Impotence And Allied Sexual Weakness
( Originally Published Early 1900's )
FOR practical purposes there may be said to be various degrees of sexual weakness, but complete impotence implies a total lack of the power of erection. One may be practically impotent, however, when the erection is weak and of short duration.
What is commonly known as "prematurity," also sometimes called irritable or partial impotence, is the most prevalent of all sexual weaknesses of this type. It is often just about as serious as complete impotence in rendering one unfit for marriage. It consists in a supersensitive or irritable condition resulting in a premature ejaculation, which, in extreme cases, may take place even before the sex relation is attempted. There are other forms of sexual weakness, though they are unusual, in which the orgasm and ejaculation may be very greatly delayed, or in which it may be impossible to bring them about at all.
The causes of impotence are to be found in all those conditions which lessen virility, and which I have outlined in some detail in Chapter 22, on "How Virility is Destroyed." Masturbation, continued and excessive seminal losses, sexual excesses, interrupted intercourse, ungratified sexual excitement, mental chastity, unnatural habits of any kind, alcoholism, tobacco poisoning, drug habits, overwork, worry, mental or emotional strain and all conditions that tend to debilitate the system are to be found among the causes of impotence. The bromide treatment, used as much by reputable physicians as by the quacks, may be the direct and immediate cause in some cases. Contact with poisonous metals in certain occupations, and especially chronic lead poisoning, may have a great deal to do with it. A tropical climate, such as that of India or the Philippines, may in the course of time produce partial or complete impotence through its destructive effect upon the nervous system and the bodily powers in general.
There is no necessary or invariable connection between sexual weakness and dyspepsia, but curiously the two are often found together. The chronic and emaciated dyspeptic does not as a rule make a very promising prospective marital partner.
Exceedingly hard and prolonged mental work in some cases seems to have a depressing effect upon the sexual function, though in most cases of this kind there have probably also been some other contributing or predisposing causes for the weakness. At any rate, the impotent intellectual worker often makes a remarkable improvement in his virility as a result of several weeks or months of camp or country life. All sedentary occupations are naturally - more or less detrimental in this respect.
There is often a close connection between obesity and impotence. Obesity is a common accompaniment of senility, indicating a loss of virility and energy, and when appearing too early in life is not a favorable sign. It is true that a certain amount of fat is natural with many persons, and when evenly distributed and very gradually acquired is consistent with activity and vigorous health. But when fat is not distributed through-out the entire body, or when it is acquired beyond what is termed normal weight it usually signifies more or less degeneration and impaired health, and is likely to accompany or produce impotence. Therefore if you think you are getting fat, you had better become as active as you can. Keep hard and vigorous.
Stricture, which, of course, is generally the result of gonorrhea, is sometimes accompanied by impotence, or by some weakening in this direction. Ofttimes also gonorrhea is a conspicuous cause of impotence through its effect upon the prostatic urethra, the prostate gland, or the other structures of the sexual system. A number of constitutional diseases, such as diabetes, pernicious anemia, leukemia, Addison's disease, those arising from a deficient thyroid gland, loco-motor ataxia or other spinal-cord diseases, injuries of the spinal cord or brain, or tumors, may occasionally be responsible for impotence. Sometimes the poisons of malaria, typhoid fever or other infections, attacking the generative structures may cause trouble of this kind. And of course various malformations would produce impotence for mechanical reasons.
There is no doubt that in the most serious and stubborn instances, especially when following extremes of sexual excess or masturbation, the real trouble lies in the exhaustion and paralysis, to a greater or less degree, of the spinal nerve-centers controlling the sexual function. Such cases are sometimes difficult to improve, especially when of long standing.
The general rule is that the first direct signs of weakening of the sexual system, apart from any seminal losses which may occur, are to be noticed in the prematurity of the ejaculation, associated usually with decreased sensation. But in most cases the orgasm is more or less diminished at the same time, and sometimes there is practically no sensation. In time, as he becomes weaker, the victim develops what one might call a "hair trigger" condition, a state of extreme sensitiveness in which the ejaculation occurs in the first moment of the relationship, or even before it is attempted, through mere excitement. This is of course embarrassing. 'It means a greatly weakened condition of the nerves and muscles, and usually an inflamed and sensitive state of the prostate gland and relative parts. Following this state, if matters go from bad to worse, one sometimes becomes entirely impotent.
