IMPOTENCY IN WOMEN. 
BY 
ELY YAN DE WARKER, M.D., 
SYRACUSE, N. Y. 
Reprinted from the American Journal of Obstetrics and Diseases of 
Women and Children, Vol. XI., iVb. /., January, 1878. 
NEW YORK: 
WILLIAM WOOD & CO., 27 GREAT JONES STREET, 
1878. IMPOTENCY IN WOMEN. 
BY 
ELY VAN DE MARKER, M.D., 
SYRACUSE, N. Y. 
Reprinted from the American Journal of Obstetrics and Diseases of 
Women and Children, Vol. XI, No. I, January, 1878. 
NEW YORK: 
WILLIAM WOOD & CO., 27 GREAT JONES STREET. 
1878. IMPOTENCY IN WOMEN. 
BX 
ELY VAN DE WARKBK, M.D., 
Syracuse, N. Y. 
In view of the just and proper restrictions thrown round the 
sexual act, this is a subject of exquisite delicacy. lam tempted 
to adopt it as a monographic text because it is of sufficient 
importance as a source of unhappiness and disease to merit the 
attention of the gynecologist; and also, that within the com- 
pass of the term lie symptoms ungrouped and facts yet unex- 
plored. 
With irnpotency in man we are dealing with a positive 
quality, and one that underlies his competency as a sexual 
being. This condition in woman furnishes us with a negative 
quality, one that does not interfere with the sexual relation, 
except such fulfilment and completion of it as constitute health- 
ful conditions of the act in the woman herself. 
Irnpotency in the female does not imply sterility, nor is 
unfertility an absolute result in man. It may be the general 
and probable result, but in the conditions that constitute this 
disability it does not exist as an invariable consequence. One 
instance of this occurred within my own experience and in the 
practice of the late Dr. John P. Whitbeck, of West Troy. A 
young man, the victim of an accident, had irnpotency, that, judg- 
ing from the subjective symptoms of sensation and the objective 
ones of motion, was the result of serious nervous disease. He 
married, and his wife presented herself in a few months for an 
explanation of her condition. It was diagnosed as pregnancy 
at the fifth month. Yet here we had the corroborative testi- 4 
Van de Waeker : Impotency in Women. 
mony of the wife and the positive evidence of the existence of 
virginal traits, that complete sexnal intercourse had never taken 
place. This approves the observations made long since by 
Sims, that pregnancy may be the result of a deposit of the fer- 
tilizing element of the male within reach of the sexual canal of 
the female, and without reference to the means. Great light 
is thrown upon the significance of impotency as generally 
understood, and as existing uncomplicated by functional or 
organic disease of the seminal glands, by the frequency of preg- 
nancy as a result of vulval intercourse.1 
This is offered as a partial explanation of the seeming para- 
dox that impotency is not an absolute bar to fertility in either 
sex. But while in man we must give it its long established 
status, both as a legal obstacle to marriage and as a probable 
cause of the defeat of the sexual act, in women we must assign it 
other significance and value. The single fact that woman’s 
sexual attitude is a passive and not an active one, renders the 
difference in result, as between the sexes, clear. 
It may be asked in what terras should we define impotency 
in women as distinct from sterility or infertility? I would 
answer broadly, that the same terms apply nearly to both sexes ; 
and in woman as in man it consists in an inability to complete, 
in the usual manner of nature, the copulative act; that in 
impotent women this act is simply mechanical, without the sub- 
jective and characteristic nervous sensations that constitute the 
acme of the sexual emotion. Hence, the woman in this condi- 
tion is passionless; the act itself being without pleasurable 
consummation, she comes to regard it with indifference, and 
finally, with aversion. 
The holier and more lasting part of the union between the 
sexes is spiritual, but united inextricably with a bodily one ; 
here then we have the substance to this spiritual essence, the 
1 The following is a curious illustration of this fact: Dr. Galabin reported 
to the Obstetrical Society of London, Nov., 1876, a case of Cesarean section 
for cicatricial obliteration of the vagina, in which the orifice of the vagina 
only admitted a No. 6 catheter. After a labor of six days a dead child was 
removed by the section.—Obstet. Jour. Great Brit, and Ire., Vol. IV., p. 
