The Sexual Life of the Child/Chapter 2

A proper understanding of physiological functions is based upon anatomical knowledge of the organs concerned. For our purpose, therefore, a knowledge of the sexual organs of the child is essential. The proper course, in this instance, appears to be to start with an account of the adult organs, and then to describe the distinctive characteristics of the same organs in the child. Let us, then, begin with the organs of the adult man.

The membrum virile or penis is visible externally, and behind it is situated the scrotum. Within this latter are two ovoid structures, named testicles or testes. Each testicle is enveloped in a fibrous capsule, known as the tunica albuginea, from which fibrous septa pass into the interior of the organ, thus dividing it into a number of separate lobules. Each lobule is composed of seminiferous tubules, which are greatly convoluted and like wise branched, the branches being continuous with those of neighbouring tubules, both within the same lobule, and (by perforating the fibrous septa) in adjoining lobules. In the walls of the seminiferous tubules the spermatozoa are formed. The seminiferous tubules unite to form the efferent ducts (vasa efferentia), about a dozen in number for each testicle; immediately passing out of the testicle, these efferent ducts make up the epididymis, situated at the upper and back part of the testicle. After numerous convolutions, these unite at length on each side to form a single canal, which leaves the epididymis under the name of the vas deferens; this is the excretory duct of the testicle, conveying the secretion of that organ to the exterior. The vas deferens traverses the inguinal canal into the abdominal cavity, and therein passes downwards to the prostatic portion of the urethra (vide infra). The anterior portion only of the penis is visible externally, dependent in front of the scrotum; the posterior portion is concealed by the scrotum and the skin of the perineum. The terminal segment of the penis is formed by the glans, which is covered by the foreskin or prepuce. This last is sometimes artificially removed: either on ritual grounds, as, for instance, among the Jews; or for medical reasons, for example, when the preputial orifice is greatly constricted. At the anterior extremity of the glans penis is the orifice of the urethra (meatus). The urethra is a canal running through the entire length of the penis, opening by its proximal extremity into the urinary bladder, and serving for the passage of the urine from the bladder to the exterior of the body. The main substance of the penis is composed of three cavernous bodies, the paired corpora cavernosa penis, and the single corpus spongiosum, or corpus cavernosum urethrae. These consist of what is known as erectile tissue, a spongy mass within whose lacunar spaces a large quantity of blood can, in certain conditions, be retained. When this occurs, the penis becomes notably thicker and longer, and simultaneously hard and inflexible. This process is known as erection of the penis, and is requisite to render possible the introduction of the organ into the genital canal of the female.

The proximal segment of the urethra is surrounded by the prostate gland. The secretion of this gland is conveyed into the urethra by numerous short ducts, known as the prostatic ducts. Behind the prostate, at the base or fundus of bladder, are the paired seminal vesicles. The duct of the seminal vesicle joins the vas deferens of the same side (both functionally and embryologically the seminal vesicle is no more than a diverticulum of the vas deferens); passing on under the name of the common seminal or ejaculatory duct, the canal opens into the prostatic portion of the urethra (the orifices of the two common seminal ducts are in the folds of mucous membrane forming the right and left lateral margins of the prostatic utricle or uterus masculinus). These ducts convey the secretion of the testicles into the urethra, along which canal it passes to the exterior. Behind the posterior part of the urethra, but distal to the prostate gland, are situate also the paired glands of Cowper, or suburethral glands, whose excretory ducts likewise open into the urethra. There are glands also in the walls of the seminal vesicles, the vasa deferentia, and the urethra; the urethral glands are commonly known as the glands of Littré.