The symptoms associated with impotence vary considerably. Some men continue to have a desire for the company of women, or perhaps even find the sexual appetite increased, in spite of the absence of the power of gratification. When this desire for the other sex is still present, it is a hopeful indication. It probably signifies that while the power of erection has been impaired and temporarily lost, the glands of the reproductive system have not suffered to the same extent. Apparently the system has not yet been entirely deprived of the influence of the substances of these glands, and one may retain at least a certain degree of the qualities that are associated with virility. The sex instinct is still alive, and that means something.
In other cases of impotence, however, there is a complete loss of the sexual appetite and the victims may even have a positive dislike for women. This is a far more serious condition than the first, indicating a greater degree of lost virility, with lesser prospects of effecting a cure. When an impotent man has entirely ceased to have any interest in the opposite sex, under any conditions, he may be regarded as sexually dead, for all practical purposes. A cure or an improvement may be secured even in most such cases, but it, would take time, and definite promises as to results are not advisable.
In cases where the desire is greatly increased in connection with impotence, or partial impotence, it is of course usually because of a greatly congested condition of the prostate gland, irritation produced by constipation, some- spinal disorder, or some other pathological condition.
There are also instances in which a man may not be impotent, strictly speaking, but in which he has no sexual desire, does not care for women.
There is often more or less atrophy of the organs, more particularly of the testicles, in connection with impotence, but this need not be present, and when this is marked the condition is usually difficult to overcome.
Psychic impotence is a purely mental condition, and usually a temporary one, due to emotions, nervousness, embarrassment, excitement or mental suggestion. It is not serious, inasmuch as it does not indicate any organic or constitutional defect, and will usually disappear by itself under normal conditions. In other words, psychic impotence is a transient condition, which may be compared with any temporary state, such as a sick stomach.
Upon the theory that those troubled with impotence are simply the victims of their own mental attitude, some writers pooh-pooh that there is any physiological basis for this difficulty. Of course it is not true that all these men have merely hypnotized themselves into the belief that they are impotent. But at the same time there is such a thing as psychic impotence, and every man should make sure of the exact nature of his own case.
Nervousness from almost any cause may produce this temporary, or psychic, impotence. The necessity for hurry may do it. Fear of any kind is likely to produce it, such as fear of venereal infection, fear of pregnancy resulting or the fear of being interrupted or discovered. Embarrassment may temporarily affect one, and the impotence thus produced will then so increase the embarrassment that the situation is hopeless, for the time being. Excitement of any kind would naturally be a factor. Too much intense desire or eagerness may in this way defeat its own purpose. Or one may be influenced by an unclean room or unclean clothing.
Mental suggestion, however, or what is called "auto-suggestion," is doubtless the most frequent cause of psychic impotence. A man may doubt his fitness for marriage. Perhaps he has been worrying a great deal about his past bad habits, or the results of a former venereal disease, and has thus conceived the idea in his head that he may be impotent. The result is that his . anxiety on the subject practically paralyzes him, and until he can overcome this mental attitude he will be practically impotent. In addition, he may be embarrassed. But this does not mean true impotence and a few weeks of marriage will set him right.
One great mistake frequently made by men who fear that they are impotent is to test themselves by visiting a prostitute. Of course such a thing cannot be recommended, or even excused. It is wrong from every possible point of view, and furthermore it is never a satisfactory test. One cannot judge of one's condition by attempting relations with a strange woman, for there is likely to be present every other factor conducive to psychic impotence, including fear of infection, lack of attraction, anxiety as to the result and embarrassment. The very fact that the attempt is made with the cold-blooded purpose of ascertaining one's capacity for the act would in itself be sufficient to insure failure in some cases. All the conditions of a satisfactory relationship, such as are only to be found in a healthy, happy marriage, are missing. A man who finds that he is practically impotent so far as a strange woman is concerned may be perfectly potent when it comes to marriage with a woman for whom he has a deep affection. There must be love as well as passion in the ideal relationship.
If a man finds himself impotent when approaching a public woman, he should congratulate himself that his instincts are healthy and clean. Any association with a prostitute involves the debasing of the sex function. It is really a perversion to some extent. Men with the best instincts cannot be tempted in this way.
In a few cases in which men have lived strictly continent lives for a long time until marriage, with continuous repression of the sex instinct, they may have developed a degree of sexual reticence. which results in more or less psychic impotence, but of course this should be only temporary. There are also examples in which incompatibility of temperament, or mutual indifference between a couple, as in "marriages of convenience," may seem to produce impotence; but such a condition cannot correctly be called impotence. Indifference or lack of desire on the part of the wife is naturally an important factor, but under such circumstances the marital relation should not be attempted.
