Nymphomania

The medical understanding of female sexuality shared by both Mrs. B. and Dr. Storer affected more than just the middle class. Poor and working-class girls generally did not go to private physicians in the nineteenth century, but in the mid-1850s, the mother of a seventeen-year-old girl contacted Dr. John Tompkins Walton because her daughter was having a "fit." In his discussion of this case in the American Journal of Medical Science, Walton described what he saw when he came to Catherine's house: her face was disfigured and her body contorted by a "peculiar and revolting paroxysm," marked by a "lascivious leer" and an "insanity of lust." Walton feared that as the only male present, he was contributing to Catherine's agitation; he proceeded to calm the girl by mesmerizing (hypnotizing) her. Then, borrowing from a technique he remembered described in medical school—farm wives who had difficulty getting their laying hens to give up their eggs would plunge the chickens' posteriors in cold water—Walton forced Catherine to sit in a tub filled directly from the tap. Quieted, Catherine was able to submit to his examination. He concluded that she was suffering from nymphomania because her attacks of ungovernable sexual excitement always occurred when she was alone or with lewd acquaintances.

In 1856, Mrs. B., a twenty-four-year-old, middle-class married woman, went to the Boston office of gynecologist Dr. Horatio R. Storer, future vice president of the American Medical Association. Described by Dr. Storer in his published case notes as small and pale, Mrs. B. sought the doctor's help for decidedly un-Victorian feelings. Excessively lascivious images of sexual intercourse with men not her husband, she told Dr. Storer, filled her dreams. Recently, whenever she met and talked to a man, she dreamed about having intercourse with him. Even during the daytime, if she conversed with a man, erotic feelings overwhelmed her. Up to that moment, she had resisted any actual sexual encounters, but she greatly feared that if the malady increased, she might not be able to restrain herself in the future. We can only surmise how difficult it must have been for a mid-Victorian woman to speak of these very private matters to a male physician. What we do know is that she understood these feelings to be a medical issue, which should be discussed with a gynecologist, not a clergyman. Whether or not she knew what nymphomania was, she interpreted her dreams as dangerous, laden with sexuality, and a warning that she was losing control. Encouraged by the doctor to tell her story, Mrs. B. revealed that although she had never masturbated, from a young age she had felt strong, undefined desire.

Nineteenth-century professional journals, medical textbooks, and encyclopedias often declared that satyriasis was the equivalent of nymphomania. Yet, in keeping with their belief that women were less highly sexed than men, many doctors took for granted that the male disease occurred far less frequently. Medical men also assumed that nymphomania, as a disease, was much more severe than satyriasis. The consequences predicted for the nymphomaniac were generally worse than those for the satyriasist; a nymphomaniac's fate was prostitution or the insane asylum, while at least some physicians thought that a satyriasist might go through life without getting into trouble if he learned to control himself. Further, many doctors recognized—although they publicly criticized the fact—that it was easier for men to fulfill their sexual desires in "illicit indulgences." According to an influential English psychiatrist and editor of the Journal of Mental Science, Henry Maudsley, such liaisons were "openly condemned, secretly practiced, and tacitly condoned." The case studies of satyriasis, both in mental institutions and in private treatment, vary enormously. Like nymphomania, cases of satyriasis included men who openly masturbated, exhibited their genitals, and sexually attacked women, children, and mental institution attendants.

Mrs. R., described as a short, stout, recently widowed twenty-year-old woman with a lively disposition, came to Dr. Bostwick out of desperation. She explained, "If I can't be relieved of this agonizing condition, I am certain that the struggle between my moral sense and lascivious longings must soon send me to the grave." She blamed reading novels and attending gay parties in her youth as the cause of "my imagination [being] wrought up to the highest point." She appeared to be familiar with the assumption that women's reason was thought to be inferior to men's. As a result, she understood that stimulating the imagination in these ways was very dangerous. Her passions were so strong, she told Dr. Bostwick, that "it was with the greatest difficulty that I could conduct myself in a decorous and ladylike manner in the presence of the other sex." Even after her marriage, her "inordinate desire" was not entirely subdued and she continued to practice "self-abuse" (masturbation). Since her husband's death, "my passion has been more inflamed than ever, and I fear that, unless something can be done to relieve me, I shall go crazy." This case, presented in Mrs. R.'s words, reads like one of the cases Bienville described in his classic study of nymphomania. It contains all the elements that shaped the eighteenth-century understanding of the disease: inflamed imagination, uncontrollable desire, novel reading, moral struggle, and an inevitable downward slide into madness. Mrs. R.'s assertion that" I am sure my lascivious feelings cannot be natural—they must be the effect of disease," suggests the influence of "medicalized" notions about female sexual desire and women's sense of proper conduct.

The development of medical specialties such as gynecology, neurology, and psychiatry over the course of the nineteenth century led to turf wars in which each specialty promoted its own physiological explanation and treatment for women's diseases. Yet nymphomania remained elusive, despite attempts to classify its symptoms and to categorize its causes on sound scientific principles. Some medical specialists, such as neurologists and alienists (the earlier name for psychiatrists), looked for a physiological cause of nymphomania in cerebral lesions, changes in the brain's blood vessels, thickening of the cranial bones, or overexcited nerve fibers. They generally took issue with the "uterine theory," which argued that diseased genitals caused the malady. By doing so, they hoped to be able to diagnose, treat, and perhaps cure nymphomania, staking out their particular medical specialty's claim to expertise. Neurologists looked to the relationship between the brain and the nervous system to explain cases of oversexed men and women. Through postmortem examinations of spinal fluid, for example, they hoped to find some evidence that might help them sustain their claim to treat these disorders. But autopsies that showed no significant alteration in the brains of those defined as nymphomaniacs critically challenged the nerve doctors' theories.

