run through the branches of the inferior hypogastric plexus, and
especially through the utero-vaginal plexus. The spinal nerves connected
with this part of the sympathetic are the 2d, 3d, and 4th sacral. The
plexuses are constituted by fibres in part from sympathic and in part
from the 2d, 3d, and 4th sacral nerves. Through the same nerves passes
the centripetal motor tract for the transversus perinei muscle, and for
the sphincter and levator ani muscles. According to _Eulenburg_, the
centre for this reflex is to be found at the level of the first sacral
nerve; when the disturbance irradiates more widely, the lumbar and
sacral plexuses as a whole are involved. The constrictor cunni
(sphincter vaginæ or bulbocavernosus muscle) is supplied by the perineal
branch of the pudic nerve. The symptom-complex of vaginismus consists of
violent spastic contraction, for a term varying greatly in duration, of
the constrictor cunni (bulbocavernosus), sphincter ani, levator ani, and
transversus perinei muscles, the spasm spreading, in severe cases, to
other muscles in the neighbourhood, and especially to the adductor
muscles of the thigh; the spasm comes on when any attempt at intercourse
is made, and even when the genitals are merely touched.
In young married couples especially, vaginismus is an extremely
distressing condition, and one that entails very serious consequences,
inasmuch as the pains and reflex spasms which result from any attempt at
coitus, and even from the mere approximation of the penis to the female
genital organs, render sexual intercourse absolutely impossible. The
cause of this pathological manifestation is in part to be found in
unskilful attempts at intercourse, which have stimulated the female
genital organs at some improper region. It may be that the young husband
is not fully instructed in sexual matters, and does not really know how
coitus ought to be effected; in other cases there is some abnormality of
the hymen, which has rendered the rupture of that membrane extremely
difficult; in some cases there is partial impotence in the male, whose
penis becomes semi-erect only, so that ever-renewed attempts at
intercourse are followed by ever-renewed failure. Any of these causes
may suffice, in susceptible women, to originate vaginismus. The sufferer
in these cases will usually be found on enquiry to be hereditarily
predisposed to nervous disorder, and to be extremely sensitive to pain.
By the fruitless efforts of her ignorant or partially impotent husband,
she is sensually excited without ever being satisfied; the injured
nervous system responds by these local spasms, whilst ultimately, in
some of these cases, an actual psychosis ensues.
In a certain number of cases, however, the husband is in no way
responsible for the origin of vaginismus, which may depend on
pathological states of the female external genitals, leading to
hyperaesthesia; or, again, on primary hyperaesthesia of the pudic nerve
and its branches; or, finally, on general neurasthenia and hysteria, on
excessive sensibility and lack of self-control on the part of a young
girl, who has entered upon married life under the dominion of
extravagant ideas. Vaginismus dependent upon general neurasthenia
especially in cases in which there is no strong affection for the
husband to give the spur to desire, and to enable the woman to bear with
fortitude the pangs which form the necessary introduction to the joys of
wedded life. It must not be forgotten, as throwing light on the origin
of vaginismus, that in the digital vaginal examination of a virgin or
even of a young wife, unless extreme care is taken, pain and painful
muscular spasms are liable to be evoked.
The local pathological conditions of the female genital organs that are
most often met with in cases of vaginismus are: a very rigid state of
the hymen; inflammation and excoriation of the hymen and its
surroundings; fissures at the vaginal orifice; inflammatory affections
of the vaginal follicles; inflammation of the carunculæ myrtiformes; a
peculiar formation of the vulva, which extends forwards over the pubic
symphysis, whereby the urethral orifice and the hymeneal aperture come
to lie upon the pubic symphysis or the subpubic ligament; vulvitis;
herpes or eczema of the vulva; colpitis; urethritis; fissure of the
anus; papillary growths; pruritus papules; urethral caruncle;
inflammation of Bartholin’s glands; at times gonorrhoeal infection.
A case came under my own observation in which a newly married woman
suffered from vaginismus. The husband believed the cause of the trouble
was his own partial impotence, consequent upon youthful venereal
excesses, and yielded to the desire of his wife and her relatives that a
divorce should be obtained. A year later, the woman remarried, when, to
her horror, the symptoms returned in full force. Now for the first time
she consulted me, and on local examination I could detect no abnormality
whatever. The vaginismus was in this instance a pure neurosis, the only
possible cause of which was to be found in bygone overstimulation of the
vaginal orifice, the wife admitting previous onanistic excesses. In
another case known to me, vaginismus in the wife made the husband an
involuntary sodomite. The movements of the wife when the spasm came on
led to the introduction of the penis per anum, and coitus had repeatedly
been effected by this abnormal route, when the fact first became
apparent as the result of a local examination.
_Le Fort_ reports the case of a young Russian wedded pair who were
spending their honeymoon in Paris. The husband took so much to heart his
inability to fulfil his marital obligations in consequence of the
vaginismus from which his wife suffered, that he shot himself through
the heart. The distressing situation of a husband whose wife suffers
from vaginismus, rendering coitus impossible, is depicted in the
well-known French romance, “_Mademoiselle Giraud, Ma Femme_.” From a
false shame, women often continue to suffer from vaginismus for months
and even years, without a single effective coitus having ever taken
place; it is only the consequent sterility which at last leads to
medical advice being sought. The physician then usually ascertains that
the hymen is still intact, or at least incompletely destroyed, that on
this membrane and on various parts of the vulva there are erosions, and
that the whole of the external genitals outside the hymen are in a state
of inflammation more or less acute. In other cases, however, neither
excoriations, erosions, nor inflammation can be detected, and the
existence of vaginismus can be proved only by the pain and the muscular
spasm set up by contact with the vagina. Often, indeed, the cause of
this most distressing affection cannot be discovered.
Introduction of the penis may be rendered impossible by spasm of the
constrictor cunni (bulbocavernosus) muscle, but equally so by spasm of
the transversus perinei or the levator ani muscle. Sometimes the spasm
affects all three muscular groups; in which case the narrowing of the
vagina is extreme, and extends for some way up into the canal. When the
levator ani alone is affected by the spasm, the penis can, indeed, be
introduced into the vagina, to encounter a powerful obstacle in the
interior of that canal; and it may happen, when the spasm comes on and
affects the levator ani only after complete intromission of the penis,
that the glans is retained in the vaginal fornix by the active
contraction of the pelvic floor.
More or less credible instances of _penis captivus_ thus brought about
are on record. The following history is by _Davis_: A gentleman entering
his stable found therein his coachman and a servant-maid in a most
compromising position. All endeavours of the pair thus surprised to
separate proved ineffectual, and their attempts to draw apart caused
them intense pain. _Davis_ was sent for, and ordered an iced douche,
which, however, failed to liberate the imprisoned penis. Release was
impossible until the woman had been placed under chloroform. The swollen
and livid penis exhibited two strangulation-furrows, a proof that two
distinct areas of the levator ani muscle had been spasmodically
contracted.
