinguished at about sixty-five years. But there are numerous exceptions. Complete potency in respect of libido, erection, and ejaculation has been observed in men of seventy and eighty years; and isolated cases have even been recorded in which men of ninety and one hundred years have procreated children.[452] In the sense of Metchnikoff and Hirth, who in their writings proclaim the prevention of senility as a hygienic ideal, this physiological potentia senilis is no Utopia, and a future scientific macrobiotic will defer the onset of old age by from ten to twenty years.
“I do not ask,” says Georg Hirth, “that the man in advanced age should play with his sexual powers; but that he should possess the consciousness of being able to use them—that I do demand” (“Ways to Love,” p. 462).
The treatment of impotence in the male in its various forms is indeed a difficult matter in individual cases, more especially in view of the great number of existing methods of treatment; but treatment promises good results when it is based upon an exact, critical, individual analysis of the separate causes and symptoms. It is partly local and partly general. In the case of impotence resulting from excessive masturbation, or in the case of the well-known “gonorrhœal” impotence, good results will be obtained from slight cauterization of the urethra and massage of the prostate, local carbonic-acid douches or carbonic-acid baths, warm or cold sitz-baths, or electrical treatment, with which, however, great care must be exercised. In some cases imperfect erection will be benefited by the application of a 10 % ethereal solution of camphor, in the form of friction or a spray, to the entire genital region. Mechanical apparatus have also been employed to favour erection, as, for example, the so-called “schlitten,” consisting of a conducting instrument for an insufficiently erect penis, made up of two thin, suitably shaped laminæ of metal, or the “erector” of Gassen, which works in a similar manner. Apparatus of this nature are useful only to this extent, that they give the penis a certain purchase. We cannot allow that they possess any other effect, any more than Gassen’s other apparatus, the “compressor,” the “cumulator,” and the “ultimo” (Löwenfeld, Fürbringer). Any local changes that can be detected as having some connexion with the occurrence of impotence must receive attention. This is obvious; and no less obvious is the treatment of any general disorders which may give rise to the impotence. As regards the general treatment of impotence, psychical influence must first be considered. In most cases this must take the form of temporary withdrawal of the thoughts from the sexual sphere in general, for which the strict prohibition of sexual activity (masturbation, etc.) forms the foundation; in addition, will and self-confidence must be strengthened. In these matters an intelligent wife can do much to supplement the work of the physician. Sometimes a mere change in the mode of life or in the relations between husband and wife, above all, a change in the mode of performing sexual intercourse (a change in posture, greater responsiveness on the part of the wife, etc.), may have a manifest curative influence. The treatment of the neurasthenia which may have caused the impotence will also have a favourable effect. Alcohol and tobacco are best entirely forbidden. Innumerable drugs have been recommended for the treatment of impotence. The belief in the beneficial effect of cantharides is as much a superstition as the belief in the aphrodisiac action of celery, asparagus, caviare, and truffles. Certainly all these may cause excitement of the genital organs, but this is merely due to an increased flow of blood to these organs, which is of a very fugitive nature, and when the effect is often repeated (especially when cantharides is used for this purpose), it may have serious consequences. The influence of these substances may be compared with the purely stimulating effect of flagellation. More confidence may be placed in phosphorus, strychnine, and, above all, in yohimbin, a drug prepared from the bark of a West African tree,[453] which is warmly recommended in cases of neurasthenic impotence by Mendel and Eulenburg. Having myself seen good results from the use of Yohimbin Riedel in two cases of pre-senile gonorrhœal impotence, I can confirm the favourable judgment of Eulenburg. In the case of pre-senile impotence in a man nearly sixty years of age yohimbin was the only means which, after several years’ intermission, enabled him once more to have erections, and repeatedly to perform coitus. Eulenburg reports the case of a man, which is probably unique, in whom, after a few days’ use, yohimbin restored sexual potency after he had been impotent for twelve years! This interesting drug is certainly a valuable enrichment of our aphrodisiac armamentarium, and the first drug of this nature to which the name of a specific against impotence can justly be given.
Quite recently Eulenburg, Posner, Nevinny, and others, have warmly recommended as a true specific in cases of functional impotence a combination of lecithin with the active principle of the Brazilian plant Muira Puama. This new drug is by Eulenburg termed “muiracithin.”
From the above-described individual troubles (masturbation, sexual hyperæsthesia, sexual anæsthesia, pollutions, and impotence) is composed the clinical picture of sexual neurasthenia, which, however, is manifested also by other symptoms, among which we must mention certain perceptions of anxiety and certain coercive ideas, such as the condition, known also to the laity, of agoraphobia, which is very frequently met with in sexual neurasthenia; also the fear of travelling alone by railway, or sudden anxiety in the theatre or concert-hall, in the form of the fear of fire, with the accompanying irresistible impulse to rush out into the open; further, lumbar pains and neuralgia of the genital organs, and anomalies and pains connected with the evacuation of urine; an inclination to sexual perversions; gastric affections,[454] such as nervous retching and vomiting, painful cramps of the stomach, loss of appetite, also excessive hunger, nervous dyspepsia, etc.; migraine and heart troubles of manifold kinds. It is not to be wondered at that when sexual neurasthenia is markedly developed, and when several of the above-described manifestations occur, the disease may pass on into a condition of complete mental exhaustion, associated with morbid irritability and hypochondriacal and melancholy ideas. We then ultimately see the development of typical sexual hypochondria.
The treatment of sexual neurasthenia—which in the last-described general symptom-complex occurs also in women, associated in their case with amenorrhœa, dysmenorrhœa, or menorrhagia[455]—consists for the most part in the already described treatment of the individual symptoms. In addition, we have to make use of hyperalimentation, hydro-therapeutic methods, gymnastic treatment, general massage, and climatic cures.