Study of Masturbation 
AND 
Its Reputed Sequelae 
BY 
JOHN F. W. MEAGHER, M.D.. F.A.GP, A Study of Masturbation 
and 
Its Reputed Sequelae 
by 
JOHN F. W. MEAGHER, M.D., F.A.C.P., 
NEUROLOGIST TO ST. MARY'S HOSPITAL, BROOKLYN, CONSULTING 
NEUROLOGIST TO THE KINGS PARK STATE HOSPITAL. 
EX-PRESIDENT OF THE BROOKLYN NEUROLOGICAL 
SOCIETY. FELLOW OF THE NEW YORK 
ACADEMY OF MEDICINE, ETC. 
NEW YORK, 
WILLIAM WOOD AND COMPANY, 
MDCCCCXXIV Copyright, 1924 
BY WILLIAM WOOD AND COMPANY 
Printed in the United States of America 
HAMILTON PRINTING CO., 
ALBANY, N. Y. TO 
DOCTOR ERNEST JONES, 
OF LONDON 
A SCIENTIST 
WHOSE WRITINGS HAVE ENRICHED 
MODERN PSYCHIATRIC THOUGHT CONTENTS 
Chapter I. Introduction. Some psycholog- 
ical considerations. Effect of 
puberty. The mechanism in- 
volved. The equivalents of 
masturbation 11 
Chapter II. Causes. Prevalence of the habit 21 
Chapter III. Exaggerations of the harmful- 
ness of the habit. The effect 
of secrecy 27 
Chapter IV. Symptoms and sequelae ... 33 
Chapter V. Masturbation and coitus com- 
pared 47 
Chapter VI. Treatment of masturbation . . 49 
Conclusions 63 
Index to Authors 65 
Index 67 PREFACE 
I have attempted to present as concisely as possible 
the essential features of this much discussed, and yet 
little understood subject. The views which I have 
propounded reflect, I believe, the modern medical 
thought on the subject of masturbation. Not only 
physicians but others interested in the psychological 
and sociological aspects of the topic have voiced the 
need of an essay such as this one. 
While the issue in the management of this prob- 
lem is essentially a medical one, the ethical or moral 
factor must be given considerable thought and study, 
if one is to appreciate the difficulties of most of these 
patients who consult us concerning masturbation. 
This is emphatically brought to our attention in the 
course of our investigating the character traits and 
trends of these patients, and their varying ways of 
reacting to their difficulties. The ones who react 
most severely to the habit are, as a rule, intelligent 
youths of the highest moral type. Contrariwise, 
those individuals of poorer moral fibre, e. g., morons, 
-often show but few neurotic manifestations as a 
result of their indulgence in this habit. And this 
is what one would expect to find. For in these lattei 
individuals, the moral conflict is extremely slight, ol 
may even be absent. 
Not only physicians, but clergymen and teacheil 
are often consulted by parents, and by the youths 
themselves, for advice in regard to disturbances 
which they attribute to this habit. In fact, clergymen 
are probably more often consulted by those individ- 
7 8 
PREFACE 
uals who in earlier years are bothered by the minor 
nervous and moral upsets which they attribute to 
indulgence in masturbation. This being true, it is 
incumbent on the clergyman not to depend entirely 
on the emotional hold which he has on the youth; but 
he should acquire a working recognition of the sig- 
nificance of masturbation. 
The average one of these youths expects, both from 
the physician and from the clergyman, something 
more tangible than mere admonitions, platitudes, or 
vague generalizations. The clergyman will use good 
judgment if he confines his activities to those youths 
who are morally troubled, and sees that those whose 
psychic upsets tend to be serious, receive competent 
medical attention. For, after all, the physician is 
the only one whose training-medical, surgical, and 
particularly psychiatric,-permits him to study the 
problem from all angles. 
The serious-minded physician who recognizes the 
great importance that the successful management of 
this problem may have for the future welfare of his 
patient, will not rest content with recommending, say 
a circumcision, for an existing phimosis. For he 
will realize that the solution of the difficulty which 
perchance has existed for years, cannot be so simple. 
He will readily understand that such a surgical pro- 
cedure alone will influence only to a slight degree the 
psychosexual attitude of the individual. 
Unless the adviser appreciates something of the 
biological significance of masturbation, he will not 
be successful in allaying the patient's morbid fears. 
So it is necessary for him to know something of the 
genesis of masturbation,-and not to regard it solely 
as a surgical problem, or a medical problem, or a 
mental problem, or a moral problem. Rather must 
he consider all of the factors related to each of these 
issues in every individual. And here, as elsewhere PREFACE 
9 
in studying any phase of human conduct, he must 
give particular attention to the personality makeup of 
each patient. For success or failure in one's attempt 
to cure this habit depends in great part on the tem- 
perament and character of the individual who is 
being treated. After a rather extensive practice 
with this class of patients, I am convinced that if 
they are properly treated early in life, much subse- 
quent post-adolescent illness will be avoided. The 
onus for much of the later upsets must be blamed on 
the failure of the parents to view the whole situation 
in a rational light. 
Wishing to check up my own deductions concern- 
ing this subject, I consulted the writings of nearly 
two hundred investigators in order to get their con- 
sensus of opinion regarding certain phases of mas- 
turbation. One can readily understand that under the 
circumstances it was rather a difficult task to limit 
my discussion to the most important facts, and at the 
same time to eliminate all unessential details. For 
obvious reasons, I have omitted all case histories. 
Their inclusion here I felt would in no way enhance 
the general principles which I have advanced. 
The designation of these sex manifestations of the 
pre-adolescent and infantile periods of life as "mas- 
turbation" might be criticized by some. It might be 
suggested that the term "autoeroticism" would be a 
more appropriate one for these earlier manifestations. 
And again it might be suggested that the term "mas- 
turbation" had better be reserved to express the adult 
type of this act. However on biologlical grounds, if 
for no other reason, such a criticism would hardly be 
a valid one. And at best, it would be an objection to 
terms, rather than to facts. 
John F. W. Meagher. 
Brooklyn, N. Y., January, 1924. CHAPTER I 
Introduction? Some psychological considera- 
tions. Effect of puberty. The mechanism 
involved. The equivalents of 
MASTURBATION 
Masturbation includes all methods of causing 
pleasurable sex sensations by an individual's own ef- 
forts. Those regions, especially muco-cutaneous, 
which when stimulated cause physical and mental 
sex reactions, are called erogenous zones. All mas- 
turbation is not genital, though when the term is 
unqualified, this is what is assumed. Nor is the oc- 
currence of masturbation limited by the production 
of an orgasm, else one could not refer to masturba- 
tion in the child, nor in many women, more especially 
single ones, who are addicted to the habit. The 
reason for this I will discuss later. 
As ordinarily practiced, masturbation is an act to 
produce a pure form of sensory pleasure bought at 
the expense of high moral tone. For when habitual, 
it interferes with altruistic aims. It is an infantile 
way of seeking sex gratification. 
As Eulenburg and others have pointed out, the 
physical act is not the most important element, but 
rather the inseparable psychic reactions with their 
influence on the emotions and character. Though the 
physician primarily looks at this subject as a psy- 
chological and physiological problem, he cannot ig- 
nore the moral phase, which is an integral part of 
the whole question. 
11 STUDY OF MASTURBATION 
12 
One must distinguish between occasional and exces- 
sive masturbation, as they present entirely different 
problems. Of course, the term "excessive," as ap- 
plied here, is a relative one. For the habit can only 
be estimated in its effects, by studying in conjunc- 
tion with it the constitutional make-up, and the 
mental and moral tone of the individual under obser- 
vation. Moll says that there is nothing to prove that 
those who claim that they have never masturbated 
are any healthier than those who have practiced the 
habit moderately in youth. 
It is well to emphasize here that infantile mastur- 
bation, by which we mean most of the autoerotic 
acts practiced before the age of puberty, presents 
an entirely different proposition from the adult type 
of masturbation. The act is chiefly to be regarded 
with concern, when it has become habitual. 
This subject is too large to exhaust in a single 
thesis. My object here will be to bring out the 
important facts. Formerly, the subject received 
scant attention in our medical schools, and many of 
the students gave it no further study, subsequent to 
graduation. It is for this reason that many physi- 
cians show a lack of interest in this phase of human 
conduct. 
It is essential that the physician approach the 
problem in a purely objective way. Injecting one's 
personal feelings into the study is, to say the least, 
unscientific, and such an attitude would prevent a 
proper understanding of the points involved. It 
is of vital importance to note carefully the patient's 
attitude toward his habit. 
Much of the present misinformation on masturba- 
tion, held by the public, and still expressed in a few 
medical books, can be traced to the pessimistic lit- 
erature written from 1760 to 1890, more particularly 
to Tissot's "De 1'Onanisme," published in St. Peters- PSYCHOLOGICAL CONSIDERATIONS 
13 
burg in the last quarter of the Eighteenth century. 
Lallemand, Simon, and Voltaire, and Leitner even as 
late as 1844 wrote in a most exaggerated way of 
the various "diseases" resulting from the habit. 
Hippocrates, writing as long ago as 380 B. C., wrote 
in a similar vein. It was not till the last quarter of 
the Nineteenth century that the subject began to be 
studied in a scientific way, and the real facts con- 
cerning the habit carefully investigated. It is to 
men like Erb, Fiirbringer, Jones, Stanley Hall, 
Healy, and many others after them, that we are 
indebted for separating facts and fancies in 
regard to the habit and its effects. 
SOME PSYCHOLOGICAL CONSIDERATIONS 
In order to understand the habit as practiced in 
the adolescent and adult, it is necessary to know 
something of the sex impulse, and the genesis of 
its expression in the child. It goes without saying 
that adult sexuality is an unknown equation to the 
young child. As Moll, Jung, and others say, the 
young child masturbates without employing erotic 
fancies. In fact, some women do likewise, not real- 
izing the sexual nature of the act. Still this is none 
the less masturbation, as the aim is autoerotic pleas- 
ure. Also some women whose repressions against 
the conscious performance of the act are strong, 
have been known to masturbate during sleep. 
The young child indulges in the habit with little 
or no thought as to its being right or wrong. As 
von Hug Helmuth says, the infant directs its feel- 
ings and reactions toward those realms which give 
him his most pleasurable excitement. Many parents 
overlook infantile masturbation. But as White, 
Kempf, and others say, some experimental masturba- 
tion is almost universal between the ages of two and 14 
STUDY OF MASTURBATION 
six years. It is to be remembered that before the 
age of six years all the erogenous zones have the 
same value as sources of pleasure to the child. But 
later masturbation tends to emphasize the primacy 
of the genital zone. 
In infancy, the pleasurable sensation depends 
more on the quality of the stimulus than on the 
region stimulated. So that the young child selects 
the most convenient zone, and in this way comes to 
learn about himself. 
Anyone who has carefully observed children will 
agree with Stanley Hall that the infant's curiosity 
leads him to have a great interest in the sexual (i. e. 
to him, the excretory) organs and their functions. 
It is strange that parents do not recognize the great 
importance that the organs of sex play in the phan- 
tasies of children, even though the parents usually 
suppress all attempts of the children to discuss their 
ideas. Parents should give more intelligent consid- 
eration to the psycho-sexual elements in their chil- 
dren's lives, and not think solely of the physical acts. 
There are three stages in the development of sex- 
uality in the child,-the dividing ages being some- 
what arbitrarily selected. It is during the first 
stage-the first five or six years of life-where we 
see the primitive forms of autoerotic expression. 
The second stage, which we call the latent period, is 
from six to eleven years. During this stage, the 
infantile autoerotic acts are in great part repressed. 