_Hildebrand_ records three cases observed by himself in which there was
spasm of the upper part only of the vagina, unaccompanied by vaginismus
(_i. e._, by pain). In two of these cases, the spasm was originated by
the contact of the examining finger with very painful ulcers of the
portio vaginalis; the third patient had a very sensitive prolapsed
ovary. _Fritsch_ reports having had on one occasion to give a woman
chloroform for the release of a swollen and imprisoned penis.
_Hildebrand_ suggests that vaginismus may be caused by an abnormal size
of the penis, or by a condition occurring in weaklings and alcoholic
subjects, in whom the greatest swellings of the glans penis occurs
before intromission, whilst this greatest swelling is normally deferred
until towards the end of the act, when the glans is in the vaginal
fornix.
_Schröder_ writes as follows regarding the etiology of vaginismus: “The
affection is dependent upon trauma, sustained in maladroit, frequently
repeated attempts at sexual intercourse; for this reason it is met with,
in the great majority of cases in young, newly married women. Impotence
in the male is by no means necessary for its production, and such
impotence is not even a frequent antecedent. Abnormal narrowness of the
vagina, or extreme firmness of the hymen, is occasionally found, but
neither is in any way necessary; all that can be said in this connection
of a small vaginal orifice is, that it _predisposes_ to vaginismus. If
the husband is devoid of previous experience in sexual matters,
maladroit attempts at intercourse are exceedingly likely to occur. The
penis is thrust in the wrong direction, pressing against either the
anterior or the posterior commissure of the vulva. Very often, moreover,
the position of the vulva, which is subject to very striking individual
variations, is concerned in the production of vaginismus. There are many
women in whom the vulva lies in part in front of the symphysis pubis, so
that the lower border of the symphysis lies below the urethral orifice.
In such cases the penis is directed too far backwards, and instead of
passing into the vaginal orifice, slips into the fossa navicularis. The
frequent repetition of such maladroit attempts at intercourse gives rise
to a gradually increasing sensitiveness of the parts concerned, with the
formation of excoriations. It now results that, on the one hand, the
woman dreads attempts at intercourse on account of the pain to which
they give rise; she shrinks away from the man, so that penetration of
the vagina by the penis is rendered even more difficult than it was
before; and, on the other hand, ungratified sexual desire leads to the
frequent repetition of attempts at complete intercourse (from which,
moreover, if conception should ensue, a cure of the trouble is
expected). In this way, the trauma is rendered more severe, the
congestion and excoriation of the fossa navicularis or of the urethral
region are aggravated, and the sensitiveness of the parts increases to
such a degree that the woman thus affected screams out when the vulva is
merely touched. Ultimately reflex cramps set in whenever intercourse is
attempted, and we then have the fully developed clinical picture of
vaginismus.”
_Winckel_ maintains that in most cases there are two principal elements
in the causation of vaginismus. In the first place, in consequence of
more or less pronounced anatomical changes, there is undue sensitiveness
and tenderness of the vaginal inlet and its neighbourhood, and in
exceptional cases also of the upper part of the vagina, the uterus, and
the ovaries. In the second place, the patient manifests an increased
general sensitiveness and nervous irritability; this is in some cases
primary, but in others it is entirely the result of the repeated
stimulation; and in either case it is heightened by the effects of
ungratified sexual desire.
_A. Martin_ points out that the spasm of the muscles of the pelvic
floor, and especially of the levator ani muscle, upon which vaginismus
depends, may be due in some cases to the influence of chill, since the
same cause will lead to pathological contractions in other muscular
areas. But in such cases it is always open to question if masturbation
or some other sexual perversion is not the true cause of the disorder.
In some instances vaginismus is merely a symptom, in extremely sensitive
women, of various diseases of the reproductive organs, and is brought on
by the increased pain which in such cases is caused by attempts at
intercourse; when produced in this way, vaginismus is usually a
transient manifestation.
_Veit_ considers that among the pathological conditions giving rise to
vaginismus, we must also enumerate diseases of the internal pelvic
organs, such as chronic metritis, displacements of the uterus,
oöphoritis, etc.; but he also attaches great importance to nervous
predisposition, consequent upon previous sexual stimulation, and upon
pre-existing inflammatory changes due to gonorrhœal infection. A
peculiar form of vaginismus is, according to _Veit_, sometimes observed
after the birth of the first child; happily the duration of this is
usually brief. After parturition the vulval mucous membrane remains for
a time very tender, and when cohabitation is resumed, often too soon,
and perhaps, after the enforced abstinence, too frequently repeated at
brief intervals, fissures are readily produced. Moreover, vaginismus
which has existed prior to parturition may, in some cases, recur after
that event. An unusual position of the vulva, undue smallness of the
vaginal inlet, and relative impotence of the man, may combine to cause
such a recurrence. Finally, vaginismus often persists throughout
pregnancy, and manifests itself during parturition. The magical effect
which chloroform has in some primiparæ, when the head is delayed at the
vulva, is explicable only by the supposition of vaginismus.
According to _Arndt_, vaginismus is not purely a local disorder, but is
in many cases the local manifestation of a neuropathic diathesis, which
may in some instances lead to general mental disorder.
_Olshausen_ regards hyperæsthesia and vaginismus as different stages of
a single disease; he believes that the excessive sensitiveness is seated
chiefly in the hymen; he explains the spasm as the reflex result of
fissures and inflammatory changes. _Pozzi_ considers that excessive
nervous irritability and an irritable state of the vulva are the
indispensable preliminaries to the occurrence of vaginismus. _Herman_
distinguishes between excessive smallness of the vaginal inlet and
vaginismus; he regards the latter as a nervous disorder, characterized
by hyperæsthesia of the vulva, and by spasmodic contraction of the
levator ani and adjoining muscles. _Frost_ distinguishes vaginodynia
from vaginismus; in vaginodynia the pain is so intense as to cause
syncope, and the muscular spasm involves the entire length of the
vagina.
It is a notable fact, to which _Veit_ has especially drawn attention,
that among the poorer classes of the population, vaginismus is
practically unknown. Among women of these classes, their sexual needs,
not having been so much lessened by “culture,” suffice to withdraw their
attention even from the pains of defloration, which would otherwise
often be very severe; whereas the sexually neurasthenic woman of the
upper classes, filled with dread at the idea of the pain she expects to
suffer, and not infrequently in a condition of hyperexcitability or
hypersensibility dependent upon previously employed abnormal means of
sexual gratification, is unable to endure the pains of defloration even
when these might be expected to prove far from severe.
In some cases, painful contractions of the vagina, to which we cannot
properly give the name of vaginismus, arise from organic diseases of the
uterus and the uterine annexa; these painful contractions render
copulation impossible. _Von Hofmann_ reports the case of a young
prostitute, who found herself unable to continue the practice of her
profession owing to the severe pain she suffered during intercourse; she
died, and the post mortem examination disclosed bilateral salpingitis,
with reproductive organs in other respects normal.