As previously mentioned, it is in the testicles that the secretion necessary for the reproductive act is prepared. This secretion is evacuated during sexual intercourse, and also during masturbation and involuntary seminal emissions. The testicular secretion is a tenacious fluid. When examined microscopically, it is seen to contain countless spermatozoa, structures about 50 (1/500 inch) in length, with a thick head and a long filiform tail. They represent the male reproductive cells, which during coitus are introduced into the interior of the female reproductive organs; a single spermatozoon unites with the ovum of the female to form the fertilised ovum. The spermatozoa are formed in the walls of the convoluted seminiferous tubules. The cells lining these tubules are of several different kinds (although in childhood they are not differentiated as they are after the puberal development has taken place). One variety of these cells, the spermatogonia, undergo an increase of size at puberty, and from these spermatogonia, after passing through several intermediate transitional stages, the spermatozoa are formed.

It was formerly believed that the sole function of the testicles was the production of the spermatozoa; recently, however, the opinion has gained ground that these organs have in addition another specific function, that of internal secretion. Whilst the spermatogonia become transformed into spermatozoa, other cellular structures of the testicle, more especially the interstitial cells, produce, it is assumed, the internal secretion of the gland. The constituents of this internal secretion, having been poured into the general circulation, are supposed to give rise to the specific masculine sexual development, and, in particular, to lead to the appearance of the secondary sexual characters. This matter will subsequently be discussed in detail, and here I shall merely add that perhaps none of the proper constituents of the internal secretion find their way into the external secretion of the testicle.

This external secretion of the testicles does, however, receive the admixture of a number of other secretions, to constitute the semen as actually discharged, viz., the secretion of the prostate gland, that of the seminal vesicles, Cowper's glands, and the glands of the vasa deferentia, and perhaps also that of the glands of Littré. The term semen is, indeed, often applied to the secretion of the testicles alone; but to avoid misunderstanding, Fürbringer recommends that only the mixed secretion, as actually discharged, should be spoken of as the semen, and that this term should never be employed to denote the testicular secretion alone.

In what has gone before, I have not only described the structure of the male sexual organs, but have alluded also in passing to their functions. These latter must, however, be described more fully. Let us begin with erection, which, as we saw, is due to distension of the penis with blood. How is this distension brought about? It results from stimulation of the erection centre. Until recently, it was supposed that this centre was situated in the lumbar enlargement of the spinal cord; but now, owing to the researches of L. R. Müller, it is believed to form part of the sympathetic plexuses of the pelvis. Stimulation of the centre leads to distension of the penis with blood, and thus to erection of that organ. The stimulation of the centre can be effected in either of two ways.

In the first place, by psychical processes. Thus, in a man, the sight of a woman exercises such a stimulus, the stimulation proceeding from the brain along the spinal cord to reach the centre. The psychical stimulus may also consist of reminiscences. In this way the memory of an attractive woman may be just as effective in causing erection as if she were actually visible at the moment; reading erotic literature may have the same result. When the sexual impulse is perverted, the ideas causing erection will naturally be themselves of a perverse character. Thus, in the homosexual male, erection occurs at the sight or remembrance of a man; in the fetichist, the idea of the fetich is operative--in the case of the body-linen fetichist, for instance, the idea of articles of underclothing.

In the second place, the activity of the erection centre can be aroused by physical stimuli. To this category belong masturbatory manipulations, stimulation of the glans penis and other parts of the genital organs. But other erogenic areas exist, the stimulation of which produces the same results. Among these areas, the buttocks must be particularly mentioned. But individual peculiarities play a great part in this connexion. Thus, in many persons, a slight stimulation of the nape of the neck, of the scalp, &c., has an erogenic effect. In all cases alike, the stimulus is conducted along the sensory nerves to the erection centre, and it is the stimulation of this centre which by reflex action leads to distension of the penis with blood and its consequent erection. The physical stimulus leading to erection may also result from some pathological process, such as inflammation of the penis or of the urethra. Finally, certain internal physiological processes may be the starting-point of the afferent physical stimuli leading to erection; for example, distension of the bladder, and also of the seminal vesicles, and of the seminiferous tubules of the testicle. In addition, it is probable that many of the processes of growth occurring in the reproductive glands act in a similar way. These internal stimuli all pass to the erection centre along the afferent (sensory) nerves, and induce erection by reflex action; and it is important to bear in mind that this effect may result without any direct affection of consciousness by the originating afferent impulses.