On the theory that alcohol is a sexual stimulant, physicians often prescribe the use of wine, with a generous diet of rich, stimulating food, in cases of impotence. There is no doubt that in some cases of psychic impotence the use of champagne or wine does produce results, but it is not because of any "strengthening" effect of the alcohol. It is simply because the effect of this poison upon the brain is to paralyze the higher mental faculties, and thus deaden any sense of restraint and blunt any fears, anxieties, or considerations, which may previously have had an inhibiting effect. The alcohol really has a detrimental effect upon the sex function, as upon the body generally. (See Chapter 22.) Under the ideal conditions of a happy marriage there is no danger of psychic impotence, and under immoral or abnormal conditions a man is to be congratulated if he finds himself temporarily lacking in the power to debase himself.
Sexual neurasthenia is the term often employed to designate a condition of great nervous and constitutional debility associated with or growing out of sexual weaknesses. It does not differ greatly from any other case of neurasthenia, except that it is the result of sexual abuses or excesses. It is true that impotence, or some degree of sexual weakness, may be the result of neurasthenia produced by other causes, such as overwork, worry, or mental and emotional strain of any kind. The sex function, like every other function, is naturally impaired by lowered vitality, poor circulation and impoverished blood, and when sexual weakness is a marked feature of such a case it may perhaps be classified as sexual neurasthenia; but as a rule this term is applied to nervous debility 'resulting from the drain upon the nervous system and the vital resources made by sexual abuses and seminal losses. Some authorities also claim that sexual neurasthenia may be the result of the continued repression of the sex instinct for many years, as when one who possesses very strong and active sex impulses is forced to live a life of complete abstinence. This probably is the case with women more often than with men.
Sexual neurasthenia may take various forms in different cases, but aside from local sexual weaknesses and disorders, ranging from seminal losses down to impotence, the marked mental symptoms that I have already mentioned in connection with extremes of masturbation and seminal losses, namely, brain fag, poor memory and inability to work are invariably present. The sufferer is at the mercy of his moods; he is inclined to worry and to exaggerate his troubles, or he may be subject to absurd fears of one kind or another. Aches and pains in the spine, usually around the small of the back, are fairly common in connection with this condition. There is a general lack of energy and poor endurance.
It is in respect to other symptoms that cases differ mostly. Some are especially characterized by digestive troubles, and in others urinary disorders are particularly marked. Stubborn and persistent cases of dyspepsia should be studied with reference to the individual's sexual health. Constipation occurs in sexual neurasthenia, though there may be periods of diarrhea. When bladder troubles are especially in evidence there is a frequent desire to urinate during the day, but no special difficulty of this kind at night, in contrast to the conditions of prostate enlargement and other disorders of the bladder. It is found difficult to commence the act of urinating, and the sufferer may be unable to do it at all in the presence of other persons. There is also usually a dribble at the end, indicating local weakness.
Disturbances of circulation are much in evidence in sexual neurasthenia, with more or less palpitation of the heart, so that the victim thinks he has some organic heart disease. His heart beats rapidly and with a feeble pulse on the least exertion. He gets out of breath quickly. He is troubled with cold feet and hands. Often he is inclined to blush easily, an indication of an unstable circulation. Often the eyes are weakened, with symptoms of eye-strain and specks floating before them. One may be sensitive to noises, and there may be various other of the ordinary symptoms characteristic of neurasthenia.
Impotence in Old Age.—It is of course to be expected that there should be a decline of virility with advancing years, though its extent will vary with individuals. At the same time, if a man were to live a life free from abuses of any kind, and could retain a *vigorous condition of the body as a whole up to the end of the normal span of life, he should retain his virility, at least to a certain extent, up to the very end. There are many men who have done so. In not a few instances they have become parents when past the age of eighty years. Of course these cases are unusual, but they show what nature is capable of under normal conditions. In fact, Metchnikoff is said to have found the spermatozoa alive and active in a man one hundred years old. Sexual power is so closely associated with general bodily vigor that one should be able to retain it if one keeps strong and active in advancing years. But to do this requires a life of sexual temperance, with no other squandering of one's vitality.