Maladroit and incomplete attempts at intercourse, and the consequent
repeated failure to obtain complete sexual gratification, affect a
woman’s nervous system to a varying degree; but apart from this, in
women who have long cohabited with men of deficient sexual potency, we
often find a remarkable condition of complete relaxation of the genital
organs, associated with great hypersecretion of the mucous membrane,
flaccidity of the muscles of the pelvic floor, and displacements of the
uterus. Moreover, the nervous shock to which the repeated but
unsatisfying attempts at intercourse give rise, affects the spinal cord
in such a manner that symptoms of spinal irritation ensue. The patient
complains of pains in the back, the loins, and the nape of the neck;
these pains also radiate round the front of the abdomen and along the
intercostal spaces; hyperæsthetic points may be detected when the finger
is passed along the spine; there is weakness of the limbs with a
sensation of numbness; and neuralgic manifestations of varying nature
occur.
The dangers which sexual intercourse may entail upon women—over and
above the irritable conditions and inflammatory disorders of the female
reproductive organs, dependent upon impetuous or unduly frequent coitus,
or upon coitus practised during menstruation—are principally due to
gonorrhœal and syphilitic infection transmitted by the cohabitating
male.
_Cardiac Troubles Due to Sexual Intercourse._
Among the troubles from which women at times suffer as a result of
sexual intercourse, certain cardiac disorders are especially worthy of
attention.
Every act of sexual intercourse in a young and sensitive woman exercises
an exciting influence on the nervous mechanism controlling the cardiac
movements, and this influence is more clearly manifested in a degree
directly proportional to the intensity of the sexual orgasm. The heart’s
action is markedly increased in frequency, the cardiac impulse is more
powerful, the large arteries of the neck are seen to pulsate far more
vigorously, the conjunctiva is markedly injected, the respiration is
increased in frequency, the respiratory movements are more superficial
and have a panting character.
But when, in a woman who is sexually irritable in an excessive degree,
the peripheral stimulation occurring in the act of sexual intercourse is
unusually powerful, there may result a notable increase or modification
of the reflex manifestations which normally occur during sexual
intercourse in the province of cardiac activity; similar results ensue
when there is a summation of stimuli owing to excessive sexual
intercourse, or contrariwise when the act of intercourse is broken off
just before its physiological climax and the natural termination of the
orgasm fails to occur.
The former cause is not infrequent in young wives during the period of
the honeymoon. The latter cause is in operation when there are diseases
of the female reproductive organs preventing the physiological
completion of intercourse; but especially in consequence of the modern
practice of coitus interruptus, in which the man breaks off the act of
intercourse the moment he feels that ejaculation is imminent, without
troubling himself regarding the natural course of sexual excitement in
the woman. Yet another cause of excessive cardiac reflex manifestations
in women is incomplete potency of the male, which may either cause a
premature ejaculation of semen, or may lead to incomplete penetration of
the penis.
In all such cases, as a result of sexual intercourse, there may arise
cardiac disorders of various kinds; among these, tachycardial paroxysms
are the most frequent, occurring either _inter actum_, or at a longer or
shorter interval after intercourse.
In several cases of vaginismus occurring in young married women which
have come under my notice, it was observed that the attempts at
intercourse gave rise to violent involuntary spasmodic contractions of
the constrictor cunni and the other muscles of the urogenital and anal
regions, and in addition it was found that these attempts were followed
by tachycardial paroxysms with dyspnœic manifestations, lasting for a
considerable period, it might be as long as one or two hours.
In women who had practised coitus reservatus for a prolonged period, in
fact for several years, in such a manner that, notwithstanding the
occurrence of intense voluptuous excitement, complete sexual
gratification rarely, if ever, occurred—in such women, in whom these
marital malpractices seemed to have profoundly influenced their
psychical life, I have frequently witnessed a form of reflex cardiac
disorder which I must regard as a variety of the multiform neurasthenia
cordis vasomotoria. In such women, still at the climax of their physical
powers and of their sexual needs, attacks of palpitation suddenly occur
at irregular intervals, several times daily or less frequently.
Associated with this increased frequency of the cardiac activity are an
extremely distressing feeling of anxiety, a sensation of faintness,
headache, vertigo, a weakness of the muscular system, and at times
actual attacks of syncope. Physically, the women are extremely
depressed, irritable, inclined to weep, unhappy, and weary of life. At
the same time, digestion is impaired, the appetite is small, and there
is constipation. The pulse is in most cases feeble, small, of low
tension, easily compressible, increased in frequency, often
intermittent, sometimes more distinctly arhythmical. The heart is found
to be sound on physical examination, nor can any abnormality be detected
in the great vessels. The lower extremities are free from œdema; the
urine does not contain albumen.
Women thus affected are sometimes believed to be suffering from cardiac
disorder, in other cases they are subjected to various modes of
gynecological treatment; until at length the physician, by appropriate
questions, becomes enlightened regarding the true cause of the cardiac
disorder, namely, coitus interruptus. If it is possible to prohibit
effectually this unwholesome practice, the cardiac symptoms soon cease
to recur.
Finally, in women at the climacteric age, cardiac troubles sometimes
ensue, which are dependent on interference with sexual intercourse in
consequence of anatomical changes in the vagina; changes of this
character frequently occur at the time of the menopause; owing to
hyperaemic or inflammatory processes, a partial or general stricture of
the vaginal passage results; in many cases this passage becomes
narrower, shorter, and almost conical in shape, whilst the vaginal inlet
is greatly diminished in size. Such a vaginal stricture, which _Hegar_
has also seen in younger women after an artificial climacteric
(oöphorectomy), interferes with sexual intercourse; and the incomplete
sexual gratification gives rise to a series of nervous manifestations,
and, among others, to the above described reflex cardiac neurosis.
Whether, and in which cases, the cardiac disorders evoked as a result of
the local stimulatory influences of sexual intercourse, are dependent on
a reflex stimulation of the sympathetic nerve on the one hand, or upon a
transient paresis of the inhibitory centre of the heart and of the
vasomotor centre on the other, cannot here be fully discussed; just as
little can we consider in what manner the psyche is sympathetically
affected by the irritative processes in the genital organs, and its
functional activity thus impaired.
Here I can do no more than briefly state that experience has taught me
that sexual intercourse is competent to originate cardiac troubles in
women.
1. In extremely sensitive, sexually very irritable women, tachycardial
paroxysms may result from sexual excesses.
2. Tachycardial paroxysms with dyspnœa occur in young women affected
with vaginismus; also in women at the climacteric with constrictive
changes in the vagina.
3. Cardiac troubles, characterized mainly by symptoms indicating
diminished vascular tone, occur in women who have long practised coitus
interruptus with incomplete gratification of their voluptuous desires.