Although either kind of stimuli, psychical or physical, acting alone, may give rise to erection, experience shows that in most instances the two varieties co-operate in the production of this effect. Thus, in the sexually mature man, the accumulation of semen in the seminal vesicles gives rise, not only to excitement of the erection centre, but also to voluptuous ideas, and these latter, in their turn, further stimulate the erection centre.

Normally, during coitus, erection is followed by ejaculation. A special nerve centre for ejaculation is also supposed to exist; and the ejaculation centre, like the erection centre, was formerly believed to be situated in the lumbar enlargement of the spinal cord, but recent investigations have shown that it also most probably forms part of the sympathetic plexuses of the pelvis. This centre also may be stimulated either by psychical or by physical stimuli. In normal conditions, however, much more powerful stimuli are needed to cause ejaculation than those which are competent to give rise to erection. For this reason, erections often occur without leading to ejaculation, whereas in normal conditions ejaculation hardly ever occurs without erection. In fact, ejaculation in the absence of erection is almost peculiar to pathological states, and may occur, for instance, in many forms of impotence, in which the ejaculation centre still remains susceptible to stimulation, whilst the erection centre is exhausted. Whereas stimulation of the erection centre exercises its reflex influence through the vasomotor nerves, thus leading to distension of the penis with blood, the reflex impulses resulting from stimulation of the ejaculation centre are transmitted by the motor nerves to certain muscles--those, namely, whose contraction forcibly expels the accumulated semen. The contractions of the affected muscles occur rhythmically, the stimulation of the ejaculation centre giving rise to a series of contractions alternating with relaxations. True ejaculation, resulting from the activity of these muscles, must be distinguished from the appearance of a drop or two of fluid at the urethral meatus, which occasionally occurs at the outset of sexual excitement--the so-called urethrorroeha ex libidine. This fluid runs out while the ejaculatory muscles are quiescent. It was formerly believed that it consisted of the secretion of the prostate gland; but Fürbringer, to whom we are indebted for the most valuable researches in this province, has shown that this view is erroneous. These drops are, he states, derived solely from the glands of Littré and the glands of Cowper (urethral and suburethral glands).

Sexual excitement is accompanied throughout by a sensation of pleasure, specifically known as voluptuous pleasure, the voluptuous sensation, or simply voluptuousness (in Latin, libido sexualis). Several stages of the voluptuous sensation must be distinguished: its onset; the equable voluptuous sensation; the voluptuous acme, coincident with the rhythmical contraction of the perineal muscles and the ejaculation of the semen; and, finally, the quite sudden diminution and cessation of the voluptuous sensation. Associated with the last stage we usually have a sense of satisfaction, and simultaneously a cessation of the sexual impulse; a sense of ease and calm ensues, and at the same time a feeling of fatigue. This voluptuous sensation localised in the genital organs must, of course, be distinguished from the general sense of pleasure produced in a man by the idea of, or by contact with, a woman in whom he is sexually interested.

Now let us pass on to the consideration of the reproductive organs in the female. The most conspicuous part of the external genital organs consists of two large folds, situated on either side of the median line, and known as the labia majora. Within these are two much smaller folds, the labia minora or nymphae. In the median line, in the space between the labia minora, we see two apertures: the anterior of these is the urethral orifice (meatus), from which the comparatively short and almost straight urethra of the female passes upwards and backwards to the bladder; the posterior aperture is the vaginal orifice. The labia minora, divergent posteriorly, converge as they pass forwards like the limbs of a V; at the apex of the V is the clitoris; in shape and structure this resembles the penis of the male, but it is much smaller, and is solid, not being perforated by the urethra. It contains two corpora cavernosa, which unite to form the body of the organ, whilst the distal extremity is known as the glans, and is homologous to the glans penis. Posteriorly to the clitoris, and beneath the mucous membrane on either side, is an additional mass of erectile tissue, known as the vaginal bulb, or bulb of the vestibule. Just outside the vaginal orifice on either side are visible the orifices of the ducts of Bartholin's glands (known also as Duverney's glands); these are homologous with Cowper's glands in the male.