After the age of forty-five or fifty a man will find it the safest plan to exercise extreme moderation in respect to his sexual indulgences. I might almost say that the question as to how long his procreative power will last will depend largely upon how it is conserved or wasted in early life. There is no doubt that in many cases it is best to live a continent life from middle age on. The physiological age for parenthood' has been passed, at least, in all probability, in the case of one's wife, and therefore it is only natural that one should gradually come to neglect and more or less forget this function, as one occupies oneself with other interests. I would not venture to lay down any rule for all men. Each must regulate his own life in conformity with his own individual needs and constitutional peculiarities. But there is no doubt that temperance, or continence, in advanced years would be advantageous, and it would probably go far toward preventing the prostate enlargement from which many old men suffer. Incontinence at this time of life may prove very weakening. Old men with young wives often age rapidly. When there is weakness of the heart or hardening of the arteries, continence is absolutely necessary.
While it is true that virility should in a large measure last as long as life, some decline in power is to be expected. In many cases impotence after the age of sixty-five years is to be regarded as physiological, and there should be no occasion for alarm if it should come even earlier. Impotence at the age of fifty years is, of course, premature, though it may be regarded as a natural result of an extremely active sex life. One cannot eat one's cake and still have it. In all cases, much depends upon the habits of early life. Many foolish young men have almost exhausted them-selves before the age of twenty. Such facts must be considered. Impotence before the age of fifty is of course abnormal. It is to be found, however, in many men under the age of thirty.
Impotence in early life, like other sexual disorders, is usually accompanied by bodily weakness, or more or less neurasthenic condition and general functional disturbances. There are exceptional cases, however, usually in men over thirty, in which there seems to be little or no in-convenience associated with the condition except for its bearing on the question of marriage or parenthood. In other words, one occasionally finds a case in which a man has become impotent before middle age, but still maintains fairly robust health and a good physique. I have known a few such cases, in which treatment seems to have little effect on the local weakness. Such cases have usually developed following a period of great excess in adult life, rather than during the period of growth. The explanation probably is that the controlling- spinal nerve-centers have been exhausted or paralyzed, thus causing the power of erection to be lost, while apparently the glands are still in a sufficiently active condition to supply the secretions which are necessary to keep the general bodily functions healthy and vigorous. But as I have said, such cases are exceptional. The rule is that sexual weakness and general constitutional debility go together, and by building up a vigorous constitution, improving the quality of the blood, promoting an active circulation and strengthening every tissue and structure in the body, a corresponding improvement will be brought about in the generative system as well.
What I have just said, therefore, indicates the most important feature of the treatment. The body as a whole must be strengthened, and the general instructions in the chapter on virility building should be followed faithfully. The suggestions on spinal stimulation are very important. Muscular exercise must be regarded as one of the most essential features of the treatment in most cases, though fresh air, sunshine, sufficient sleep, a strengthening diet and general blood-purifying measures are all necessary. Simply make yourself as perfect a specimen of manhood as you possibly can.
A complete sexual rest is necessary in all cases, whether of prematurity, sexual neurasthenia or complete impotence. There should be no at-tempt at indulgence of any kind. This rest should last from two or three months to a year or two.
The causes or conditions at the bottom of the trouble must always be considered. For in-stance, in a case of sexual neurasthenia, with more or less impotence, which obviously depends largely upon continuous seminal losses, it will be necessary to stop these before any marked improvement can be expected, and the special suggestions which I have given in the chapter on that subject should be carefully and diligently followed. Again, in many cases of prematurity there is considerable congestion or inflammation of the prostate gland, making it supersensitive, and this must be remedied. (See the chapter on that subject.) And sometimes one has to do with the lingering effects of. gonorrhea in this gland, or in the posterior urethra.
Usually when there is an extreme degree of prematurity it is highly important to avoid any very stimulating treatment. The diet in such cases should be free from red meats, condiments and stimulating drinks, and should include comparatively few eggs. Even cold sitz-baths may be too stimulating, and the soothing effect of the hot sitz-bath may be more effective, though this should be replaced by the morning cold sitz-bath later on when the extremely sensitive condition of the prostate gland has been overcome.
Remember that the cold sitz-bath is especially valuable for toning up weakened and relaxed tissues and invigorating the nerve centers. It will be of very great value for this purpose where the parts are not too sensitive and irritable. When there is inflammation the hot sitz-bath will have a quieting and soothing effect, but whenever cold water can be used without aggravating the trouble it is usually best. As a rule, the colder the water the better.
In any one with complete impotence, especially when it has existed for some time, a more or less stimulating regimen is to be advised. This should include a fairly full diet, with eggs to the extent to which the appetite may call for them, plenty of milk or buttermilk, if appetizing, and meat at least once a day, if desired. An exclusive milk diet for two or three months might be helpful in some cases where there is serious assimilative or digestive difficulties.
