Part 20

_Börner_ reports cases in which the sexual impulse remained in full activity after the change of life, and in some cases was greatly increased in intensity—these latter individuals being in a condition of real torment, which induced them to masturbate to obtain relief.

The sexual impulse may be present in cases in which the ovaries are entirely wanting. Thus, _Hauff_ reports the case of a young girl who had no ovaries, but was nevertheless excessively addicted to masturbation. _Gläveke_ speaks of a puella publica in whom the uterus and the ovaries were entirely absent, but who asserted that she experienced during coitus active sexual sensation. Both _Kussmaul_ and _Puech_ report similar experiences in cases of absence or arrested development of the uterus.

As regards the effect on the sexual impulse of the operation of oöphorectomy, most authors state that no change occurs; still, there remain many who express the opposite opinion. From the collective summary of cases bearing on this question made by _Gläveke_, it appears that after extirpation of the ovaries the sexual impulse remains unchanged in the great majority of cases, or at most is but slightly diminished in intensity. _Hegar_ states that he has often witnessed a diminution of the sexual impulse after oöphorectomy, but that this decline is by no means constant, indeed he states that one of his patients assured him that in her case no decline in the intensity of the sexual impulse had followed the operation. Similarly variable reports were the experience of _Schmalfuss_. In one case he found there was but little sexual inclination; in one case, disinclination; in one case disinclination at first, followed by a return of inclination. _Bruntzel_ reports that in four patients subjected to oöphorectomy, in two cases the sexual impulse persisted, but in the remaining two it was extinguished. _Köberle_ is of opinion that sexual inclination diminishes as a result of this operation. _Peaslee_, on the contrary, asserts that the patients remain striking examples of womanhood, in whom all the qualities peculiar to their sex are preserved. _Péan_ observed as a rule no difference in the sexual impulse to result from this operation, but he considers that the patients are apt to describe in exaggerated terms the amount of sexual feeling that remains to them. In one case, _Spencer Wells_ observed after oöphorectomy an increase in sexual excitability; _Tissier_ had the same experience, and this author believes that in these cases the sexual impulse is generally preserved. On the other hand, _Bailly_ observed a case, in which both ovaries were removed on account of new growths, where the sexual impulse at first became excessive, and then completely disappeared. _Anger_ and _Goodell_ speak in the same sense.

I am myself acquainted with a woman twenty-six years of age who in girlhood underwent oöphorectomy on account of extremely severe nervous troubles associated with menstruation; she had not experienced in consequence any loss of the sexual impulse; she married a man belonging to the upper strata of society, and consulted me four years later to learn if she could by any means be rendered capable of bearing a child. Two other cases have come within my personal experience in which young women married after extirpation of the ovaries, and in whom sexual desire and sexual sensation were all that could be wished.

In twenty-seven women who had undergone the operation of oöphorectomy, _Gläveke_ made inquiries regarding the three following points: First, whether the sexual impulse had been affected by the operation; secondly, whether during intercourse sexual pleasure was experienced to the same degree as formerly; and thirdly, whether during intercourse any kind of difference was observed as compared with pre-operative experience. He obtained the following results:

Sexual inclination was Unaffected in 6 cases 22 per cent. Diminished in 10 cases 37 per cent. Extinguished in 11 cases 41 per cent. Sexual pleasure during coitus was Unaffected in 8 cases 31 per cent. Diminished in 10 cases 38 per cent. Extinguished in 8 cases 31 per cent.

In a considerable number of cases the sexual impulse was thus found by _Gläveke_, not indeed to be entirely extinguished, but still notably diminished. In another set of cases, the sexual impulse was entirely extinguished, but only in one case was there actual aversion to coitus. The women readily permitted intercourse when their husbands desired it, but remained themselves quite indifferent. The greater number of these women stated that the specific sensation of pleasure during coitus was markedly weakened, but not entirely lost; in a small proportion, this sensation was completely extinguished. In the case of seven women who complained that coitus was very painful, _Gläveke_ found that the calibre of the vagina was much diminished. In these cases, the sensation of pleasure during coitus was either greatly diminished or completely extinguished. The women permitted intercourse very unwillingly, their unwillingness arising, not from any actual aversion, but because they dreaded the pain which coitus produced. An extremely hysterical woman, affected with severe prolapse of the uterus, stated that every attempt at intercourse was frustrated by violent hysterical convulsions. The sexual impulse appears always to suffer first and most severely, and only after this is the sensation of pleasure during coitus affected. In a few women only, according to the experience of this author, was the sexual impulse quite unaffected by the removal of the ovaries.

Amputation of the clitoris appears notably to diminish both the sexual impulse and the sensation of sexual pleasure, but the results of clitoridectomy for the cure of masturbation are by no means always favorable. In the women of the Russian sect of the _Skopstki_, the clitoris, the nymphæ, and a part of the labia majora are removed, in order to destroy sexual desire. According to _von Krafft-Ebing_ it is probable that in the virgin the clitoris is the only erotogenic zone, that is to say, that only by the stimulation of the clitoris can erection, the orgasm, and the sensation of ejaculation be induced. It is probable that the vagina becomes erotogenic only as a result of coitus; thenceforward, however, the erotogenic significance of the clitoris is notably lessened, and in multiparæ may entirely disappear.

NYMPHOMANIA, ANÆSTHESIA AND PSYCHOPATHIA SEXUALIS.

The sexual impulse in women is subject to morbid changes, both in the way of increase and of diminution, exhibiting abnormal violent increase (nymphomania), or declining to the state of complete frigidity and sexual indifference, or, finally, manifesting itself in some perverse manner (psychopathia sexualis).

Psychopathically increased sexual impulse in woman is known as nymphomania or uteromania. In such women there is a dominant state of psychical hyperæthesia, principally in the genital sphere. The most indifferent perceptions give rise to erotic sensations and to lascivious impulses. All sensory perceptions obtain a sexual content, and induce stimulation of the cerebral cortex. All sensation and all activity in such unhappy beings ultimately concentrates itself in the act of copulation, or in some other form of sexual gratification, the greatest perversities of sexual practice frequently arising, masturbation, tribadism, and, for the most part, prostitution, even in the case of married women.

The nymphomaniacal woman, says _von Krafft-Ebing_, endeavors to allure men by means of exposure of the genital organs or indecent gestures; the sight of man produces intense sexual excitement, which is gratified by masturbation or by stimulatory movements of the pelvis. According to this author, nymphomania is not very infrequent at the climacteric period; it may even occur in old age. Abstinence in association with simultaneous excitement of the sexual sphere by mental or by peripheral stimuli (pruritus pudendi, oxyuris, etc.), may induce these states, probably, however, only in those hereditarily predisposed.

The history of antiquity contains records of the corrupt practices of nymphomaniacal empresses. Thus, Messalina furnishes a well-known historical example of the abnormal violence of a pathologically intensified sexual impulse in woman. She was given the agnomen of _invicta_, having received the embraces of fourteen athletes. _Pliny_ says of her, _die ac nocte superavit quinto et vicessimo concubitu_; and _Juvenal_ writes of her the verses,

... tamen ultima cellam Clausit, adhuc ardens rigidæ tintigine vulvæ Et resupina jacens multorum absorbuit ictus Et lassata viris, necdum satiata, recessit.

In corrupt Rome, Messalina was not the only woman _necdum satiata_, ever insatiable; we need only refer to the orgies of an Aggripina, a Livia, a Mallonia, or a Poppæa; and _Seneca_ hurls against the women of h