When we attempt to pass from the vaginal orifice to the internal reproductive organs, we find that in the virgin an obstacle exists, the hymen or maidenhead, consisting of a duplicature of the mucous membrane. It is very variable in form, but in the great majority of instances it diminishes the size of the vaginal inlet to such an extent as to render coitus impossible until the hymen has been torn. Through the vaginal orifice access is gained to the interior of the vagina, a tubular structure, but flattened from before backwards, so that in the quiescent state the anterior and posterior walls of the passage are in apposition. The uterus or womb is a muscular, pear-shaped organ, with an elongated central cavity, which opens into the upper part of the vagina. At the upper end of the cavity of the uterus are two small laterally placed apertures, which lead into the Fallopian tubes (or oviducts). These tubes pass outwards in a somewhat sinuous course towards the ovaries, the reproductive glands of the female, homologous with the testicles in the male, and situated on either side of the upper extremity of the uterus. The shape of the ovaries is somewhat ovoid. They contain a large number of vesicular structures, the ovarian follicles, the largest, ripe follicles being known as Graafian follicles, whilst the smaller, partially developed follicles are termed primitive ovarian follicles, or primitive Graafian follicles. In the interior of each follicle is an ovum. In the sexually mature woman, a Graafian follicle ripens at regular intervals of four weeks. When ripe, the follicle bursts, the ovum is expelled, and passes through the Fallopian tube into the interior of the uterus: here it is either fertilised by uniting with a spermatozoon derived from the male, in which case it proceeds to develop into an embryo; or else it remains unfertilised, in which case it is shortly expelled from the body.

In the uterus, as well as in the ovaries, an important change occurs at intervals of four weeks, characterised by an increased flow of blood to the organ, culminating in an actual outflow of blood from the vessels into the uterine cavity, and thence through the vagina to the exterior of the body; the whole process is known as menstruation, the monthly sickness or the (monthly) period. After the fertilisation of the ovum, during pregnancy, that is to say, menstruation usually ceases until after the birth of the child, and often until the completion of lactation.

I do not propose to discuss here the nature of the connexion between these periodic processes in the ovaries and the uterus, respectively--that is, between ovulation and menstruation. I shall, however, take this opportunity of stating that, as careful investigations have shown, the periodic processes in question are not limited to the uterus and the ovaries, but affect also the external genital organs, which become congested simultaneously with menstruation; and further that the entire feminine organism is affected by an undulatory rhythm of nutrition, the rise and fall of which correspond to menstruation and to the intermenstrual interval, respectively.