607. Also case of Dr. Packard, Amer. Jour. Obstet., Vol. 11., p. 848. 
Two interesting cases were also reported by Dr. Leopold, to the Obstetrical 
Society of Leipzig, entitled, “Two Cases of Existing Complete Impotentia 
Coeundi,” Archiv fur Gynakologie, Bd. XI., p. 400. Yatt de Waeker : Impotency in Women. 
5 
perfection and preservation of which conserve moral purity, 
social welfare, as well as bodily health and happiness. 
Like its analogous condition in the other sex, it has the sig- 
nificance of a symptom and not that of a morbid entity. It is 
the outcome of errors of either structure or function of the 
parts involved in the reproductive apparatus, or it may be the 
result of subjective mental conditions. 
I believe it occurs far more frequently among women than 
men. Indeed, this may be made a general observation con- 
cerning the relative frequency of diseases of the sexual parts 
and functions in the sexes; and further, that diseases of this 
nature, extremely rare as they are among men, are postponed 
to the decline of life, while among women they are mostly 
confined to the meridian of life. This has also a close relation 
to the causes of this excessive liability of women to sexual dis- 
eases. The activity of the generative organs in women are 
nearly ceaseless, while in man, unless actually engaged in the 
performance of function, they are undergoing the recuperation 
of rest. Further, these organs and their function in women 
afford a more complete measure of her organic life, and define 
more nearly the limits of her activities than in man, in whom 
these parts and functions are subordinate to other phases of 
activity. A brief reference to the moral atmosphere that is 
liable to envelop these cases will serve to confirm my opinion 
of their importance and to preserve the apologetic tone of this 
introductory. 
It may exist as a twofold cause of unhappiness and ill- 
health. Firstly, in dealing with man so far as he bears rela- 
tion to my subject, we are regarding him in his coarser rela- 
tions—not in any sense as an intellectual being, but as he exists 
among animals as one supremely selfish. He not only demands 
pleasure and satisfaction for himself, but he requires some- 
thing much more difficult to give—the appearance, if not the 
real existence, of satisfaction and pleasure in the object of his 
attentions. Unhappiness and suspicion are often the result of 
the absence of this pleasure, and are sure to work the material 
disadvantage of the weaker party. To show that this is really 
the case, I need but to remind physicians how often they are 
approached by husbands upon this subject; and yet further, 6 
Van de Waeker : Imjpotency in Women. 
how often the coldness and indifference of wives are alleged as 
the excuse for conjugal infidelity. 
In the absence of any definite knowledge concerning the 
physiology of the subjective sensations involved in this act, all 
speculation would be out of place in a practical view of the 
subject. Our knowledge of the matter may be summed up in 
the words.: that we know they are concomitants of moral and 
physical health, and that their absence points to either a radi- 
cal and innate psychical or physical defect, or to coexisting 
disease. 
This brings ns to a consideration of the causes. We may 
divide them into three groups : 
I.—Mental, subdivided into: 
a. Congenital psychical defects. 
h. Temporary mental conditions. 
c. Sexual incompatibility. 
ll.—General physical causes. 
a. Debility resulting from constitutional and other 
diseases not sexual. 
h. General defective development. 
g. Lactation. 
lll.—Conditions of the sexual organs and near parts. 
a. Defective development and result of injury. 
h. Dyspareunia (Barnes) resulting from (1) uterine dis- 
' placement; (2) hyperemia of the uterine body ; (3) 
ovarian inflammation or congestion ; (4) colpitis, 
either simple or specific ; (5) spasmodic contrac- 
tion of the vagina (vaginismus, Sims) ; (6) vascu- 
lar tubercles of meatus urinarius ; (7) diseases of 
the rectum, as fistula, fissure, or inflamed piles 
or ulcers. 
o Deranged nervous system from uterine displace- 
ments and other chronic uterine diseases, and 
debility from exhausting discharges and chronic 
uterine disease. 
d. Morbid growths. 
e. Delayed or arrested menstruation. Yan de Warker : Impotency in Women. 
