SEMINAL INCONTINENCE.
BY SAMUEL W. GROSS, A.M., M.D.
DEFINITION.—By the term seminal incontinence, which is synonymous with involuntary or abnormal seminal emissions, pollutions, and spermatorrhoea, is meant the involuntary discharge of semen beyond the limits of health. Although usually described as a distinct disease, it is symptomatic of, and, as a rule, primarily dependent upon, weakness or exhaustion, along with exaggerated irritability, excitability, impressibility, or mobility of the centres which preside over erection and ejaculation. Hence it should be regarded as a motor neurosis, and not as a functional disorder of the testes.
CLASSIFICATION.—Involuntary seminal losses embrace three conditions, which constitute as many varieties of the affection, and which may exist separately, or pass into one another, or be combined. These varieties are, first, nocturnal losses or pollutions, which occur during sleep, and are generally attended with an erection, erotic dream, and pleasurable sensation; secondly, diurnal pollutions, which take place when the patient is awake, are excited by trivial mechanical or psychical causes, and are associated with imperfect erection and diminished sensation; and, thirdly, spermorrhagia, or spermatorrhoea, in the strict acceptation of that term, which is characterized by a constant escape of a slight amount of seminal fluid, without the orgasm, pleasurable sensation, or impure thoughts, or during micturition and defecation.
1. Nocturnal Pollutions.—By far the most common of the varieties of seminal incontinence is the first, or that in which the emissions occur during sleep under the influence of an erotic dream, and which may, therefore, be regarded as an exaggeration of the normal or physiological condition. In health, provided the subject leads a continent life, the number of emissions varies greatly, and as they are merely reflex signs of distension of the seminal passages, they are not pathological nor are they attended with ill effects. The knowledge of this fact is of great practical importance, as it frequently enables the physician to assure his patient that the emissions are not abnormal, thereby relieving his mind of a great weight. It is, of course, to be remembered that the frequency of nocturnal pollutions depends upon age, climate, habits, temperament, constitution, diet, and predisposition, and that young men who suffered during childhood from nocturnal incontinence of urine are particularly obnoxious to them. Their frequency also varies greatly in the same person, and it is scarcely possible to determine what constitutes the standard of health merely by the intervals of their repetition, since a number which would be normal in one person would be abnormal in another. In men, however, who possess sound nervous systems and who do not trouble themselves with sexual matters an emission every fortnight is a sign of excellent health; and even if they should occur at intervals of several days, they are not inconsistent with temporary good health. The latter statement is well exemplified by a case which came under my observation in 1882. A druggist, twenty-seven years of age, had had for six years from three to live emissions a week, and occasionally two during a single night, attended with erections and voluptuous dreams, without the slightest evidence of impairment of his health. In all such cases, however, as well as in those in which the emissions have occurred at longer intervals for a number of years, it only requires a little longer time for general symptoms to manifest themselves.
Nocturnal pollutions are to be regarded as pathological when they occur in married or single men who indulge in regular intercourse; when they are followed by backache, headache, enfeeblement of the functional powers of the brain, mental depression, and bodily or mental lassitude; when they take place without erections or dreams; when they accompany or follow acute or chronic diseases; when they coexist with diurnal pollutions or spermorrhagia; and, finally, when they are complicated by one of the varieties of impotence, which may be the only indication that the emissions are abnormal or one of the effects of impairment of the functions of the genital nervous centres. The associated symptoms of myelasthenia and cerebrasthenia vary very much in degree in men of apparently the same amount of vigor and tolerance, and in whom the pollutions occur with equal frequency, or they may even be absent altogether.
2. Diurnal Pollutions.—Ejaculation of semen during the day is fortunately of comparatively infrequent occurrence, since it indicates a more serious condition than do losses of seminal fluid occurring when the patient is asleep, the genital organs and the centres which preside over them being highly impressible or in a state of irritable weakness. In what may be regarded as the lesser form of the affection the ejaculation is due to slight peripheral irritation, induced, for example, by friction of the clothing, crossing of the legs repeated several times, horseback exercise, driving over rough streets, riding in railway-cars, or even shaving, combing the hair, or shampooing the head; while in the more aggravated variety an emission is induced by psychical irritation, such as reading libidinous books, the sight of indecent pictures, dwelling upon sexual ideas, or the mere sight of a female. In the former of these varieties there is a fair erection, but the sensibility is blunted; in the latter the erection is flabby or the penis is flaccid and there is little if any pleasure.