Von Krafft-Ebing, to whom we owe the most important observations regarding the pathological etiology of sexual perversions, enumerates the following conditions: Psychical developmental inhibitions (idiocy and imbecility), acquired weak-mindedness (after mental disorders, apoplexy, injuries to the head, syphilis, in consequence of general paralysis), epilepsy, periodical insanity, mania, melancholia, hysteria, paranoia.
Among these, epilepsy possesses the greatest importance.[485] It comes into play much more frequently as a causal morbid influence in the case of sexually perverse actions and offences than has hitherto been believed. The psychiatrist Arndt maintains that wherever an abnormal sexual life exists, we must always consider the possibility of epileptic influence. Lombroso assumes that all premature and peculiar instances of satyriasis are instances of larval epilepsy. He gives several examples in support of this view, and also a case of Macdonald’s which illustrates the connexion between epilepsy and sexual perversity.[486] Especially in the so-called epileptic “confusional states” do we meet with sexually perverse actions; exhibitionism and other manifestations of sexual activity coram publico are frequently referable to epileptic disease. Similar impulsive sexual activities and similar confusional states are seen after injuries to the head and in alcoholic intoxication, also after severe exhaustion. Many cases of “periodic psychopathia sexualis” are due to epilepsy.
Senile dementia and paralytic dementia (general paralysis of the insane), also severe forms of neurasthenia and hysteria, often change the sexual life in a morbid direction, and favour the origin of sexual perversions.
It is a fact of great interest that Tarnowsky and Freud attribute to syphilis an important rôle in the pathogenesis of sexual anomalies. In 50 % of his sexual pathological cases Freud found that the abnormal sexual constitution was to be regarded as the last manifestation of a syphilitic inheritance (Freud, op. cit., p. 74). Tarnowsky observed that congenital syphilitics, and also persons whose parents had been syphilitic, but who themselves had never exhibited any definite symptoms of the disease, were apt later to show manifestations of a perverse sexual sensibility (Tarnowsky, op. cit., pp. 34 and 35). Obviously this is to be explained by the deleterious influence upon the nervous system (perhaps by means of toxins?) which syphilis is also supposed to exert in the causation of tabes dorsalis and general paralysis of the insane. When investigating the clinical history of cases of sexual perversion, it appears that previous syphilis is a fact to which some importance should be attached.[487]
From syphilis we pass to consider direct physical abnormalities and morbid changes in the genital organs as causes of sexual anomalies. In women prolapsus uteri sometimes leads to perverse gratification of the sexual impulse—for example, by pædication;[488] in men, shortness of the frænum preputii plays a similar part,[489] also phimosis. Wollenmann reports the case of a young man suffering from phimosis, who, at the first attempt at coitus, experienced severe pain, and since that time had an antipathy to normal sexual intercourse. He passed under the influence of a seducer to the practice of mutual masturbation. Only after operative treatment of the phimosis did his inclination towards the male sex pass away, and the sexual perversion then completely disappeared.[490]
[456] Hermann Joseph Löwenstein, “De Mentis Aberrationibus ex Partium Sexualium Conditione Abnormi Oriundis” (Bonn, 1823).
[457] Joseph Häussler, “The Relations of the Sexual System to the Psyche” (Würzburg, 1826).
[458] Heinrich Kaan, “Psychopathia Sexualis” (Leipzig, 1844).
[459] R. von Krafft-Ebing, “Psychopathia Sexualis” (Stuttgart, 1882).