There is developed in the children an attitude of 
shame or disgust toward their former interests by 
the parents, guardians, and other ethical and social 
agencies. If the culture of the family life is bad, 
there may be no latent period, in which case autoe- 
rotic habits are kept up throughout this period. The 
third stage is from eleven years to the onset of pu- 
berty, during which time the previous repressions PUBERTY 
15 
may fail. The child's interest may now be centered 
on its pelvis. Masturbation at this age and during 
adolescence is so common, particularly in boys, as 
to be regarded as usual. 
PUBERTY 
As Healy says, it is at puberty that the instinctive 
trends give most trouble, especially in neurotic indi- 
viduals. And this is what we would expect. For 
at this time there is not only an excess of energy, 
but there coexists a poor inhibitory control. All in- 
vestigators have noted that boys are more active 
sexually than girls at this period. And at this time 
boys are more apt to masturbate spontaneously, 
whereas girls may not do this unless seduced to the 
habit, for their repressions against sex manifesta- 
tions are stronger. The habit is more apt to be 
indulged in by both sexes, if there is an accumula- 
tion of sex energy, because of a lack of suitable social 
contacts, acting as vicarious outlets, as games, all 
sorts of innocent play with good comrades, etc. For 
the energy must be neutralized (used up) in some 
way. 
It is usually at the time of puberty that the child 
first becomes aware of the supremacy of the sex 
organs as sources of pleasure. He may first become 
aware of this through masturbation. It is for this 
reason that some writers refer to the act at this 
period as being physiological in purpose. As to 
whether masturbation in youth is normal or abnor- 
mal depends in part on whether the act expresses 
normal or abnormal wish constellations. And Kempf 
says it is abnormal at this period only if there is a 
narcissistic fixation,-a self-love which prevents the 
person from seeking to win the esteem of another 
personality. And the sexual aim becomes differen- 16 
STUDY OF MASTURBATION 
tiated at this time. From now on the sex activities 
of the child, which have been infantile in their ex- 
pressions, tend to become adult in character. 
The sexual trends of the child are the result of 
inherited tendency and environmental moulding. Ac- 
cording to Bousfield, these trends vary at different 
ages, as follows- 
HOMO- 
HETERO- 
AUTOEROTIC 
SEXUAL 
SEXUAL 
TRENDS 
TRENDS 
TRENDS 
Infant 
100% 
• • • • 
• • • • 
At 12 years 
40% 
50% 
10% 
At puberty (15 
yrs.) 20% 
30% 
50% 
As to the source of the sex impulse, whether it be 
the endocrine glands, muscle spindles, etc., we will 
not dwell on here. But the suggestion that the crea- 
tion of sexual desire is due to tension in the seminal 
vesicles is hardly satisfactory, as it would not ex- 
plain desire in women, nor in boys before the age 
when they have the power to ejaculate. 
MECHANISM 
Not all masturbation is genital, though when the 
term is not otherwise qualified, this is what is meant. 
In the case of the adult, there are more erogenous 
zones in woman than in man. The mind when called 
into play may act as a strong stimulus to the peri- 
pheral sex apparatus. The indulgence in erotic rev- 
eries is common in adolescents, usually stimulating 
only to the point of turgescence, and not to the ex- 
tent of causing an orgasm. This psychic auto- 
eroticism is bad, because it produces neither affective 
nor physical neutralization of the individual's feel- 
ings. It might be stated here that with the majority MECHANISM 
17 
of women, even physical masturbation usually stops 
short of orgasm. 
In the male youth, the mechanism of masturbation 
is usually a simple matter, being produced by stim- 
ulation of the glans penis. In this thesis we are 
not concerned with any perversions associated with 
this habit, though recognizing the frequency of 
breast, perineal, anal and rectal masturbation etc. 
The last phase of this subject, I considered in an 
article which I published in 1921 in the New York 
Medical Journal. 
In the adolescent girl and in the woman, mastur- 
bation is a more complicated affair than in the male. 
In the female, the clitoris chiefly, and next the labia 
minora are used for purposes of masturbation. My 
experience corroborates the views of Bloch and Moll 
as against those of Jone! and Freud as to the great 
frequency of nymphae masturbation. Bousfield 
also differs with the views of Jones that clitoris 
masturbation prevents the later adult transition of 
the centre of gratification from the clitoris to the 
vagina (anaesthesia), and Bousfield says, again 
taking issue with Jones, that after marriage the 
clitoris normally remains the essential seat of grati- 
fication. In 150 apparently normal women, he found 
that 
3 were completely anaesthetic, 
14 had pleasure chiefly in the vagina, 
133 had pleasure chiefly in the glans clitoridis, 
with diffuse vaginal, perineal and anal 
feelings also. 
The use of foreign bodies in the vagina and ure- 
thra is much less common as a habitual method of 
masturbating than is ordinarily supposed. In fact, 
a large percentage of young girls do not know of the 
existence of the vagina. Manual masturbation is 
by far the most common. Many aesthetic women 18 
STUDY OF MASTURBATION 
have a repugnance to touching the mucous membrane 
directly, and yet masturbate by means of thigh move- 
ments, or by rubbing the external genitals against 
various objects. It is not uncommon for parents to 
deny the existence of masturbation in their children 
because they do not use their hands. And while ad- 
mitting the children practice autoeroticism by means 
of thigh movements, they try to minimize the im- 
portance of this performance. This is a distinction 
without a real difference. 
The attempt to cure an adolescent of the habit of 
masturbation by illicit intercourse is always unavail- 
ing, to say nothing of the immorality of such a 
proposition. And further, coitus without affection 
is merely a form of masturbation. 
Psychiatrists are aware that psychotic patients get 
satisfaction from their sex fancies and hallucinations. 
Their abnormal ideas and hallucinations relieve their 
sex cravings, usually in a veiled, symbolic way. 
EQUIVALENTS OF MASTURBATION 
Pleasure seeking equivalents for tabooed direct sex 
expressions are common in children and in neurotics. 
The equivalents depend on the association of tabooed 
with permissible modes of gaining pleasure. Jung, 
however, taking exception to the views of other writ- 
ers, cautions that obtaining pleasure is not identical 
with sexuality, and the latter designation should not 
be all-inclusive. 
Consider the act of thumb-sucking, which is rather 
a common way in which many young children derive 
pleasure. This act is frequently practiced as a sub- 
stitute when the habit of masturbation has been for- 
cibly prevented. Nail-biting is really a variant of 
thumb-sucking. Obtaining pleasure from his own EQUIVALENTS OF MASTURBATION 
19 
body is all that both masturbation and thumb-suck- 
ing do for the child; and likewise both would cer- 
tainly be regarded as eccentric ways of getting 
pleasure later in life. There are instances where the 
child goes from thumb-sucking to masturbation. As 
von Hug-Helmuth says, older children after sucking 
the thumb for a long time often show signs of sexual 
excitement, followed by an attitude of comfortable 
relaxation. It is only when followed by sexual ex- 
citement, that thumb-sucking is to be regarded as an 
equivalent for masturbation. Practically every in- 
vestigator, except Moll, agrees as to the sensual 
nature of thumb-sucking. This fact is also substanti- 
ated by the reactions of psychotics who are given to 
this practice. It might be well to again emphasize 
that infantile sexuality has no sex object. 
We have already referred to the great interest 
young children take in the excretory organs and their 
products. In this regard we need only refer to cer- 
tain games of young boys. In weaning the child 
away from such interests, care must be exercised in 
inculcating repressive measures. A basis may be 
laid for the assumption in adult life that all of sex 
is "unclean." From this there might follow abnor- 
mal ideas and behavior in regard to their adult sex 
life. 
Bed-wetting occurring in adolescence is not un- 
common. Freud claims that where enuresis nocturna 
does not represent an epileptic attack, it corresponds 
to a sex pollution. This is almost incomprehensible 
to the normal adult who can no longer feel like the 
child, nor appreciate emotionally the care and at- 
tention bestowed on the child after such an occur- 
rence. These phenomena and their associations must 
be studied from the child's and not from the adult's 
point of view. 
Most of us will agree with Jones and others in STUDY OF MASTURBATION 
20 
their claim that the mucous membrane of the mouth, 
urethra and anus have erogenous potentiality, and 
so may be used for sexual excitement. Skin eroticism 
may be manifested in various ways. Rhythmical 
rocking movements (muscle eroticism) may replace 
the forbidden act. Other equivalents, in certain cases 
only, of course, are the habitual taking of enemas and 
vaginal douches (especially where self-prescribed), 
rectal massage etc. Some individuals give up mas- 
turbation, and substitute exhibitionism or some other 
abnormal trend or expression. CHAPTER II 
Causes. Prevalence of the habit 
CAUSES 
I have already referred to some of the psychic 
causes of masturbation. Agreeing with most of the 
other investigators, I feel that the psychic factors are 
by far the most important. However, as Bloch says, 
in considering a condition which may have numer- 
ous etiological factors, it is hardly correct to speak 
of only one cause. We must not forget that some 
children have a multiplicity of bad habits, and not 
merely one. One must look for any physical condi- 
tion, general or local, which might have some con- 
tributory value in keeping up the habit of masturba- 
tion. A careful study of the social setting of the 
patient is also essential. One reason why I regard 
the average local cause as only contributory, is be- 
cause it is usually easily removed, whereas the habit 
itself takes some time to cure. 
Oppenheim's hypothesis that heredity is an import- 
ant etiological factor is probably true, though of 
course rather difficult to prove. It is unquestionably 
true that some people practice abstinence with less, 
and others with greater difficulty. 
Authorities differ sometimes as to where a cause 
leaves off, and an effect begins. And so we see op- 
posing views, not only in relation to this subject, but 
in regard to other questions. For example, Bloch 
says neurasthenia is the cause of masturbation, 
whereas Freud claims it occurs as the result of mas- 
21 22 
STUDY OF MASTURBATION 
turbation. The latter view is the one held by nearly 
all modern investigators,-at least in respect to the 
actual neurosis, neurasthenia. Persistent, excessive 
masturbation is more often a symptom of a psycho- 
pathic state than the cause of it. 
In as much as our knowledge of the endocrines is 
still rather chaotic, we will not discuss their influ- 
ence on the sex impulse here. Without doubt they 
are important in determining the strength of the 
sex impulse, but here we are studying not the im- 
pulse itself, but rather one of the ways in which it 
is expressed. 
Children are sometimes taught masturbation by 
companions, and also by perverse adults. But Dana 
is incorrect when he says that the habit is usually 
so learned; and he is also incorrect when he says 
that the act is usually done because of local irrita- 
tion. For the mechanism of the habit is not so 
simple. What Healy says is true, however, that 
adolescent girls often learn of the habit from conver- 
sations with other girls. Many writers caution 
against even innocent, undue fondling of children, 
for while the motive is most laudable, the effect on 
some few children may not be good. Masturbation is 
more often spontaneously learned by boys than by 
girls. Moving picture shows, newspapers, books, 
etc., may be the source of erotic fancies. But Stanley 
Hall claims-and Brill says about the same-that 
the reading of a serious book on the subject of sex 
never causes the habit. If instances were given to 
contradict this view, the assertion is made by him 
that it is safe to assume that the intention was there 
first to indulge in the habit. 
