Nevertheless there is hardly any anatomical basis at all for this very common condition, and though I have always carefully examined the organs concerned in the sexual feelings, I have never been able to detect any abnormality of the ovaries, and have only twice seen a distinct atrophy of the clitoris. Nor have I been able to prove the existence of any of the numerous other causes of this " frigidit6," which have been described especially in French literature. Of course, general diseases, like chlorosis, and maladies of the sexual organs, may diminish sexual desire, and so may excesses in venery, and especially masturbation. But if we are.not unbelieving enough to be unjust, we will find that in most of these cases none of the above-mentioned causes will be present. Nor do I believe that the condition has been induced in psychic ways by education and tmining, for it occurs among uncultured peasants. It certainly has no connection with hysteria. I cannot decide whether heredity has anything to do with it. Whether advancing civilization has anything to do with its development, we cannot say so long as we do not know the frequency of its occurrence among savages.
We are especially interested here in the relations of this condition to sterility. I have found it but rarely, and on the other hand have seen an excessive proportion of rapidly succeeding pregnancies. I (lo not think that the absence of sensation has much influence upon conception at all.
Many physiologists and gynecologists, however, do not agree with me, and believe that sexual d.esire and ptusion, being present in most cases, aro essential to the propagation of the race. Tilt and Duncan especially, regard it as a frequent cause of sterility. But sterile wotnen who have no sexual passion seek medical aid much more quickly than do others in like condition, and even to laymen it seems a very plausible explanation of infecundity. If we extend our inquiries beyond those patients who come to us for sterility, and question our gynecological and obstetric patients and their husbands, we will find that dyspareunia is not only extremely common, but is very frequently found in fecund WOMCIII. And on the other hand we usually find in erterile women other abnormal ities of the genitals which would explain that condition. Leopold Meyer found want of voluptas frequently in these cases, but always also some other deficiency. I do not lay much stress upon dyspareunia or frigidity as a cause of sterility.
Others claim that heightened sexual appetite, with too frequent and stormy cohabitation, causes sterility. It is difficult to say how much basis there is for this view. The physician can obtain less frequent and less reliable data about it than about dyspareunia. I cannot t,ell whether
the increased desire is very common in sterile women, and whether it is -not much more frequent in fecund women. If we exclude those cases in which from male weakness the act is unsatisfactory, and also those cases in which the heightened orgasm is merely the expression of some mental disturbance, it is a question whether the few remaining cases cannot be referred to some genital disease, which at the same time causes sterility. Some years ago an exquisite case of this kind came under my observa tion. The girl was twenty.two years old, and of very excellent family. Excessive sexual appetite caused her to lead a very loose life and commit many follies. Examination showed that both ovaries were greatly en larged, an I fixed in Douglas's cul-de-sac by dense exudation. The anam nesis showed that the local malady was the primary, and the excessive sen suality the secondary election.
I have observed certain cases which reveal the possibility of sterility occurring from repeated abortion due to too frequent and to over-vehement cohabitation. Physicians who practise much among prostitutes agree that the frequent occurrence of menses several days late, with abundant hemorrhage, are to be regarded as instances of abortion. There can be no doubt that such habitual abortions must letul to further changes in the genitals, which must finally lead to true sterility.
Masturbation has been claimed to have great influence upon fecundity. Here also we have no data; for but few repentant souls will confess it. Our impression, however, is that perhaps the unnatural satisfaction of the sexual appetite before marriage may injure the legitimate sexual faction later, but we do not believe that it can ever really cause sterility. Nervous Influences.—It has been assumed that sterility can occur from purely nervous causes. Psychic emotions are supposed to be espec ially hurtful to ovulation. It is undoubted that menstruation may be stopped for a longer or shorter time, or rarely, for ever in this way. And since we cannot as yet reject the idea of a connection between menstrua tion and ovulation, the possibility of sterility occurring in this way can not be confidently denied. But here also our data are too few for us to have a decided opinion. The influence of nervous disease proper upon the function has not yet been investigated. It appears to me that none such exists, though I have no experience in the matter save in the case of hys teria. This latter malady occurs so frequently in connection with genital diseases, that it is almost impossible to decide upon its relation to sterility.