_Dyspareunia._
In normal conditions the act of sexual intercourse is accompanied in
women, as in men, by a voluptuous sensation, and this sensation must be
regarded as a necessary link in the chain of those processes by which
gratification of the sexual impulse—the most powerful of all our natural
impulses—is obtained. The absence of this voluptuous sensation in a
woman, the state in which she experiences during coitus no voluptuous
sensations, but feels either apathy, or positive distaste, is termed
dyspareunia: in former times it was also known as anaphrodisia. This
abnormal state of sexual sensibility, which up to the present is hardly
alluded to in gynecological textbooks, has received remarkably little
attention from the medical standpoint, and its importance has been
underestimated. Most unfortunately so, for dyspareunia is an important
symptom, exercising a powerful influence on the general health of the
woman who suffers from it, upon her social status in marriage, and, as
is easy to understand, upon her procreative capacity.
Dyspareunia must be clearly distinguished from two somewhat similar
conditions, with which at first sight it is liable to be confused,
namely, from anæsthesia sexualis, and from vaginismus. By sexual
anæsthesia we understand, as previously explained, the absence of the
sexual impulse, a symptom which, when the reproductive organs are normal
in structure and function, is either of central nervous origin, a result
of disease of the brain or spinal cord, or else is due to general
nutritive disorders such as diabetes, morphinism, or alcoholism. A woman
affected with dyspareunia does, however, experience the sexual impulse,
it may be very actively, but sexual intercourse brings about no
gratification of her desires. In vaginismus, on the other hand, the
introduction of a foreign body, that is to say of the membrum virile,
into the vagina, gives rise to painful reflex cramps of the sphincter
vaginæ, or of the muscles of the pelvic floor, whereby the completion of
coitus is rendered impossible: whereas in dyspareunia coitus can be
effected, but gives rise to no voluptuous sensations.
The pleasure which normally occurs in woman during sexual intercourse is
brought about in this way, that contact with and friction by the penis
stimulates the sensory nerves of the clitoris, the vulva, the vestibule,
and the vagina; this stimulus is propagated to the cerebral cortex,
where it gives rise to voluptuous sensations, and then, by reflex
stimulation of the genito-spinal centre, gives rise to a series of
reflex discharges. The pudic nerve, a branch of the sacral plexus,
supplies the female external genital organs. Some of its branches pass
in the clitoris to a peculiar form of nervous end-organ discovered by
_W. Krause_, Krause’s genital corpuscles: the structure of these
corpuscles appears to fit them exceptionally well for the transmission
of stimulatory waves to the nerve centres. “When this stimulus,” says
_Hensen_, in his work on the physiology of reproduction, “in addition to
other effects, also gives rise to a voluptuous sensation, the cause must
be sought in central nervous connections and apparatus. Similar
relations are to be found in connection with the mechanism of nutrition,
for example, in the association of hunger, appetite, agreeable
sensations of taste, the act of mastication, and the secretion of
saliva.” By means of this stimulus, several reflex processes are
originated in the reproductive canal, the most notable of which are the
erection of the clitoris, and the ejaculation of the secretions of
various glands. The cavernous tissue of the clitoris is connected with
that of the bulbus vestibuli, and the dorsal nerve of the clitoris is
one of the principal nerves of voluptuous sensation. The venous plexus
constituting the bulb of the vestibule lies at either side along the
margin of the vestibule at the boundary between the labium majus and the
labium minus, and laterally it is covered by the constrictor cunni[48]
muscle. During coitus the blood is driven out of this bulb into the
glans clitoridis, and thus the sensibility and the erection of the glans
are increased. The constrictor cunni and ischiocavernosus muscles draw
the clitoris, which is bent at a right angle downwards, into contact
with the penis. By means of the pressure of the constrictor cunni, the
mucous secretion of Bartholin’s glands, which open into the vulva at the
back of the labia majora, is expressed.
As additional reflex actions, dependent upon the activity of the reflex
centre in the lumbar enlargement of the spinal cord, there ensue
contractions of the vagina, peristaltic movement of the tubes, some
descent of the uterus, relaxation of the os uteri and rounding of this
orifice, and induration of the portio vaginalis, whereby the tubal and
uterine mucus and the secretion of the cervical glands are expressed.
This process of _ejaculation_ constitutes the culminating point of the
voluptuous sensation occurring in the sexual act; this act thus exhibits
two phases, the sensation of friction, and the sensation of ejaculation.
With regard to voluptuous sensations, and processes analogous to
pollutions, occurring in women, we append an extract from _von
Krafft-Ebing_.
“The occurrence of voluptuous excitement during coitus is dependent in
the women, just as in the man, upon:
“1. The peripheral influence of the intensity and duration of the
sensory stimulation (anæsthesia of the genital passage may be the cause
of the absence of voluptuous sensation). 2. The condition of
excitability of the reflex (ejaculation) centre in the lumbar spinal
cord. The activity of this centre varies within wide limits, not merely
in different individuals, but in the same individual at different times.
There are, indeed, women in whom it seems as if this centre were always
in vigorous activity. In normal women, the irritability of the centre
appears to be most marked at the menstrual epoch, and to decline rapidly
soon after menstruation. In pathological conditions, the activity of the
centre may be temporarily in abeyance (organic inhibitory processes,
such as are seen in certain cases of hysteria with temporary frigidity);
or again the centre may be abnormally active owing to irritable weakness
(neurasthenia sexualis), in consequence of which ejaculation may, just
as in the male in similar circumstances, occur too easily. 3. The
occurrence of the voluptuous sensation in woman is unfavourably
influenced by psychical inhibitory perceptions (analogous to the
inhibitory influence of psychical processes in the male, such as, for
example, fear of incapacity to perform sexual intercourse). As examples
of such inhibitory perceptions in women may be mentioned, dislike of the
man, physical loathing to sexual intercourse, etc.”
_Gutceit_ records interesting experiences, which are readily
intelligible in view of what we have already quoted. He finds that of
ten women after defloration, two only immediately experience full sexual
pleasure. Of the eight others, four only have an agreeable sensation
produced by the friction during coitus: but the sensation of ejaculation
does not make its appearance until the lapse of at least six months, or
it may be even several years, after marriage. In the remaining four
women, pleasure during sexual intercourse may never become properly
established. The women of the first class are described by the author as
being of a very ardent temperament, and passionately attached to their
husbands. In such women, the sensation of ejaculation occurs during
intercourse with any man toward whom they are sympathetic. Women of the
second class are of a less ardent temperament, and are often
comparatively indifferent toward the man with whom they cohabit. Women
of the third class have little or no amatory feeling, and they either
hate the man with whom they are cohabiting, or at least feel physical
repulsion to the idea of intercourse with him. _Gutceit_ considers that
meretrices usually belong to the third category. In the practice of
their trade, they make a counterfeit of voluptuous enjoyment, and only
experience real sexual gratification in intercourse with the man of
their choice.