While the adult type of masturbation is most com- 
mon during adolescence, it is not rare even as late 
as the menopause. Some patients, more particularly 
women, masturbate without employing any erotic PREVALENCE OF THE HABIT 
23 
reveries. In fact, some of them do not recognize the 
sexual element in the act. The deed is done in many 
such cases because it acts as a sedative, and relieves 
insomnia and various nervous tensions; or because 
it acts as a temporary relief from various painful 
mental states, as anxiety, depression, or ennui. But 
the average patient of good moral tone is very apt 
to have these painful states accentuated as the re- 
sult of masturbation. For a moral conflict with its 
sequelae usually follows. 
The habit is very common in hysterics and in epi- 
leptics. In fact, in hysterics, the major motor phe- 
nomena may represent a sexual equivalent. Among 
defectives (morons etc.), little attempt is made to 
inhibit masturbation. 
A pathological idea held by a few male patients is 
that semen is an excretion, and should be gotten rid 
of as a physiological necessity. 
In some cases an obsessional neurosis, homosexu- 
ality, etc., may be back of the habit. I shall have 
more to say about the causes of masturbation when 
I discuss its treatment. 
PREVALENCE OF THE HABIT 
We have already referred to the universality of 
the habit at some period in the young child. Most 
investigators will agree with Moll, Kempf, Aschaff- 
enburg and others that it is practically universal in 
the male adolescent for a varying period of time,- 
usually for a few years. Moll says it is the com- 
monest bad habit among boys; that while all boys 
do not smoke, they all masturbate at some time. 
There may be a few exceptions, as is true of most 
rules. Stanley Hall says it is mere hypocrisy to 
deny how widespread the habit is. Youths naturally 
are prone to deny the habit-especially to an unsym- 24 
STUDY OF MASTURBATION 
pathetic examiner-as they fear a loss of social 
esteem. In fact, they will invent all sorts of subter- 
fuges to hide the fact that they masturbate. A girl 
will often deny the habit, unless she is allowed to give 
an ethical excuse-e. g., that the act is done to re- 
lieve some physical discomfort, as pruritus. She is 
more apt to confess to the habit when she is enabled 
to give an apparently legitimate motive for her 
actions. 
Girls are more closely guarded in the home, and 
so are less exposed to erotic stimuli than are boys. 
And their repressions in regard to any expression 
of the sex impulse are also stronger. Not only be- 
cause of ethical and social reasons, but also on ana- 
tomical grounds, the young girl learns of sexual sen- 
sibility later than the young boy does. But a girl 
who is addicted to masturbation, may very well in- 
dulge in the habit more to excess than the boy, as 
the physiological warnings (effects of orgasm, etc.) 
are less urgent in her. 
Among adults the habit is most common in seclu- 
sive, shut-in types who have few or no personal or 
social outlets, and particularly in those whose crav- 
ings for social esteem are slight. Many of this 
class have a propensity for justifying all their acts, 
no matter how selfish. And as Kempf states, the 
habit is common in adults isolated from the rest of 
society. Again let me repeat here that one must dif- 
ferentiate the occasional from the habitual mastur- 
bator. 
In answer to the question whether adult masturba- 
tion is more common in men or in women, I would 
say that the majority of writers agree that it is more 
common in the latter. My own experience corrobor- 
ates this, as my case files show that it is four or five 
times as common in women as in men. 
Lawson Tait, Spitzka, and Metchnikoff are among PREVALENCE OF THE HABIT 
25 
the prominent writers who say that it is less common 
in women. Mercier tries to show that it is not so 
common in cultured women. Deslandes states that 
there is no difference in its practice between the two 
sexes. Ellis states that after puberty it is more com- 
mon in women. Otto Adler says it is quite common 
in women, as do Lbwenfeld, Eulenburg, and the 
gynaecologist, Kisch. Gutceit claims that masturba- 
tion is less common in girls 10 to 16 years old than 
in boys of that age; but above the age of 18 years, 
it is extremely common in single women. Moll ex- 
cepts to the high incidence of masturbation in women 
claimed by Gutceit. And Bloch also excepts to Roh- 
leder's statement that 95% of women have mastur- 
bated. (Berger gives even a higher percentage- 
99%). 
However, it is often difficult if not impossible to 
scientifically substantiate such statements as to per- 
centages, and other broad generalizations on a sub- 
ject like this one. For social conventions force 
women to be secretive about all their sex expressions 
and so naturally they are apt to be deceptive about 
their indulgence in this habit. And as is well-known, 
the majority rarely consult the physician for this 
habit alone. The fact of its occurrence is brought 
out incidentally in the history or in the examination. 
It is safe to assume, however, that the habit in women 
is more common than is ordinarily supposed. And 
if psychic masturbation be included in our estima- 
tions, then the percentage is much higher still. 
Even among married women, the habit is by no 
means rare. According to my experience, to say that 
10% of married women masturbate is a conservative 
statement. Among married men it is very rare. 
The habit is found especially in unhappily married 
women who belong to the repressed erotic type, and 
who superficially are often regarded as frigid. To 26 
STUDY OF MASTURBATION 
a lesser degree, in unethical types, extra-marital 
coitus is indulged in by some of these women. But 
we might repeat here that coitus without affection 
is really a form of masturbation. 
The statement of Frink agrees with my experi- 
ence, i. e., that many married women, anaesthetic in 
coitus, are nevertheless chronic masturbators. It is 
found especially where there is a fundamental dys- 
harmony in their marital relations. Against Bloch's 
idea that frigidity is due to the blunting of local 
sensibility as a result of over-stimulaton, is the fact 
that the same sort of physiological reaction is not 
observed in other fields,-e. g., one rarely sees a per- 
manent loss of taste for food from over-eating etc. 
Rather the anaesthesia is due in the majority of in- 
stances to various psychic causes, just as a dislike 
for certain foods is often due to certain mental 
associations. 
It is true as Kempf says that a girl may be con- 
ditioned against normal heterosexual ideas and ex- 
pressions, and after marriage may develop an auto- 
erotic habit. Also, fear of pregnancy may cause a 
dislike for coitus, with a secondary development of 
masturbation,-as a substitute. As a matter of fact, 
among certain psychopathic adults, it is well recog- 
nized that masturbation may be the only adequate 
form of sex gratification. A situation not unknown 
is for a patient to give up the habit, and then to 
indulge in the act during sleep. 
It might be well to mention here that not a few 
men and women marry, hoping that a normal mar- 
ital relationship will cure them of autoeroticism and 
homosexual trends. This is a sad motive for mar- 
riage and the results are often disastrous to both 
parties to such a contract. CHAPTER III 
Exaggerations of the harmfulness of the 
habit. The effect of secrecy 
THE ALLEGED EFFECTS EXAGGERATED IN THE 
OLDER LITERATURE 
It goes without saying that occasional masturba- 
tion in the adolescent can be harmful only in the psy- 
chic and moral spheres. The effects will depend in 
great part on the individual's make-up, the number of 
healthy trends inculcated by his guardians, his moral 
tone, and particularly his own attitude toward the 
habit; e. g., the presence or absence of pathological 
fear in regard to the effects of his habit. We know 
that seclusive, introverted types, who often indulge 
in the habit excessively, and also withdraw much of 
their energy from reality to indulge in erotic rever- 
ies, are the ones who later on have the most fears 
as to the possible consequences of their habit. 
Habitual masturbation will lessen an adolescent's 
ideals and it will tend to cause emotional upsets. 
Nearly all modern scientific investigators agree 
that a large part of the so-called dangers and se- 
quelae of the habit portrayed by ancient writers, 
and some modern lay writers, are exaggerations or 
even myths. Such ideas come down as relics from 
the writings of Tissot and his contemporaries. To 
Aschaffenburg, Jones, Moll, and others belongs the 
credit of showing the real facts in regard to mastur- 
bation. There are some men (e. g. Stekel) who go 
to the opposite extreme, and speak of the absolute 
27 28 
STUDY OF MASTURBATION 
harmlessness of the habit. But as Jones says, the 
truth lies between the two extremes,-of absolute 
harmlessness on the one side, and of causing all sorts 
of unrelated human ills on the other. One could 
hardly deny its psychic effect on cultured adult 
patients, whose mental and moral feelings have been 
offended by the habit. 
Healy, whose observations have been almost en- 
tirely with adolescents, says that worry does more 
harm than the habit itself. Moll writes similarly, 
referring to the individual's self-reproach on moral 
grounds, and to the fear of having done irreparable 
physical injury to himself. It might be apropos to 
mention here that some patients have the erroneous 
idea that the loss of semen does all the harm. Jel- 
liffe and White write that "the physical act of mas- 
turbation is perhaps relatively unimportant as com- 
pared with the crippling effect of the autoerotic in- 
troversion." Bloch and Hall write along similar 
lines. So it must be admitted that while the phy- 
sical dangers have been greatly exaggerated in the 
older literature, still the psychic and moral reactions 
are very important. This is also proven by the 
statements of nearly all our patients. And even on 
the physical side, excessive repetition of the act will 
favor the development of certain physical syndromes; 
e. g., numerous pathological vasomotor phenomena, 
and particularly the neurosis known as Primary Neu- 
rasthenia. Moll makes the assertion that the act is 
less harmful when spontaneously done, than when 
artificial bodily and mental stimuli are employed. 
Healy has shown that masturbation is a factor in 
10% of the delinquencies occurring in adolescents,- 
that in such individuals there is a breaking down 
of the moral stamina. 
The somewhat popular lay idea that masturbation 
may cause imbecility, consumption, etc., is not only EXAGGERATION OF HARMFULNESS 
29 
without foundation, but is ridiculous. Yet a patient 
may unfortunately accept such a false idea and re- 
act accordingly. And it may be very difficult to 
wean him away from such a belief, at least by logic 
alone. The fears of some credulous patients in this 
respect are made worse by reading quack literature, 
which abounds in this sort of nonsense. 
For a person whose position in life gives authority 
to what he says, to exaggerate the dangers of the 
habit, is uncalled for. By a false statement, he may 
be the unwitting cause for the patient's developing 
a neurosis. His remark may also be the cause for 
a patient making the decision not to marry. He 
may thus change the whole subsequent life of an 
individual. According to Moll, exaggerated teaching 
may help to cause hypochondriasis. 
The fact is that if early masturbation produced 
all of the evil results ascribed to it, a large part of 
mankind would be in a bad way mentally and phy- 
sically. The youth, by all means, must be weaned 
away from the habit, but not by falsely exaggerating 
its effects. To falsely tell a suggestible patient that 
he will surely die or go insane as a result of the habit, 
does no real good. And it may produce lasting fears, 
even after the habit has been given up. And we are 
all agreed that the fears do more harm than the 
habit itself. 
Let me repeat that masturbation while almost a 
normal phenomenon for the child and the adolescent, 
is not to be so regarded in the adult. When per- 
sisted in by the latter, it shows a failure of psycho- 
sexual development. It is a bad way to meet sex 
cravings. It increases his selfishness, and interferes 
with his social progress. And it is hardly necessary 
to say that if kept up, it will alter the later sex rela- 
tions in marriage. 30 
STUDY OF MASTURBATION 
THE EFFECT OF SECRECY 
Where the adolescent maintains absolute secrecy 
in regard to his habit, the harder it is for him to con- 
quer it. With the assistance of a sympathetic adult, 
it will be easier for him to assimilate the whole sub- 
ject later on. Kempf says that the bad effects are 
lessened where the adolescent felt justified (though 
erroneously) in practicing the habit on physiological 
grounds; that also the effects were lessened where 
the youth shared his secret with some one who was 
able to convince him of the real effects of masturba- 
tion, and of the fact that he was by no means alone 
in its practice. 
