1396 



HORMONAL REGULATION OF BEHAVIOR 



removed and the urethral orifice was re- 

 located near the anus, requiring urination 

 from a sitting position. He was interviewed 

 psychologically at the age of 42. After his 

 injury, he frequently had erection of his 

 penile stump in response to seeing or joking 

 with an attractive woman. In sexual rela- 

 tions, mutual genital friction sufficient to 

 induce mutual orgasm was produced. 



Another patient reported loss of the ca- 

 pacity for ejaculation, although he retained 

 the sensation of orgasm in dreams. His was 

 a case of penectomy due to malignancy. 

 There were metastases to both groins re- 

 quiring radical bilateral groin dissection. 

 The man was 56 when interviewed and had 

 been in the hospital a year. He said he 

 continued to feel sexually aroused, the feel- 

 ings being the same as they always had 

 been, as for example when his wife came to 

 visit him. 



D. VULVECTOMY 



It is roughly accurate to say that the fe- 

 male equivalent of penectomy is radical 

 vulvectomy. An interview was obtained 

 with one patient who had this operation. 

 Fifteen years earlier she had had an epi- 

 dermoid carcinoma of the vulva which en- 

 tailed complete resection of the clitoris, 

 labia majora, labia minora, and the mucosa 

 of the introitus. The patient was 45 years 

 old and still premenopausal when she re- 

 turned, through the courtesy of Dr. Howard 

 W. Jones, Jr., for an interview. She was 

 very frank and spontaneous about her sex 

 life postoperatively. She said that, although 

 she was still self-conscious about her genital 

 appearance, so far as sexual feeling was 

 concerned there was no difference. The feel- 

 ing or orgasm occurred sometimes in 

 dreams, she said, as well as in coitus. 



Summarizing, it is seen that from patients 

 who have undergone extensive surgical re- 

 section of the genitals, erotic arousal can be 

 initiated and carried to the completion of 

 orgasm despite the loss of large zones of 

 erotic sensory tissue, including the vulva or 

 the penis itself. From paraplegics one learns 

 that cognitional arousal is possible in sub- 

 jects in whom the genital tactile receptors 

 are intact while their connections with the 

 brain are broken. From eunuchs and hypo- 

 gonadal patients (their detailed case illus- 



trations omitted at this point) one learns 

 that erotic arousal and climax can some- 

 times occur despite hormonal deficiency 

 that in men causes absence of seminal fluid. 

 Thus, among the coordinates of sexual func- 

 tion there are three: local genital surfaces, 

 the brain, the hormones, any one of which 

 can fail in its contribution without total 

 destruction of sexual function. No one of the 

 three can be said to be indispensable more 

 than the others, except insofar as the hor- 

 mones are indispensable to fertility. None- 

 theless, it is evident that loss of any one of 

 the three constituents is an immense handi- 

 cap to effective sexual functioning. 



VII. Concluding Remarks 



The sex hormones, it appears, have no 

 direct effect on the direction or content of 

 erotic inclination in the human species. 

 These are assumed to be experientially de- 

 termined. The importance of experiential 

 factors is nowhere better revealed than in 

 iiermaphrodites. 



To refer back to the beginning of the 

 chajiter, the gender role and gender ori- 

 entation of hermaphrodites became estab- 

 lished in accordance with the sex of assign- 

 ment and rearing. One may say that all 

 through childhood these people accumulated 

 a continuous sequence of cognitional re- 

 hearsals in accordance with the encounters 

 and transactions of their sex of assignment. 

 This accumulation exerted its formative in- 

 fluence irrespective of contradictory chro- 

 mosomal sex, gonadal sex, hormonal sex, or 

 morphologic sex. 



Even in those few cases where the gender 

 role and orientation developed ambiguously 

 or contradicted the sex of rearing, the sig- 

 nificance of cognitional rehearsals emerged 

 as paramount. In the first place, these were 

 never cases of children who, irrespective of 

 hidden hermaphroditic incongruities, had 

 external genitals that looked perfectly male 

 or perfectly female. The external genitals 

 looked ambiguous, thereby permitting the 

 child from infancy onwards to make com- 

 parisons and conjectures about being a boy 

 or a girl. Many of the children had am- 

 biguous external genitals. The few who de- 

 veloped an ambiguous gender role and ori- 

 entation experienced a reinforcement of 

 ambiguity in the social environment. The 