I must now give some account of the peripheral processes occurring in the female genital organs in connexion with the sexual act. In part, they are completely analogous to those which take place in the male. I have already pointed out that in many respects the clitoris in the female corresponds to the penis in the male. In the clitoris, also, erection occurs, conditioned partly by psychical and partly by physical stimuli. The psychical stimuli consist of ideas relating to the male. The physical stimuli may, just as in the case of the other sex, vary in their nature. Thus, the condition of the reproductive glands may act as a physical stimulus to erection; also the touching of certain regions of the body, especially the clitoris, the labia minora, or other erogenic zones. Under the influence of such stimuli, the venus plexuses making up the vaginal bulbs also become distended with blood. In fact, speaking generally, sexual excitement is characterised by a vigorous flow of blood to the genital organs. During coitus, in woman, as in man, a process of ejaculation normally occurs, taking the form of rhythmical muscular contractions, affecting not only the perineal muscles, but also the muscular investment of the vagina, and occasionally, perhaps, the uterus itself. These muscular contractions also favour the expulsion of a secretion, but this secretion does not contain the reproductive cells of the female, and consists merely of a mixture of in different secretions--the secretion of Bartholin's glands, that of the uterine mucous membrane, and that of the mucous glands of the vagina and vulva. In the woman also, even at the outset of the sexual act, a secretion from the local glands takes place, whereby the genital region is moistened prior to the actual orgasm. We have as yet no precise knowledge as to which glands are concerned in the production of this phenomenon, which is homologous to the urethrorrhoea ex libidine of the male. In woman, as in man, the curve of voluptuousness exhibits four phases: an ascending limb, the equable voluptuous sensation, the acme, and the rapid decline. There are, however, in this respect, certain differences between man and woman, to which von Krafft-Ebing drew attention, and whose existence was confirmed by Otto Adler. Whereas in the male the curve of voluptuousness both rises and falls with extreme abruptness, in the female both the onset and the decline of voluptuous sensation are slower and more gradual. There is an additional difference between man and woman. In woman very often voluptuous pleasure is entirely lacking; certainly such absence is far commoner in women than in men--a condition of affairs which must on no account be confused with absence of the sexual impulse. Even when the sexual impulse is perfectly normal, the entire voluptuous curve with its acme may be wanting. In such cases, the after-sense of complete satisfaction, which occurs more especially when ejaculation has been associated with an extremity of voluptuous pleasure, is commonly also lacking. Finally, it is necessary to add that in woman, as in man, the reproductive glands appear to have a duplex function--such is, at least, the belief to which recent investigations more and more definitely point. The ovaries, that is to say, do not only produce ova; they also, like the testicles, furnish an internal secretion, and the absorption and distribution of this secretion by the blood are supposed to cause the development of the secondary sexual characters in woman.

Having now concluded our account of the structure and functions of the reproductive organs of adults, let us turn to consider the differences between these organs and those of children. In the child, the testicles are considerably smaller; smaller also are the penis and the other genital organs. In the adult, the root of the penis is surrounded by the pubic hair; this hair is absent in the child. The most important distinctive characteristic, however, lies in the fact that in the child the morphological elements upon which the capacity for procreation depends, namely, the spermatozoa, are not yet present in the testicles. The spermatozoa first make their appearance during that year of life which is usually regarded as the year of the puberal development. The microscopial appearances of the testicle, of which an account has previously been given, thus naturally differ according as the specimen under examination has been taken from a child or from an adult. As regards the other glands considered to form part of the genital organs, some of these secrete even in childhood. This matter will be subsequently discussed in some detail.

In the female sex, also, there are notable differences in the condition of the genital organs between the adult and the child. In the first place, the relative sizes of the various organs differ greatly. But other differences are also noticeable, not dependent, however, on differences in age, but on whether there has or has not been experience of sexual intercourse, and on whether pregnancy and parturition have occurred. When we compare a female child with an adult woman, the first obvious difference is in the shape of the external genital organs. In the child, the vulva is placed much higher and more to the front, so that, it, is distinctly visible even when the thighs are in close apposition. In the child, also, the labia majora are less developed, for as womanhood approaches a great deposit of fat takes place in these structures. Again, in the child, the outer surfaces of the labia majora and that part of the skin of the abdomen just in front of the labia (the mons veneris) are as hairless as the rest of the body, whereas in the adult woman these regions are covered with the pubic hair. According to Marthe Francillon, to whom we are indebted for an elaborate study of puberty in the female sex, during the puberal development changes occur also in the clitoris. The genital corpuscles of Krause and the corpuscles of Finger (Wollustkörperchen), the terminals of the nerves passing to the erectile tissue of the clitoris, undergo at this time a marked increase in size. The clitoris itself, hitherto comparatively small, now attains a length of three to four centimetres (1.2 to 1.6 inch), in the quiescent state, and of four and a half to five centimetres (1.8 to 2 inches) when erect. In the virgin also, as previously mentioned, the hymen is present, a structure of very variable form. After defloration its remnants persist in the form of small prominences around the margin of the vaginal inlet (carunculae myrtiformes). But, quite independently of defloration, in the child the vaginal orifice is much smaller than in the riper girl. The uterus undergoes remarkable changes. In the foetus, during the latter part of intra-uterine life, this organ grows very rapidly; but immediately after birth its growth is arrested, so that in a girl of nine it is little larger than in the new-born infant. During the period of puberal development, however, the growth of the organ is once more extremely rapid. Its shape also changes at this time. In the child, the uterus is longer in proportion to its thickness; in childhood, too, the comparative length of the cervix in relation to that of the body of the organ is much greater than in the adult woman. We need only allude in passing to the fact that later in life marked changes occur in the uterus as a result of pregnancy and parturition. The hypertaemia and the bleeding that take place periodically during menstruation lead to certain changes in the mucous surface of the uterus. Ovulation, which in the sexually mature woman recurs at four-weekly intervals, also gives rise to certain permanent changes in the ovaries. The site of each ruptured Graafian follicle becomes cicatrised, and in consequence of the formation of these little scars, the ovary no longer retains the smoothness of surface which was characteristic of the organ in childhood. From birth onwards the ovaries gradually increase in size, but the growth is disproportionate in different diameters. Thus, for instance, during the eighth year of life, growth is chiefly in thickness, so that the ratio between the length and the thickness becomes less than before. The structure of the ovaries also varies at different ages. In a girl of three years, the primitive ovarian follicles number about 400,000; at the age of eight it is estimated that their number has been reduced to about 36,000. Certainly the majority of the primitive follicles come to nothing. True Graafian follicles, of which an account has already been given, are not usually formed prior to the beginning of the puberal development; occasionally however, they are formed in the ovaries of immature girls.