The cold sitz-bath would be very valuable, in total impotence, but the use of alternate hot and cold sitz-baths would be even more stimulating and effective, two tubs being provided for the purpose, with the hot water at 110 to 115 degrees Fahrenheit. Remain in the hot sitz-bath for one minute, then in the cold for two or three minutes, then return to the hot, and so on, making several changes and ending with the cold water.
If the alternate hot and cold sitz-baths are not convenient, then use the cold sitz-bath in the morning, from three to five minutes, and sponge the generative organs in the evening, or at some other time during the day, with hot and cold water alternately, always ending with cold water. Five or ten minutes may be devoted to such treatment. Sun baths, in which the organs concerned are exposed directly to the rays of the sun, should be of special value in a case of this kind. Of course these suggestions must be combined with the general instructions on virility building.
When the organs are more or less atrophied or wasted, such a stimulating course of treatment will be especially necessary, except where there is the extremely sensitive and irritable condition already mentioned. But one should be sure that there is really a wasted condition, or lack of development, before torturing himself with worry about it. Often the idea of atrophy exists only in the imagination. The sexual neurasthenic is inclined to worry about these things, and some men have an exaggerated idea as to what should be the normal size of the generative organs.
The truth is that men differ greatly in respect to the size of these parts. The variations apparently have no relation to virility, or to the size of the individual. Some very large men have comparatively small organs, while small men occasionally have comparatively large ones. Size has nothing to do with power. There is no rule that applies, though on the average the male organ when erect measures from five to six inches. In its relaxed condition as well as erected it may be quite small without indicating any deficiency. Real atrophy of this member is not very common. An unusual shrinking may be due to anxiety or nervousness, especially when under medical examination. An exceptionally small size of this part is usually congenital.
True atrophy of the testicles, however, is likely to result from excessive masturbation or sexual over-indulgence. Probably most cases of greatly shrunken glands are the outcome of masturbation commenced early and continued with unusual frequency during the years of growth. The same result, however, may be produced by gonorrhea or any other infection causing severe inflammation.
It is sometimes said that atrophy of the generative organs may be the result of continence, on the theory that any part of the body not used tends to waste away. It is extremely doubtful, however, if this rule ever holds good for these particular parts. The facts apparently indicate that in practically all cases of atrophy through supposed continence there has been some other definite and direct cause in the way of abuse of one kind or another. Shrinking of these parts in the case of an abstinent and debilitated man is of course due to his debility.
The treatment for wasted organs calls for the building up of all the tissues and nervous, digestive and muscular forces of the body by every possible means, combined with stimulating local treatment, the same as for chronic impotence. Alternate local hot- and cold-water bathing, or sitz-baths, should be persisted in, though other means of improving the circulation may also be used. The vacuum or "cupping" treatment has often been recommended in such cases, and some-times does produce results. But such treatment can rarely be advised, as it over-stimulates the nerves and blood vessels. The suction exerted by this apparatus brings a large amount of blood into the parts, and though in a few instances it might have a beneficial effect its value is questionable. Such treatment, if used, should be brief and should be followed by sponging with very cold water or by a cold sitz-bath, to prevent too much relaxation or dilatation of the blood vessels.
Another treatment that may be very effective in extreme cases, but with which one should be equally careful, is mechanical vibration. This should not be applied directly, but only to the lower part of the pelvis or abdomen, just above the pubic bone, thus influencing the arteries which supply the generative organs. This treatment should also be brief and should precede the cold sitz-bath or cold-water sponging. It should never be used when there is trouble with seminal losses of any kind. Either the vibration or vacuum treatment might be tried in any stubborn case of impotence, as a sort of last resort, though nothing definite can be promised in the way of results.
What are the possibilities of a cure in an individual with complete impotence? To what ex-tent can an impotent man improve himself? These are questions of vital interest. To a large extent I have answered them in the chapter dealing with the results of masturbation. Many with total impotence are cured, but I cannot promise this result always. When of long standing cure is usually difficult. I may say, however, that a gratifying improvement may certainly be secured in the majority of cases. It depends partly upon the individual and the extent of the damage done by the vices or excesses of the past or through the ravages of venereal disease. When some local inflammation is the cause a complete cure is usually possible. But when the nerve-centers are more or less paralyzed it will be much harder to get appreciable results. Do not expect a cure in a hurry. Make up your mind to live a continent life until you have regained a normal condition. This may mean any-where from a few months to two or three years.
Such is the vitality of the human body that it can often be built up, after it seems to have been completely wrecked, to such a degree that one actually may have reason to be proud of his physique and his manhood.