7 
I.—a. There are phases of impotency beyond the power of 
medicine to remove, and, as having their causes within that 
debatable ground existing between mental physiology and 
psychological speculation, beyond the power of science to know. 
It is useless to theorize about these cases; we simply know that 
they do exist. In married life they are rare, but it is impossi- 
ble to know how many among the vast number of female celi- 
bates owe their condition to the repulsion of the other sex, that 
would naturally result from an entire absence or great repres- 
sion of the sexual tendency. The few cases that have come to 
my knowledge were not associated with any common state of 
physical condition or temperament. These cases show marked 
traces of heredity, and are, I believe, the accompaniment of 
those instances of sterility that are known to prevail in families. 
This condition has been anciently recorded. Solomon, than 
whom no man was more competent to offer an opinion, in one 
of his Proverbs (xxx. 16) compares the insatiable qualities of the 
barren uterus to the grave. 
b. In the male sex impotency is often dependent upon 
transient mental conditions. Numerous cases are cited in 
medical jurisprudence, of men who are impotent as to one 
woman, but virile to another. An offensive person, dislike, 
extreme differences in age, and even less evident causes, may 
produce this result. The acute emotional nature of woman 
renders her far more liable than man to the operation of these 
causes. In addition to these, other causes exist in her case to 
which men are less exposed. Habitual intoxication, neglect, 
and known immorality, and the presence of secondary syphilis 
in the husband has, within my own knowledge, been the cause 
of such intense dislike that the sexual act was entirely devoid 
of subjective completion. These causes are outside of the 
office of the gynecologist, and are here brought forward for the 
purpose of demonstrating the great variety of causes which 
may tend to this condition. 
With regard to the third cause under this head (c), sexual 
incompatibility, the careful physician can accomplish some 
good. Owing to the reticence that one instinctively feels when 
speaking of this subject, I shall not do more than allude to it. 
So far as my own observation extends, the husband is generally 
at fault. The more common cause is acute sexual irritability 8 
Van de Warner : Impotency in Women. 
on the part of the husband. This is often the case with young 
husbands who have been guilty of masturbation in early life. 
So sensitive are the male organs in some cases to the sexual 
stimulus, that it amounts nearly to irapotency. This is the 
result of either of one or the other of the following causes— 
debility or excess of sexual emotion. In the first, good results 
are often obtained by the use of phosphorus, mix vomica, iron, 
cantharides, cold sponge-baths, complete and prolonged absti- 
nence from sexual attempts, and discontinuing stimulants or 
tobacco if indulged in ; the last cause is often moderated 
or removed by the use of the bromides, digitalis, camphor, 
low diet, and if these fail, by a resort to some of the numerous 
articles that are known or supposed to have antiphrodisiac 
properties. 
There is one other condition which belongs properly under 
this division of the subject—the unequal development of the 
sexual organs in the sexes. Nature usually provides a remedy 
in the power of the vagina to accommodate itself to almost any 
distending force. This condition I believe to be but seldom 
brought to the notice of the physician; but the other often 
forms the subject of complaint, and deserves delicate and con- 
siderate attention. 
ll.—General physical causes operate directly to produce the 
result we are studying, and chief among them is (a) debility of 
the system at large. It may be said usually to accompany the 
amenorrhea that is the result of tuberculosis of the lungs; and 
in those-cases of this disease in which the menstrual function 
is preserved to the last, it is developed when the resulting gen- 
eral physical depression reaches a certain point. The dyscrasia 
of scrofula, cancer, or syphilis, has the same result. Diseases 
of a less profound character, if prolonged to the extent of caus- 
ing depression to this limit, are also potent. I have a case now 
under my care of a well-developed young married woman, who 
for several years has suffered from a mild form of chronic 
diarrhea. She says that for a long time she has not experi- 
enced the sexual orgasm, and as a consequence her relations 
with her husband have been nearly suspended. In this case, 
although quite a degree of debility was produced, there was 
but slight loss of flesh. While for several months past the 
diarrhea has been to a great extent under control, and she has Van de Warkee : Impotency in Women. 
9 
been gaining in strength, yet the sexual disability has not been 
removed. Let this case suffice to illustrate the great variety 
of causes that, operating through a depressed physical tone, 
may produce this result. The indications for treatment are 
self-evident. 
