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Gynæcology is chiefly concerned with the physical condition and position of the genital organs. Sometimes psycho-analysis is able to contribute an interpretation of the phenomena in terms of libido and explain the present conditions in terms of the patient's past love attachments and his capacity to renounce infantile sexuality for an exogamous genital gratification. The physiology of use must be supplemented by a 'physiology of pleasure' (Ferenczi).
In the psycho-analytical literature we read of the genitalization of other organs and learn something of the changes so produced, but little has been said of the changes in the genitals themselves when not acting as the central erotic organ of the body. Recent investigations have led me to think that weakness of the pelvic floor and of the suspending ligaments of the uterus may be evidence that the genital stage has not been reached or maintained, and that loss of 'tone' in these tissues is a sign of 'degenitalization'. A case to illustrate this point.
A woman of twenty-seven, six years married, suffered from horror of intercourse—she feared something terrible would happen to herself and to her husband; she was also constipated, having no 'power' to expel fæces, and did not perceive the call to stool. She developed prolapse, and was treated with douches, pessaries and pads, but without relief; she was convinced the treatment would do her no good. In the course of time her fears diminished to some extent and consenting to coitus she had a child, but it died soon after birth. She conceived the idea that she had suffocated it in utero by pressing on the umbilical cord with a vaginal nozzle used as an enema nozzle. Her dread of sexual relations returned, and the bearing-down pain and dragging sensations and heaviness in the legs grew worse. The analysis of the horror of intercourse led to the discovery of unconscious phantasies of strangling, squeezing, and 'nipping' her husband's and father's penis; any activity of