The adolescent's dependence on the assurance of 
an authoritative adult will do much to help dispel 
many of the accompanying fears and dreads, and his 
feeling of being inferior. This is particularly so if 
he can be convinced that his fear of ruin, social 
ostracism, etc., are groundless. And the intelligent 
parent or teacher will assist the youth to find proper 
outlets for his energies, not forgetting at the same 
time to strengthen his moral tone; and teach him to 
live a life of ethical reality, instead of one of erotic 
dreams. Of course we are assuming a desire on the 
part of the youth to overcome his baser cravings, and 
to conquer the habit; and that his own self pride and 
his desire for social esteem are normal. 
Intelligent sympathy will often do more good than 
drugs or surgery. A youth will frankly discuss his 
habit with one in whom he has confidence,-whether 
it be parent, physician, or clergyman. But where 
the parent or teacher assumes an unfriendly or 
harshly critical attitude, the youth's secretiveness 
will be increased, and in addition he will probably 
show resentment, or else a broken spirit. Where a 
youth reacts with arrogance, this frequently is com- THE EFFECT OF SECRECY 
31 
pensatory for a real feeling of lowered self-esteem. 
It might not be out of place here to note that secret 
sex knowledge may be as morally and emotionally 
harmful as physical sex experiences. 
Healy has brought out that youths who are very 
secretive about the habit will often blame their com- 
plaints of lassitude, weakness, etc., on coffee or smok- 
ing, rather than to tell the truth concerning their 
habit of masturbation. For naturally they realize 
what they are doing is asocial, and wish to avoid the 
stigma attached to asocial acts. It is quite evident, 
even on physiological grounds, why the continual 
struggle to be secretive results in all sorts of nervous 
tensions in the chest, abdomen, eyes, etc. CHAPTER IV 
Symptoms and sequelae 
SYMPTOMS 
Inasmuch as masturbation is rather a habit than 
a disease, it is questionable whether it is quite proper 
to speak of its symptoms and signs. But as some 
writers speak of effects as symptoms, we will briefly 
refer to some of them here. Later on I will con- 
sider in more detail the effects which are said to 
result from excessive indulgence in the habit. 
As I said before occasional masturbation can have 
only mental and moral consequences. Even in excess, 
as the gynaecologist Graves says, one is more apt 
to see psychoneurotic than gynaecological symptoms. 
In a temperamental, religious person, the act is more 
apt to cause greater mental conflict than in an inac- 
tive person of lower moral tone. Thus we can under- 
stand why in a very sensitive, ethical individual, an 
act of masturbation done on only one occasion may 
cause a severe psychic reaction, whereas another in- 
dividual with no conflicts about his conduct may 
practice the habit for some time with very few after- 
effects. And it is evident that it is hard to state 
what constitutes excess in regard to this habit. It 
depends in part on the general physical health, the 
constitutional nervous make-up, the personality, the 
moral tone, the severity of the mental conflict, and 
the accompanying motor reactions etc. to the habit. 
So it goes without saying that some types of indi- 
viduals are more upset by the habit than others. 
32 SYMPTOMS 
33 
The reactions are quite different in the infant, youth, 
and adult. We have previously made some reference 
to this distinction. 
It is hardly necessary to say that a careful study 
must be made of each patient's personality, and the 
environmental influences must be estimated as to 
their effect on character. Sex is no exception to the 
rule that most psychopathic types usually choose the 
easiest way to achieve their aims. The struggle 
for such people to be pure or to win a suitable mari- 
tal object is too great. As many of them are not 
ethically well-grounded, excessive masturbation with 
them is common. 
Many of these patients suffer from a loss of self- 
pride. Their conviction of sin with feelings of un- 
worthiness, and numerous self-reproaches form quite 
a characteristic picture. This state of affairs soon 
leads to egocentricity, undue reticence, a loss of in- 
terest in school work, friends, etc. There comes a 
feeling of loneliness, depression, and even despair. 
In deeply religious youths, not those who are merely 
formally so, there is an accentuation of the above 
trends. In some cases, over-scrupulousness is a re- 
action against the habit. Where the patient's feeling 
of guilt is very marked, he may be indifferent to the 
physician's explanation that the act is not physically 
as harmful as he fears, and that the psychic phe- 
nomena can be overcome after a manly struggle. 
The continual mental conflict, the compensations 
and over-compensations, cause a chronic feeling of 
fatigue. This state of turmoil uses up energy which 
had better been utilized in other acceptable and use- 
ful ways. Some of these patients have a feeling of 
having been polluted. Others who have a feeling of 
moral impurity develop, as a compensation, a com- 
pulsive washing of the hands. A compulsion neur- 
otic will usually not accuse himself of indulgence in 34 
STUDY OF MASTURBATION 
the habit itself, but may complain of a pathological 
fear of contamination. Psychotic types often say 
that they have wasted their vital forces through the 
practice of the habit. 
So we now can understand why the worry and 
fears over adolescent masturbation can change an 
individual's whole career. This might all have been 
avoided had he learned the truth, not only about the 
prevalence of the habit and its real effects, but also 
the reason for his being upset. So it behooves reg- 
ular physicians and guardians to give some atten- 
tion to this phase of human conduct, in order to 
assist these patients in their serious struggle to over- 
come the habit. 
APPEARANCE 
Most authorities agree with Hall when he says 
that there is no characteristic attitude nor expres- 
sion by means of which an expert can pick out a 
youth who masturbates. Dana mentions a long list 
of phenomena as proving evidence of masturbation, 
many of them indicating vasomotor instability and 
timidity, which might just as readily and reasonably 
have been ascribed to anaemia or some other con- 
dition. Much of the popular description of the ap- 
pearance of a chronic masturbator would be more 
applicable as the description of a psychopath. True, 
many of the latter masturbate, but one should not 
confound the evidences denoting a psychopathic char- 
acter with the effects of masturbation. As Healy 
says, there are some cases where the effects of the 
habit are noticeable, but the rule is that moderate 
masturbation in the normal youth is not reflected in 
his face. Unfortunately, many of these depressed 
patients fear that anyone can pick them out by a 
mere inspection. Quacks recognize this failing in SEQUELAE 
35 
some patients, and are glad to foster it. This, of 
course, increases his shyness and depression. The 
greatest mistake a youth or his family can make is 
to consult a charlatan for advice as to masturbation. 
EFFECTS OF THE HABIT 
In studying the results of excessive masturbation, 
it is best to consider separately its effects on the 
character, the mental and moral conditions, and the 
physical status. All physicians have noted how many 
neurotic individuals in telling their stories, often con- 
nect their difficulties with masturbation. 
I will leave the discussion of neurasthenia and 
mental aberration as sequelae of masturbation till 
later. But it is well to reiterate here that when cer- 
tain writers say that moderate masturbation in youth, 
is harmless, they are without doubt thinking chiefly 
of the physical effects, for such a conclusion could 
not hold true in regard to the mental and moral 
spheres in ethical individuals. It might be possible 
to disregard the moral factors in a certain type of 
male, and in that type of female known as the demi- 
vierge, described by Kisch and Bloch as women who 
are physically virgins, inasmuch as they still retain 
their hymens intact, but who are morally not living 
on a high ethical plane. The chronic autoerotic ac- 
tivities of this type often condition them to be per- 
verse in their later expressions of sex. 
EFFECTS ON CHARACTER 
White says that as ordinarily practiced, masturba- 
tion has not the serious significance usually given 
it, but that if indulged in excessively, its greatest 
danger lies in the crippling limitations it places on 
the individual's personality. And Dejerine asserts 36 
STUDY OF MASTURBATION 
it is not the physical exhaustion which does the harm, 
but rather the moral reproaches, or the fears of 
having inflicted physical harm by the habit. The 
deleterious effects on character are especially to be 
noted in adult masturbation. 
Where the habit has become uncontrollable, Kempf 
states that it may lay the foundation for a wretched 
personality. It is because of the fact that masturba- 
tion is an infantile method of sex gratification, that 
persistence in it causes a limitation of normal psy- 
cho-sexual development. And naturally normal so- 
cialization of the individual also becomes difficult, 
for he eventually comes to feel that he has lost the 
appreciation of his fellow men. So the habit tends 
toward exclusiveness, and in some cases to a narciss- 
istic fixation on self. Among asocial types, cul- 
tural repressions are weak, and so masturbation is 
common. 
In studying a patient, one must be careful not to 
blame every character defect on the masturbation, 
for many of the bad traits and trends of the intro- 
verted psychopath exist independent of the mastur- 
bation. Moll states this in a different way, when he 
says that it is often difficult to tell which symptoms 
are due to congenital predisposition and which to 
masturbation. But certain traits and trends may be 
caused by, or if present, accentuated by the habit, 
e. g., seclusiveness, secretiveness, laziness, abnormal 
timidity, scrupulousness, a lack of altruism, resent- 
ment and grudge. The chronic masturbator is often 
indifferent to other people, because of the fact that 
he is his own love object. 
PSYCHIC EFFECTS 
It is in this field where we look for the most nu- 
merous sequelae of masturbation. And it is par- SEQUELAE 
37 
ticularly in this realm where we see the reactions 
which mostly demand treatment, e. g., the great 
remorse, and the conviction of sinfulness and moral 
depravity, the depression accompanying the feeling of 
guilt, the numerous fears, etc. A lack of tact on the 
part of the examiner may unwittingly increase the 
patient's self-consciousness. According to Jones, the 
remorse in measure depends on the fact that the act 
is a revivifying of infantile activities and phantasies. 
Psychotic patients indulge in all sorts of self-accusa- 
tions, and also develop self-mutilation compulsions, 
as their way to cure their difficulties. A severe de- 
pression may be accompanied by suicidal ideas and 
tendencies. 
The feeling of guilt experienced by these patients 
is often undifferentiated; the masturbation may be 
the carrier of guilty feelings from other sources. 
Feelings of shame and reproach are socially useful 
as they are antagonistic to this selfish manner of 
expressing the sex impulse. 
Abnormal self-consciousness and morbid introspec- 
tion are commonly observed. For interest in this 
form of sexual activity draws the patient away from 
healthful mental and physical occupations, and 
is inimical to a normal family and social life. The 
youth who persists in this form of selfishness may 
later become deceitful, jealous, cruel, and obstinate. 
Some girls instead of being timid, exhibit a cold, 
blase manner, and are very bold and egotistical. 
The youth may develop a very disabling feeling of 
inferiority, or if it already exists, have it greatly ac- 
centuated by the habit. With this goes a loss of 
self-confidence and an uncertain will. Harsh criti- 
cism by a parent may increase the feeling of infer- 
iority, particularly if the parent's struggle against the 
habit in the child has been almost futile. Incidentally, 38 
STUDY OF MASTURBATION 
I might mention that punitive measures to correct 
the habit often have quite the opposite effect. 
Healy says that chronic masturbation can contrib- 
ute to the causation of mental dullness. In such 
patients, there is poor attention, a lack of concentra- 
tion, and a great desire to change positions, because 
of a loss of interest in their work. Many of them 
show great irregularity in intelligence tests. In an- 
other type of patient, there results a search for all 
sorts of artificial and stimulating amusements with 
bad mental habits and a bad imagination. Mastur- 
bation favors delinquency, though in only six out of 
one thousand of Healy's cases, was it the sole cause 
of mental dullness and delinquency. One must be 
careful not to mistake some of these youths for 
morons. 
It may possibly be true, as some writers claim, 
that masturbation is less harmful physically (and 
socially) in women than in men. But in the case of 
adolescent girls, who are more emotional than boys, 
the psychic bad effects may be worse. So the state- 
ments of Bloch, Lbwenfeld, Mercier and others, that 
it causes less harm in girls can only be true if there 
are no mental or moral scruples involved. What 
might be referred to as a social bitterness not sel- 
dom follows masturbation in adult women. 
