Epistaxis in a Man Simulating Menstruation

The patient, a young man who had been under analytic treatment for nearly a year, entered my consulting-room dabbing his nose, which I saw was bleeding, there being many spots of blood on his handkerchief. I asked him when his nose had commenced to bleed and he said just as he reached my street door. He told me that it had before bled very

occasionally, and then only a few drops which ceased if he lay down. It had never bled so profusely before. He lay down on the couch saying he expected it would now stop, as he was on his back. He then commenced talking about a dream he had had the previous night. All the time he was talking he kept dabbing his nose, and his handkerchief became fairly saturated with blood. After this had been going on for about twenty minutes, I thought something should be done regarding the epistaxis, as it did not seem to be stopping, so I particularly directed his attention to the bleeding. He remarked that the peculiar thing about it was that it had commenced just as he reached my door, and he thought that this must signify that it had a psychological explanation, for he knew of nothing that could have caused the condition.

I asked him to give me his first thought with regard to this bleeding. He said, 'To prevent me talking'. He then added it reminded him of menstruation and castration. I asked him to give his thoughts about menstruation. He said, 'Menstruation is a particular characteristic of women. If the nose-bleeding represents menstruation, then I am a woman. Menstruation also means a person is not pregnant, therefore I am not pregnant'. The bleeding still continued. I then asked him if any other idea occurred to him with regard to menstruation. He said nothing else came to his mind. I suggested that menstruation might be a defence. He said he did not understand, paused, then said, 'If a woman were menstruating she would not have sexual intercourse, therefore menstruation would be a defence or protection against sexua