It is of great practical interest, alike from the gynecological and from
the neuropathological standpoint, to determine the consequences in women
of ungratifying sexual intercourse. In the present state of our
experience it must be assumed that the effect of abnormal sexual
intercourse, that is of intercourse which does not culminate in
gratification produced by the sensation of ejaculation, is deleterious.
This is explained by the fact that, owing to the absence of the muscular
contraction of the genital passage, the latter remains engorged with
blood; the resultant hyperæmia passes away very slowly, and, when
frequently repeated, gives rise to chronic tissue changes, manifesting
themselves as diseases of the reproductive organs. Injury to the nervous
system ensues, partly in consequence of these organic changes, partly
also in consequence of psychical non-gratification in the widest sense
of the term. The nervous disorders thus produced are typical forms of
(sexual) neurasthenia; and in cases in which the pathogenesis is
predominantly psychical (antipathy to the husband, etc.) hysterical
types of disorder are especially frequent. _Von Krafft-Ebing_ believes
that incomplete coitus, that is, coitus not culminating in the sensation
of ejaculation, is a frequent cause of hysterical disorders in women.
When once the clinical picture of neurasthenia sexualis is fully
developed, each act of intercourse (like pollutions or coitus in the
sexually neurasthenic male) gives rise to renewed troubles, which are
easily recognized as symptoms of venous stasis in the reproductive
organs (sacrache, sensations of weight and bearing-down in the pelvis,
fluor albus): in addition we observe exacerbations of the lumbar spinal
disorder, in the form of spinal irritation, irradiating pains in the
sacral plexus, etc. In this way general neurasthenia develops. The
conditions found in such cases on gynecological examination (chronic
endometritis, metritis, oöphoritis, etc.) are produced by the same cause
as the nervous symptoms, namely, by an unhygienic mode of sexual
intercourse. They are not the cause of the neurosis, but important
concomitant disorders; and their effect in rendering the nervous
disturbances more severe must be freely admitted.
Among important causes of ungratifying coitus must be enumerated: weak
erection and ejaculatio praecox in the male, rendering the stimulation
inefficient; in addition, coitus reservatus, coitus interruptus, and
coitus condomatus. If the noxious influence is frequently repeated, the
occurrence of neurasthenia sexualis and its consequences is greatly to
be feared, and in women of neuropathic constitution it is practically
inevitable.
Unsympathetic coitus appears to act, not merely in a somatic manner, but
mainly upon the psyche, and to originate states of hystero-neurasthenia
or pure hysteria. If the influence of such unhygienic conditions of the
vita sexualis co-operates with that of inherited or acquired sensuality,
further dangers ensue: in cases of ungratifying sexual intercourse, the
danger of manustupration; in cases of unsympathetic intercourse, the
danger of psychical onanism, or that of marital infidelity.
Although until recently the matter received but little attention, it
must now be regarded as a well-established fact, that in the female (as
in the male) the climax of voluptuous sensation in sexual intercourse is
normally characterized by a process of ejaculation, accompanied by a
voluptuous sensation of ejaculation, dependent upon the acme of
excitement of a reflex centre in the lumbar enlargement of the spinal
cord.
Just as in the male, this centre may be excited to action, not only by
local stimulation of the genital organs, but also by (psychical) stimuli
proceeding from the brain (pollutions), so also in the female a similar
process may occur, and for this reason it is correct to speak of
“pollutions in the female.” _Rosenthal_ appears to have been the first
writer to speak of pollutions in women. In his clinical study of nervous
diseases, _Rosenthal_ described processes of the nature of pollutions,
originated in erotically over-stimulated women by lascivious dreams. In
one case he detected the outflow of a “mucus-like” fluid from the
apparently intact genital organs; he believed this to proceed from the
ducts of Bartholin’s glands, and from the mucous glands surrounding the
urethral orifice. _Féré_ reports the case of a patient who had an
erogenic zone in the region of the upper part of the sternum; pressure
on this zone gave rise to a profuse secretion of vulvo-vaginal fluid. In
this connection we may also recall the “clitoris-crises” to which
tabetic women are subject. _Gutceit_ described the process of pollution
in women in the following words: “It is remarkable that in dreams such
women experience the sensation of ejaculation.”
The psychical preliminary is invariably constituted by lascivious dream
perceptions. It merely remains open to question whether this process,
which in the male is indisputably physiological, in the female may be
said to occur within physiological limits. The researches published by
_von Krafft-Ebing_ more than twenty years ago, under the title
“Concerning Processes Analogous to Pollutions Occurring in the Female,”
gave negative results as far as healthy individuals were concerned; on
the other hand, the phenomenon in question was by no means rare in
nervously disordered, and above all in sexually asthenic women. The
neurosis was in part found as a result of psychical or manual onanism in
virgins with morbidly intensified libido: in part in married women, as a
result of ungratifying coitus, as previously described: in part, also,
in married women with powerful libido and enforced abstinence from
intercourse, owing to acquired impotence or death of the husband.
Just as in the case of the neurasthenic male, these pollutions made the
primary neurosis more severe, and relief from the nervous trouble was
not obtained until the factor of the “pollutions” had been recognized,
and made the object of special treatment. In exceptional cases the
“pollutions” appeared to be the starting point of the entire neurosis.
It was further remarkable, again here displaying analogy with what
occurs in the male, how much stronger and more deleterious was the
shock-effect of an inadequate process of ejaculation occurring in a
sexual dream, as compared with the far less deleterious influence of
similar incomplete ejaculation when occurring _viâ coitus_. In very
severe degrees of neurasthenia sexualis, just as in the male, the waking
imagination may give rise to a “pollution.” In such cases the
shock-effect on the nerve centres tends to be excessively severe. A
still higher degree of irritability of the genital system appears to
exist in cases in which excitement and orgasm of the reproductive organs
may culminate in a “pollution” by purely spinal paths, without the
intervention of the imagination. The significance of this fact would
appear to be considerable for the proper comprehension and for the
treatment of certain conditions of neurasthenia (sexualis) in the
female. The “pollution” may here be the actual cause of the neurosis.
But in any case, in the female, the occurrence of pollutions is an
extremely important symptom as regards both diagnosis and therapeutics.
It is extremely probable that hallucinations of coitus, and the
complaints made by insane women of attempted violation during the night,
are really dependent upon such “pollutions.”
_Von Krafft-Ebing_ reports the following characteristic case. Miss X.,
thirty years of age, belonging to a family predisposed to insanity, and
herself neuropathic since early childhood, declared that since she was
six years old she had been subject to lascivious imaginations, to which
she became continually more liable as she grew older. Ultimately,
typical psychical onanism developed, and in recent years her trouble
assumed the form of sexual neurasthenia. The patient herself suspected
there was a connection between her nervous disorder and her evil habit.
