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During his analysis a young man complained of occasional attacks of pruritis ani. As the analysis progressed it became evident that the pruritis developed regularly upon occasions when he would be taken out, for example to dinner, by older men who were personally interested in him. The analytic material showed clearly that passive anal homosexual wishes were aroused by these situations. They appeared frankly in the material and the patient gave a history of having indulged in homosexual practices in childhood with attempts at both the active and passive rôles. After adolescence he had a single passive homosexual experience and had an orgasm at the instant at which his anus was penetrated. He occasionally indulged in anal masturbation and stated that he often used the pruritis merely as an excuse for this indulgence. The regular occurrence of pruritis when his passive anal homosexuality was aroused, as well as the analytic material, left no doubt as to the connection. It is of interest that the pruritis was often relieved following a satisfactory defæcation.
Dr. Thomas M. French has told me of a woman patient of his in which the connection between pruritis ani and passive wishes was equally clear. The itching provoked insertion of the finger into the rectum and violent rubbing manipulation, which constituted an unrecognized form of anal masturbation. Her pruritis disappeared as satisfactory genital erotism developed.
It is by no means concluded that passive anal homosexual wishes are regularly connected with pruritis ani but in these cases they were clearly of etiological importance. In other cases, other causative factors are more prominent, for example