Let us now pass to the consideration of the sexual impulse. We learn from personal observation that two entirely distinct processes participate in this impulse. In the first place, we have the physical processes that take place in the genital organs; these are in part unperceived, but in part they affect consciousness in the form of common sensations, or as ordinary tactile and other similar sensations. In the second place, we have those higher psychical processes by means of which man is attracted to woman, and woman to man. In our actual experience of the normal sexual life, both these groups of processes do, as a matter of fact, work in unison; but not only is it possible for us to distinguish them analytically; it is, in addition, possible in many instances to observe them in action clinically isolated each from the other. A long while ago I utilised this distinction for the analysis of the sexual impulse, describing the impulse in so far as it was confined to the peripheral organs as the detumescence-impulse (from detumescere, to decrease in size), and in so far as it takes the form of processes tending towards bodily and mental approximation to another individual, as the contrectation-impulse (from contrectare, to touch, or to think about). The distinction will become clearer to our minds if we familiarise ourselves first with cases in which either process occurs independently of the other. The detumescence-impulse is sometimes the sole manifestation of the sexual impulse. Certain idiots practise masturbation as a physical act, because sensations proceeding from the genital impel them to do so, precisely as itching of an area of the skin impels us to scratch. They masturbate without thinking of another person, and they feel no impulsion whatever towards sexual contact with another person. Analogous phenomena may be witnessed in the animal world also, in connexion with the masturbatory acts of monkeys, bulls, and stallions. When a stallion kicks its genital organs again and again with its hind-foot, and repeats the action until ejaculation ensues, we are hardly justified in assuming that the animal has the idea of a mare before its mind. We must rather suppose that we have to do with a local physical stimulus, to which the stallion reacts in the manner above described. The other component, also, of the sexual impulse, the contrectation-impulse, manifests itself, occasionally, at any rate, in isolation. Certain boys, long before the appearance of any signs of the puberal development, are impelled towards physical contact with members of the other sex, to kiss them, to think of them, although these boys may exhibit no tendency whatever to masturbate, or to manipulate their genital organs. It often happens, indeed, that such a boy is himself greatly astonished to find, some day, that these ideas are reflected to the genital organs, giving rise to erection; or, when he is embracing a girl, to experience erection and ejaculation. In the sexually mature normal man, the detumescence-impulse and the contrectation-impulse act in unison, and hence he is impelled towards intimate contact with the woman, and is ultimately driven to effect detumescence by the practice of coitus. Nevertheless, we must hold fast to the idea that in the normal adult man the sexual processes may also be theoretically analysed into these two components.