FEAR 
Fear is one of the commonest and most persistent 
sequelae. The fear or fears relate to some form of 
mental, moral, or physical failure or ruination. The 
youth's fear of his practice of masturbation acts as 
a steady irritant and wears him out. Insomnia is a 
natural sequence of all forms of pathological fear. 
To well-intentioned but foolish parental threats to 
amputate the penis or hand of the young child in SEQUELAE 
39 
order to cure the masturbation can be traced some 
cases of psychic impotence in later life; also various 
hysterical vasomotor symptoms in the hands and 
arms. 
Fear usually causes a simple depression, without 
this developing into a psychosis. A fear of being 
followed and watched may be due to the projection 
of a guilty conscience, and is often seen in psychotics. 
Some psychotic women also have a fear that mastur- 
bation is the cause of some disorder or disease from 
which they suffer. They sometimes think, too, that 
it can be the cause of pregnancy. This latter idea 
is often a wish-fulfillment. 
FEAR OF INSANITY 
The fear of insanity is very acute and disturbing 
in many of these patients. Jelliffe and White sum 
up the modern view concerning the relation of mas- 
turbation to insanity by saying that masturbation 
is more often a result than a cause of mental aber- 
ration. Bloch and Rohleder write similarly. J. R. 
Hunt says it may cause neurasthenia, but not insan- 
ity per se. However masturbation is undoubtedly 
an important factor in some cases of acute psychoses. 
This is particularly so in some sensitive religious pa- 
tients. It is Healy's opinion that masturbation can 
favor erratic conduct. It might be mentioned here 
how frequently we observe psychic upsets after the 
habit has been given up. Any tendency to resume 
the habit is sure to cause an acute mental conflict. 
If a neurosis develops, it is to be regarded as a com- 
promise formation. The masturbation and the neur- 
osis both express similar trends,-one postively, and 
the other negatively. Few observers could endorse 
Aschaffenburg's statement that he never met a single 40 
STUDY OF MASTURBATION 
serious nervous disorder unquestionably due to mas- 
turbation alone. 
The laity have an erroneous idea that masturbation 
is a potent and frequent cause of insanity. For ex- 
ample, many dementia praecox patients are chronic 
masturbators. And it is hard to convince some par- 
ents that the habit is the result, not the cause of the 
dementia praecox. Likewise some patients connect 
their mental upset with masturbation. On recovery 
they may over-react against the whole subject, even 
to the point of not bearing to hear the name of the 
habit mentioned. 
It is well-known that the lack of self control char- 
acteristic of dementia praecox, favors the excessive 
practice of this habit; which in turn increases the 
demoralizing or deteriorating effect of the original 
mental disorder. 
As Brill says, most of the cases designated by 
writers in former days as "Masturbatory Insanity" 
were really cases of dementia praecox,-a disorder 
which had not yet been recognized in those days. 
Healy says, "The earlier writers spoke of an insan- 
ity of masturbation (e. g. Mercier). If it ever does 
cause insanity, it must be very rare." Marro (in 
his "Evolution Psychologique Humaine a 1'Ecole 
Pubere") is the only modern authority who refers 
to an insanity of masturbation. No modern psy- 
chiatric text book uses the term at all. 
PHYSICAL EFFECTS 
Let me reiterate what I stated previously, that 
where masturbation is indulged in moderately, there 
are usually no physical sequelae. Gynaecologists and 
genito-urinary specialists in mentioning the somatic 
after-effects refer to cases where masturbation is 
practiced excessively. SEQUELAE 
41 
In studying the mechanism of this habit, one can 
distinguish between masturbation limited by the pro- 
duction of sensory gratification, and masturbation go- 
ing on to the production of an orgasm. The latter 
is associated with convulsive motor reactions and 
increased secretory reactions. The former is the 
usual female way, the latter, the usual male way of 
reacting. So the statement of Eulenburg that not 
only the physical, but also the psychic effects are less 
marked in women needs some qualification. For 
physiologically, this certainly is not so for all women. 
And psychologically, there is no reason why the two 
sexes should show such discrepancies in their reac- 
tions to a mental conflict. For though most women- 
particularly single women-do not masturbate to the 
point of orgasm, still if the woman realizes that what 
she is doing is a sexual act, and has to overcome 
scruples in its performance, why should she exhibit 
less mental conflict? In fact, in many instances the 
contrary is true. 
In the case of young boys, Moll denies that mas- 
turbation is more deleterious if practiced before the 
boy is old enough to have an orgasm, for the reason 
that most boys begin the habit before that time. 
NEURASTHENIA 
By this term I refer to the neurosis known in 
modern nomenclature as Primary Neurasthenia,- 
a pure fatigue neurosis. I will discuss this condi- 
tion, but very briefly. As a primary condition, it 
is rather uncommon. It must not be confounded 
with those various "neurasthenic" syndromes of the 
older writers, occurring secondary to other diseases. 
Nor must we confuse it with the various forms of 
hysteria. Modern investigators as Kisch, Gattel, 
Jones, etc. attribute primary neurasthenia to years 42 
STUDY OF MASTURBATION 
of masturbation, which has been practiced in excess, 
both in frequency and in length of time. Lbwenfeld 
and Eulenburg agree to this view, but state other fac- 
tors must be added. The statement of Kisch that 
this disorder is less common in women is quite true. 
The cardinals signs of a primary neurasthenia are 
fatigue, pains in the legs, arms, and spine, a feel- 
ing of pressure in the head, headaches, and a flatu- 
lent dyspepsia. Various temporary vaso-motor phe- 
nomena are common. Bloch calls attention to the 
numerous subjective complaints of the eye and heart. 
A hypochondriacal trend is frequent. Among the 
symptoms enumerated by Kisch, besides the above, 
are backache, insomnia, palpitation, and some few 
gynaecological complaints, which I will enumerate 
later. Some of these patients are anaemic and com- 
plain of an intolerable weakness. Many of them 
feel a little better in the morning but are tired and 
irritable at night. 
, There are some writers who dissent from the views 
just mentioned. Thus Bloch says that masturbation 
is the result not the cause of neurasthenia. Stekel 
says that he knows no neurasthenia; that all such 
cases are psychogenic disorders. 
Few authorities can be found who will agree with 
Aschaffenburg when he says that "the sexual life 
exerts no dangerous influence worth mentioning on 
the nervous system," if in his statement he includes 
the psyche. Even the genesis of pathological fears in 
these cases is recognized by the laity. Jones gives the 
accepted modern view when he says that the neu- 
rasthenia resulting from excessive masturbation is 
only an exaggeration and fixation of the fatigue and 
general slackness that so commonly follows a single 
act of masturbation which has been accomplished 
after a moral struggle. This struggle uses up en- SEQUELAE 
43 
ergy, and this is a greater factor in producing fa- 
tigue than is the physical act itself. 
As a result of conflict, there is an increased bodily 
tension, due to a damming back of energy. Though 
legitimate orgasm in coitus lowers physical tension, 
this is not so in cases of masturbation, where the 
feelings are pent up, there being no emotional outlet. 
In fact this same mechanism applies in those cases 
of unsatisfactory coitus, where marked dysharmony 
exists between husband and wife. So when Anstie, 
a gynaecologist, says that these cases are cured by 
marriage, one has to accept such a statement with 
reservations. For as a matter of fact, if other bad 
traits and trends co-exist, marriage may very pos- 
sibly make the patient worse. 
It must be admitted that many of the so-called 
symptoms mentioned as characteristic of masturba- 
tion might with equal justification be ascribed to 
other conditions. For example, Kisch says that many 
of these girls are weary, pale, and have rings under 
their eyes; that they spend much time in bed. But 
the same might be said of an anaemic girl living a 
sedentary life, who was not addicted to the habit 
of masturbation. And if you will have a series of 
blood pictures made in some of these apparently anae- 
mic girls, you will be surprised to find the blood 
normal. Instead of anaemia in such cases, the pale- 
ness is the result of a chronic vasomotor constriction 
(tension). 
The fatigue and languor so regularly complained 
of by these patients is partly of psychic, and partly 
of physical origin (mental conflict added to deplet- 
ing motor and vasomotor reactions.) For it must 
be admitted that persistent bodily tensions will na- 
turally cause fatigue. In fact, some adolescents ex- 
haust themselves with a continual battle with their 
sex difficulties. And yet a continent person may 44 
STUDY OF MASTURBATION 
stay well by avoiding a damming up of his sex ener- 
gies, by means of working them off in sublimations 
and non-erotic aims; (physical exercises, social 
pleasures, study, etc.) 
According to Freud, four neuroses may result 
from masturbation,-Primary Neurasthenia, Anxi- 
ety Neurosis, Hysteria and Compulsion Neurosis. 
Kempf claims that excessive masturbation, as is 
observed chiefly in psychotics, may in part be the 
cause of refusal of food, vomiting, headache, weak- 
ness, and emaciation. And Jones and other writers 
say that excessive masturbation may cause frigidity 
and anaesthesia in women, and psychic impotence 
in men. Other factors, as fear, dysharmony, etc. 
enter into the causation of these pathological states, 
of course. 
LOCAL PHYSICAL EFFECTS 
Gynaecologists differ in their estimation of the 
physical effects in women, resulting from the habit. 
Graves of Harvard has summed up this phase of the 
question very well. Kisch in his "Sexual Life of 
Woman" says that local signs of chronic masturba- 
tion in the female are an enlarged, elongated, red- 
dened clitoris; nymphae which are attenuated-often 
assymmetrically so,-thickened, wrinkled, and pig- 
mented. My own observations are in agreement 
with this statement of Kisch. However one must 
remember that if masturbation is only occasionally 
practiced, or if local manipulation is not employed, 
these signs, may all be absent. The labia majora 
and hymen in some cases are flaccid and the vaginal 
outlet is red. In some instances there is a chronic 
pelvic congestion, and endometritis with leucorrhoea, 
menorrhagia or metrorrhagia. With all this, some SEQUELAE 
45 
diminution of sexual sensibilty may be present in 
some of the patients. 
The gynaecologist, Montgomery, adds to the above 
signs-swelling of the groove between the urethra 
and the clitoris; a clear abundant secretion from the 
Bartholinian glands; local hyperaesthesia, and pru- 
ritus in some patients; pains referred to the ovarian 
regions. In the married woman, dyspareunia is fre- 
quent. Some of these patients show an exaggerated 
prudery to any local examination. Some gynaecolo- 
gists claim that the uterus may be enlarged, and 
that there may be a varicocele of the broad ligament, 
corresponding to the scrotal varicocele as found in 
the male. 
Some genito-urinary specialists stress without suf- 
ficient foundation in most cases, the claim that in 
the male one usually finds trouble in the posterior 
urethra. They even claim that this acts as a potent 
cause of masturbation. I think I express the views 
of most modern authorities, when I say I could not 
subscribe to such an opinion. 
As to the question whether the hymen is not often 
ruptured by masturbation, Moll answers in the neg- 
ative. He says that such a method of rupture would 
be too painful,-that the individual would not persist 
in the act under the circumstances. And Maschka 
said that it is rare for the hymen to be ruptured, 
except by ordinary defloration and surgical meas- 
ures. There are a few cases where the rupture is 
probably due to masturbation, wherein foreign bodies 
have been suddenly inserted into the vagina. For 
a fall or inflammation to cause this trouble is very 
unlikely. CHAPTER V 
Masturbation and coitus compared 
DISSIMILARITY OF THE TWO ACTS 
It might be well to make a few comparisons be- 
tween the acts of masturbation and normal coitus. 