The popular work by _Bock_ finally brought her full enlightenment,
associated with severe emotional disturbance. This latter was now
increased by misfortunes from which the family suffered. The patient
then relinquished her bad habit, but her state of health nevertheless
became worse. She was nervously extremely irritable; her sleep was
insufficient, unrefreshing, and disturbed by lascivious dreams; she
suffered from spinal irritation, anæmia, scanty and painful
menstruation. Inclination toward the opposite sex and toward marriage,
hitherto but slight, now sank to a minimum: on the other hand, the
patient, in spite of all efforts to the contrary became more and more
subject to a condition analogous to priapism in the male, a genital
orgasm by no means voluptuous in character, and often indeed actually
painful. Associated therewith, nocturnal pollutions occurred, the
patient awaking from lascivious dreams with a voluptuous sensation and
moistness of the external genital organs. After such pollutions,
throughout the ensuing day, she felt extremely weary and depressed and
suffered from severe spinal irritation. After a time, the nocturnal
pollutions occurred without being preceded by lascivious dreams, and
ultimately analogous states were experienced in the daytime. With much
difficulty the patient now made up her mind to seek medical advice. She
was anæmic, emaciated, emotional, and moody. The lumbar and cervical
regions of the spine were extremely sensitive to pressure. Sleep was
scanty and unrefreshing, the patient felt weary and miserable, she
complained of dragging sensation and other paralgic sensations, in the
regions supplied by the lumbar and sacral plexuses. The deep reflexes
were increased. She dreaded the onset of disease of the spinal cord, and
believed that the cause of her illness was to be found in the prolonged
indulgence in psychical onanism. The perusal of _Bock’s_ book had first
made her understand the true nature of her misconduct. She had never
practised manual masturbation. Her principal complaint was of an almost
unceasing uneasiness and excitement in the genital organs. She compared
it to the uneasiness in the stomach produced by hunger. In the genital
organs (which on examination appeared quite normal), she had a
distressing sense of burning heat, of pulsation, of disquiet as if there
were a clockwork mechanism working there. Very rarely now were these
sensations associated with voluptuous ideas. This sexual neurosis had an
intensely depressing constitutional effect. She had transient relief
only when the local sensations culminated in pollution; but this, on the
other hand, increased her general neuropathic troubles. She suffered
most severely during the menstrual period. She was ordered sitz-baths at
a temperature of 23° to 19° R. (84° to 75° F.), suppositories of
monobromide of camphor, 0.6 (9 grains), with extr. belladon. 0.04 (⅗
gr.), sodium bromide 3.0 to 4.0 (45 to 60 grains), every evening; also
powders containing camphor 0.1 (1½ grains), lupulin 0.05 (¾ grain),
extr. secal 0.08 (1¼ grains), twice daily. This treatment gave the
patient great relief, and secured complete ease during the daytime.
Therewith returned her greatly impaired trust in the future, and her
emotional calm was restored.
The frequent occurrence of pollutions in women, the so-called
vulvo-vaginal crises and clitoris-crises, is regarded by _Eulenburg_ as
a striking manifestation of sexual neurasthenia in woman; in such cases
a lascivious dream is spontaneously followed by a more or less abundant
discharge of the clear gelatino-mucous secretion of Bartholin’s glands.
In women who masturbate, and in tribadists, a profuse and even violent
secretion of these glands is produced by touching the clitoris or the
erogenic zones at the entrance to the vagina, close to the orifices of
Bartholin’s ducts.
Dyspareunia, the absence of voluptuous sensation in women during coitus,
may be referred to three fundamental causes:
1. Insufficient or completely wanting peripheral stimulation of the
sensory nerve terminals in the female reproductive canal: in these cases
the conducting tracts to the nerve centres never become active.
2. Diminution or cessation of the excitability of the reflex centre in
the lumbar enlargement of the spinal cord: this leads to failure of the
sensation of ejaculation.
3. Inhibitory influences proceeding from the cerebral cortex whereby
voluptuous sensations and perceptions are checked.
The first-named of these etiological influences is in my experience the
commonest. Incomplete or quite inadequate stimulation of the sensory
nerves of the genital canal may be due to the maladroit performance of
copulation on the part of the male, owing to inexperience, or it may
depend on gross disproportion in size between the reproductive organs of
the man and the woman; in other cases it may be due to disease of the
reproductive organs in either sex, influencing unfavourably the
sensibility to stimulation of the nerves of the genital canal. Awkward
or incomplete performance of coitus may thus lead to failure of
voluptuous sensation, and this may ultimately pass into permanent
dyspareunia. Temporary dyspareunia is very common in young wives during
the first months of married life, ensuing on the pains of defloration;
and very gradually gives place to normal voluptuous sensation. It may be
one or two years after marriage before the sensation of ejaculation is
first experienced. Not infrequently, dyspareunia depends on incomplete
potency in the husband, who is incompetent to arouse voluptuous
sensation in his wife. For this reason, dyspareunia is common in young
women married to elderly men; but is common also, where (as so
frequently among Russo-Polish Jews) the men also marry very young, at an
age of from sixteen to seventeen years, and where, moreover, the husband
has often before marriage impaired his potency by masturbation: finally
dyspareunia is common when girls still undeveloped sexually are married
to powerfully built men.
Regarding the pathological conditions of the female reproductive organs
which counteract the peripheral sensory excitants of voluptuous
sensation, we exclude from further consideration the obvious causes,
absence and atrophy of the reproductive organs, and senile marasmus. Of
prime importance as a cause of the failure of sexual sensibility in the
early period of married life must be mentioned inflammation of the fossa
navicularis, due to awkward attempts at intercourse. Other causes of
deficient sensibility are: complete or partial persistence of the hymen,
lesions of the vaginal inlet, acute or chronic vulvitis in consequence
of irritating abundant secretion, especially as a sequel of gonorrhœal
vaginitis. The last named infective disorder is especially harmful,
because Bartholin’s glands are involved in the associated vulvitis. Even
after the cure of the vulvitis, permanent dyspareunia may remain.
Perineal fissures may result in the stimulant effect of coitus being
insufficient, owing to the slight friction possible at the vaginal inlet
in these cases. Not less serious sometimes are small, hardly discernible
fissures in the vagina. Additional causes of deficient sexual
sensibility are recto-vaginal, and vesico-vaginal fistulæ.
The second cause of dyspareunia, diminution or complete lack of
irritability of the reflex centre of the lumbar enlargement of the
spinal cord, appears to be less frequently operative. We must, however,
assume that certain nervous disorders, such as hysteria and pathological
changes in the spinal cord, are responsible in this connection. The
activity of the lumbar sexual centre appears in women to be normally
subject to variation within certain limits; and seems usually to attain
its maximum irritability during menstruation. But normally these
variations are never so great as to produce in women complete though
merely temporary dyspareunia; in this respect offering a marked contrast
to what occurs in other animals at other times than the rutting season,
and of which every bitch not on heat furnishes an example when she
refuses the sexual advances of the dog.