This is true also of woman, in whom the processes in the genital organs are equally separable from those which impel to contact with a member of the other sex. But in woman, the processes in the genital organs do not culminate in the ejection of the reproductive cells, that is, of the ovum, but, as we have seen, in the ejaculation of indifferent secretions. In the woman, also, the detumescence-impulse is occasionally met with in isolation--for example, in many female idiots. In the animal world, too, we encounter it as an isolated phenomenon. Certain mares, when rutting, rub their hind quarters against some object in their stalls. The contrectation-impulse may also manifest itself in isolation in woman. It is then directed towards the male, but is not in any way associated with the wish for a definite sexual act. Most commonly, however, in woman also the two components of the sexual impulse are united, and from this union results the impulsion towards coitus. But to this extent the conditions in woman are apt to differ from those in man, inasmuch as, in the former, voluptuous sensations are more often in abeyance; or in woman voluptuous pleasure may not arise during coitus, but may be produced in some other way, as, for instance, by a masturbatory act.

The sexual impulse, and indeed either of its components, may be excited either by bodily or by mental stimuli; but we must always bear in mind the fact that in normal adults, both male and female, the two components are so intimately associated that they can as a rule be separated only by artificial analysis. The nature and mode of operation of the stimuli need not be further discussed, since enough has been said about the matter in our description of erection. Nor is it necessary in this place to deal with such differences as may exist between the psycho-sexual life of the child and that of the adult, since this matter will be fully considered in the fourth chapter. In this chapter my aim has merely been to give a general description of the sexual impulse.

Here I need allude to one more point only, a knowledge of which is indispensable for the understanding of the sexual life of the child, namely, the connexion between the central processes and the peripheral voluptuous sensation. Let us ask, in the first place, by what means the voluptuous sensation, the voluptuous acme, and the sense of satisfaction, are produced. Various factors are here operative. A homosexual man, in heterosexual coitus, by keeping present to his imagination the idea of coitus with a man, may succeed in obtaining erection and ejaculation; but he does not experience the voluptuous acme, nor does he feel the sense of satisfaction. Notwithstanding the fact that the peripheral processes occur in normal fashion, the sense of satisfaction remains in abeyance; because the act is in his case inadequate, the sexual act in which he is engaged lacks harmonious relationship to his sexual impulse. But the same homosexual man, embracing a man with whom he is in full sympathy, will experience alike the voluptuous acme and the sense of satisfaction. Mutatis mutandis, the like is true of woman. Many cases which have been regarded as instances of sexual anaesthesia would appear in quite another light if the woman concerned were to have intercourse with a sexually sympathetic man. I have myself known cases in which women were able to experience the voluptuous acme in intercourse with men whom they earnestly loved, whilst in intercourse with men to whom they were indifferent, the voluptuous sensation and the sense of satisfaction were wanting, even though in some of these cases the peripheral processes culminated in ejaculation. Such a physically complete sexual act, without voluptuous acme or sense of satisfaction, may occur when the woman, having intercourse with a man whom she does not love, pictures in imagination that she is having intercourse with her lover. Unquestionably, the psychical processes are of the greatest importance in contributing to the occurrence of the voluptuous sensation and the sense of satisfaction. On the other hand, of course, certain peripheral conditions must also be fulfilled if the voluptuous acme is to ensue. Among these conditions may be mentioned a certain anatomical state of the skin and the nerves concerned. Experience also shows that in the adult the voluptuous acme coincides with the act of ejaculation. Ejaculation is effected by the rhythmical contraction of certain definite muscles, and Otto Adler believes that it is these contractions which are principally effective in producing the voluptuous acme, and that actual ejaculation is not indispensable. He believes, that is, that the voluptuous acme may occur in the absence of any discharge of actual secretion.

In any case, let us hold fast to the fact that in the adult, for the occurrence of the voluptuous acme and of the sense of full satisfaction, certain central processes are, in general, indispensable.