SEX HORMONES IN HUMAN EROTICISM 



1395 



he said, as he might formerly have done in a 

 masturbation fantasy. Again he would get 

 a feeling that something was building up 

 pelvically, whereas, in fact, nothing was 

 hai)pening. 



The patient introduced the topic of sleep- 

 ing dreams in which he dreamed of inter- 

 course and orgasm. The dream-orgasm was 

 not accompanied by an erection or ejacula- 

 tion, but the feeling was the same as it had 

 been in an ordinary nocturnal emission, the 

 man said. 



The sexy thoughts and fantasies of a 

 paraplegic patient may serve the literal pur- 

 pose of rehearsals and lead to attempts at 

 intercourse. Then one has the exceptional 

 phenomenon of cognitional eroticism occur- 

 ring simultaneously with involuntary, re- 

 flex action of the pelvic genitalia, the only 

 possible connection between the two being 

 via the eyes and hands. 



So much for paraplegics, the accidental 

 experimental subjects in whom the genital 

 tactile receptors remain intact while their 

 distant connections with the brain are 

 broken. Turn now to the obverse case, pa- 

 tients whose external genitals have been 

 damaged or resected so that, whatever the 

 extent of neural damage, it is local only. 



B. CLITORECTOMY IN HERMAPHRODITES 



Genital resection, in the course of surgical 

 reconstruction, is desirable in the manage- 

 ment of certain cases of hermaphroditism 

 (Jones and Scott, 1958) . An enlarged clitoris 

 of penis-like proj^ortions is incompatible 

 with complete femininity in the experience 

 of the majority of hermaphrodites living as 

 girls and women. They desire that their 

 masculinized clitoris be amputated. 



Such an operation is usually performed 

 on hyperadrenocortical hermaphrodites if 

 they are to be reared as girls, or if they are 

 already psychosexually established as fe- 

 males. For present purposes, the older pa- 

 tients with this adrenogenital type of her- 

 maphroditism (Table 22.1) are of particular 

 interest. Before the introduction of cortisone 

 therapy in 1950, these patients had under- 

 gone a precocious but virilizing jniberty in 

 early childhood, under the influence of an 

 excessive supply of adrenal androgen. Under 

 the impact of these androgens, the enlarged, 

 unamputated clitoris was erotically very 



sensitive. At the same time, the vagina re- 

 mained unestrogenized and immature. In 

 most instances the vaginal opening was con- 

 genitally misplaced in a urogenital sinus 

 and needed surgical reconstruction. 



Among 17 older potential informants in 

 this category of hyperadrenocortical her- 

 maphrodites, there were 9 who satisfied the 

 triple condition: (a) they had been brought 

 up as girls and lived as women; (b) they 

 were older than 16 at the time of reporting 

 on eroticism; (c) they had been clitorecto- 

 mized and reported on their postsurgical 

 eroticism. 



The breakdown of findings in these 9 

 cases was as follows: in 4 the data indicated 

 the patient had not experienced orgasm; in 

 5 the evidence was that the patient had ex- 

 perienced orgasm, in 2 masturbatory, in 3 

 coital. 



The 9 women were receiving cortisone 

 when they reported on eroticism. There was 

 no evidence, however, to suggest that or- 

 gasm might have been lost following clitor- 

 ectomy only to reappear after hormonal 

 feminization had been established under 

 cortisone therapy, or that orgasm was lost 

 under the influence of cortisone. 



There is no ready explanation for the 

 lack of orgasm in the 4 patients where such 

 appeared to be the case. So far as could be 

 ascertained from unstandardized operative 

 notes, lack of orgasm did not correlate with 

 the amount of clitoral tissue removed, or 

 with any other surgical factor. 



The point of these data on orgasm and 

 clitorectomy is not, however, that some 

 clitorectomized patients did not experience 

 orgasm. On the contrary, the point is that 

 capacity for orgasm proved compatible with 

 clitorectomy and surgical feminization of 

 the genitalia in some of these patients. 

 Erotically sensitive though it had been, the 

 main body of the clitoris, including the 

 glans of the clitoris, was dispensable with 

 respect to orgasm. 



C. PENECTOMY 



Four patients with an amputated penis 

 (Table 22.1) were available for psychologic 

 study. All reported retention of the capacity 

 for orgasm. 



One of the patients lost his penis at the 

 age of 30. Ten years later the prostate was 