As regards the third causal influence in the production of dyspareunia,
the influence of the brain, this, though important, is less frequently
in operation. Diseases of the brain, degenerative processes, may
constitute a cerebral cause for the failure of sexual sensation. But
more frequently, certain cortical perceptions, such as dislike or hatred
of the cohabiting male, an ardent passion for some other lover, grief
and trouble, exercise inhibitory influences, which render the occurrence
of voluptuous pleasure during the sexual act difficult or quite
impossible.
A condition like dyspareunia, our knowledge of which depends entirely
upon the subjective sensations of the woman concerned, is naturally one
regarding whose existence accurate information is difficult to obtain.
Very rarely does it happen that women spontaneously approach the
physician with complaints of this condition; indeed, in my experience,
they do so only when they are sterile, and when they assume, in
accordance with the widespread popular belief, that their sterility is
connected with the absence of voluptuous sensation during sexual
intercourse. More commonly, however, it is the husband who feels it his
duty to confide to the medical man the remarkable apathy of his wife in
sexual intercourse. But when once the medical man’s attention has been
directed to this question, and when he institutes enquiries among his
patients in a scientific, passionless manner, one making due allowance
for a woman’s modesty, as the moral importance of the subject demands,
he will be astonished at the frequency of dyspareunia, and he will find
herein the explanation of many obscure phenomena in the life of women.
On the other hand, it must never be forgotten that a certain number of
women complain of dyspareunia without any justification whatever, in
order to arouse interest and sympathy, by representing themselves as
unwilling sacrifices on the marital altar: the experienced gynecologist
will readily detect the cases in which he is being misinformed; he can,
moreover, always check the wife’s statements by conversation with the
husband.
The constant sign of dyspareunia is the failure of ejaculation during
coitus. We have previously described the muscular contractions which
lead to ejaculation of the secretion of Bartholin’s glands and to the
expulsion of the uterine and cervical mucus, as reflex actions evoked by
the sensory stimulus dependent on friction of the female genital organs.
The voluptuous sensation of ejaculation, associated with these muscular
contractions, which the woman whose sensibility is normal experiences as
the culminating point of her sexual “gratification,” is either quite
unknown to a woman affected by dyspareunia, or is experienced by her
only in a voluptuous dream, as a pollution, in which the sexual
dream-perceptions act as the psychical stimuli by which the reflex
discharge is originated. It has repeatedly happened to me, that on
enquiring of women suffering from dyspareunia regarding their experience
of the sensation of ejaculation, I have been informed that such
sensations are known to them only from the descriptions of their female
friends, or occasionally from dreams from which they have awakened with
a feeling of moisture in the external genitals. _Von Krafft-Ebing_
refers this process to a peristaltic contraction of the muscular fibres
of the Fallopian tubes and the uterus, “whereby the tubal and uterine
mucus is expressed;” whereas, for my part, I am of opinion, that
ejaculation affects in the first place and principally the glands of
Bartholin, the secretion of which is expressed by the contraction of the
constrictor cunni muscles, and secondarily only affects the cervical
glands of the uterus.
As a second sign of dyspareunia, I recognize a remarkably rapid outflow
of the male semen from the female genital canal, immediately after
coitus (_profluvium seminis_). The woman thus affected complains, when
suitably questioned, that she is unable to retain the semen, and that it
flows out of the vagina immediately after ejaculation. The cause of this
remarkable phenomenon no doubt lies in the fact, that, owing to the
absence of the voluptuous sensation, the reflex contractions of the
muscles of the female genital organs, normally accompanying this
sensation during intercourse, fail to occur. At the vaginal inlet, in
normal conditions, the constrictor cunni muscle contracts, and farther
up in the vagina a peristaltic contraction of the circularly disposed
muscular fibres of the tunica media occurs: in this way the semen
ejaculated into the vagina is for a time retained under a certain
pressure. But in the absence of these muscular contractions, as well as
of the muscular contraction of the pelvic floor, retention of the semen
fails to occur. Cattle-breeders and horse-breeders have made similar
observations regarding cows and mares, namely, that these animals are
sometimes unable to retain the semen after coitus, and it is suggested
that in these cases the animals are not properly on heat. Experienced
cattle-breeders recommend in such cases that the retention of the semen
should be promoted by douching the root of the tail and the external
genitals with cold water. It is well known that by stimulating the
peripheral sensory nerves in the neighbourhood of the genital organs, a
reflex excitement of the lumbar sexual nerve centre is produced, as is
seen, for example, in the practice of flagellation of the buttocks, for
the increase of sexual desire.
Passing to the consideration of the pathological changes to be found in
the reproductive organs of women suffering from dyspareunia, the nature
of these will for the most part be obvious in relation to the etiology
of the disorder. Most frequent, in my experience, were chronic
inflammatory states of the vulva and of the vaginal and uterine mucous
membrane, chronic metritis and parametritis. A very frequent appearance,
and one practically characteristic of dyspareunia when of long standing,
is a marked total relaxation of the reproductive apparatus. The uterus
is extremely mobile, usually retroverted and partially prolapsed, thin,
with lax walls, and usually an enlarged cavity; the portio vaginalis is
flaccid, and runs to a point; the vagina is roomy; there is marked
hypersecretion of the mucous membrane of the entire genital canal; there
is great flaccidity of the constrictor cunni and levator ani muscles,
and of the perineum. In several women with dyspareunia, I found old
unhealed lacerations of the perineum. In some cases, the very small size
of the clitoris is noteworthy. In one case amenorrhœa was present with
an infantile uterus. In a large proportion of the cases I was able to
detect a diminution both of the tactile and algic sensibility of the
vaginal mucous membrane. The women were for the most part anæmic; many
were extremely obese, and of lymphatic constitution. In some cases,
however, no pathological changes whatever could be detected in the
reproductive apparatus.
Dyspareunia is a condition which affects a woman’s whole nature,
powerfully influences her mental life, and thus gives rise to greater
psychical than physical damage. The consciousness of being deprived of
the greatest joy of physical love produces great emotional depression,
even in a woman by no means sensually inclined, and gives rise to a
hypochondriacal state, at times even to melancholia. In other cases, the
idea, not infrequently suggested by more happily situated women friends,
that the woman herself is not to blame for this condition, has a
demoralizing effect upon her, and destroys the happiness of married
life. (It has been confessed to me, in isolated cases, that the
dyspareunia was relative only.) Apart from this, the absence of sexual
gratification gives rise to a series of nervous troubles, presenting
either the variable characters of hysteria, or else the symptoms of
neurasthenia. Finally, the frequently repeated incomplete coitus,
incomplete inasmuch as the woman does not experience the sensation of
ejaculation, induces chronic hyperæmia in the female reproductive
organs, passing on into blood stasis, and ultimately into chronic
inflammatory tissue changes; in this way arise metritis, perimetritis,
and parametritis, salpingitis, oöphoritis, disorders of menstruation,
menorrhagia, and atypical uterine hæmorrhages. The possibility cannot be
disproved, that in this way new-growths of the reproductive organs may
also originate. The act of sexual intercourse, which at first may be to
the woman a matter of comparative indifference, and in which she plays
her part merely from a sense of duty, becomes, in cases of long-standing
dyspareunia, something to which she feels a positive dislike, and is
recognized by her as the actual cause of the troubles that ensue upon
intercourse, such as sacrache, sensations of weight and pressure in the
pelvis, strangury, fluor albus, a feeling of exhaustion, etc.