Coitus is the normal adult way of expressing the 
sex impulse. It involves two elements,-the affec- 
tive (emotional) and the physical. It is quite evi- 
dent, if one will consider the physiology and psychol- 
ogy of the two acts, why masturbation cannot be a 
satisfactory equivalent for coitus. There could be 
no emotional satisfaction to any normal adult in an 
act of masturbation; but rather it would cause dis- 
satisfaction, remorse, and revulsion. But it must 
be remembered that while masturbation as a source 
of sex gratification is an impossibility to a normal 
adult, nevertheless some neurotic types get more 
physical satisfaction from masturbation than from 
coitus. But even in them, this is rarely done without 
a feeling of guilt. 
Bloch rightfully takes issue with the statements 
of Sir James Paget, Erb, and Curschmann, that in 
some people masturbation may be less deleterious to 
the nervous system than coitus. Normal, i. e., legi- 
timate coitus of itself has no bad effects; whereas 
no normal ethical adult could possibly indulge in 
masturbation without suffering great mental distress, 
and experiencing a lowering of his self-respect. 
Anyone who has carefully studied these patients, 
46 MASTURBATION AND COITUS 
47 
will have to admit that no matter what the physical 
reaction, the psychic reaction in a normal adult is 
bad. 
From what I have already said, one can see that 
these two acts have nothing to harmonize one with 
the other. The mechanism of the two acts, the sex- 
ual attitudes related to them, the sensations aroused, 
and the reactions induced by the two acts,-not only 
local, but general,-are quite dissimilar. 
Masturbation is begun earlier in life. It is more 
apt to be practiced excessively than coitus; and so 
it soon necessitates stronger stimuli for its comple- 
tion. Masturbation is a more precipitate act; it does 
not call into excitation the secondary sex factors; 
instead imagination replaces reality, which is an 
infantile attitude. So ontogenetically, masturbation 
is a regressive phenomenon. It causes a feeling of 
ill-being and unrest, whereas legitimate coitus causes 
a feeling of well-being and relaxation. As White 
and Jelliffe say, coitus reaches its full biological de- 
velopment when in addition to affording individual 
gratification, it is of social value (as increasing 
the love of the couple, one for the other; the pro- 
ducing of a child, etc.). In contradistinction to this, 
masturbation is purely selfish, with no other aim 
than sensory gratification. Let me reiterate that 
most extra-marital coitus is masturbatory in char- 
acter, and even marital coitus where no affection 
whatever exists between the couple, belongs in this 
category. 
There are some married women-exceptions to the 
general rule-in whom the physical component of 
sex far outweighs the affective element. Such a type 
of woman craves almost solely sensual gratification. 
If she be married to a sexually unsuitable man-as 
one suffering from ejaculatio praecox-she often re- 
sorts to masturbation to complete the act. The stim- 48 
STUDY OF MASTURBATION 
ulus furnished by her autoerotic act is longer and 
more definite than her marital act. 
Women who fear or who despise pregnancy, not 
infrequently come to prefer masturbation to coitus 
for self-evident reasons. This type of woman hav- 
ing no ethical scruples about her acts may escape a 
neurosis, and so not consult a physician. As a rule, 
she has no desire to be cured of her habit. But it 
is not hard to see why the sexual life of herself and 
her husband becomes abnormal. 
There are some married women who because of 
faulty early training, are convinced that they are 
"victims" of sex, which they feel is purely a male 
attribute. Many of them develop the habit of mas- 
turbation as their relief from coitus, which they 
dislike. 
It is safe to say that almost any strong fear will 
favor sexual anaesthesia in women. And all writers 
agree that chronic masturbation favors frigidity in 
woman and sexual impotence in man. And, of course, 
there is always the possibility in both of developing 
a neurosis later, because of their abnormal sex life. CHAPTER VI 
Treatment of masturbation 
As Stanley Hall of Clark University has said, this 
branch of sex hygiene has hitherto been almost 
criminally neglected. Physicians and clergymen 
especially should have a comprehensive knowledge of 
all phases of masturbation if they will give the 
greatest aid to those individuals who consult them 
for aid in conquering the habit of masturbation. 
DUTIES OF THE PHYSICIAN 
Some knowledge of psychopathology is of great 
value in order fully to appreciate these patients. 
It goes without saying that no advice should be 
given these individuals which would be contrary to 
the standard of ethics observed in the community, 
nor which would offend the normal moral tone of 
these individuals. Fortunately very few regular 
physicians ever give such bad counsel as to indulge in 
extra-marital coitus, which would be productive of 
nothing but harm. 
Any recommendation to marry in order to cure the 
habit is abominably bad and unfair; and if followed 
would very likely be disastrous to both of the indi- 
viduals concerned. This is not a laudable aim for 
marriage, nor would it be an incentive for making 
any marriage successful. 
The truth only must be taught in regard to mastur- 
bation. The evolution of the habit as it affects the 
49 50 
STUDY OF MASTURBATION 
average youth may be told. Exaggeration of the 
effects of the habit only does harm. 
The problem of each one of these patients is some- 
what different, so that every one requires individual 
study and attention. Sympathy and encouragement 
are great aids in the hands of the medical adviser 
and teacher. The patient will frankly unburden his 
difficulties, if there is a good rapport between him- 
self and the physician. But on the contrary, if the 
physician does not show tact, the patient may show 
resentment at questions asked him; proving that 
one's attitude may cause greater offense than one's 
questions. The patient must never be made to feel 
humiliated, nor that he is an inferior being because 
of his habit. Nor must anything be said which will 
increase his own feeling of moral depravity and hope- 
lessness ; nor increase his unwarranted fears of 
physical ruination. 
The physician must show the youth how to divert 
his sex energy into other non-sexual channels, the 
latter acting as vicarious outlets for this energy. 
Normal cultured adults follow this course on their 
own initiative. Stimulate his desire for social esteem. 
The youth must be encouraged to conquer the habit 
for moral reasons and to please his parents; and also 
to show that by so doing, he has left infantile reac- 
tions behind him, and so is ready to enter adulthood. 
And as von Hug-Helmuth says, the youth must give 
up the habit because it not only is not nice, but is 
wrong, and if kept up will cause selfishness and ab- 
normal sensitiveness. These are all strong incentives 
if properly suggested. Every normal youth both 
consciously and unconsciously craves the love and 
esteem of his parents and guardians; and he must 
have them if he will enjoy perfect mental health. 
So again, I will repeat that it is not necessary to 
exaggerate concerning the effects of the habit. T<? TREATMENT 
51 
tell the truth will be sufficient, if in addition, con- 
structive measures are employed to cure the youth. 
DUTIES OF PARENTS AND GUARDIANS 
Much of what already has been written can be con- 
sidered with profit by parents and guardians. 
More attention should be given by parents to the 
friends their children make. They should also take 
more time to inquire into the thoughts and wishes of 
their children. For mothers and fathers should re- 
member that the inner mental conflicts and worries 
regarding a habit like masturbation can do vastly 
more harm (particularly if over a long period) than 
the act itself. Unfortunately the parents as a rule 
only concern themselves with outward physical acts. 
Many highly optimistic parents overlook mastur- 
bation in their own children. In fact, many of them 
do not want to believe it is possible. Such an attitude 
will prevent their being of any aid to the children, 
in their later efforts to correct the habit. Other 
parents become unnecessarily excited when they 
learn the truth, not knowing of the prevalence of 
masturbation, nor of its biological significance. 
The mother who has a psychologically bad attitude 
toward everything pertaining to the habit,-who is 
shocked and repelled by any reference to it in any 
form-is as a rule not only intellectually but tem- 
peramentally unfitted to be of much constructive help 
in aiding her child to rid himself of masturbation. 
These remarks apply to teachers and guardians as 
well. It is the attitude rather than the sex of the 
instructor which is most important. 
Prudishness and unnecessarily severe expressions 
of horror, and also undue censure only cause a youth 
to draw a circle of defense around himself. This 
will favor a seclusive way of behaving. One should 52 
STUDY OF MASTURBATION 
never try to instil abnormal fear into these children, 
for this is apt to result in much harm. But of course, 
a child must be shown the benefits of self-restraint, 
in all spheres, and not only in regard to his sex life. 
In young children, rewards may be useful to stimu- 
late further effort. A little spontaneous sympathy 
now and then will help the youth to gain self-con- 
fidence. Physical punishment is mentioned merely 
to be condemned. 
SEX ENLIGHTENMENT 
All investigators know that a child has a natural 
curiosity for knowledge regarding himself. The 
parent and teacher should acquaint himself concern- 
ing psychosexual development in children, if he 
wishes to be in a position to intelligently advise the 
child. A certain amount of sex enlightenment has 
nothing to oppose it, and if given by the right person, 
it may help to keep the child from senseless and 
harmful preoccupation with questions of sex in the 
following years. 
But if the child's serious questions are met in a 
prudish or even in a threatening way, he will natur- 
ally seek information from unreliable sources (as 
other children). From such sources he usually gets 
not only misinformation, but also learns many things 
which he should not know till later in life; and which 
because of the irritating emotional states they create, 
may cast a shadow over him for years to come. As 
Stanley Hall says, for science to refuse to do openly 
and properly what the press, movies, and ultra high 
life do by example and in a bad way, is not only 
illogical but decidedly wrong. Telling the truth 
about the habit under discussion, certainly never 
tends to increase it. 
A failure to give any instruction whatever to these TREATMENT 
53 
individuals who need it, only lays a basis-because of 
ignorance or misinformation-for all sorts of fears 
subsequently. Later in life, particularly in those who 
develop a neurosis, there is apt to be loss of confidence 
in, or even resentment toward, their elders, for their 
omission to impart any helpful knowledge. 
Though masturbation is common in schools 
(chiefly because at this age it is almost universal, 
among boys at least), the subject is rarely handled 
in a constructive way. As a rule, it is treated with 
silence as being something "unclean." It is true that 
knowledge alone will not cure this habit. There must 
be an overwhelming desire to conquer it if a success- 
ful issue is to be obtained. A psychopathic youth will 
continue the habit even after being cautioned. Great 
tact must be used, as to the amount of knowledge to 
be imparted. Too sudden or too much information- 
especially if it is neither understood nor digested- 
may cause an emotional upset. In such a case, good 
intentions will produce results neither anticipated 
nor desired. It may have as bad an effect as ex- 
aggerated or fanatical teaching. 
Some writers advise teaching only enough to 
satisfy curiosity. Others say to talk frankly, while 
still others say to talk in a symbolic way. But as I 
stated before, each individual must be handled differ- 
ently. All writers agree that complete repression 
of all information on the subject is bad. Both Jones 
and White feel that instruction as to the effects of 
masturbation should be limited to those who need it, 
because of their conflicts, doubts, fears, etc. 
Personal individual instruction is of greater emo- 
tional value, and hence is better than public instruc- 
tion, which must needs appeal almost entirely to the 
intellect. Children are not adults and are influenced 
more by their feelings than by their intellect. And 54 
STUDY OF MASTURBATION 
also the same amount of knowledge cannot be di- 
gested by all children alike. 
The best plan to follow in giving instruction is to 
be guided by the age (intellect), attitude, and ques- 
tions of the child. I refer chiefly to the child, because 
results can be obtained so much more easily in him. 
The adult who persists in practicing masturbation 
needs psychotherapy more than mere advice. Remem- 
ber to teach not only physiological facts, but also 
the moral obligations which demand sexual refine- 
ment. The proper scientific management of this 
habit in the adolescent is very important for his sub- 
sequent character development. 
