SEXUAL HYPOCHONDRIASIS.
BY 0. EVANS JOHNSON, M. D., ATLANTA, GA.
Every one who does any work in the line of venereal dis-
eases has had to deal to a greater or less extent1 with that
peculiar class of cases termed sexual hypochondriacs, who
apply complaining of an abnormal condition of things relative
either to the appearance or the functions of their genital
organs.
These patients are of two distinct classes. There are those
who need only to be assured by you that both the appear-
ance and the functidns of these organs vary in different indi-
viduals and are yet normal, and those who refuse to accept
all such statements—whose minds are really unsound in
regard to this point, and who, unless something is done for
them, and some pretense at treatment is made, will continue
brooding over their supposed troubles, leading a life which is a
burden alike to themselves and those around them, until their
fitful career is ended within the walls of an asylum for the
insane, or they fill a suicide's grave.
You will be consulted by men declaring that they have
noticed a few herpetic vesicles appearing from time to time
upon the penis and scrotum, that one testicle hangs lower
than the other, that they have nocturnal emissions once or
twice a month, that during an effort at sexual intercourse^
ejaculation occurs before an entrance can be effected, or, pos-
sibly, they are suffering from impotence which will be found
to be purely psychical.
But nocturnal emissions are the source of complaint of the
greater number of sexual hypochondriacs, and will ba
ascribed by them to masturbation, which will be found to
have been only moderately practiced by them in former years.
Even men who have enjoyed a period of many years of vigor-
ous sexual powers, and who, by reason of being left widowers
or because of the ill-health of their wives are leading a life of
•continence, will ascribe an occasional nocturnal emission to
their early indiscretions.
If such patients as these enumerated happen to be blessed
with common sense, the majority can be convinced that the
herpetic vesicles are of no consequence; that it is perfectly
natural that one testicle should be the lower (which, in. the
-greater'number of instances, will be found to be the left,
because of the fact that most men dress upon the right side,
displacing the testicles to the left); that nocturnal emissions
occur independent of the practice of masturbation, it, fre-
quently being found in subjects who have never masturbated,
and is incident to early healthful manhood; that their premature
ejaculation is due to excessive stimulation of the passions and
their anxiety to complete the sexual act, occurring most fre-
quently in newly married men and those practicing illicit sex-
ual intercourse ; and that their impotence is not a pathologi-
cal condition, is due wholly to the influence of the mind and
can be corrected by themselves through fexercise of the will-
power.
The patients require little treatment, but must be dealt with
plainly, and if they can be made to see that you are honest
with them, and you can get their confidence, the battle is won.
But some are not so easily convinced, and it is often neces-
sary to administer a "placebo" purporting to have a power-
ful effect, which will generally accomplish the end desired.
However, every patient who comes to you complaining of
night emissions, premature ejaculation and impotence cannot
be styled as belonging to this class of patients. This should
be carefully looked into. If he has ever masturbated, it must
be ascertained to what extent it has been carried, the patient
must be closely questioned as to gonorrhoea and syphilis, and
all statements duly weighed and accepted with proper reserve,
and the mind of the physician fully satisfied as to the com-
plaints of the patient being wholly without foundation—a
thorough examination being generally deemed advisable.
Nocturnal seminal emissions are usually met with in young
men between the ages of sixteen and twenty-five. At this
period the sexual functions are most active, and the secretion
of semen is continually going on, and must give itself vent in
either one way or another. It is, of course, governed to a
greater or less degree by the habits of the individual, and will
depend somewhat upon the purity of his thoughts, and
whether the sexual desires have ever been excited by mastur-
bation, illicit sexual congress or the marriage relation. But
to find a healthy young man of ordinary intelligence, living
continently, and surrounded by the ordinary environments, and
pursuing the usual walks of life, who does not have an occa-
sional nocturnal emission, is an exceedingly rare instance.
Usually these emissions are found to occur once a month or
once a fortnight, but they may occur two or three times a
week without any detrimental results to follow; again, the
patient may, for several weeks, be entirely free from them,
when they will appear upon several successive nights or even
upon the same night.
Bumstead says: In ninety-nine cases out of one hundred,
these emissions require no medical or surgical treatment.
The chief danger from them lies in the patient attaching un-
due importance to them, in dwelling upon them, and in mak-
ing himself miserable over them. If he can be induced to
give his mind and body pure thoughts and healthy exercise,
and to look upon their occurrence as a physical necessity,
nature will take care of the rest.
As to masturbation being the most frequent cause of noc-
turnal emissions, I wish here to quote the words of Sir James
Paget1: You may teach positively that masturbation does
neither more nor less harm than sexual intercourse practiced
with the same frequency, in the same conditions of general
health and circumstances. Practiced frequently by the very
young—that is, at any time before or at the beginning of
puberty—masturbation is very likely to produce exhaustion,
effeminacy, over-sensitiveness and nervousness; just as
1	Clinical Lectures and Essays, London, 1875.
equally frequent copulation at the same age would probably
produce them, or practiced every day or many times in one
day, at any age, either masturbation or copulation is likely to
produce similar mischiefs or greater. And the mischiefs are
especially likely or nearly sure to happen, and to be greatest,
if the excesses are practiced by those who, by inheritance or
circumstances, are liable to any nervous disease—spinal irri-
tation, epilepsy, insanity or any other. But the mischiefs are
due to the quantity, not to the method of the excesses; and
the quantity is to be estimated in relation to age and the
power of the nervous system. I have seen as numerous and
as great evils consequent on excessive sexual intercourse, as
on excessive masturbation; but I have not seen or heard any-
thing to make me believe that occasional masturbation has
any other effect on one who practices it than has sexual inter-
course, nor anything justifying the dread with which sexual
hypochondriacs regard the having occasionally practiced
it. I wish I could say something worse of so nasty a practice;
an uncleanliness, a filthiness forbidden ,by God, an unmanli-
ness despised by men.