At times, perverse sexual sensation is associated with dyspareunia.
Women who find no enjoyment in normal sexual intercourse with a male,
sometimes masturbate, sometimes indulge in amor lesbicus, etc.
Of great importance appears to me the relation between dyspareunia and
sterility in women. As already pointed out, dyspareunia comes chiefly
under medical observation in cases in which it is associated with
sterility. The husband, seeking advice concerning his wife’s failure to
conceive, complains of her frigidity in sexual intercourse as the
probable cause; or the wife comes to seek advice, saying that she never
experiences sexual gratification, and that for this reason she has
failed to become pregnant. As a matter of actual fact, dyspareunia and
sterility are associated with such remarkable frequency, that my own
experience leads me to believe in the existence of an etiological
connection between the two conditions, at least in a certain proportion
of the cases. Among 69 sterile women whom I questioned regarding
dyspareunia, the latter condition was present in 26, that is to say, in
38% of the cases. _Matthews Duncan_ reported that of 191 sterile women,
62 did not experience sexual enjoyment. Sexual excitement of the woman
during copulation would certainly appear to have a definite bearing upon
the occurrence of conception, for we know that by the voluptuous
sensation reflex actions are aroused in the genital canal, favouring the
retention of semen and its passage through the os to the interior of the
uterus, and perhaps also giving rise to reflex changes in the cervical
secretion which favour the passage of the spermatozoa into the uterine
cavity.
In cases of relative dyspareunia, the influence of this condition in
producing sterility is also manifested, the unfaithful wife being
impregnated by her lover though she has remained sterile in intercourse
with the husband to whom she is indifferent. To dyspareunia of this
nature (dependent upon sexual disharmony), we may also refer the
sterility of a married pair who have for some time lived together in
unfruitful intercourse, whereas, after divorce and the contraction of
fresh unions, both the man and the woman prove normally fertile. Such
cases have been personally known to me; and similar instances aroused
the attention of the natural philosophers of antiquity, for instance,
that of Aristotle. The importance of voluptuous sensation in promoting
conception is also manifest from the fact that in the majority of women,
after the pains of defloration, dyspareunia usually persists for a
season during the early period of married life; and, corresponding with
this, the first conception is usually deferred for some little time
after marriage, to a period corresponding with the awakening of the
sensation of ejaculation. In this connection, _Courty_ reports the case
of a lady who, although in blooming health, remained sterile during the
first fifteen years of her married life; she then gave birth to a child
whose father was unquestionably her lover; and after this in succession
to two other children whose progenitor was the legal husband. This lady
had never experienced voluptuous sensation in intercourse prior to the
time of her first conception. Similar circumstances with an even clearer
significance have been frequently observed among the lower animals; and
_Darwin_ records several striking observations of this character. Taking
all the evidence into consideration, we are compelled to regard
dyspareunia as a condition capable of causing sterility in women,
although the sequence is not an absolutely necessary or invariable one.
In order to excite voluptuous sensation during intercourse, savage races
make use of various means, some of which we here transcribe from the
work of _Ploss-Bartels_. In Abyssinia, and on the Zanzibar coast, young
girls receive instruction in certain rotary muscular movements known by
the name of duk-duk, which they employ during coitus for the increase of
sexual pleasure. Many Daiaks perforate the glans penis with a silver
needle from above downwards; this needle is kept in place like a seton,
until a permanent canal is formed through the glans: in order during
coitus to stimulate the woman more powerfully, into this canal, just
before coitus, various small articles are inserted, such as little rods
of brass, ivory, silver, or bamboo, or silver instruments ending in
small bundles of bristles; these project from the surface of the glans,
and exercise a more powerful friction of the vagina, thus increasing the
sexual pleasure of the woman. Men without such an apparatus are rejected
by the women, whilst those who have made several such canals in the
glans, and can therefore insert several instruments, are especially
sought after and prized by the women. Such an apparatus is known as an
ampallang, and in a symbolic manner the woman indicates to a man of her
choice her desire that he should make use of one; he finds in his bowl
of rice a rolled-up leaf, enclosing a cigarette which represents the
size of the desired ampallang. Among the Alfurs of North Celebes, in
order to increase the voluptuous pleasure of the woman during
intercourse, the men bind round the corona glandis the eyelids of a
goat, beset with the eyelashes, thus forming a bristly collar; in Java
and in Sunda, before coitus, the men surround the penis with strips of
goat-skin, leaving the glans free. In China they wind round the corona
glandis torn fragments of a bird’s wing; these also project like
bristles and increase the friction. Among the Batta of Sumatra,
travelling medicine-men perform an operation by means of which they
insert, beneath the skin of the penis, small stones, sometimes to the
number of ten, at times also angular fragments of gold or silver; these
heal in beneath the skin, and increase the stimulus of coitus for the
women. Among the Malays of Borneo the penis is perforated, and some fine
brass wire with the ends turned inwards is inserted: before coitus, the
sharp ends of the wire are drawn out so as to project from the skin.
In our own part of the world, voluptuaries make use of an india-rubber
ring beset with spines, which before coitus is passed over the corona
glandis, in order to promote sexual gratification in the woman during
intercourse. In cases of diminished potency in the male, in order to
produce sufficient sexual excitement in the female by more powerful
erection of the penis, various mechanical means are now employed. For
instance, in such a partially impotent man, a constricting band of
india-rubber may be passed over the root of the penis, whereby the
reflux of blood from the corpora cavernosa is hindered, and a more
complete and more enduring erection is induced. Elderly men have
frequently declared to me that they were well satisfied by the
employment of this simple measure, whilst behind their backs, their
wives have assured me that the results were far from satisfactory. The
apparatus described by _Roubaud_ for the enlargement of the penis is no
longer employed. Partially impotent men make use, however, of an
instrument known by the name of “schlitten,” made of gold, silver, or
white-metal; it consists of two delicate laminæ, united at the base by a
metal ring, and at the upper end by an india rubber ring. This small
apparatus, which must be made exactly to measure, renders possible the
introduction of the imperfectly erect penis into the vagina; it supports
the penis, and readily accommodates itself to the change in size of the
organ as it slowly becomes erect.