Those extremely rare cases (h) in which there is an arrest of 
development generally, the form preserving the characteristics 
of childhood, simply require mention. In lactation (c), how- 
ever, we have a more important subject to consider. I believe 
it to be often the physiological cause of female impotency. 
That it is not generally the case, however, is clear. Neither is 
it generally the case that menstruation is suspended during the 
entire continuance of this function. Lactation may be regarded 
as a vicarious outlet for sexual energies, and therefore upon 
theoretical grounds such a result may be looked for more par- 
ticularly during that part of lactation in which the uterine 
function is in abeyance. In abnormal or excessive lactation, 
and which is not rarely found associated with profuse menstru- 
ation, we have combined both the physiological result and that 
referred to above {a). So far as either of these conditions 
relates to our subject, it does not require treatment. 
We enter a more practical field when we consider (III.) those 
conditions of the 'sexual organs or adjacent parts that may 
directly cause this phase of impotency. 
In defective development the results of injury (a) there exist 
mechanical causes, some of them admitting of a surgical rem- 
edy. In atresia vaginae, the patency of the passage may be 
restored ; and in fistula, extensive rupture of the perineum, and 
the binding of cicatricial bands, the remedy lies in the same 
measure. In the forms of impotency that depend upon defec- 
tive and deformed development, we are narrowed to a very 
small field in our efforts at correction. In imperforate and 
undue resistent hymen, and in such as I reported in the New 
York Medical Journal for March, 1876, of a congenital trans- 
verse vaginal septum, the treatment is evident and simple. In 
the case referred to, the sexual incompetency did not disap- 
pear for several months after the operation. So far as injuries 
are concerned, we may say that they are productive of impo- 
tency whenever they are of such an extent as to interfere with 
the value of the parts as a sexual apparatus. It would need- 10 
Yah de Waekee : Lnjpotency in Women. 
lessly extend this paper to refer to them separately, or speak 
of the details of treatment. 
Dyspareunia (b), or painful or difficult sexual intercourse, 
exceeds in a great measure all the conditions enumerated above 
as causes of impotency. As a general principle, it may be said 
that uterine disease can produce this result only through dys- 
pareunia, or by means of debility or the serious nervous symp- 
toms that are liable to group themselves round old forms of 
uterine disease. I believe that retroversions or flexions are 
nearly always attended with this result if of long standing.1 
The opposite form of dislocation is not usually so attended, for 
the reason that the hypersensitive uterine body is thrown for- 
ward out of the way of the male organ, while in the posterior 
dislocation the line of displacement lies directly across that of 
copulative effort. Prolapsus—unless of the third degree—free 
from any cause productive of tenderness of the uterine body or 
neck, cannot usually tend to impotency ; in fact, a slight degree 
of prolapsus is known to favor conception. The other causes, 
hyperemia of the uterus (2), ovarian inflammation or neuralgia 
(3), colpitis, either simple or specific (4), are direct causes of 
dyspareunia. Another condition, termed vaginismus (5), has 
of itself attracted great attention; but the description of Sims 
and other authors is confined to the rare and extreme forms of 
the disease, ignoring its lighter and less painful phases, and as 
the latter are far more common, they are consequently of 
greater importance. If the term vaginismus is confined to the 
extreme forms of this disease, the condition I wish to designate 
may be termed painful spasm of the vagina.2 It is not so 
1 Dr. Wright quotes Dr. Chambers to this effect: “ When the anteversion 
has become considerable, ‘ that many wives lose suddenly the inclination for, 
and the power to bear their matrimonial privileges.’ ”—“ Uterine Disorders : 
their Constitutional Influence and Treatment,” by Henry G. Wright, London, 
1868, p. 68. 
2 Upon the anatomy of this subject the opinion of Hildebrandt is of interest. 
He says : “It appears unquestionable to me that this group of muscles can be 
no other than that of the levator ani, which embraces the middle lateral and 
the posterior portion of the vagina in the shape of a horse-shoe, and which 
during its most; powerful tonic contraction seizes a cylindrical body enclosed 
in its grasp, like the erected penis, from behind and both sides, and presses it 
forward against the anterior pelvic wall.” And in regard to the superior 
vaginal constrictor of Sims (constrictor cunni superior), the author’s opinion Yaw de Waeker : Impotency in Women. 