In 1841, Miss T., the twenty-nine-year-old daughter of a Massachusetts farmer, was diagnosed with nymphomania. According to the physicians who described the case in the Boston Medical and Surgical Journal, her conversation and actions left no doubt that she suffered from the disease: she uttered the "most disgusting obscenities" and moved her body in ways that expressed her uncontrolled "libidinous feelings." Although in good health, she had been restless and morose, exhibiting a "paroxysm of hysteria" when the doctors arrived. After a vaginal examination, they determined that her uterus was enlarged, her vagina over-abundantly moist, but her long and "tumid" clitoris was the telltale sign of nymphomania. They applied various caustics to her genitals to cool her ardor and tried other traditional remedies, such as bleeding and cold-water douches. After several weeks, the doctors pronounced her greatly improved, with "not a symptom remaining referable to nymphomania." This time when she was examined vaginally, she exhibited "every appearance of modesty," including a retracted and very diminutive clitoris. At the time, the doctors' treatment of Miss T., particularly the use of bleeding and caustics, was a typical medical approach to most illnesses.

Sexual expression is a natural part of a well-rounded life. But if you have an overwhelming need for sex and are so intensely preoccupied with this need that it interferes with your job and your relationships, you may have a problem called compulsive sexual behavior. You may spend inordinate amounts of time in sexually related activities and neglect important aspects of your day-to-day life in social, occupational and recreational areas. You may find yourself failing repeatedly at attempts to reduce or control your sexual activities or desires. Health experts use a number of labels for this potentially serious condition. Compulsive sexual behavior is sometimes called hypersexuality, nymphomania or erotomania. Others use the term "sexual addiction," comparing it with the uncontrolled use of a drug. Others argue that it's an issue of impulse control or obsessive-compulsive behavior. No matter what name is attached to the behavior, compulsive sexual behavior is a very real affliction that interferes with everyday living. Current research indicates that compulsive sexual behavior is most common among men. Treatment may involve individual or with counseling and homoeopathic medications.

Nymphomania is a layperson's term used to label a woman whose sex drive or sexual activity is subjectively deemed too high. This is not a scientifically meaningful term because there are no specific criteria defining how much sexual desire or activity is too much. The clinical conditions that include the concept of high levels of sexual desire and/or activity are hypersexuality and sexual addiction or compulsivity. The central features of these disorders are that sexual activity is an insatiable need, often interfering with other areas of everyday functioning; sex is impersonal, with no emotional intimacy; and despite frequent orgasms, sexual activity is generally not satisfying. The label of nymphomania is used in a pejorative and derogatory manner, almost exclusively in reference to women. To many men, the idea of a woman with a greater sex drive than their own is somewhat threatening, so they may use the label to preserve their own egos by "proving" that the woman is abnormal. Similarly, men with sexual dysfunction might accuse their partners of being oversexed in an effort to hide their own fears or sense of inadequacy, just as some women who object to the frequency of their partner's sexual advances might accuse him of being oversexed.

Much of this column's male readership is now thinking: Gosh, Unca Cecil, can I help with the research? Down, boys. The nymphomaniac of legend was probably best defined by sex research pioneer Alfred Kinsey: "someone who has more sex than you do." Although wacky theories about female sexuality have circulated since ancient times, as a medical diagnosis nymphomania is only a couple centuries old. According to Carol Groneman, author of Nymphomania: A History (2000), the concept of nymphomania was first laid out by the French physician Bienville in his 1771 treatise, Nymphomania, or a Dissertation Concerning the Furor Uterinus. Among the behaviors Bienvillle cited as conducive to or symptomatic of nymphomania: dwelling on impure thoughts, reading novels, and eating too much chocolate. Oh, and indulging in "secret pollutions" (masturbation). Scientific thought on the subject didn't advance much for the next 175 years. Victorian medical literature is peppered with anecdotes about female patients exhibiting what we would regard as simple horniness but which back then could be a ticket to the insane asylum, especially if accompanied by physical symptoms like an "overheated" vagina or an enlarged clitoris or uterus. Treatments ranged from the comical to the downright criminal: cold baths and enemas, leeches applied to the perineum (the area between the vagina and rectum), and clitoridectomy (surgical removal of the clitoris).

Reading Carol Groneman's new book "Nymphomania" in a public place elicits reactions from people ranging from bewildered stares to lewd grins. These responses confirm everything she has written on the pages behind the simple and erotic line drawing on the cover. That is, we still don't know what to make of nymphomania. Anyone who has ever wondered how much sex is too much sex -- and who decides -- will be fascinated by this thoroughly researched and well-executed book. Groneman guides the reader through the history of nymphomania as a medical illness, mental disorder, legal construct, cultural perception and off-color joke. In chronicling the transformation of the term, the author begins with the medical model of the 1800s, when strong sexual desire in a woman was considered a disease stemming from lack of morals and willpower. Groneman's analysis continues to the present day as she describes how new attitudes are colliding with persistent stereotypes surrounding female sexuality. "Nymphomania is a metaphor which embodies the fantasies and fears, anxieties and dangers connected to female sexuality," she writes. "By tracing its many meanings over two hundred years, we see how clearly it is reflected in the eye of the beholder."