RELIGION AS AN AID 
We are all aware that not all people can suppress 
or repress their sex impulses with the same ease, 
nor with the same degree of comfort. Everyone can- 
not attain to exactly the same level. But everyone 
should strive to do his or her best. A good moral and 
religious tone is a potent barrier against all abnormal 
methods of sex expression. A superficial formal 
religiosity is but little helpful. But the development 
of idealistic thinking by means of genuine religion is 
one of the greatest aids in inhibiting this habit. For 
the genuine practice of religion is disciplinary. 
It is true as I stated before that knowledge alone 
will not always control the sex feelings of youth. 
The inspiring aid of religion must always be utilized 
in treating these youths. Knowledge aids on the 
theory that the individual can better manage a situ- 
ation of which he knows something, than he can one 
which is shrouded in darkness. We must remember 
that ignorance is not a protection for innocence. But 
civilization demands a certain amount of renunciation 
and a great amount of refinement of an individual's TREATMENT 
55 
sex energy. It does not demand the annihilation of 
the sex impulse, however. The normal adult expres- 
sion of sex is usually deferred for many years. But 
in carrying out the ordinary repressions demanded 
by civilization, it is not necessary to teach the indi- 
vidual to regard everything pertaining to sex as 
vulgar. Such a concept is not only untenable and 
demoralizing, but it will favor the development of 
abnormal sexual trends in adulthood. 
On the psychological assumption that example has 
greater influence on the child than mere advice or 
admonition, it naturally follows that a high ethical 
family and social life, combined with deep and sincere 
religious practices will be the physician's greatest 
aid in curing an adolescent of masturbation. 
SOCIAL OUTLETS 
Those adolescents who have numerous active social 
contacts and whose associates have a fine moral tone, 
have less need to resort to this habit than do in- 
dividuals who live a sedentary, uninteresting, stupid 
life, and who tend toward seclusion. Laziness in a 
youth favors masturbation. The healthy boy and 
girl should use up their energies in ardent pursuit 
of their studies, athletic games, and all sorts of active 
play, with happy lively companions. Rivalry is a 
potent means of relieving nervous tension. 
Some exercises as bicycling, horseback riding, etc., 
may be bad in certain cases. Music and the cultiva- 
tion of the arts and sciences, and good clean literature 
are all helpful to stimulate a good moral tone. And 
there is nothing better than hard work, which should 
be with tasks that are not only productive but 
pleasant. In general, I might say that all forms of 
innocent pleasures furnish vicarious outlets for sex 
energy. And if parents furnish enough of these, 56 
STUDY OF MASTURBATION 
there will be little necessity for the youth to fall a 
victim to the habit of masturbation, which has not 
a single ethical aim. 
As Healy says, the treatment of these patients in 
great part depends on building up new interests and 
new ways of pleasant living. Besides this, the youth 
must be protected from bad associations, and the 
temptations that go with them. Co-operation is 
easily obtained from the normal youth,-but not 
from the youth full of psychopathic tendencies. 
Every child should have a regular daily regime. 
Then his interests would not be centered on himself. 
Parents should see to it that their adolescent child- 
dren lead good, clean, active lives. They should go 
to bed, tired, and enjoy a long restful sleep in a well- 
aired room. The recommendation of Moll not to 
permit the youth to stay in bed late in the morning is 
apt, for erotic reveries in those so inclined are com- 
monly indulged in at this time. It is best if the oc- 
casion be avoided. 
Successful results in a youth addicted to excessive 
masturbation, will be shown by an improvement in 
his school work, and in his general behavior. 
Puberty, a time when the habit is very common, 
is also the time when normal object love,-i. e. in- 
terest in a person of the opposite sex outside the 
family group,-is first noticed. This trend is often 
utilized to spiritualize the youth's feelings, and to 
divert his interests away from his physical sensa- 
tions. This psychosexual transition at puberty is 
usually more sharp and sudden in the male than in 
the female. And according to Frink, even in the 
adult, female love retains more of the infantile char- 
acter than does male love. 
Naturally the longer masturbation is practiced, the 
longer it will take, as a rule, to conquer the habit. 
This is especially true if the youth has numerous TREATMENT 
57 
other associated bad traits and trends which prevent 
full co-operation with parent or physician. It is the 
duty of the parent to work through those incentives 
which will carry the greatest weight with the par- 
ticular child,-whether it be religion, self-pride, or 
desire for social esteem. A child's mind may be 
likened to a flower garden. Even with much atten- 
tion, weeds are apt to find their way into the garden; 
where there is no attention given, the weeds will 
outnumber the flowers. And good character traits 
are as flowers and bad ones as weeds. It is as sen- 
sible to expect a flower garden to take care of itself 
and be beautiful to the eye, as it is for a child's char- 
acter to be allowed to just "grow" with no directing 
influences, and expect to have no disastrous traits 
and trends in later life. The wonder is that so many 
badly brought up children are as good as they are. 
TREATMENT AT THE PHYSICAL LEVEL 
While I feel, in common with most modern inves- 
tigators of this subject that the essential management 
of masturbation must take place at the psychological 
level, I have not failed to consider the medical and 
surgical, and also the social aspects of the problem. 
So a careful medical examination should be made in 
all cases. Any disease or defect, general or local, 
which might favor the habit, either directly or in- 
directly, should be cured or remedied. But again I 
must emphasize that the medical and surgical factors 
are in most cases only aids in our treatment of these 
patients. For a definite psychological adjustment is 
necessary in every case, whereas a physical one is 
needed in only a limited number. 
While I admit the importance of the ductless 
glands in the genesis of the sex impulse, it is a ques- 
tion in the light of our present knowledge how much 58 
STUDY OF MASTURBATION 
or how little of this energy depends on the gonads, 
the thyroid, the pituitary, etc. But though we are in 
doubt as to how much the endocrines influence the 
strength of the sex impulse, we have no doubt what- 
ever that any attempt to control this abnormal ex- 
pression of the sex impulse-masturbation-by endo- 
crine therapy alone, would be a farce. Disorders of 
human conduct cannot be treated in any such simple 
fashion. 
So we see that there is no panacea nor any rapid 
road to recovery from this habit. Victory comes only 
after a struggle,-in some cases a long one. A 
hygienic way of living must be insisted on, and of 
course all forms of erotic stimuli must be avoided. 
The recomendation of one writer to sit up all night 
in order to watch the child and prevent his practicing 
the act is rather silly. For no parent or guardian 
can be with his child every minute of the day and 
night. If the parent cannot get a moral and intel- 
lectual grip on his child, the situation is rather a 
bad one. For the same reasons, mechanical means 
advised for the control of the habit, are quite useless. 
This includes tying the hands. The latter is espec- 
ally useless in the case of girls, who could still con- 
tinue the habit by thigh movements. And how would 
any of these means prevent bad mental imaginations ? 
These adolescent patients should scrupulously 
avoid liquor in all forms, for the ethical feelings are 
the first ones to be inhibited by alcohol. Considering 
that a prime factor in treatment is a strengthening of 
the moral tone, one can see why abstinence from 
liquor is essential. 
MEDICAL TREATMENT 
The following are some of the purely medical 
measures recommended in the treatment of this TREATMENT 
59 
habit. They may be an aid in certain cases, if used 
in conjunction with the principles of treatment al- 
ready given. They must not be depended on alone. 
Baths-Sitz, cold, spinal douches, sponges, 
swimming. 
Electricity-Contraindicated in most cases. 
Drugs-Sedatives, as bromides, camphor, bella- 
donna, etc. As von Kraft-Ebing says, the 
effect of drugs given for their anaphrodisiac 
effect is slight, and we can expect to ac- 
complish little by them used alone. At best, 
they only lessen irritability, but do not cure. 
The impulse asserts itself as soon as the 
effects of the drugs have worn off. 
Moll states, other writers to the contrary notwith- 
standing, that the character of the food eaten has 
little to do with the sex impulse in the child. The 
strength of the impulse does have a relationship to 
the general good health of the child. 
Proper attention should be paid to the functions of 
the bowels. Local genital cleanliness should be main- 
tained to prevent pruritus, which if present might 
eventually lead to masturbation. 
Most modern text-books on Neurology and Gynae- 
cology give only a perfunctory discussion on mastur- 
bation. The best descriptions of the subject are to 
be found in works on Psychopathology. The genito- 
urinary specialists confine most of their attention to 
the posterior urethra, congestion of which they regard 
as of prime importance in causing masturbation in 
the male. Their reasons for so doing, certainly in 
the vast majority of cases, seem to me to be without 
justification. And in fact local treatment directed to 
the posterior urethra, by fixing the patient's atten- 
tion on this part of his pelvic region can do harm. 
This form of treatment (instillations into the pos- 
terior urethra, the passing of cold sounds etc.) would 60 
STUDY OF MASTURBATION 
not apply at all to women and children,-in whom 
masturbation is most common. This in itself is suffi- 
cient to discard the theory that congestion in the pos- 
terior urethra is an important etiological factor in 
masturbation. As Eulenburg of Berlin says, it is a 
mistaken notion to blame masturbation on congestion 
in the posterior urethra. The idea is a relic of the 
teachings of Lallemand and some of his contem- 
poraries. Treatment directed solely at such a 
supposed cause is usually without results. 
Apropos of this method of treatment, I might refer 
to some of the statements of Huhner, a genito- 
urinary specialist. Few psychopathologists would 
agree with most of his views. He blames the cause 
of masturbation in children on phimosis, acid urine, 
etc. And he says that masturbation in the male adult 
is not a nervous disease, nor a "disease of the imagin- 
ation" ; that tonics, sports, etc., are of no use in cur- 
ing the habit, in as much as it is due(?) to irritation 
in the prostatic urethra. He treats masturbation by 
massage of the prostate through the rectum, and by 
instillations of a silver nitrate solution into the deep 
urethra. Practically every psychopathologist would 
severely condemn this form of treatment in the 
majority of cases. 
LOCAL SURGICAL TREATMENT 
The usefulness of surgery to cure masturbation is 
limited, both in the number of patients who need 
such treatment and in the scope of the treatment it- 
self. Such operative treatment as is sometimes in- 
dicated, is limited almost entirely to the external 
genitals. For needless to say, major pelvic opera- 
tions can have little or no direct influence in curing 
the habit of masturbation. 
In the male, about the only operation of importance TREATMENT 
61 
which is done is circumcision for phimosis, for the 
prevention of local genital irritation. But as Healy 
says, where grooves of habit are already worn 
deeply, an operation for phimosis in itself, rarely 
cures masturbation. It must be supplemented by 
such treatment already outlined as would apply in 
the individual case. 
In the case of females, operations on the external 
genitals are but seldom to be recommended. Kisch, 
the celebrated gynaecologist, refers to the failure to 
cure masturbation by clitoridectomy. And Crossen 
in his text-book says that such an operation is only 
rarely practiced. Inasmuch as woman's sexual sen- 
sibility has a wider distribution than man's, it is 
evident why ablation of the clitoris for sexual hyper- 
aesthesia does not cure masturbation. As a matter 
of fact, the operation is more apt to be harmful, and 
is condemned by most authorities. 
The chief minor operations done on females are 
for the correction of adhesions of the clitoris, and 
minor plastic operations here, on the nymphae, and 
on the hymen or its residuals. In a few cases, the 
surgical removal of a urethral caruncle is necessary. 
The gynaecologists, Ashton and Montgomery, rec- 
ommend operation where adhesions cause irrita- 
tion, or where they retard development of the glans 
clitoridis. Hirst recommends retraction of the pre- 
puce of the clitoris and the prevention of adhesions 
where indicated. Eden does not go into the subject 
in his book. Graves gives the best resume on mas- 
turbation from the gynaecologists' standpoint. 