11 
severe as to exist as an obstacle to sexual intercourse, bnt adds 
the element of pain to what ought to be painless and pleasur- 
able. I have heard women who have been years married, make 
the confession that they had never attempted intercourse with- 
out pain. I recall the case of Mrs. S., thirty-eight years old, 
eighteen years married and childless, who applied to me for 
treatment for this trouble. I was unable after a most careful 
search to reach an explanation, and after attempting treatment 
under various theories as to the cause, my patient left me with- 
out receiving any benefit. These cases are, however, generally 
associated with dryness and hyperemia of the vaginal walls, 
and an inspection of the ostium vaginae shows the same condi- 
tion existing at this point. Oftentimes the vagina does not 
resist the entrance of either the finger or the speculum by 
spasm, nor does the examination elicit pain, yet the sexual act 
is painful. This pain is usually referred to the entrance of 
the vaginal canal. The explanation that seems to meet the 
phenomenon is that the excitement attending the sexual act 
induces a spasm of the parts not produced by any other form 
of irritant. So far as my own experience goes, and 1 have 
seen quite a number of them, these cases are always impotent, 
and are so as a direct result of the dyspareunia. The only 
treatment I shall venture to suggest is the free use of the warm 
vaginal douche, the temperature of the water being about 105°, 
and the amount not under a gallon. This is to be followed by 
the injection of a drachm of glycerine by means of a small 
glass vaginal syringe. Vascular tubercles (6) of the urinary 
meatus are always painful, as are also minute points of erosion 
of the mucous membrane not rarely found at this point. Cases 
of the latter, from the absence of serious uterine symptoms, 
are liable to exist for a long time undiscovered; and are only 
found by actual inspection of the parts. The vascular growths 
at the meatus are generally brought to the notice of the physi- 
cian, owing to the severe pain that is excited by urination, 
wdiile the pain in sexual intercourse is rarely referred to unless 
in answer to a question. As the relief is prompt after proper 
treatment, the physician, without suspecting it, cures one disease 
is expressed emphatically that it ‘ ‘ can be no other than the levator ani ” (“ On 
spasmodic contraction of the levator ani during coition.”—Archiv fiir Gyna- 
kologie, Vol. 111., pp. 234, 330.) 12 
Van de Warker : Imjpotency in Women. 
by removing the other. I shall make one suggestion as to the 
treatment of these growths, namely, to use fuming nitric acid 
as a caustic instead of the generally popular silver nitrate. The 
latter is much more painful than the acid, and is too feeble to 
remove even the most minute tubercles, except several applica- 
tions are made. Of course, if the tubercles are numerous and 
of large size, the use of the scissors is the better way. 
Diseases of the rectum (7) come in for a large share in the 
production of dyspareunia, and are always serious and some- 
times difficult to treat. Fistula and hemorrhoids are the less 
serious and better understood in their treatment, while some 
nearly incurable diseases occur in this part. I have met with 
cases of chronic ulcers of the rectum that have existed for 
years and defied the treatment of skilful surgeons. The 
tuberculous ulcers of the rectum are oftentimes incurable. 
Simple ulceration treated by means of nitric acid, or the nitric 
acid of mercury, is usually quite tractable. The common per- 
ineal retractor is the best instrument to employ in exposing the 
cavity of the rectum, compared to which all forms of rectal 
speculse are very imperfect instruments. In regard to the in- 
veterate and tuberculous ulcers, I have no special treatment to 
recommend, as in one case all the means I had ever read of, or 
had originated myself, failed. 
Deranged nervous system from uterine displacements and 
chronic uterine disease, as well as the general debility that 
results from the same causes (c), act by destroying the degree of 
health necessary to the proper performance of the sexual effort. 
This act is a normal and functionally healthful one, and, not 
unlike all other normal physical acts, requires the presence of a 
certain degree of vigor and health for its proper performance. 