Marriage has been advised, whenever practicable, for young
men of this class, and while it usually accomplishes all that
is intended it should, physicians should be very chary in
urging this point, and is admissible only when it is absolutely
certain that there exists those conditions and circumstances
which combine to make a happy marriage, and is not simply
a union having for its purpose sexual intercourse, for marriage
under these conditions is likely to entail far greater evils than
can ever result from nocturnal emissions; nor is illicit sexual
cpngress ever to be advised in lieu of marriage, because of the
fact that it invariably leads to excesses which have an effect
entirely at variance with the end desired, and leaves the patient
in far worse condition than he was originally.	,
Another very frequent complaint of this class of patients is
a too speedy ejaculation in the effort at coition, which may
take place in attempting intercourse with any woman, or with
some one woman in particular, especially if the attempt be
the first one with her. Here the mind is at fault; over-anxi-
ety to perform the act well is very apt to its being done
badly. Young husbands in their eagerness to consummate
the rite, not infrequently fail, and I fancy that there are few
men who did not ejaculate prematurely when they had con-
nection for the first time.
In January, 1892,1 was consulted by a young man, H. E. L.,
age 22, book-keeper, for premature ejaculation of semen.
•Came to me in gieat distress. Had been married four days,
and upon first attempt at sexual intercourse, had failed
utterly because of ejaculation of semen before intromission
could be accomplished. Had not since made effort at repeti-
tion of act, fearing he would again fail, and dreading further
mortification. Found he had never masturbated, had never
had gonorrhoea, nor had he ever been so troubled before in
attempting intercourse with other women. I explained to him
that his failure was most probably due to normal impetuosity
and want of self-control, telling him that it was frequently the
case in newly-married men and that he would not likely have
any further trouble upon a second effort. On the way to my
office next morning, I chanced to meet him, when he greeted
me wjth a happy, confident smije and passed on.
Impotence from the restraining or inhibitory control of the
brain over the genito-spinal centre is a condition often met
with. That erection may fail or cease under the influence of
excitement, depressing or other emotions, or mental preoccu-
pation, is a fact with which every one is familiar.
Thus, it will be found in the history of nearly all cases of
rape, that where a considerable struggle has taken place, the
performance of the act has been more dr less imperfect, due
to the muscular exertion, the excited state of the mind and the
-difficulty attendant upon its performance. Young husbands
who were previously potent, and had never indulged in sex-
ual or unnatural excesses, or young men about to have illicit
sexual intercourse with some young woman for the first time,
are liable to be troubled in this way, the undue stimulation of
the passions at their first efforts at copulation having the
•effect of causing the erection to cease before the act is com-
pleted, or even before intromission. As in premature ejacu-
lation, repetition of the effort generally corrects the trouble.
The satisfactory accomplishment of the sexual act can bo
influenced by the most absurd fancy or the merest whim.
One man will be told by a friend of his sexual weaxness, and
with this story in his mind, he too, will find himself unablo
for a time to complete the act. The utterance of a vulgar ex-
pression, or a coarse word by a woman, may take away all
desire for her, and the power and desire yet remain for othersr
Excessive desire, with gratification long delayed, may tempo-
rarily deprive a man of his power.
One of the most frequent causes of impotence, is the fear
that coitus is impossible, and you will be told by patients that
the moment intercourse is attempted, no matter who the
woman may be, or how passionately fond he may be of her,
the power leaves him entirely, although the desire is exces-
sive.
Grimaud de Caux2 relates the instance of a mathematician
in whom erection ceased before ejaculation, because his
thoughts wandered to the solution of an intricate problem^
The wife resorted to the stratagem of partially intoxicating
her husband before the attempt at connection, which rendered
his powers all that could be desired.
Ribaud3 relates the story of a young Frenchman who was
given the initiatory steps into the pleasures of Venus by a
young woman occupying the position of governess in some one
of the neighboring country homes, who was ablonde, and always
wore when she met him, English boots, corsage and blue silk
dress. After a'time it became desirable by his family, that a
marriage should be consummated by him, but he found him-
self impotent except under the conditions that the woman be
a blonde, she must wear English boots, corsage and blue silk
dress, under which circumstances, his powers were vigorous
enough. Bibaud, under pretense of giving him a powerful
drug which would certainly cure him, administered a "placebo"
which brought about the desired result.
Onimus and Legros4 speak of a young man who was impo-
2	Physiologie de l'Espece.
3	Traite de l'lmpuissance et de laSterilite.
4	Traite d'Electricite Medicale.
tent for years after having been surprised at the moment of
connection by the husband.
I mention these instances to illustrate to what extent a
man's powers may be governed by his mental condition, and
the importance of obtaining the confidence of patients who
apply afflicted with these imaginary troubles.

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