Whether any local surgery is needed or not should 
be decided by a reputable physician. Parents of 
these patients must be careful to avoid quacks,-one 
class of whom I described in an article which I pub- 
lished in the New York Medical Journal (Feb. 21, 
1923). This class make a cult out of operating on the 62 
STUDY OF MASTURBATION 
female external genitals, recommending such oper- 
ations for the most absurd reasons (as anaemia, hay- 
fever, goitre, etc.) Parents should be warned of the 
danger of consulting such charlatans. 
As Healy again says, these operations on the 
females do not alter predisposed paths of nervous 
conduction. But he writes that if nymphomania be 
present, it requires both mental and medical treat- 
ment. His investigations had to do chiefly with 
delinquents, who would naturally not be as suscep- 
tible to moral influences as normal refined girls 
would be. 
Those of us who served on special mental boards 
of the army during the World War saw instances of 
attempted cure of the habit of masturbation by self- 
mutilation. Such reactions are only seen in psychotic 
individuals. 
In writing this thesis in this way, I have purposely 
reiterated some of my contentions to make them 
stand out more emphatically. I have also stressed 
the psychosexual factor, though not neglecting the 
physical factor, because the former is so often ne- 
glected by many writers, or else treated in a cursory 
manner. For all those engaged in the study of hu- 
man conduct, and particularly for those whose duty 
it is to ameliorate the mental and physical sufferings 
of mankind, the subject of masturbation demands 
some attention; which hitherto has not been given 
by most of those to whom these individuals must 
look for help and encouragement. My aim has been 
to present the modern scientific teachings on the 
subject as clearly and briefly as possible. CONCLUSIONS 
1. Infantile masturbation is practically universal; 
in adolescents, it is the rule with boys, and is very 
common in girls; in adulthood, it is more common in 
women than in men. 
2. Physiologically, masturbation is not abnormal 
in young children, but the habit is always abnormal 
in adults, in whom it shows a psychosexual mal- 
development, or a regressive phenomenon. 
3. The harm resulting from excessive indulgence 
in the habit is chiefly in the mental and moral 
spheres, rather than in the physical sphere. 
4. In the adolescent and in the adult, a cure of the 
habit is easiest where the traits and trends of the 
individual are predominantly good, where the wish 
to give up the habit is strong, and where numerous 
good incentives are actively present. 
5. Sympathy and encouragement are great aids to 
the patient, whereas an antagonistic attitude, cen- 
sure, and punishment are usually harmful. 
6. The problem is more often a psychopathological 
one, than a medical and surgical one. 
63 INDEX TO AUTHORS 
Adler-25 
Anstie-43 
Aschaffenburg-23, 27, 39 
Ashton-61 
Berger-25 
Bloch-17, 21, 25, 26, 28, 35, 
38, 39, 42, 45 
Bousfield-16, 17 
Brill-22, 40 
Crossen-61 
Curschmann-46 
Dana-22, 34 
Dejerine-35 
Deslandes-25 
Eden-61 
Ellis-25 
Erb-13, 46 
Eulenburg-11, 25, 41, 42, 60 
Freud-17, 19, 21, 44 
Frink-26, 56 
Fiirbringer-13 
Gattel-41 
Gutceit-25 
Graves-32, 44, 61 
Hall-13, 14, 22, 23, 28, 34, 
49, 52 
Healy-13, 15, 22, 28, 31, 34, 
38, 39, 40, 56, 61, 62 
Hirst-61 
von Hug-Helmuth-13, 19, 50 
Hiihner-60 
Hunt, J. R.-39 
Jelliffe-39, 47 
Jones-17, 19, 27, 28, 37, 41, 
42, 44 
Jung-13, 18 
Kempf-13, 15, 23, 24, 26, 30, 
36, 44 
Kisch-25, 35, 41, 42, 43, 44, 
61 
von Kraft-Ebing-59 
Lallemand-13, 60 
Leitner-13 
Lowenfeld-25, 38, 42 
Marro-40 
Maschka-45 
Meagher-17, 61 
Mercier-25, 38, 40 
Metchnikoff-24 
Moll-12, 13, 17, 19, 23, 27, 
28, 29, 36, 41, 45, 56, 59 
Montgomery-45, 61 
Paget-46 
Rohleder-25, 39 
Simon-13 
Spitzka-24 
Stekel-27, 42 
Tait-24 
Tissot-12, 27 
White-13, 28, 39, 47 
65 INDEX 
Abnormal trends (see psycho- 
pathic), 20, 55 
Aim of masturbation, 11, 23 
Anaemia often apparent only, 
43 
Anaesthesia sexualis and 
masturbation, 17, 26, 44, 48 
Appearance, 34 
Causes, 21 
Causes and effects con- 
founded, 21, 36 
Character, effects on (see 
personality), 35 
Children and the excretory 
organs, 14, 19, 23 
Children and masturbation, 
13 
Children, other, the influence 
of, 22 
Children, the questions of, 52, 
54 
Children and sexual curi- 
osity, 14 
Clitoridectomy contraindi- 
cated, 61 
Clitoris, local operations on, 
62 
Clitoris masturbation, 17 
Coitus, extra-marital, mastur- 
batory in type, 18, 26, 47 
Coitus and masturbation com- 
pared, 46 
Coitus unsatisfactory, and 
masturbation, 43 
Compulsions, 33 
Conclusions, general, 63 
Conflicts, mental, 32, 42, 51 
Curiosity, sexual, and the 
child, 14, 52 
Delinquency and masturba- 
tion, 28, 38 
Dementia Praecox and mas- 
turbation, 40 
Denial of the habit (see 
parent), 24, 31, 51 
Effects of masturbation (see 
sequelae), 12, 32 
Emotional upsets (see psy- 
chic), 27, 38, 52, 53 
Endocrines and the sex im- 
pulse, 22, 57 
Enuresis nocturna, 19 
Equivalents of masturbation, 
18 
Erogenous zones, 11, 14, 16, 
20 
Exaggerated t e a c h i n gs, 
sources of, 12, 27 
Exaggerations cause harm, 
29, 50 
Exaggerations as to injuri- 
ousness of the habit, 27 
Excessive masturbation, 12, 
27, 32, 36, 40, 44, 56 
Excretory organs, infantile 
interest in, 14, 19, 23 
Fatigue (see Neurasthenia), 
33, 42, 43 
Fear, 27, 29, 38, 50 
Fear of insanity, 39 
Fixation and abnormalities, 
15, 36 
67 68 
INDEX 
Frequency (see prevalence), 
13, 15, 23, 24, 25 
Genesis of sexuality, 13, 14 
Girls and boys contrasted 
sexually (see women), 15, 
34 
Guilt, feeling of, 37 
Harmfulness often exagge- 
rated, 27 
Heredity and masturbation, 
21 
Hymen, rupture of, and mas- 
turbation, 45 
Hypocrisy, as to the habit 
(see parent), 23, 49 
Inferiority, feeling of, 37, 50 
Insanity, fear of, 39 
Insanity not a sequela, 29, 40 
Instruct, failure to, inimical, 
52 
Instruction in medical schools, 
12 
Introverted types, 27, 28 
Knowledge alone not suffi- 
cient (see sex enlighten- 
ment), 53, 54 
Living, moral and hygienic, 
55 
Local irritation, 22, 59 
Marriage and masturbation, 
25, 26, 29, 43, 47, 48, 49 
Marriage not to be recom- 
mended as a cure, 26 
Masturbation, clitoris, 17 
Masturbation and coitus com- 
pared, 46 
Masturbation by foreign 
bodies, 17 
Masturbation, forms of, 17 
Masturbation, manual, 17 
Masturbation, nymphae, 17 
Masturbation by thigh 
muscles, 18, 58 
Mechanical treatment usually 
valueless, 58 
Mechanism of masturbation, 
16, 41 
Medical treatment, 58 
Mental reactions (see psy- 
chic), 33 
Modern teaching, 13 
Moral element in infancy, 13 
Moral factor, the, 11 
Moral reactions, 28, 32, 33, 
35 
Moral tone, strengthening of 
the, 49, 54, 58 
Morons, 23, 38 
Motives, 11, 23 
Nail-biting, 18 
Neurasthenia, Primary, 21, 
28, 41 
Neurasthenia, symptoms of, 
42 
Neuroses, 44 
Nymphae masturbation, 17 
Nymphomania, 62 
Objective study necessary, 12 
Occasional masturbation, 12, 
32 
Operative treatment, 60 
Orgasm and masturbation, 
11, 41, 43 
Outlets, vicarious social, 43, 
50, 55 
Parents, attitude of, 13, 18, 
38, 50, 51 
Parents, undue repression by, 
(see repression), 14, 51 
Personality of the individual, 
(see character and psycho- 
pathic), 27, 30, 32, 33, 57 
Phimosis, 61 
Physical effects, 28, 40, 44 
Physical treatment, 57 
Physician, duties of the, 49, 
62 
Pleasure as an aim, 13, 18 
Pregnancy, fear of, as a 
factor, 26, 48 INDEX 
69 
Prevalence of masturbation, 
23 
Prevalence in adults, 24 
Prevalence in infancy, 13 
Prevalence after marriage, 
25 
Prevalence in women, 24, 25 
Prevalence in youth, 15 
Primacy of sex organs, 14, 15 
Prudishness and sex enlight- 
enment, 51 
Psychic effects, 36 
Psychic masturbation, 16, 58 
Psychic factor more impor- 
tant than local causes, 21, 
26, 28, 32, 35, 42, 51, 57 
Psychic reactions in women 
(see women), 41 
Psychological considerations, 
some, 13 
Psychopathic types, 23, 26, 
27, 33, 34, 53, 56 
Psychotics and masturbation, 
18, 34, 37, 39, 44, 62 
Puberty, effect of, 15, 56 
Punishment not helpful, 38, 
52 
Quacks, 34, 61 
Questions of the child as to 
sex, 52, 54 
Reasons for masturbating, 
11, 23 
Rectal masturbation, 17 
Religion as an aid (see 
moral), 54 
Religious patients, reactions 
in, 33 
Remorse, 37 
Repression of the sex im- 
pulse, 14, 19, 51, 55 
Repression, undue, and ab- 
normalities, 19 
Resentment, 38, 50, 53 
Secrecy, effect of, 30 
Secret sex knowledge, 31 
Security and youth, 30, 31, 50 
Selfishness and masturbation, 
13, 18, 29, 37 
Sequelae, 32 
Sex enlightenment, 22, 52 
Sex enlightenment and prud- 
ishness, 51 
Sex impulse not to be an- 
nihilated, 55 
Sex impulse, genesis of, 13,14 
Sex knowledge, improper, 52, 
53 
Sex trends at various ages, 
16 
Sexual desire, 16 
Signs, local, 44 
Social esteem and masturba- 
tion, 24, 50 
Socialization of youth, 43, 55 
Surgical treatment, local, 60 
Sympathy, intelligent, 30, 50, 
52 
Sympathy, lack of, 23, 30, 37, 
50 
Symptoms, 32 
Tensions, Nervous, as effects, 
43 
Thumb-sucking, 18 
Training necessary, 57 
Treatment of masturbation, 
49 
Urethra, congestion of pos- 
terior, 45, 59 
Urethra, local treatment in, 
usually contraindicated, 59, 
60 
Women and anaesthesia sexu- 
alis, 17, 26, 44, 48 
Women and masturbation, 13, 
16, 17, 22, 24, 38, 41, 44, 
47, 48