These conditions are sufficient to induce impotency in man, 
and are still more potent to produce the same result in the 
more delicately constructed system of woman. The group of 
nervous symptoms that attend various forms of uterine disease is 
but little understood. The nervous system is the field in which 
uterine diseases produce their most disastrous effects. The laws 
that govern the relations of the reproductive organs with the 
various system of nerves—more especially in their diseased 
relations—yet require to be studied. Impotency is, of necessity 
almost, a direct result of this nervous derangement when it is a Van be Warkee : Irnpotency in Women. 
13 
constant attendant of uterine disease or profound in its sympa- 
thetic relations. There is, nevertheless, a large class of cases in 
which the vigor and nutrition of the body are mainly and dis- 
astrously affected by uterine disease while the nervous system 
preserves its normal tone. So far as my experience goes, these 
are cases of disease attended by exhausting discharges—either 
of albuminous leucorrhea or hemorrhage, rather than by dis- 
placements. In the end, irnpotency is accomplished through 
the same agency, that of lack of vital energy. In both of these 
conditions dyspareunia is not an element in the defect of the 
copulative act. 
Morbid growths id) are a mechanical cause, and act by the 
production of pain, or by interposing an obstacle to sexual in- 
tercourse. They are alluded to in order to render the analysis 
of the conditions leading to this result complete, and do not 
require further attention, the indications for treatment being 
evident. 
In considering the effect of delayed or arrested menstruation 
{e) in the production of irnpotency, we enter a wide field of 
speculation. In our present knowledge of menstruation and its 
physiological relations to the purely sexual function, it will 
lead to but slight advantage to enter into details. It is prob- 
able, however, that when suppressed menstruation is an attend- 
ant upon a delayed puberty, irnpotency is necessarily a result 
for the time being. The same conclusion is reasonable when 
menstruation is arrested by reason of chlorosis or debility, or 
from a congenital or acquired feebleness of constitution. Per- 
verted, irregular, or arrested ovarian action must strike at the 
very origin of sexual emotions as directly involved in the act 
itself, and as such, must be an efficient cause of irnpotency. 
The*absence of the ovaries, not congenital, as a result of ovari- 
otomy or destructive disease, needs not be more than alluded to, 
as there is evidence, in some cases at least, that their removal 
has had no effect upon the sexual sensations of the woman. 
It is worth while, however, to observe, that these cases may be 
those of women who never experienced the sexual orgasm, and 
therefore their subjective sensations would remain unchanged. 
There is every reason to believe that there exists a large class 
of women—as the reader may have inferred from this paper— 
who remain ignorant through life of these sensations. An 14 
Vais' de Waeker : Impotency in Women. 
arrested menstruation the result of accidental causes, and not 
symptomatic of a general and serious derangement of the health, 
would not imply impairment of sexual vigor. The functions 
of menstruation and ovulation, as distinct acts both as to time and 
cause, have, it is to be presumed, not a united action in causing 
impotency, except as they may result from a common cause. 
Normal arrest of menstruation, such as attends pregnancy and 
lactation, do not require mention other than they have received 
in a former part of this paper. 
I have thus gone briefly over the more evident conditions 
that may lead to impotency in women, for the purpose of call- 
ing attention to a subject that I believe to be important, both 
as a conservator of morals and as a necessity to domestic hap- 
piness. I have purposely omitted details of treatment, as the 
causes mainly alluded to are generally well understood, 
A few words in conclusion as to the motive of this paper. 
Woman in her sexual relations is generally written and spoken 
of as if she were naturally deficient in any physical sensations 
that are purely and in every sense the analogue of virility in 
the male. There is no word for this normal and necessary 
sexual tone, as applied to women, in gynecic literature. It 
seems proper in the absence of any such term to express the 
idea, with unavoidable circumlocution, by saying that it is the 
analogue of the subjective copulative sensations of man, and 
that the acme of the sexual orgasm in woman is the sen- 
sory equivalent of emission in man, observing the distinction 
necessarily implied between the sexes—that in woman it is 
psychic and subjective, and that in man it has also a physical 
element and is objective. The absence, therefore, of such sensa- 
tions in woman 1 have termed impotency.